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Feng Y, Gu XB, Zhou M, Wang HL, Feng RN, Zhang ZH. Association between dietary glycine intake and the prevalence of hypertension, hyperlipidemia, overweight or obesity in rural northern China: a cross-sectional study. Front Nutr 2024; 11:1364309. [PMID: 39070255 PMCID: PMC11272656 DOI: 10.3389/fnut.2024.1364309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/21/2024] [Indexed: 07/30/2024] Open
Abstract
Objective The objective of this research is to investigate the relationship between dietary glycine consumption and the prevalence of hypertension, hyperlipidemia, and overweight or obesity in economically disadvantaged areas of northern China using a cross-sectional study design. Methods A cross-sectional study involving 774 participants utilized a web-based dietary questionnaire (IDQC) and underwent physical measurements. Data analysis was conducted using IBM SPSS Statistics software (Version 21). Participants were stratified into four groups based on quartiles of their dietary glycine intake: Q1 (<1.32), Q2 (1.32-1.82), Q3 (1.82-2.26), and Q4 (>2.26). Continuous variables were reported as mean ± standard deviation and compared using ANOVA or the Kruskal-Wallis test, while categorical variables were presented as frequencies (%) and compared using the chi-square test. Finally, multivariable logistic regression with p-value of less than 0.05 was considered statistically significant. Results Significant differences in dietary glycine intake were observed between the highest quartile group (Q4) and the lowest quartile group (Q1), with corresponding dominance ratios of 0.590 (95% CI, 0.360-0.966), 0.547 (95% CI, 0.327-0.913), and 0.547 (95% CI, 0.353-0.850) for the risk of hypertension, hyperlipidemia, and overweight/obesity, respectively. Furthermore, no significant correlation was found between dietary glycine intake and hypertension or hyperlipidemia within each sex and age subgroup. Conclusion There exists a potential correlation between increased dietary glycine intake and reduced prevalence of hypertension, hyperlipidemia, and overweight/obesity. However, additional research is necessary to validate this finding through larger-scale studies conducted at a population level.
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Affiliation(s)
- Ying Feng
- Department of Nutrition and Food Hygiene, School of Public Health, Heinz Mehlhorn Academician Workstation, Hainan Medical University, Haikou, Hainan, China
| | - Xing-bo Gu
- Department of Nutrition and Food Hygiene, School of Public Health, Heinz Mehlhorn Academician Workstation, Hainan Medical University, Haikou, Hainan, China
| | - Meng Zhou
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin, China
| | - Hong-lan Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Heinz Mehlhorn Academician Workstation, Hainan Medical University, Haikou, Hainan, China
| | - Ren-nan Feng
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin, China
| | - Zhi-hong Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Heinz Mehlhorn Academician Workstation, Hainan Medical University, Haikou, Hainan, China
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Ransome Y, Martinez-Brockman JL, Galusha D, Thompson TA, Adams OP, Nazario CM, Nunez M, Nunez-Smith M, Maharaj RG. Prevalence and correlates of alcohol use among the elderly in the Eastern Caribbean Health Outcomes Research Network (ECHORN) cohort study. Addict Behav 2024; 153:108001. [PMID: 38447411 DOI: 10.1016/j.addbeh.2024.108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/17/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Alcohol use is pervasive in the Caribbean; however, the prevalence and correlates of alcohol use and drinking problems in the elderly have not been extensively studied. METHODS Data were obtained from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study, a cohort study of Caribbean people from Puerto Rico, Barbados, Trinidad, and Tobago, and the U.S. Virgin Islands, collected between 2013 and 2018 (baseline study sample, ages 60+, n = 811). Descriptive statistics were used to compare the differences in drinking status (current vs. former vs. never), alcohol problems (Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) scale score ≥2 vs. <2), and binge drinking days (0 days vs. 1-2 days vs. ≥3 days) across sample characteristics. Logistic regression analyses estimated the association of these alcohol measures with sociodemographic (e.g., sex), psychological (depression), and cultural (e.g., religion) correlates. RESULTS Thirty-six percent were 70 + years of age, 64 % were female, and 41 % had less than a high school education. Alcohol problems (≥2 CAGE score) was 21 %. Binge drinking ≥3 days was 30.6 %. Never attending religious services (vs. attending once a week or more) was associated with almost three times higher odds of alcohol problems (adjusted Odds Ratio: OR = 2.88, 95 % CI = 1.02, 8.15) four times higher odds of increasing binge drinking days (aOR = 4.04, 95 % CI = 1.11, 14.96). College education was protective against both the outcomes. CONCLUSION We provide current estimates of alcohol problems among elderly Eastern Caribbean people. Among the sociodemographic, psychological, and cultural correlates examined, religious attendance was significant. Replicate longitudinal studies using DSM-5 alcohol dependence are recommended.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA.
| | - Josefa L Martinez-Brockman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT 06510, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Deron Galusha
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
| | | | - Oswald P Adams
- Department of Family Medicine, Faculty of Medical Sciences, University of the West Indies, Cave Hill BB11000, Barbados.
| | - Cruz M Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico at Medical Sciences Campus, San Juan 00936, PR, USA.
| | - Maxine Nunez
- School of Nursing, University of the Virgin Islands, St. Thomas, VI 00802, USA.
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT 06510, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Rohan G Maharaj
- Department of Paraclinical Sciences, University of the West Indies, Saint Augustine, Trinidad and Tobago.
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Chen Z, Wu F, Shi Y, Guo Y, Xu J, Liang S, Huang Z, He G, Hu J, Zhu Q, Yu S, Yang S, Wu C, Tang W, Dong X, Ma W, Liu T. Association of Residential Greenness Exposure with Depression Incidence in Adults 50 Years of Age and Older: Findings from the Cohort Study on Global AGEing and Adult Health (SAGE) in China. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:67004. [PMID: 38885140 PMCID: PMC11218708 DOI: 10.1289/ehp13947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/07/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Depression is a social and public health problem of great concern globally. Identifying and managing the factors influencing depression are crucial for preventing and decreasing the burden of depression. OBJECTIVES Our objectives are to explore the association between residential greenness and the incidence of depression in an older Chinese population and to calculate the disease burden of depression prevented by greenness exposure. METHODS This study was the Chinese part of the World Health Organization Study on Global AGEing and Adult Health (WHO SAGE). We collected the data of 8,481 residents ≥ 50 years of age in China for the period 2007-2018. Average follow-up duration was 7.00 (± 2.51 ) years. Each participant was matched to the yearly maximum normalized difference vegetation index (NDVI) at their residential address. Incidence of depression was assessed using the Composite International Diagnostic Interview (CIDI), self-reports of depression, and/or taking depression medication. Association between greenness and depression was examined using the time-dependent Cox regression model with stratified analysis by sex, age, urbanicity, annual family income, region, smoking, drinking, and household cooking fuels. Furthermore, the prevented fraction (PF) and attributable number (AN) of depression prevented by exposure to greenness were estimated. RESULTS Residential greenness was negatively associated with depression. Each interquartile range (IQR) increase in NDVI 500 -m buffer was associated with a 40% decrease [hazard ratio ( HR ) = 0.60 ; 95% confidence interval (CI): 0.37, 0.97] in the risk of depression incidence among the total participants. Subgroup analyses showed negative associations in urban residents (HR = 0.32 ; 95% CI: 0.12, 0.86) vs. rural residents, in high-income residents (HR = 0.28 ; 95% CI: 0.11, 0.71) vs. low-income residents, and in southern China (HR = 0.50 ; 95% CI: 0.26, 0.95) vs. northern China. Over 8.0% (PF = 8.69 % ; 95% CI: 1.38%, 15.40%) and 1,955,199 (95% CI: 310,492; 3,464,909) new cases of depression may be avoided by increasing greenness exposures annually across China. DISCUSSION The findings suggest protective effects of residential greenness exposure on depression incidence in the older population, particularly among urban residents, high-income residents, and participants living in southern China. The construction of residential greenness should be included in community planning. https://doi.org/10.1289/EHP13947.
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Affiliation(s)
- Zhiqing Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
- Key Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, China
| | - Fan Wu
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Shi
- Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China
| | - Yanfei Guo
- Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China
| | - Jiahong Xu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Shuru Liang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Zhongguo Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Guanhao He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Jianxiong Hu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Qijiong Zhu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Siwen Yu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Shangfeng Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Cuiling Wu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Weiling Tang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Xiaomei Dong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
- Key Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, China
| | - Tao Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
- Key Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, China
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Bin Dahman L, Al-Awbathani AM, Bawazir AA, Al-Awbathani AS, Alhabshey HA, Saad HO, Ahmed NA. Prevalence of Hypertension and Its Associated Risk Factors Among Adults Attending Medical Outpatient Clinics at Ibn Sina General Hospital Authority in Mukalla City, Yemen. Cureus 2024; 16:e60540. [PMID: 38887361 PMCID: PMC11181146 DOI: 10.7759/cureus.60540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Hypertension (HTN) is the most generally acknowledged modifiable risk factor for cardiovascular disease, cerebrovascular disease, and end-stage renal disease. Accordingly, the World Health Organization has listed HTN as the third greatest cause of death globally. OBJECTIVES The objective of this study was to assess the prevalence of HTN and its associated risk factors among adults attending medical clinics at Ibn Sina Hospital Authority in Mukalla City, Yemen. METHODS A cross-sectional descriptive survey was conducted using a self-administered questionnaire applied to 384 male and female adults aged ≥18 years attending Ibn Sina General Hospital Authority outpatient clinics in Mukalla City, Yemen, between December 2022 and May 2023. The participant's body weight, height, and waist circumference were measured. The data were analyzed using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY). P values of <0.05 were considered statistically significant. RESULTS Among the 384 participants, 20.5% had HTN, and the remaining (79.5%) did not have HTN, with a substantial proportion (47.2%) reporting a positive family history of HTN. Diabetes mellitus was present in 16.1% of the participants, whereas dyslipidemia and other chronic diseases were reported by 9.3% and 15.8% of the participants, respectively. A total of 75.6% of the participants had never smoked, and 11.7% were past smokers. More than half of the participants (57.29%) had never chewed khat, 20.57% were former khat chewers, and 22.14% were currently chewing khat. Nutritional status, as indicated by body mass index, showed that 29.8% were overweight. CONCLUSIONS HTN was found to be prevalent among the study participants. However, the respondents' awareness of the problem and the overall control rates were very low. Certain factors, such as family history of HTN, diabetes mellitus, and high body mass index, were found to be associated with HTN. Therefore, intervention measures are warranted emphasizing modifiable risk factors to prevent HTN.
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Affiliation(s)
| | | | | | | | | | - Halima O Saad
- College of Medicine, Hadhramout University, Mukalla, YEM
| | - Noran A Ahmed
- College of Medicine, Hadhramout University, Mukalla, YEM
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Fu L, Guo Y, Zhu Q, Chen Z, Yu S, Xu J, Tang W, Wu C, He G, Hu J, Zeng F, Dong X, Yang P, Lin Z, Wu F, Liu T, Ma W. Effects of long-term exposure to ambient fine particulate matter and its specific components on blood pressure and hypertension incidence. ENVIRONMENT INTERNATIONAL 2024; 184:108464. [PMID: 38324927 DOI: 10.1016/j.envint.2024.108464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Epidemiological evidence on the association of PM2.5 (particulate matter with aerodynamic diameter ≤ 2.5 μm) and its specific components with hypertension and blood pressure is limited. METHODS We applied information of participants from the World Health Organization's (WHO) Study on Global Ageing and Adult Health (SAGE) to estimate the associations of long-term PM2.5 mass and its chemical components exposure with blood pressure (BP) and hypertension incidence in Chinese adults ≥ 50 years during 2007-2018. Generalized linear mixed model and Cox proportional hazard model were applied to investigate the effects of PM2.5 mass and its chemical components on the incidence of hypertension and BP, respectively. RESULTS Each interquartile range (IQR = 16.80 μg/m3) increase in the one-year average of PM2.5 mass concentration was associated with a 17 % increase in the risk of hypertension (HR = 1.17, 95 % CI: 1.10, 1.24), and the population attributable fraction (PAF) was 23.44 % (95 % CI: 14.69 %, 31.55 %). Each IQR μg/m3 increase in PM2.5 exposure was also related to increases of systolic blood pressure (SBP) by 2.54 mmHg (95 % CI:1.99, 3.10), and of diastolic blood pressure (DBP) by 1.36 mmHg (95 % CI: 1.04, 1.68). Additionally, the chemical components of SO42-, NO3-, NH4+, OM, and BC were also positively associated with an increased risk of hypertension incidence and elevated blood pressure. CONCLUSIONS These results indicate that long-term exposure to PM2.5 mass and its specific components may be major drivers of escalation in hypertension diseases.
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Affiliation(s)
- Li Fu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; Tianhe District Center for Disease Control and Prevention, Guangzhou 510655, China
| | - Yanfei Guo
- Shanghai Municipal Centre for Disease Control and Prevention, Shanghai 200336, China; General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Qijiong Zhu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Zhiqing Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Siwen Yu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Jiahong Xu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Weiling Tang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Cuiling Wu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Guanhao He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Jianxiong Hu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Xiaomei Dong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Pan Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Ziqiang Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Fan Wu
- Shanghai Medical College, Fudan University, Shanghai 200032, China.
| | - Tao Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China.
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
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Hlahla MO, Kunene LA, Mphekgwana PM, Madiba S, Monyeki KD, Modjadji P. Comparison of Malnutrition Indicators and Associated Socio-Demographic Factors among Children in Rural and Urban Public Primary Schools in South Africa. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1749. [PMID: 38002840 PMCID: PMC10670259 DOI: 10.3390/children10111749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
Most children in South Africa attending public schools are predisposed to malnutrition due to poor infrastructure and social inequality. This is despite the implementation of the National School Nutrition Programme to address barriers to learning associated with hunger and malnutrition and the National Development Plan to reduce child malnutrition through provision of social grants. In view of this, we compared malnutrition indicators and associated socio-demographic factors among children in rural Mpumalanga and urban Gauteng in South African public primary schools selected using a multistage cluster random sampling. A validated researcher-administered questionnaire was used to collect socio-demographic data of caregivers, along with primary school children data collected on age, sex, learning grade, and anthropometric measures. Malnutrition indicators, which are stunting (low height-for-age z-scores), underweight (low weight-for-age z-scores), thinness (low body-mass-index-for-age z-scores), and overweight/obesity (high body mass index) were computed using WHO Anthro Plus 1.0.4 and data were analyzed using Stata 18. A total of 903 children (rural = 390 and urban = 513) with a mean age of 10 ± 2 years in the foundation phase (learning grades one to three) and the intermediate learning phase (learning grades four to seven) participated with their caregivers (mean age: 39 ± 8 years). Significant levels of poor socio-demographic status were observed among caregivers living in the rural setting compared to in the urban setting. Overall, thinness (18%), stunting (12%), underweight (10%), and overweight/obesity (24%) were observed among school children. Children in the rural schools had a significantly higher prevalence of stunting (20% vs. 3%; p < 0.0001), underweight (17% vs. 2%; p < 0.0001) and thinness (28% vs. 7%; p < 0.001) than their urban counterparts. In the urban, the odds of stunting, underweight and thinness were less among school children, while overweight/obesity was twice as likely in the urban setting. The multivariate final model showed lower odds of underweight [adjusted odds ratio (AOR) = 0.16; 95% confidence interval (CI): 0.06-0.42] and stunting [AOR = 0.33; 95% CI: 0.13-0.87] in the urban compared to the rural schools. The association of stunting with sex [AOR =0.53; 95% CI: 0.30-0.94] and the intermediate learning phase [AOR = 7.87; 95% CI: 4.48-13.82] was observed in the rural setting, while thinness was associated with living in households with an income of USD 52.51 to USD 262.60/month [AOR = 2.89; 95% CI: 1.01-8.24] and receiving the child social grant [AOR = 2.49; 0.90-6.86] in the urban setting. Overweight/obesity was associated with living in a household with an income of USD 52.51 to USD 262.60/month [AOR = 1.80; 95% CI: 1.02-3.10]. The findings suggest nutritional intervention approaches that are accustomed to the context of settings to effectively tackle malnutrition.
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Affiliation(s)
- Mosebudi Olga Hlahla
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Lindy Agatha Kunene
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Peter Modupi Mphekgwana
- Research Administration and Development, University of Limpopo, Polokwane 0700, South Africa
| | - Sphiwe Madiba
- Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa
| | - Kotsedi Dan Monyeki
- Department of Physiology and Environmental Health, University of Limpopo, Polokwane 0700, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Roodepoort, Johannesburg 1709, South Africa
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Chanda A, Kaeley N, Kumar B, Khapre M. Clinico-Epidemiological Profile of Patients Presenting With Acute Chest Discomfort in Emergency Medicine Department of a Tertiary Care Hospital in Uttarakhand, India: A Prospective Observational Study. Cureus 2023; 15:e44681. [PMID: 37809205 PMCID: PMC10550850 DOI: 10.7759/cureus.44681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Acute chest discomfort is a common presenting complaint in the emergency department. There is a paucity of studies related to clinico-epidemiological profile of patients with acute chest discomfort in the emergency department (ED). Hence, we intended to conduct the study to address the dearth of research in this field. Aims and objectives The primary objective of this study was to study the clinico-epidemiological profile of patients with acute chest discomfort presenting to the ED. The secondary objectives were to assess the prevalence of premature acute coronary syndrome (ACS), to study the ED disposition and final hospital discharge diagnosis, and to assess the predictors of 24-hour mortality in such patients. Methods A prospective observational study of patients presenting with acute chest discomfort was conducted in the emergency medicine department of a tertiary care hospital. We included adults above the age of 18 years from December 2021 to December 2022 and excluded trauma patients. A standardized form was used to document patient demographic patterns, comorbidities, chest discomfort description, physical findings, investigations, consultations, ED management, and disposition. Variables having p-value ≤ 0.05 were considered to be significant. Results A total of 200 patients were included. The most common cause of chest discomfort in the ED was cardiac, accounting for 48.5% (n = 97) of patients. The most common cardiac cause of acute chest discomfort was ST-elevation myocardial infarction (STEMI) ~ 21% (n = 42). Cardiac diagnosis was associated with the maximum number of admissions (≈80%; n = 78). The prevalence of premature ACS was 13.9% (n = 10). A 24-hour mortality was significantly associated with male gender, ambulance transport, history of coronary artery disease, and hypoxia and hypotension at the initial presentation. Conclusions ACS followed by respiratory causes are the predominant etiologies of acute chest discomfort in the ED. Knowledge of the differential diagnosis of acute chest discomfort in the ED can aid in prompt diagnosis and delivery of lifesaving treatment to these patients.
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Affiliation(s)
- Anmol Chanda
- Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Nidhi Kaeley
- Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Barun Kumar
- Cardiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Meenakshi Khapre
- Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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Getahun GK, Goshu BY, Goshu DY, Mekuria ZN. Cardiovascular disease risk among hypertensive patients and associated determinants in Addis Ababa, Ethiopia: an institutional-based cross-sectional study. BMJ Open 2023; 13:e068948. [PMID: 37339829 DOI: 10.1136/bmjopen-2022-068948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the level of cardiovascular disease (CVD) risk and associated factors among hypertensive patients having follow-up at selected hospitals in Addis Ababa, Ethiopia, in 2022. SETTING A hospital-based cross-sectional study was conducted in public and tertiary hospitals in Addis Ababa, Ethiopia, from 15 January 2022 to 30 July 2022. PARTICIPANTS A total of 326 adult hypertensive patients who visited the chronic diseases clinic for follow-up were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES A high predicted 10-year CVD risk level was assessed using an interviewer-administered questionnaire and physical measurement (primary data) and reviews of medical data records (secondary data) by using a non-laboratory WHO risk prediction chart. Logistic regression with an adjusted OR (AOR) using a 95% CI was calculated for independent variables associated with 10-year CVD risk. RESULTS The prevalence of a high predicted 10-year CVD risk level was 28.2% (95% CI 10.34% to 33.2%) among the study participants. A higher CVD risk level was found to be associated with age (AOR 4.2 for age 64-74, 95% CI 1.67 to 10.66), being male (AOR 2.1, 95% CI 1.18, 3.67), unemployment (AOR 3.2, 95% CI 1.06 to 6.25) and stage 2 systolic blood pressure (AOR 11.32; 95% CI 3.43 to 37.46). CONCLUSION The study showed that the respondent's age, gender, occupation and high systolic blood pressure were determinant factors for CVD risks. Therefore, routine screening for the presence of CVD risk factors and assessment of CVD risk are recommended for hypertensive patients for CVD risk reduction.
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Affiliation(s)
- Genanew Kassie Getahun
- Department of Public Health, Menelik II Medical and Health Science College, Addis Ababa, Ethiopia
| | | | - Dejuma Yadeta Goshu
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Rashmi R, Mohanty SK. Examining chronic disease onset across varying age groups of Indian adults using competing risk analysis. Sci Rep 2023; 13:5848. [PMID: 37037884 PMCID: PMC10086019 DOI: 10.1038/s41598-023-32861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/04/2023] [Indexed: 04/12/2023] Open
Abstract
In low-and-middle-income countries, people develop chronic diseases at a younger age, leading to health-and-economic loss. Estimates of the age of onset of chronic disease provide evidence for policy intervention, but in the Indian context, evidence is limited. The present study aims to explore the onset of seven chronic diseases across adults and the elderly, along with the prognostic factors of chronic disease onset. Using Wave 1 data of the Longitudinal Ageing Study in India (LASI), we estimated the statistical distributions, the median age at onset, and Loglogistic and Weibull accelerated failure time model to understand the onset of seven medically diagnosed self-reported chronic diseases across age groups. We also obtained the sub-distribution hazard ratio (SHR) from the Fine-Gray model to determine the risk of contracting selected chronic diseases in a competing risk setup. The seven chronic diseases- hypertension, diabetes, lung disease, heart disease/stroke, arthritis, neurological disease, and cancer- were developing early, especially in individuals aged 45-54 and 55-64. Arthritis risk was higher in rural areas, and physically active adults and elderly were 1.32 times (95% CI 1.12-1.56) more likely to develop heart disease/stroke. The emerging evidence of the early onset of neurological diseases in middle-aged adults (i.e., among the 45-54 age group) reminds us of the need to reinforce a balance between the physical and mental life of individuals. The early onset of chronic diseases in the independent and working-age category (45-54 years) can have many social and economic implications. For instance, it can create a greater healthcare burden when these individuals grow older with these diseases. Further, disease-specific interventions would be helpful in reducing future chronic disease burden.
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Affiliation(s)
- Rashmi Rashmi
- Department of Population and Development, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Sanjay K Mohanty
- Department of Population and Development, International Institute for Population Sciences, Mumbai, 400088, India
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Javad Alaeian M, Pourreza S, Yousefi M, Golalipour E, Setayesh L, Zeinali Khosroshahi M, Bagheri R, Ashtary-Larky D, Wong A, Zamani M, Asbaghi O. The effects of guar gum supplementation on glycemic control, body mass and blood pressure in adults: A GRADE-assessed systematic review and meta-analysis of randomized clinical trials. Diabetes Res Clin Pract 2023; 199:110604. [PMID: 36958432 DOI: 10.1016/j.diabres.2023.110604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/13/2022] [Accepted: 02/28/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND This systematic review and meta-analysis sought to evaluate the effects ofguar gum supplementation on glycemic control, blood pressure, and body mass in adults. METHODS Relevant studies were obtained by searching the PubMed, SCOPUS, Embase, and Web of Science databases (from inception to January 2022). Weighted mean differences (WMD) and 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity, sensitivity analysis, and publication bias were reported using standard methods. RESULTS Pooled analysis of 14 randomized controlled trials (RCTs) revealed that guar gum supplementation led to significant reductions in hemoglobin A1c (HbA1c) (WMD: -0.47 mg/dL, 95% CI: -0.75, -0.18, p = 0.001). However, there was no effect on fasting blood sugar (FBS), systolic and diastolic blood pressure, and body mass among adults in comparison with the control group. A subgroup analysis demonstrated that intervention in patients with type 2 diabetes (T2DM), and high supplementation dosages (>15 g/d) significantly decreased FBS concentrations, but not in other subgroups. CONCLUSION Guar gum supplementation may yield a beneficial effect on glycemic control in T2DM patients. However, the extant clinical trials, thus far, are not sufficient enough to form guidelines for clinical practice.
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Affiliation(s)
| | - Sanaz Pourreza
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohsen Yousefi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Elnaz Golalipour
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Leila Setayesh
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE.
| | | | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran.
| | - Damoon Ashtary-Larky
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, United States.
| | - Mohammad Zamani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
| | - Omid Asbaghi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Lotfi M, Nouri M, Turki Jalil A, Rezaianzadeh A, Babajafari S, Ghoddusi Johari M, Faghih S. Plant-based diets could ameliorate the risk factors of cardiovascular diseases in adults with chronic diseases. Food Sci Nutr 2023; 11:1297-1308. [PMID: 36911818 PMCID: PMC10002912 DOI: 10.1002/fsn3.3164] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
Adherence to plant-based diets is recommended to prevent and control chronic diseases. However, not all plant-based foods are healthy for this purpose. This study investigated the relationship between plant-based diets and risk factors for cardiovascular diseases (CVDs) in adults with chronic diseases. This cross-sectional study was performed on 3678 males and females (age range: 40-70 years) with chronic diseases who participated in the Kharameh cohort study. A validated semiquantitative food-frequency questionnaire was used to calculate the plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI). Lipid profile, fasting blood sugar (FBS), blood pressure, and anthropometric indices were measured. Multivariable-adjusted logistic regression analysis was performed to determine the association between plant-based diets and CVDs risk factors. Higher adherence to the PDI was inversely associated with the level of FBS (odds ratio [OR] = 0.42; 95% confidence interval [CI]: 0.33-0.53; p < .001). A significant decrease was observed for total cholesterol in those with higher adherence to hPDI (OR = 0.80; 95% CI: 0.65-0.98; p = .035). Additionally, the score of uPDI was positively related to FBS (OR = 1.23; 95% CI: 1.00-1.53; p = .01), total cholesterol (OR = 1.23; 95% CI: 1.01-1.49; p = .061), and low-density lipoprotein (OR = 1.39; 95% CI: 1.13-1.71; p = .009). It was concluded that adherence to PDI and hPDI was related to a lower level of FBS and total cholesterol, respectively. Moreover, the findings suggested that regular intake of the uPDI was correlated with some risk factors for CVDs in adults with chronic diseases.
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Affiliation(s)
- Mostafa Lotfi
- Department of Community Nutrition, School of Nutrition and Food ScienceShiraz University of Medical SciencesShirazIran
| | - Mehran Nouri
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
- Students' Research CommitteeShiraz University of Medical SciencesShirazIran
| | | | - Abbas Rezaianzadeh
- Department of Epidemiology, School of Health and NutritionShiraz University of Medical SciencesShirazIran
| | - Siavash Babajafari
- Nutrition research center, Department of Clinical NutritionSchool of Nutrition and Food Science, Shiraz University of Medical SciencesShirazIran
| | | | - Shiva Faghih
- Department of Community Nutrition, School of Nutrition and Food ScienceShiraz University of Medical SciencesShirazIran
- Nutrition Research CenterShiraz University of Medical SciencesShirazIran
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Socioeconomic inequalities in diabetes prevalence: the case of South Africa between 2003 and 2016. BMC Public Health 2023; 23:324. [PMID: 36788553 PMCID: PMC9926686 DOI: 10.1186/s12889-023-15186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Diabetes is a growing epidemic worldwide and the effect of socioeconomic status (SES) is frequently acknowledged in the literature. This study aims to compare the effect of SES on diabetes prevalence in South Africa between 2003 and 2016. In addition, vulnerable groups regarding diabetes development in 2016 will be identified. METHODS Using DHS data there were 8,006 participants (59.19% women) in 2003 and 10,292 participants (59.42% women) in 2016. Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for diabetes by age, gender, educational level and place of residence. To identify vulnerable groups with high risk of developing diabetes in 2016, the method of p-value based regression tree analysis was applied using "wealth index" and "weight perception" as additional variables. RESULTS There was an increase in diabetes prevalence from 3.86% in 2003 to 4.46% in 2016. Women had more risk of developing diabetes at both time points (27% in 2003 and 24% in 2016 more risk). Increase in age and living in urban areas were associated with more risk of developing diabetes at both time points. There was no specific pattern regarding risk of developing diabetes and educational level in case of women. However, men who completed secondary school or had a higher diploma or above had more risk of developing diabetes in 2016 (OR = 2.24 and 4.67 respectively). Vulnerable groups who have higher risk of developing diabetes in 2016 were participants aged "60 years or older" with a wealth index of "rich" or "richer", followed by participants from the same age group who were "poor" or "poorer" and participants aged "40-59 years" with a wealth index of "rich" or "richer". Subsequently were participants from the age group "15-39 years" with a weight perception of "overweight" or "obese". CONCLUSION Diabetes prevalence increased in South Africa between 2003 and 2016. Main risk factors were age, gender and living in urban areas. Men with high educational level were more at risk of developing diabetes in 2016. Vulnerable groups in 2016 were participants 40 years and older, particularly with high SES. This was followed by younger participants who were obese or overweight.
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Khowaja S, Hashmi S, Zaheer S, Shafique K. Patterns of smoked and smokeless tobacco use among multimorbid and non-multimorbid middle-aged and older-aged adults in Karachi, Pakistan: a cross-sectional survey. BMJ Open 2022; 12:e060090. [PMID: 36600352 PMCID: PMC9730344 DOI: 10.1136/bmjopen-2021-060090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to compare the patterns of smoked and smokeless tobacco use among multimorbid and non-multimorbid middle-aged and older-aged individuals in Karachi, Pakistan. STUDY DESIGN This was an observational cross-sectional study conducted during 2015-2016. STUDY SETTING AND PARTICIPANTS A total of 3250 participants aged 30 years and above, residing in the Gulshan-e-Iqbal town, Karachi, Pakistan were enrolled in the study through systematic random sampling. The selected area of residence represents diverse socioeconomic and ethnic groups of the city. People who could speak and write English or Urdu, and those who provided written informed consent were included in the study. OUTCOME MEASURES The primary outcome measure of the study was to determine the differences in patterns of tobacco consumption among multimorbid and non-multimorbid adult individuals. RESULTS We found no difference in patterns of smoked (adjusted OR (aOR) 1.15, 95% CI 0.88 to 1.50, p=0.289) or smokeless tobacco (aOR 1.13, 95% CI 0.86 to 1.48, p= 0.379) use among multimorbid and non-multimorbid individuals. Individuals who perceived tobacco as a risk were less likely to consume smokeless tobacco products. CONCLUSION There was no difference in tobacco consumption among individuals with and without multimorbidity. Evidenced-based guidelines are required to implement mental and behavioural interventions in patients with multiple chronic diseases to help them modify their behaviours.
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Affiliation(s)
- Salima Khowaja
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Shahkamal Hashmi
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Sidra Zaheer
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Kashif Shafique
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
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Xu T, Loban K, Wei X, Wang W. Determinants of choice of usual source of care among older people with cardiovascular diseases in China: evidence from the Study on Global Ageing and Adult Health. BMC Public Health 2022; 22:1970. [PMID: 36303176 PMCID: PMC9615328 DOI: 10.1186/s12889-022-14352-w] [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: 01/05/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) are emerging as the leading contributor to death globally. The usual source of care (USC) has been proven to generate significant benefits for the elderly with CVD. Understanding the choice of USC would generate important knowledge to guide the ongoing primary care-based integrated health system building in China. This study aimed to analyze the individual-level determinants of USC choices among the Chinese elderly with CVD and to generate two exemplary patient profiles: one who is most likely to choose a public hospital as the USC, the other one who is most likely to choose a public primary care facility as the USC. METHODS This study was a secondary analysis using data from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) Wave 1 in China. 3,309 individuals aged 50 years old and over living with CVD were included in our final analysis. Multivariable logistic regression was built to analyze the determinants of USC choice. Nomogram was used to predict the probability of patients' choice of USC. RESULTS Most of the elderly suffering from CVD had a preference for public hospitals as their USC compared with primary care facilities. The elderly with CVD aged 50 years old, being illiterate, residing in rural areas, within the poorest income quintile, having functional deficiencies in instrumental activities of daily living and suffering one chronic condition were found to be more likely to choose primary care facilities as their USC with the probability of 0.85. Among those choosing primary care facilities as their USC, older CVD patients with the following characteristics had the highest probability of choosing public primary care facilities as their USC, with the probability of 0.77: aged 95 years old, being married, residing in urban areas, being in the richest income quintile, being insured, having a high school or above level of education, and being able to manage activities living. CONCLUSIONS Whilst public primary care facilities are the optimal USC for the elderly with CVD in China, most of them preferred to receive health care in public hospitals. This study suggests that the choice of USC for the elderly living with CVD was determined by different individual characteristics. It provides evidence regarding the choice of USC among older Chinese patients living with CVD.
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Affiliation(s)
- Tiange Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Katya Loban
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Wenhua Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
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Karan A, Farooqui HH, Hussain S, Hussain MA, Selvaraj S, Mathur MR. Multimorbidity, healthcare use and catastrophic health expenditure by households in India: a cross-section analysis of self-reported morbidity from national sample survey data 2017-18. BMC Health Serv Res 2022; 22:1151. [PMID: 36096819 PMCID: PMC9469515 DOI: 10.1186/s12913-022-08509-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this research is to generate new evidence on the economic consequences of multimorbidity on households in terms of out-of-pocket (OOP) expenditures and their implications for catastrophic OOP expenditure. METHODS We analyzed Social Consumption Health data from National Sample Survey Organization (NSSO) 75th round conducted in the year 2017-2018 in India. The sample included 1,13,823 households (64,552 rural and 49,271 urban) through a multistage stratified random sampling process. Prevalence of multimorbidity and related OOP expenditure were estimated. Using Coarsened Exact Matching (CEM) we estimated the mean OOP expenditure for individuals reporting multimorbidity and single morbidity for each episode of outpatient visits and hospital admission. We also estimated implications in terms of catastrophic OOP expenditure for households. RESULTS Results suggest that outpatient OOP expenditure is invariably lower in the presence of multimorbidity as compared with single conditions of the selected Non-Communicable Diseases(NCDs) (overall, INR 720 [USD 11.3] for multimorbidity vs. INR 880 [USD 14.8] for single). In the case of hospitalization, the OOP expenditures were mostly higher for the same NCD conditions in the presence of multimorbidity as compared with single conditions, except for cancers and cardiovascular diseases. For cancers and cardiovascular, OOP expenditures in the presence of multimorbidity were lower by 39% and 14% respectively). Furthermore, around 46.7% (46.674-46.676) households reported incurring catastrophic spending (10% threshold) because of any NCD in the standalone disease scenario which rose to 63.3% (63.359-63.361) under the multimorbidity scenario. The catastrophic implications of cancer among individual diseases was the highest. CONCLUSIONS Multimorbidity leads to high and catastrophic OOP payments by households and treatment of high expenditure diseases like cancers and cardiovascular are under-financed by households in the presence of competing multimorbidity conditions. Multimorbidity should be considered as an integrated treatment strategy under the existing financial risk protection measures (Ayushman Bharat) to reduce the burden of household OOP expenditure at the country level.
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Affiliation(s)
- Anup Karan
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurugram, 122002, India
| | | | - Suhaib Hussain
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurugram, 122002, India
| | | | - Sakthivel Selvaraj
- Health Economics, Financing and Policy, Public Health Foundation of India, Gurugram, 122002, India
| | - Manu Raj Mathur
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurugram, 122002, India. .,Institute of Dentistry, Bart's and The London School of Medicine and Dentistry, New Road, London, E1 2AT, UK.
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Micklesfield LK, Kolkenbeck-Ruh A, Mukoma G, Prioreschi A, Said-Mohamed R, Ware LJ, Motlhatlhedi M, Wrottesley SV, Norris SA. The Healthy Aging Adult South Africa report card: a systematic review of the evidence between 2013 and 2020 for middle-aged South African men and women. Cardiovasc J Afr 2022; 33:200-219. [PMID: 35789240 PMCID: PMC9650148 DOI: 10.5830/cvja-2022-015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 03/14/2022] [Indexed: 10/03/2023] Open
Abstract
Due to the increasing non-communicable disease burden in Africa, several strategies that target the major lifestyle and physiological risk factors have been implemented to combat such diseases. The Healthy Aging Adult South Africa report card systematically reviews national and regional prevalence data of middle-aged South African adults (45-65 years) published between 2013 and 2020 on diet, physical activity, tobacco use and alcohol consumption, obesity, hypertension, dyslipidaemia and diabetes mellitus. Each indicator was assigned two grades, (1) based on the availability of prevalence data, and (2) based on whether policies have been proposed and implemented for the respective indicators. Alcohol consumption, obesity, hypertension and diabetes received an A grade for the availability of prevalence data. Tobacco use and diet received an A grade for policy and implementation. Gaps have been identified that need to be filled by future research focusing on continued surveillance of all indicators in order to inform and implement effective policies.
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Affiliation(s)
- Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Andrea Kolkenbeck-Ruh
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gudani Mukoma
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rihlat Said-Mohamed
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Molebogeng Motlhatlhedi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie V Wrottesley
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Abdallah SI, Abubaker NE, Ibrahim MA, Abd Alla A, Humaida RA. Plasma glucose, HbA1c, insulin and lipid profile in Sudanese type 2 diabetic patients with cardiovascular disease: a case control study. F1000Res 2022; 11:472. [DOI: 10.12688/f1000research.110927.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) and its consequences are a serious global public health issue. By 2030, the number of people with type 2 diabetes is predicted to reach 439 million. The purpose of this study is to evaluate the plasma levels of glucose, HbA1c, insulin, and lipid profile in Sudanese T2DM patients. Methods: This case control study included 165 Sudanese patients with diabetic type 2 and a cardiovascular condition as cases and 165 diabetic type 2 volunteers without a cardiovascular disorder as controls. The concentrations of plasma glucose, HbA1c, and lipid profile were assessed using a Mindray BS-480 auto-chemistry analyzer, and insulin was analyzed using a Cobase 411 auto analyzer. The collected data were analyzed using statistical tools for social science computer programs (SPSS version 21). Results: According to the findings, (59.4 %) of patients between the ages of (50-69). Females made up 50.9 %. (38.2 %) of patients had an illness duration of between (8-15 years). (41.8%) of individuals did not have hypertension. There was a substantial rise in BMI, FBG, HbA1c, HDL-C, and insulin among diabetics with cardiovascular disease compared to diabetics without cardiovascular disease (p-value = 0.001, 0.000, 0.018, and 0.000). Females had significantly higher blood TC, LDL-C, HDL-C, and BMI than males (p-values = 0.000, 0,001, and 0.000, respectively). There were significant positive correlation between FBS, HBA1c, insulin and duration of disease (r=0.155, p, value=0.005) (r=0.160, p, value=0.004)(r=0.103, p. value=0.061)respectively, while there were significant negative correlation between TC, TG,LDL-C, HDL-C and duration of disease (r=-0.152, p, value= 0.006)(r=-0.023, p, value=0.678)(r=-0.113, p, value= 0.040)(r=-0.145, p, value=0.008)respectively. Conclusion: When comparing diabetics with cardiovascular disease to diabetics without cardiovascular disease, there was a substantial rise in BMI, FBG, HbA1c, HDL-C, and insulin. FBS, HBA1c, insulin, and illness duration all had a strong positive connection.
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Ewuola AI, Olorunfemi G, Mthombeni JQ. Sociodemographic predictors of endometrial cancer mortality in South Africa (1997 to 2015): a case-control study. J OBSTET GYNAECOL 2022; 42:2241-2247. [DOI: 10.1080/01443615.2022.2036971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Adebukola I. Ewuola
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, Faculty of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Julian Q. Mthombeni
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Yang Y, Jin H, Zhang P, Cheng M, Liu X, Cao Z, Gao X, Zhou L, Lv Y, Huang J, Chen N, Wang Z, Shi J, Yu W. Influencing mechanisms of lifestyle and dietary factors on chronic diseases among community residents: updated evidence in Shanghai, China. Public Health Nutr 2021; 25:1-13. [PMID: 34713793 PMCID: PMC9991707 DOI: 10.1017/s1368980021004493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/31/2021] [Accepted: 10/17/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to determine the risk factors for chronic diseases and to identify the potential influencing mechanisms from the perspectives of lifestyle and dietary factors. The findings could provide updated and innovative evidence for the prevention and control of chronic diseases. DESIGN A cross-sectional study. SETTING Shanghai, China. PARTICIPANTS 1005 adults from Yangpu district of Shanghai participated in the study, and responded to questions on dietary habits, lifestyle and health status. RESULTS Residents suffering from chronic diseases accounted for about 34·99 % of the respondents. Logistic regression analysis showed that age, diet quality, amount of exercise and tea drinking were related to chronic diseases. Age > 60 and overeating (Diet Balance Index total score > 0) had negative additive interaction on the occurrence of chronic disease, while overexercise (Physical Activity Index > 17·1) and tea drinking had negative multiplicative interaction and negative additive interaction on the occurrence of chronic disease. Diet quality, physical activity and tea drinking were incomplete mediators of the relationship between types of medical insurance residents participating in and chronic diseases. CONCLUSIONS The residents in Yangpu District of Shanghai have a high prevalence of chronic diseases. Strengthening access of residents to health education and interventions to prevent chronic diseases and cultivating healthy eating and exercise habits of residents are crucial. The nutritional environment of the elderly population should be considered, and the reimbursement level of different types of medical insurance should be designed reasonably to improve the accessibility of medical and health services and reduce the risk of chronic diseases.
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Affiliation(s)
- Yan Yang
- School of Economics and Management, Tongji University, Shanghai, People’s Republic of China
| | - Hua Jin
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, People’s Republic of China
| | - Peipei Zhang
- Anting Hospital, Jiading District, Shanghai, People’s Republic of China
| | - Mingwang Cheng
- School of Economics and Management, Tongji University, Shanghai, People’s Republic of China
| | - Xiang Liu
- Department of Respiratory Disease, The 903rd Hospital of PLA, Hangzhou, Zhejiang, People’s Republic of China
| | - Zilong Cao
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai200025, People’s Republic of China
| | - Xiang Gao
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai200025, People’s Republic of China
| | - Liang Zhou
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai200025, People’s Republic of China
| | - Yipeng Lv
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai200025, People’s Republic of China
| | - Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai200025, People’s Republic of China
| | - Ning Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai200025, People’s Republic of China
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai200025, People’s Republic of China
| | - Jianwei Shi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai200025, People’s Republic of China
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai200025, People’s Republic of China
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Global and Regional Patterns in Noncommunicable Diseases and Dietary Factors across National Income Levels. Nutrients 2021; 13:nu13103595. [PMID: 34684595 PMCID: PMC8537506 DOI: 10.3390/nu13103595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Noncommunicable diseases (NCDs) are the leading global cause of death and share common risk factors. Little quantitative data are available on the patterns of each NCDs death and dietary factors by national income level and region. We aimed to identify the trend of NCDs deaths and dietary factors with other health-related behaviors across national income levels and geographical regions. Methods: Three databases were collected, including the World Health Organization, Food and Agriculture Organization, and World Bank in 2014. These were analyzed to describe the trend for NCDs deaths and dietary factors with health-related behaviors across national income levels (high income, upper-middle income, lower-middle income, and low income) from 151 countries using variance-weighted least-squares linear regression. Results: Lower-middle-income and low-income countries in Africa and Asia had higher death rates of NCDs. More than 30% of the population had raised blood pressure with higher carbohydrate intake and lower protein and fat intake compared to high-income European countries in 2014. High-income countries had the highest prevalence of raised total cholesterol, overweight, and obesity, the highest total energy, fat, and protein intake, and the highest supplies of animal fat, stimulants, sugar and sweetener, vegetable oil, and milk, as well as insufficient activity with an increasing trend (p for trend < 0.001). Conclusion: There were differences in NCDs risk factors and dietary factors by national income and region. Accordingly, measures should be taken to suit the situation in each country. Our findings have significance for health workers and health policies preventing and controlling the rise of NCDs.
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Qiao X, Wang B, Guo H. Chronic Diseases and Labor Force Participation Among Presenile and Senile Chinese. Front Public Health 2021; 9:675927. [PMID: 34604151 PMCID: PMC8483147 DOI: 10.3389/fpubh.2021.675927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The incidence of chronic diseases has increased dramatically due to rapid aging and lifestyle changes of China in recent decades. The population aged more than 45 years is an important participant in the labor force market, and the health status directly affects their labor force participation decision. This study aims to explore the relationship between chronic diseases and the labor force participation among the elderly Chinese population aged more than 45 years. Method: We employ a multivariate probit (MVP) model to construct five structural equations for an analysis. The advantage of this model is that it can deal with the endogeneity of chronic diseases. Results: Firstly, compared with the elderly, younger people are more likely to participate in the labor force market; the influence of chronic diseases is the largest for presenile women in the decision-making of labor force participation; the impact of psychological problems on labor force participation cannot be ignored, especially for men aged more than 45 years. In addition, sociodemographic factors such as geographical location and marital status also have direct effects on the probability of labor force participation while the impact of both family wealth and family number is much smaller. Finally, unhealthy lifestyles through chronic diseases have negative and indirect marginal effects on labor force participation. Conclusions: This article proves that chronic diseases have a negative impact on the labor force participation for Chinese aged more than 45 years. The public should give more tolerance and opportunities to these groups. The population aged more than 45 years are more vulnerable and face more psychological problems, which will lead to a decline in labor force participation. Psychological health counseling and services are urgently needed. As the urban areas enjoy more social welfare, Chinese welfare policy needs to be tilted toward the rural elderly. For individuals, maintaining healthy lifestyles can help you stay away from chronic diseases and stay in the labor force market.
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Affiliation(s)
- Xiaotuo Qiao
- Finance, School of Management, Harbin Institute of Technology, Harbin, China
| | - Bo Wang
- Economics, School of Humanities, Social Science and Law, Harbin Institute of Technology, Harbin, China
| | - Haifeng Guo
- Finance, School of Management, Harbin Institute of Technology, Harbin, China
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Saha S, Oldewage-Theron W, Napier C. Be active: a food-based dietary guideline for elderly South Africans. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2021.1947038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sanjoy Saha
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
- Department of Sustainable Food Systems and Development, University of the Free State, Bloemfontein, South Africa
| | - Carin Napier
- Department of Food & Nutrition Consumer Sciences, Durban University of Technology, Durban, South Africa
- Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
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23
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Saha S, Mukherjee U, Miller M, Peng LL, Napier C, Grobbelaar H, Oldewage-Theron W. Food and beverages promoting elderly health: six food-based dietary guidelines to plan good mixed meals for elderly South Africans. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2021.1956232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sanjoy Saha
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Upasana Mukherjee
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Makenzie Miller
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Li-Ling Peng
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Carin Napier
- Department of Food & Nutrition Consumer Sciences, Durban University of Technology, Durban, South Africa
- Centre for Longitudinal Research, The University of Auckland, Auckland, New Zealand
| | - Heleen Grobbelaar
- Department of Food & Nutrition Consumer Sciences, Durban University of Technology, Durban, South Africa
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
- Department of Sustainable Food Systems and Development, University of the Free State, Bloemfontein, South Africa
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Living at the Margins or Elevated Citizenship? Challenges and Opportunities for Social Participation Experienced by Older Adults in Ghana. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Fadelu T, Damuse R, Lormil J, Pecan E, Greenberg L, Dubuisson C, Pierre V, Triedman SA, Shulman LN, Rebbeck TR. Body Mass Index, Chemotherapy-Related Weight Changes, and Disease-Free Survival in Haitian Women With Nonmetastatic Breast Cancer. JCO Glob Oncol 2021; 6:1656-1665. [PMID: 33151773 PMCID: PMC7713562 DOI: 10.1200/go.20.00307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Few studies have explored the relationship between body habitus and breast cancer outcomes in Caribbean women of African ancestry. This study evaluates the association between body mass index (BMI) and disease-free survival (DFS) in a retrospective cohort of 224 female Haitian patients with nonmetastatic breast cancer. PATIENTS AND METHODS BMI was obtained from the medical records and categorized as normal weight (< 25 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). DFS was defined as time from surgical resection to disease recurrence, death, or censoring. Kaplan-Meier survival curves were generated, and the association between BMI and DFS was evaluated using Cox proportional hazard models to control for multiple confounders. Exploratory analyses were conducted on weight changes during adjuvant chemotherapy. RESULTS Eighty-three patients (37.1%) were normal weight, 66 (29.5%) were overweight, and 75 (33.5%) were obese. There were no statistical differences in baseline characteristics or treatments received by BMI group. Twenty-six patients died and 73 had disease recurrence. Median DFS was 41.1 months. Kaplan-Meier estimates showed no significant DFS differences by BMI categories. After controlling for confounders, normal weight patients, when compared with overweight and obese patients, had adjusted hazard ratios of 0.85 (95% CI, 0.49 to 1.49) and 0.90 (95% CI, 0.52 to 1.55), respectively. Overall, mean weight loss of 2% of body weight was noted over the course of adjuvant chemotherapy. Patients who were postmenopausal (P = .007) and obese (P = .05) lost more weight than other groups. However, chemotherapy-related weight changes did not have an impact on DFS. CONCLUSION Baseline BMI and weight changes during adjuvant chemotherapy did not have an impact on DFS in this cohort. Future prospective studies in similar Caribbean breast cancer cohorts are needed to verify study findings.
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Affiliation(s)
| | - Ruth Damuse
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.,Zanmi Lasante, Croix-des-Bouquet, Haiti
| | - Joarly Lormil
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.,Zanmi Lasante, Croix-des-Bouquet, Haiti
| | - Elizabeth Pecan
- Wharton Business School, University of Pennsylvania, Philadelphia, PA
| | | | - Cyrille Dubuisson
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.,Zanmi Lasante, Croix-des-Bouquet, Haiti
| | - Viergela Pierre
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.,Zanmi Lasante, Croix-des-Bouquet, Haiti
| | - Scott A Triedman
- Dana-Farber Cancer Institute, Boston, MA.,The Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Timothy R Rebbeck
- Dana-Farber Cancer Institute, Boston, MA.,Harvard T.H. Chan School of Public Health, Boston, MA
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Determinants of Fruits and Vegetables Consumption among In-School Adolescents in Ghana. ADOLESCENTS 2021. [DOI: 10.3390/adolescents1020016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Fruit and vegetable consumption is an important source of nutrients for healthy growth and development, as well as a protective factor against chronic non-communicable diseases. Paucity of data exists on adolescents’ fruit and vegetable consumption in Ghana. This study, therefore, sought to determine the prevalence and correlates of fruit and vegetable consumption among in-school adolescents in Ghana. Methods: Data for this study were extracted from the 2012 Global School-Based Health Survey. A cross-sectional analysis on 2786 in-school adolescents from junior and senior high schools was conducted. Descriptive analyses using frequencies and percentages were used to present the results on the prevalence of fruit and vegetable consumption. Multivariable binomial regression analysis was performed to determine the association between fruit and vegetable consumption and explanatory variables. The results of the regression analyses were presented using adjusted odds ratio (aOR) with their respective confidence intervals (CIs). Statistical significance was set at p < 0.05. Results: The prevalence of adequate fruits, adequate vegetables, and adequate fruit and vegetable consumption were 35.7%, 26.8%, and 27.8%, respectively. In-school male adolescents had lower odds of adequate fruit and vegetable consumption compared to female adolescents (aOR = 0.64, 95%CI = 0.51–0.82). Adolescents in senior high schools (aOR = 0.36, 95%CI = 0.22–0.61) were less likely to consume adequate fruits and vegetables compared to those in junior high schools. The odds of adequate fruit and vegetable consumption were higher among adolescents who consumed soft drinks (aOR = 3.29, 95%CI = 2.42–4.46), fast foods (aOR = 1.42, 95%CI = 1.13–1.77), and those who had sedentary behavior (aOR = 1.38, 95%CI = 1.07–1.77). Conclusions: The findings revealed that fruit and vegetable consumption among Ghanaian adolescents is relatively low. Sex of adolescents, grade, soft drink intake, fast food consumption, and sedentary behavior were factors associated with adequate fruit and vegetable consumption. Health promotion interventions to scale up fruit and vegetable consumption should pay attention to the factors identified in this study.
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Konkor I, Dogoli MA, Kuuire V, Wilson K. Examining the Relationship Between Occupational Physical Activity and Hypertension Status: Evidence from the Ghana WHO Study on Global Ageing and Adult Health. Ann Work Expo Health 2021; 65:1050-1060. [PMID: 34089319 DOI: 10.1093/annweh/wxab035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/18/2021] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
The employment landscape has changed significantly over the past few years in emerging economies including Ghana where many people are rapidly transitioning from livelihood activities that originally involved physical exertion to work environments where performance of duties are mostly non-physical. Working under non-active conditions could, however, exacerbate the risk of developing chronic diseases that are increasingly becoming problematic in many developing countries. Drawing on a cross-sectional nationally representative sample data of 4425 adult Ghanaian workers collected by the WHO Study on Global Ageing and Adult Health in developing countries, we examined the relationship between occupational physical activity and hypertensive status. We employed the complementary log-log analysis technique to build nested models with results presented in odds ratios. After controlling for several relevant variables, the results show that performing sedentary related work (AOR = 1.23, CI = 1.06-1.42) is significantly associated with a higher likelihood of being hypertensive compared with those whose work involved moderate physical activity. Other factors that were significantly associated with being hypertensive included tobacco use (AOR = 1.33, CI = 1.05-1.70), living in an urban environment (AOR = 1.15, CI = 1.01-1.32), and being a female (AOR = 1.18, CI = 1.01-1.37) and being an older person. Policies on reducing the risk of developing chronic conditions especially hypertension need to recognize the contributions of the work environment in emerging developing economies.
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Affiliation(s)
- Irenius Konkor
- Department of Geography, Geomatics and Environment, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Maurice Anfaara Dogoli
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON N2L, Canada
| | - Vincent Kuuire
- Department of Geography, Geomatics and Environment, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Kathi Wilson
- Department of Geography, Geomatics and Environment, University of Toronto Mississauga, Mississauga, ON, Canada
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Sundanese culture-sensitive family nursing model improves behavior in controlling blood sugar in elderly patients with diabetes. ENFERMERIA CLINICA 2021. [PMID: 33849200 DOI: 10.1016/j.enfcli.2020.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetes is a chronic disease that has associations with an unhealthy lifestyle. The purpose of this study was to determine the effect of a Sudanese culture-sensitive family nursing model on improving family behavior in controlling blood sugar in elderly patients with diabetes. This study used a quasi-experimental design, involving 57 respondents in the intervention group and 57 respondents in the control group of families containing elderly members with diabetes. Samples were taken by multistage cluster sampling, and univariate, bivariate, multivariate statistical analysis was applied. The results showed an increase in mean family behavior and a decrease in mean blood sugar levels after the intervention model, with p-value=0.000. Sundanese culture-sensitive family nursing models can improve family behavior in controlling blood sugar in elderly patients with diabetes and it is recommended as a pattern of a culture-based approach in the treatment of the elderly with diabetes.
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The Influence of Anthropometric Indices and Intermediary Determinants of Hypertension in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115646. [PMID: 34070454 PMCID: PMC8197532 DOI: 10.3390/ijerph18115646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Abstract
Hypertension is a major public health burden in Bangladesh. However, studies considering the underlying multifaceted risk factors of this health condition are sparse. The present study concurrently examines anthropometric parameters and intermediary factors influencing hypertension risk in Bangladesh. Using the 2018 World Health Organisation (WHO) STEPwise approach to non-communicable disease risk factor surveillance (STEPS) study conducted in Bangladesh and involving 8019 nationally representative adult respondents, bivariate and multivariate logistic regression analyses were performed to determine the association between anthropometrics, other intermediary factors and hypertension. The regression results were presented using the odds ratio (OR) and adjusted odds ratio (AOR) at 95% confidence intervals (CIs). The risk of hypertension was higher among females and males who were 40 years and older. However, among females, those who were age 60 years and older were more than twice and thrice more likely to be hypertensive compared to those in the younger age groups (18–39, 40–59). Females who were obese (body mass index [BMI], waist to hip ratio [WHR], waist to height ratio [WHtR]) or had high waist circumference [WC] were twice as likely to be hypertensive. Males and females who were physically active, consuming more fruits and vegetables daily and educated had lower odds of developing hypertension. Key findings suggest that the association between anthropometric indices (body mass index [BMI], waist to hip ratio [WHR], waist to height ratio [WHtR]), waist circumference [WC]), other intermediary determinants (e.g., education, physical activity) and hypertension exist across gender and with increasing age among adults in Bangladesh. Developing appropriate public health interventions (e.g., regular assessment of anthropometric parameters) for early identification of the risk and pattern of hypertension through appropriate screening and diagnosis is required to meet the specific health needs of the adult Bangladesh population.
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Feng Z, Cramm JM, Nieboer AP. Associations of Social Cohesion and Socioeconomic Status with Health Behaviours among Middle-Aged and Older Chinese People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094894. [PMID: 34064460 PMCID: PMC8125501 DOI: 10.3390/ijerph18094894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/16/2022]
Abstract
Background: An understanding of factors associated with health behaviours is critical for the design of appropriate health promotion programmes. Important influences of social cohesion, education, and income on people's health behaviours have been recognised in Western countries. However, little is known about these influences in the older Chinese population. Objective: To investigate associations of social cohesion and socioeconomic status (SES) with health behaviours among middle-aged and older adults in China. Methods: We used data from the World Health Organization's Study on Global AGEing and Adult Health. Logistic regression and multivariate linear regression were performed. Results: Participants who reported greater social cohesion were more likely to have adequate vegetable and fruit (VF) consumption, be socially active, and less likely to smoke daily, but were not physically more active; participants with lower education levels were less likely to have adequate VF consumption and be socially active, and more likely to smoke daily; higher incomes were associated with decreased odds of daily smoking, increased odds of adequate VF consumption, increased likelihood to be socially active, but also less likelihood to have sufficient physical activity (PA). Associations of social cohesion and SES with health behaviours (smoking, PA, and VF consumption) differed between men and women. Discussion: Our findings are an essential step toward a fuller understanding of the roles of social cohesion and SES in protecting healthy behaviours among older adults.
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Affiliation(s)
- Zeyun Feng
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3000 DR Rotterdam, The Netherlands; (J.M.C.); (A.P.N.)
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai 200031, China
- Correspondence:
| | - Jane M. Cramm
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3000 DR Rotterdam, The Netherlands; (J.M.C.); (A.P.N.)
| | - Anna P. Nieboer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3000 DR Rotterdam, The Netherlands; (J.M.C.); (A.P.N.)
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Marmamula S, Modepalli SB, Kumbham TR, Challa R, Keeffe JE. Prevalence of disabilities and non-communicable diseases in an elderly population in the Telangana state, India: a population-based cross-sectional study. BMJ Open 2021; 11:e041755. [PMID: 33608399 PMCID: PMC7898867 DOI: 10.1136/bmjopen-2020-041755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To assess the prevalence of disabilities (vision, hearing, mobility, cognitive, self-care and communication) and non-communicable diseases (NCDs) among the elderly population in two districts in Telangana, India. DESIGN Population-based cross-sectional study using a cluster random sampling method to select the study clusters. SETTING Elderly population in Khammam and Warangal districts were recruited. Detailed interviews were conducted by trained community health workers. Personal and demographic information such as age, gender, level of education and a self-report of NCDs was collected. The Washington Disability Questionnaire was administered to assess the presence of disabilities. PARTICIPANTS 1821 participants aged ≥60 years, 54.5% were women, and 73.3% had no education. PRIMARY OUTCOME MEASURE Prevalence of disabilities and NCDs. RESULTS Overall, the prevalence of at least disability was 20.3% (95% CI 16.3 to 24.9). The prevalence of self- reported disabilities were: seeing (5.9%; 95% CI 4.4 to 7.8), mobility (12.8%; 95% CI 9.7 to 16.8), hearing (3.6%; 95% CI 2.7 to 4.8), cognition (4.8%; 95% CI 3.5 to 6.7), self-care (3.3%; 95% CI 2.3 to 4.7) and communication (1.8%; 95% CI 1.2 to 2.6). Overall, the prevalence of at least one NCD was 34.2% (95% CI 30.9 to 37.7). Hypertension was the most common systemic condition (25.4%; 95% CI 22.4 to 28.7), followed by diabetes (9.0%; 95% CI 7.3 to 11.0), and body pains (muscle-skeletal) (9.9%; 95% CI 8.1 to 12.2). CONCLUSION Every fifth elderly person in the districts of Khammam and Warangal in Telangana had at least one self-reported disability. Besides, a third of the elderly had at least one NCD. There is a definite need to develop comprehensive public health strategies to address disabilities and NCDs in Telangana.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry & Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Wellcome Trust /DBT India Alliance fellow, L V Prasad Eye Institute, Hyderabad, India
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Thirupathi Reddy Kumbham
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Jill E Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
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Macek P, Biskup M, Terek-Derszniak M, Manczuk M, Krol H, Naszydlowska E, Smok-Kalwat J, Gozdz S, Zak M. Competing Risks of Cancer and Non-Cancer Mortality When Accompanied by Lifestyle-Related Factors-A Prospective Cohort Study in Middle-Aged and Older Adults. Front Oncol 2020; 10:545078. [PMID: 33330023 PMCID: PMC7734021 DOI: 10.3389/fonc.2020.545078] [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: 03/23/2020] [Accepted: 10/26/2020] [Indexed: 01/16/2023] Open
Abstract
Background The study aimed to identify the association between the lifestyle-related factors and the cancer-specific, or non-cancer-specific mortality, when accompanied by a competing risk. Two statistical methods were applied, i.e., cause-specific hazard (CSH), and sub-distribution hazard ratio (SHR). Their respective key advantages, relative to the actual study design, were addressed, as was overall application potential. Methods Source data from 4,584 residents (34.2% men), aged 45–64 years, were processed using two different families of regression models, i.e., CSH and SHR; principal focus upon the impact of lifestyle-related factors on the competing risk of cancer and non-cancer mortality. The results were presented as hazard ratios (HR) with 95% confidence intervals (95% CI). Results Age, smoking status, and family history of cancer were found the leading risk factors for cancer death; the risk of non-cancer death higher in the elderly, and smoking individuals. Non-cancer mortality was strongly associated with obesity and hypertension. Moderate to vigorous physical activity decreased the risk of death caused by cancer and non-cancer causes. Conclusions Specific, lifestyle-related factors, instrumental in increasing overall, and cancer-specific mortality, are modifiable through health-promoting, individually pursued physical activities. Regular monitoring of such health-awareness boosting pursuits seems viable in terms of public health policy making.
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Affiliation(s)
- Pawel Macek
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland.,Department of Epidemiology and Cancer Control, Holycross Cancer Centre, Kielce, Poland
| | - Malgorzata Biskup
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland.,Department of Rehabilitation, Holycross Cancer Centre, Kielce, Poland
| | | | - Marta Manczuk
- Department of Epidemiology and Cancer Prevention, Maria Sklodowska-Curie Institute- Oncology Center, Warsaw, Poland
| | - Halina Krol
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland.,Research and Education Department, Holycross Cancer Centre, Kielce, Poland
| | - Edyta Naszydlowska
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
| | | | - Stanislaw Gozdz
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland.,Clinical Oncology Clinic, Holycross Cancer Centre, Kielce, Poland
| | - Marek Zak
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
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Okafor UB, Goon DT. Applying the Ecological Model to understand pregnant women's perspectives on the modifiable constraints to physical activity during pregnancy: A qualitative research study. Medicine (Baltimore) 2020; 99:e23431. [PMID: 33285736 PMCID: PMC7717830 DOI: 10.1097/md.0000000000023431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/19/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022] Open
Abstract
The benefits of physical activity (PA) during pregnancy are widely reported; however, PA practice is seemingly not a valued habit among pregnant women attending public antenatal health centres in the Eastern Cape of South Africa. Guided by the ecological model, we sought to explore modifiable barriers to PA among pregnant women.Semi-structured interviews involved a purposive sample of 15 pregnant women. Interview questions were guided by the ecological model constructs at intrapersonal, interpersonal, and environmental level. Thematic analysis was applied to summarise the modifiable barriers to PA during pregnancy.Three main themes emerged, based on the modifiable barriers to PA during pregnancy that belong to the varying Ecological Model constructs. On the intrapersonal level, 5 themes emerged, namely, time-constraint beliefs, feeling of tiredness, low energy, lack of motivation, and a lack of knowledge on benefits and types of PA. Two themes emerged for the interpersonal level, lack of PA advice and lack of information on PA recommendations and guidelines. Another theme defined the environmental level lacking resources. Most themes related to individual factors, which prevent PA-promoting behaviour.Overall, intrapersonal factors relating to tiredness and exhaustion, lack of time beliefs, work and household commitments, and lack of motivation were key modifiable barriers to PA by the women. The findings provide insights into possible interventional strategies to optimise PA during pregnancy among women in this setting. Appropriate knowledge, education and advice on the benefits, types, and intensity of PA in pregnancy are needed.
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Affiliation(s)
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, East London, South Africa
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de Almeida MGN, Nascimento-Souza MA, Lima-Costa MF, Peixoto SV. Lifestyle factors and multimorbidity among older adults (ELSI-Brazil). Eur J Ageing 2020; 17:521-529. [PMID: 33381003 PMCID: PMC7752941 DOI: 10.1007/s10433-020-00560-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The objective of the study was to evaluate the association between unhealthy lifestyle factors (individual and combined) and multimorbidity stratified by sex, in a national sample representative of Brazilians aged 50 years or older. Data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline, conducted in 2015-2016, were used. Multimorbidity was defined by the existence of two or more of the 19 chronic diseases. Four unhealthy lifestyle factors were considered: (1) at-risk alcohol consumption, (2) current or past smoking, (3) insufficient physical activity and (4) below-recommended consumption of fruits and vegetables. The association between unhealthy lifestyle factors, individual and combined, was assessed by logistic regression. Among the 7918 study participants, the prevalence of multimorbidity was 75.8% (95% CI 73.7-77.7) among women and 58.7% (95% CI 56.0-61.3) among men. Among women, none of the analyzed behaviors presented an independent and statistically significant association (p < 0.05) with multimorbidity. Among men, at-risk alcohol consumption was associated with lower odds of multimorbidity. On the other hand, current or past smoking and insufficient physical activity were associated with greater odds of this condition. In addition, the presence of three or four unhealthy lifestyle factors was associated with greater odds of multimorbidity among men. The results reinforce the need for interventions to promote healthy behaviors among older men with two or more chronic diseases. In addition, it is evident that the health services need to act in an attempt to modify unhealthy behaviors after medical diagnosis of chronic diseases to reduce the risk of future complications.
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Affiliation(s)
| | | | | | - Sérgio Viana Peixoto
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG Brazil
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG Brazil
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Rahmati S, Azami M, Jaafari Z, Pouratar N, Asodollahi K. An evaluation of the risk factors of breast cancer in women in Ilam Province: a case–control study based on hospital. BREAST CANCER MANAGEMENT 2020. [DOI: 10.2217/bmt-2020-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: The present study aimed to identify the most associated risk factors of breast cancer in Ilam province in 2015–2016. Materials & methods: In this case–control study, the case group consisted of 50 women with breast cancer with a definitive diagnosis from date 23 September 2015 to 22 September 2016. The two groups were group matched in terms of age. Data were collected through interviews and medical records. Results: According to the results, there was a significant relationship between the disease status and variables of family history, history of irregular menstrual cycles, history of breastfeeding, menopausal status, history of oral contraceptive pill consumption, BMI, menarche and number of pregnancies (p < 0.05). Conclusion: Regarding decisive risk factors of breast cancer, more studies with larger sample sizes that take into account more risk factors are necessary.
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Affiliation(s)
- Shoboo Rahmati
- Department of Epidemiology, Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Milad Azami
- Department of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Zahra Jaafari
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Nasrin Pouratar
- Department of Epidemiology, Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Khairollah Asodollahi
- Department of Epidemiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
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Tachi K, Tetteh J, Yawson AE, Agyei-Nkansah A, Archampong T. Alcohol consumption and fruits and vegetable intake among older adults in Ghana: a cross-sectional survey based on WHO-SAGE Wave 2 data. BMJ Nutr Prev Health 2020; 3:220-228. [PMID: 33521532 PMCID: PMC7841822 DOI: 10.1136/bmjnph-2020-000102] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Alcohol consumption and inadequate fruits and vegetable (FnV) intake are major reasons for the shift from communicable to non-communicable diseases (NCDs) over the years. The older Ghanaian adult is at high risk of NCD and data on alcohol and FnV consumption are required to guide policy to mitigate its effect. This analysis aimed to determine the factors associated with alcohol consumption and assess the relationship between alcohol consumption and FnV intake among Ghanaians aged 50 years and older. METHODS This analysis used WHO Study on Global Ageing and Adult Health (SAGE) Wave 2, Ghana data set conducted between 2014 and 2015. Data on demographic characteristics, FnV intake, and alcohol consumption were collated and analysed. Multivariable Poisson, logistic and probit regression analyses were performed to assess the associations between alcohol consumption and inadequate FnV intake. RESULTS A total of 3533 Ghanaians aged 50 years and older, 41.0% men and 59.0% women, were included in this study. The prevalence of lifetime alcohol consumption was 22.8% (95% CI 20.7% to 25.1%). Alcohol consumption was significantly associated with sex, age group, marital status, religion, place of residence and history of smoking. The prevalence of adequate FnV intake was 52.6% with a mean daily intake of 6.45 servings: 2.98 for fruits and 3.47 for vegetables. There was a significant positive correlation between inadequate FnV intake and alcohol consumption. Inadequate FnV consumption was significantly higher among lifetime alcohol consumers compared with non-alcohol consumers. (Poisson estimate; adjusted Prevalence Ratio (aPR) (95% CI)=1.35 (1.12 to 1.63), logistic estimate; adjusted Old Ratio (aOR) (95% CI)=1.13 (1.05 to 1.21) and probit estimate; adjusted normalized coefficient (aβ) (95% CI)=0.19 (0.07 to 0.31)). CONCLUSION About a quarter and nearly half of older Ghanaian adults consume alcohol and inadequate FnV, respectively. Alcohol consumption is significantly associated with inadequate FnV intake. Interventions to address inadequate FnV intake among older adults in Ghana should also include policies that regulate the use of alcohol in this population.
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Affiliation(s)
- Kenneth Tachi
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, Korle Bu, Greater Accra, Ghana
| | - John Tetteh
- Department of Community Health, College of Health Sciences, University of Ghana Medical School, Korle Bu, Greater Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, College of Health Sciences, University of Ghana Medical School, Korle Bu, Greater Accra, Ghana
| | - Adwoa Agyei-Nkansah
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, Korle Bu, Greater Accra, Ghana
| | - Timothy Archampong
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, Korle Bu, Greater Accra, Ghana
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Matsuzaki M, Sherr K, Augusto O, Kawakatsu Y, Ásbjörnsdóttir K, Chale F, Covele A, Manaca N, Muanido A, Wagenaar BH, Mocumbi AO, Gimbel S. The prevalence of hypertension and its distribution by sociodemographic factors in Central Mozambique: a cross sectional study. BMC Public Health 2020; 20:1843. [PMID: 33261617 PMCID: PMC7709228 DOI: 10.1186/s12889-020-09947-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/19/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hypertension (HTN) is a major risk factor for cardiovascular diseases, and its prevalence has been rising in low- and middle-income countries. The current study describes HTN prevalence in central Mozambique, association between wealth and blood pressure (BP), and HTN monitoring and diagnosis practice among individuals with elevated BP. METHODS The study used data from a cross-sectional, representative household survey conducted in Manica and Sofala provinces, Mozambique. There were 4101 respondents, aged ≥20 years. We measured average systolic and diastolic BP (SBP and DBP) from three measurements taken in the household setting. Elevated BP was defined as having either SBP ≥140 or DBP ≥90 mmHg. RESULTS The mean age of the participants was 36.7 years old, 59.9% were women, and 72.5% were from rural areas. Adjusting for complex survey weights, 15.7% (95%CI: 14.0 to 17.4) of women and 16.1% (13.9 to 18.5) of men had elevated BP, and 7.5% (95% CI: 6.4 to 8.7) of the overall population had both SBP ≥140 and DBP ≥90 mmHg. Among participants with elevated BP, proportions of participants who had previous BP measurement and HTN diagnosis were both low (34.9% (95% CI: 30.0 to 40.1) and 12.2% (9.9 to 15.0) respectively). Prior BP measurement and HTN diagnosis were more commonly reported among hypertensive participants with secondary or higher education, from urban areas, and with highest relative wealth. In adjusted models, wealth was positively associated with higher SBP and DBP. CONCLUSIONS The current study found evidence of positive association between wealth and BP. The prevalence of elevated BP was lower in Manica and Sofala provinces than the previously estimated national prevalence. Previous BP screening and HTN diagnosis were uncommon in our study population, especially among rural residents, individuals with lower education levels, and those with relatively less wealth. As the epidemiological transition advances in Mozambique, there is a need to develop and implement strategies to increase BP screening and deliver appropriate clinical services, as well as to encourage lifestyle changes among people at risk of developing hypertension in near future.
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Affiliation(s)
- Mika Matsuzaki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA
- Health Alliance International, Seattle, WA, USA
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Community Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Yoshito Kawakatsu
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Falume Chale
- CIOB, University of Washington, Seattle, WA, USA
| | | | | | | | - Bradley H Wagenaar
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Sarah Gimbel
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Family and Child Nursing, University of Washington, Seattle, WA, USA
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Calys-Tagoe B, Nuertey BD, Tetteh J, Yawson AE. Individual awareness and treatment effectiveness of hypertension among older adults in Ghana: evidence from the World Health Organization study of global ageing and adult health wave 2. Pan Afr Med J 2020; 37:264. [PMID: 33598079 PMCID: PMC7864259 DOI: 10.11604/pamj.2020.37.264.24526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/30/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION the aim of this study was to report the prevalence of hypertension, its awareness and treatment effectiveness among older adults (aged 50 years and above) in Ghana. METHODS the Ghana World Health Organization´s (WHO) Study on Global Aging and Adult Health (SAGE) wave 2 dataset was used in this study. The study adopted a cross-sectional study design. Information on self-reported hypertension as well as measured hypertension was analyzed. The level of awareness regarding hypertension and the effectiveness of treatment was determined using descriptive statistics. Factors associated with an individual´s awareness of their hypertensive status were determined using Rao-Scott Chi square test statistic and the predictors of unawareness of hypertension were determined using adjusted logistic regression analysis. A p-value of ≤0.05 was deemed significant. RESULTS information on 3,575 adults in Ghana aged 50 years or older was included in this analysis. The mean age of study participants was 65.1 ± 10.7 years with 59% being female. The prevalence of measured hypertension was 50.7% [95%CI=48.3-53.2]. The overall prevalence of hypertension among older adults in Ghana who were hypertensive but were not aware of it was 35.0% [95%CI=31.6-38.5]. Of the 332 individuals who self-reported being hypertensive, only 74 (22.2%) were on any form of treatment, with only 17 (5.1%) having their blood pressures well controlled. CONCLUSION approximately half of all older adults in Ghana have elevated blood pressures. Most of these are not aware of their elevated blood pressure and for those who are aware, very few are on treatment and even fewer have their blood pressure well controlled. Structured national population level screening and health promotion for elevated blood pressure by Ministry of Health/ Ghana Health Service is worthy of consideration.
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Affiliation(s)
- Benedict Calys-Tagoe
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Benjamin D Nuertey
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Zhao X, Hong F, Yin J, Tang W, Zhang G, Liang X, Li J, Cui C, Li X. Cohort Profile: the China Multi-Ethnic Cohort (CMEC) study. Int J Epidemiol 2020; 50:721-721l. [PMID: 33232485 PMCID: PMC8271196 DOI: 10.1093/ije/dyaa185] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China,Corresponding author. West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Renmin South Road, Chengdu, Sichuan, CN 610041, China. E-mail:
| | - Feng Hong
- School of Public Health, the key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China
| | - Jianzhong Yin
- Kunming Medical University, Kunming, Yunnan, China,Baoshan College of Traditional Chinese Medicine, Baoshan, Yunnan, China
| | - Wenge Tang
- Chongqing Centre for Disease Control and Prevention, Chongqing, China
| | - Gang Zhang
- Sichuan Provincial Hospital for Women and Children (Affiliated Women and Children's Hospital of Chengdu Medical College), Chengdu, China
| | - Xian Liang
- Chengdu Centre for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Jingzhong Li
- Tibet Centre for Disease Control and Prevention, Lhasa, Tibet, China
| | - Chaoying Cui
- High Altitude Medical Research Centre, School of Medicine, Tibet University, Lhasa, Tibet, China
| | - Xiaosong Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Santosa A, Zhang Y, Weinehall L, Zhao G, Wang N, Zhao Q, Wang W, Ng N. Gender differences and determinants of prevalence, awareness, treatment and control of hypertension among adults in China and Sweden. BMC Public Health 2020; 20:1763. [PMID: 33228600 PMCID: PMC7685617 DOI: 10.1186/s12889-020-09862-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Failure to promote early detection and better management of hypertension will contribute to the increasing burden of cardiovascular diseases. This study aims to assess the gender differences in the prevalence, awareness, treatment and control of hypertension, together with its associated factors, in China and Sweden. Methods We used data from two cross-sectional studies: the Västerbotten Intervention Program in northern Sweden (n = 25,511) and the Shanghai survey in eastern China (n = 25,356). We employed multivariable logistic regression to examine the socio-demographics, lifestyle behaviours, and biological factors associated with the prevalence, awareness, treatment and control of hypertension. Results Men had a higher prevalence of hypertension (43% in Sweden, 39% in China) than their female counterparts (29 and 36%, respectively). In Sweden, men were less aware of, less treated for, and had less control over their hypertension than women. Chinese men were more aware of, had similar levels of treatment for, and had less control over their hypertension compared to women. Awareness and control of hypertension was lower in China compared to Sweden. Only 33 and 38% of hypertensive Chinese men and women who were treated reached the treatment goals, compared with a respective 48 and 59% in Sweden. Old age, impaired glucose tolerance or diabetes, a family history of hypertension or cardiovascular diseases, low physical activity and overweight or obesity were found to increase the odds of hypertension and its diagnosis. Conclusions This study shows the age and gender differences in the prevalence, awareness, treatment and control of hypertension among adults in China and Sweden. Multisectoral intervention should be developed to address the increasing burden of sedentary lifestyle, overweight and obesity and diabetes, all of which are linked to the prevention and control of hypertension. Development and implementation of the gender- and context-specific intervention for the prevention and control of hypertension facilitates understanding with regard to the implementation barriers and facilitators. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09862-4.
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Affiliation(s)
- Ailiana Santosa
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187, Umeå, Sweden.,Global Public Health, School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, 41390, Gothenburg, Sweden
| | - Yue Zhang
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Lars Weinehall
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187, Umeå, Sweden
| | - Genming Zhao
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Na Wang
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Qi Zhao
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Weibing Wang
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China.
| | - Nawi Ng
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187, Umeå, Sweden. .,Global Public Health, School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, 41390, Gothenburg, Sweden.
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van Zyl S, van Rooyen FC, Joubert G, Kruger WH, Walsh CM. A Comparison of the Socio-Behavioral-Metabolic Risk Profiles and Associated Factors for Chronic Diseases of Lifestyle in Urban and Rural Communities in Central South Africa. Front Public Health 2020; 8:570676. [PMID: 33178661 PMCID: PMC7596254 DOI: 10.3389/fpubh.2020.570676] [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: 06/09/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background: The global escalating prevalence of lifestyle-related non-communicable diseases places a significant burden on health systems. Chronic diseases of lifestyle (CDL) are a group of diseases that share similar modifiable risk factors that can result in long-term disease processes. Considering the socio-behavioral-metabolic risk profiles of communities and risk factors predictive of the presence of CDL can assist in the development of focused and effective community-based prevention, intervention, and treatment programs for CDL. Aim: To determine the socio-behavioral-metabolic risk profiles and identify associated factors for the following CDL: obesity, cardiovascular disease, hypertension, and type 2 diabetes mellitus in rural and urban communities in central South Africa. Methodology: This cross-sectional study included adults aged 25–65 years in the rural Southern Free State and urban Mangaung. Social determinants, behavioral and metabolic risk factors, and inflammatory biomarkers for CDL were determined. Results: In total, 575 rural (mean age: 42 years; 71% female) and 429 urban (mean age: 44 years; 76% female) participants were included in the study. More than 20% of participants in both communities reported being previously diagnosed with cardiovascular diseases; with reported hypertension and diabetes mellitus more prevalent among rural participants. Insufficient intake of fruit and vegetables, alcohol use, and high blood pressure were among the top five risk factors in both communities. Physical inactivity ranked among the top two risk factors in the urban community; while alcohol and tobacco use was significantly higher in the rural community. Fibrinogen was the most prevalent inflammatory marker in both communities (32.9 rural vs. 48.3% urban). High sensitivity C-reactive protein (Hs-CRP), only available for rural participants, was high with increased levels in more than 80% of participants. In both communities, being female, having high blood pressure and increased fibrinogen levels were associated with obesity. Conclusion: This study illustrated the high prevalence of socio-behavioral-metabolic risk factors for CDL, and identified similarities and distinct differences in the risk profiles of rural and urban communities. Considering the CDL risk profiles of communities can assist in prioritizing health needs and contribute to the development of tailor-made community-based primary health care prevention, intervention, and health promotion programs.
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Affiliation(s)
- Sanet van Zyl
- Department of Basic Medical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Francios C van Rooyen
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Gina Joubert
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Willem H Kruger
- Department of Community Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Corinna M Walsh
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Feng Z, Cramm JM, Nieboer AP. Social participation is an important health behaviour for health and quality of life among chronically ill older Chinese people. BMC Geriatr 2020; 20:299. [PMID: 32831028 PMCID: PMC7444063 DOI: 10.1186/s12877-020-01713-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/16/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Health behaviours (physical activity, maintenance of a healthy diet and not smoking) are known to be beneficial to the health and well-being of chronically ill people. With China's ageing population and increased prevalence of people with chronic diseases, the improvement of unhealthy behaviours in this population has become crucial. Although recent studies have highlighted the importance of social participation for health and quality of life (QoL) among older people, no study to date has included social participation along with more traditional health behaviours. Therefore, this study aimed to identify associations of multiple health behaviours (social participation, physical activity, maintenance of a healthy diet and not smoking) with health and QoL outcomes (including cognitive and physical function) among chronically ill older adults in China. METHODS For this nationally representative cross-sectional study, wave 1 data from the World Health Organization's Study on global AGEing and adult health (China) were examined. In total, 6629 community-dwelling older adults (mean age, 64.9 years) with at least one chronic disease were included. Multivariate linear regression analyses were used to evaluate associations of health behaviours with health and QoL outcomes while controlling for background characteristics. RESULTS Greater social participation was associated with better QoL [β = 0.127, standard error (SE) = 0.002, p < 0.001], cognitive function (β = 0.154, SE = 0.033, p < 0.001) and physical function (β = - 0.102, SE = 0.008, p < 0.001). Physical activity was associated with better QoL (β = 0.091, SE = 0.015, p < 0.001) and physical function (β = - 0.155, SE = 0.062, p < 0.001). Sufficient fruit and vegetable consumption was associated with better QoL (β = 0.087, SE = 0.015, p < 0.001). CONCLUSIONS Our findings suggest that social participation is an important health behaviour for quality of life and cognitive function among chronically ill older people in China. Health promotion programmes should expand their focus to include social participation as a health behaviour, in addition to physical activity, maintenance of a healthy diet and not smoking.
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Affiliation(s)
- Zeyun Feng
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, DR. Rotterdam, Rotterdam, 3000 the Netherlands
- Department of Health Technology Assessment, Shanghai Health Development Research Center (Shanghai Medical Information Center), Jianguo Road 602, Shanghai, 200031 China
| | - Jane Murray Cramm
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, DR. Rotterdam, Rotterdam, 3000 the Netherlands
| | - Anna Petra Nieboer
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, DR. Rotterdam, Rotterdam, 3000 the Netherlands
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Ganju A, Goulart AC, Ray A, Majumdar A, Jeffers BW, Llamosa G, Cañizares H, Ramos-Cañizares IJ, Fadhil I, Subramaniam K, Lim LL, El Bizri L, Ramesh M, Guilford M, Ali R, Devi RD, Malik RA, Potkar S, Wang YP. Systemic Solutions for Addressing Non-Communicable Diseases in Low- and Middle-Income Countries. J Multidiscip Healthc 2020; 13:693-707. [PMID: 32801732 PMCID: PMC7394587 DOI: 10.2147/jmdh.s252300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022] Open
Abstract
Non-communicable diseases (NCDs) have been on the rise in low- and middle-income countries (LMICs) over the last few decades and represent a significant healthcare concern. Over 85% of "premature" deaths worldwide due to NCDs occur in the LMICs. NCDs are an economic burden on these countries, increasing their healthcare expenditure. However, targeting NCDs in LMICs is challenging due to evolving health systems and an emphasis on acute illness. The major issues include limitations with universal health coverage, regulations, funding, distribution and availability of the healthcare workforce, and availability of health data. Experts from across the health sector in LMICs formed a Think Tank to understand and examine the issues, and to offer potential opportunities that may address the rising burden of NCDs in these countries. This review presents the evidence and posits pragmatic solutions to combat NCDs.
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Affiliation(s)
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Amrit Ray
- Research, Development and Medical, Upjohn - a Pfizer Division, New York, NY, USA
| | - Anurita Majumdar
- Research, Development and Medical, Emerging Markets, Upjohn - a Pfizer Division, Singapore
| | - Barrett W Jeffers
- Research, Development and Medical, Upjohn - a Pfizer Division, New York, NY, USA
| | - Gloria Llamosa
- Mexican Neurology and Psychiatry Society, Mexico City, Mexico
| | - Henry Cañizares
- Vicente Sotto Memorial Medical Center, Cebu City, Philippines
| | | | | | - Kannan Subramaniam
- Research, Development and Medical, Upjohn - a Pfizer Division, Sydney, Australia
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Luna El Bizri
- School of Pharmacy, Lebanese University, Hadath, Lebanon
| | - M Ramesh
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | | | - Raghib Ali
- Public Health Research Center, New York University, Abu Dhabi, United Arab Emirates
| | - Ratna Duddi Devi
- Executive Office, DakshamA Health and Education, Gurgaon, India.,Board of Directors, International Alliance of Patient Organizations, London, England
| | | | - Shekhar Potkar
- Research, Development and Medical, Upjohn - a Pfizer Division, Dubai, United Arab Emirates
| | - Yuan-Pang Wang
- Instituto de Psiquiatria (LIM-23), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Shin J, Lee KS, Kim JH. Predicting Old-age Mortality Using Principal Component Analysis: Results from a National Panel Survey in Korea. Medicina (B Aires) 2020; 56:medicina56070360. [PMID: 32708355 PMCID: PMC7404716 DOI: 10.3390/medicina56070360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background and Objectives: This study aimed to group diseases classified by the International Classification of Diseases using principal component analysis, and discuss a systematic approach to reducing the preventable death rate from a perspective of public health. Materials and Methods: Using a 10-year follow-up analysis of the Korean Longitudinal Study of Aging (KLoSA) data, this study obtained de-identified data including participants’ data of community-dwelling individuals aged ≥45 years from 2006 to 2016. Participants were randomly selected using a multistage, stratified probability sampling based on geographical area and housing type. We excluded 37 participants with missing information at baseline and included 10,217 study participants. This study used the principal component analysis to extract comorbidity patterns, and chi-square test and Cox proportional hazards models for analyzing the association between the factors of interest. Results: Principal component 1 (diabetes, heart disease, and hypertension) was associated with an increased hazard ratio (HR) of 1.079 (95% confidence interval (CI) 1.031–1.129, p = 0.001). Principal component 3 (psychiatric and cerebrovascular diseases) was related to an increased HR of 1.134 (95% CI 1.094–1.175, p < 0.0001). Moreover, principal component 4 was associated with a high HR of 1.172 (95% CI 1.130–1.215, p < 0.0001). However, among participants aged between 45 and 64 years, principal component 4 showed a meaningfully increased HR of 1.262 (95% CI 1.184–1.346, p < 0.001). In this study, among the four principal components, three were statistically associated with increased mortality. Conclusions: The principal component analysis for predicting mortality may become a useful tool, and artificial intelligence (AI) will improve a value-based healthcare strategy, along with developing a clinical decision support model.
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Affiliation(s)
- Jaeyong Shin
- Department of Policy Analysis and Management, College of Human Ecology, Cornell University, Ithaca, NY 14853, USA;
- Department of Preventive Medicine, School of Medicine, Ajou University, Suwon, Gyeonggi-do 16499, Korea
| | - Kwang-Soo Lee
- Department of Health Administration, College of Health Sciences, Yonsei University, Wonju, Gwangwondo 26493, Korea;
| | - Jae-Hyun Kim
- Department of Health Administration, College of Health Science, Dankook University, Cheonan-si, Chungcheongnam-do 31116, Korea
- Correspondence: ; Tel.: +82-41-550-1472; Fax: +82-41-559-7934
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Hirschmann R, Bortolotto CC, Martins-Silva T, Machado AKF, Xavier MO, Fernandes MP, Martins RC, Bielemann RM, Tovo-Rodrigues L, Wehrmeister FC. Simultaneity of risk factors for chronic non-communicable diseases in a rural population of a Southern Brazilian city. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200066. [PMID: 32667466 DOI: 10.1590/1980-549720200066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/24/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To describe the occurrence of simultaneous risk factors for chronic noncommunicable diseases, and factors associated with these prevalences in rural adults of a Southern Brazilian city. METHODS The design of this study was cross-sectional with a sample of 1,445 adults from the rural area of Pelotas, RS. Four risk factors were considered: smoking, alcohol consumption, physical inactivity and inadequate consumption of vegetables. To verify the simultaneous occurrence of the outcomes, a cluster analysis was used. The association was tested by ordinal regression resulting in odds ratios. RESULTS Among the four risk factors evaluated, three were the most prevalent among men, and only physical inactivity was greater among women. In the cluster analysis, only the combination of alcohol consumption + smoking + inadequate vegetable consumption presented an observed prevalence that was significantly higher than the expected (O/E = 2.67, 95%CI 1.30, 5.48), and higher than another study in the south of the country. This can be justified because that study included an evaluation of urban dwellers and the consumption of fruits. After adjustment, men, single individuals, non-white people, those with less schooling, those with a worse socioeconomic status, those who reported poor perception of health, and those who do not work in specifically rural activities had a greater probability of having the simultaneity of risk factors. CONCLUSION The results show the importance of developing priority actions regarding the health of rural populations with special attention to the subgroups with an identified higher risk.
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Affiliation(s)
- Roberta Hirschmann
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | | | - Thais Martins-Silva
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | | | - Mariana Otero Xavier
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Mayra Pacheco Fernandes
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Rafaela Costa Martins
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Renata Moraes Bielemann
- Programa de Pós-Graduação em Nutrição e Alimentos, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Luciana Tovo-Rodrigues
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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Green MA, Pradeilles R, Laar A, Osei-Kwasi H, Bricas N, Coleman N, Klomegah S, Wanjohi MN, Tandoh A, Akparibo R, Aryeetey RNO, Griffiths P, Kimani-Murage EW, Mensah K, Muthuri S, Zotor F, Holdsworth M. Investigating foods and beverages sold and advertised in deprived urban neighbourhoods in Ghana and Kenya: a cross-sectional study. BMJ Open 2020; 10:e035680. [PMID: 32595155 PMCID: PMC7322322 DOI: 10.1136/bmjopen-2019-035680] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods. DESIGN Cross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. Latent class analysis was used to explore the interactions between food advertisements, food outlet types and food type availability. SETTING Three deprived neighbourhoods in African cities: Jamestown in Accra, Ho Dome in Ho (both Ghana) and Makadara in Nairobi (Kenya). MAIN OUTCOME MEASURE Types of foods and beverages sold and/or advertised. RESULTS Jamestown (80.5%) and Makadara (70.9%) were dominated by informal vendors. There was a wide diversity of foods, with high availability of healthy (eg, staples, vegetables) and unhealthy foods (eg, processed/fried foods, sugar-sweetened beverages). Almost half of all advertisements were for sugar-sweetened beverages (48.3%), with higher exposure to alcohol adverts compared with other items as well (28.5%). We identified five latent classes which demonstrated the clustering of healthier foods in informal outlets, and unhealthy foods in formal outlets. CONCLUSION Our study presents one of the most detailed geospatial exploration of the urban food environment in Africa. The high exposure of sugar-sweetened beverages and alcohol both available and advertised represent changing urban food environments. The concentration of unhealthy foods and beverages in formal outlets and advertisements of unhealthy products may offer important policy opportunities for regulation and action.
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Affiliation(s)
- Mark Alan Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Amos Laar
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Nathaniel Coleman
- Department of Population, Family and Reproductive Health, University of Ghana, Legon, Ghana
| | - Senam Klomegah
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Milka Njeri Wanjohi
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Akua Tandoh
- Department of Population, Family and Reproductive Health, University of Ghana, Legon, Ghana
| | - Robert Akparibo
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | | | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Kobby Mensah
- Business School, University of Ghana, Legon, Ghana
| | | | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Michelle Holdsworth
- NUTRIPASS Unit, French Research Institute for Sustainable Development (IRD), Montpellier, France
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Jesus TS, Landry MD, Hoenig H, Zeng Y, Kamalakannan S, Britto RR, Pogosova N, Sokolova O, Grimmer K, Louw QA. Physical Rehabilitation Needs in the BRICS Nations from 1990 to 2017: Cross-National Analyses Using Data from the Global Burden of Disease Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4139. [PMID: 32531949 PMCID: PMC7312462 DOI: 10.3390/ijerph17114139] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/06/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022]
Abstract
Background: This study analyzes the current and evolving physical rehabilitation needs of BRICS nations (Brazil, Russian Federation, India, China, South Africa), a coalition of large emergent economies increasingly important for global health. Methods: Secondary, cross-national analyses of data on Years Lived with Disability (YLDs) were extracted from the Global Burden of Disease Study 2017. Total physical rehabilitation needs, and those stratified per major condition groups are analyzed for the year 2017 (current needs), and for every year since 1990 (evolution over time). ANOVAs are used to detect significant yearly changes. Results: Total physical rehabilitation needs have increased significantly from 1990 to 2017 in each of the BRICS nations, in every metric analyzed (YLD Counts, YLDs per 100,000 people, and percentage of YLDs relevant to physical rehabilitation; all p < 0.01). Musculoskeletal & pain conditions were leading cause of physical rehabilitation needs across the BRICS nations but to varying degrees: from 36% in South Africa to 60% in Brazil. Country-specific trends include: 25% of South African needs were from HIV-related conditions (no other BRICS nation had more than 1%); India had both absolute and relative growths of pediatric rehabilitation needs (p < 0.01); China had an exponential growth in the per-capita needs from neurological and neoplastic conditions (p < 0.01; r2 = 0.97); Brazil had a both absolute and relative growth of needs coming from musculoskeletal & pain conditions (p < 0.01); and the Russian Federation had the highest neurological rehabilitation needs per capita in 2017 (over than three times those of India, South Africa or Brazil). Conclusions: total physical rehabilitation needs have been increasing in each of the BRICS nations, both in absolute and relative values. Apart from the common growing trend, each of the BRICS nations had own patterns for the amount, typology, and evolution of their physical rehabilitation needs, which must be taken into account while planning for health and physical rehabilitation programs, policies and resources.
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Affiliation(s)
- Tiago S. Jesus
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine - NOVA University of Lisbon (IHMT-UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Michel D. Landry
- School of Medicine, Duke University, Durham, NC 27710, USA;
- Duke Global Health Institute (DGHI), Duke University, Durham, NC 27710, USA
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC 27705, USA;
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Yi Zeng
- Center for Study of Aging and Human Development and Geriatrics Division, School of Medicine, Duke University, Durham, NC 27710, USA;
- National School of Development and Raissun Institute for Advanced Studies, Peking University, Beijing 100871, China
| | - Sureshkumar Kamalakannan
- Public Health Foundation of India (PHFI), South Asia Centre for Disability Inclusive Development and Research (SACDIR), Indian Institute of Public Health, Hyderabad 500 033, (IIPH-H), India;
| | - Raquel R. Britto
- Rehabilitation Science Post Graduation Programs of Universidade Federal de Minas Gerais and Universidade Federal de Juiz de Fora, Juiz de Fora 36036-900, Brazil;
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow 524901, Russian Federation; (N.P.); (O.S.)
| | - Olga Sokolova
- National Medical Research Center of Cardiology, Moscow 524901, Russian Federation; (N.P.); (O.S.)
| | - Karen Grimmer
- Department of Health and Rehabilitation Sciences, Physiotherapy Division, Stellenbosch University, Stellenbosch 7505, South Africa; (K.G.); (Q.A.L.)
| | - Quinette A. Louw
- Department of Health and Rehabilitation Sciences, Physiotherapy Division, Stellenbosch University, Stellenbosch 7505, South Africa; (K.G.); (Q.A.L.)
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Physical Health Status of Emergency Care Providers in South Africa. Asian J Sports Med 2020. [DOI: 10.5812/asjsm.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Emergency care providers (ECPs) have a physically, mentally, and emotionally demanding profession. Therefore, they are predisposed to cardiovascular and other non-communicable disease risk factors. Objectives: The objective of the study was to determine the physical health status of ECPs in the North West province of South Africa through a selected anthropometric and other health parameter test battery. Methods: Ninety-one ECPs (64 males, 27 females) took part in the study voluntarily for health screening tests including body mass index (BMI), lean body mass (LBM), resting heart rate (RHR), blood pressure (BP), skinfold measurement, waist circumference (WC), waist-to-hip ratio (WHR), fasting blood glucose (FBG), and total cholesterol (TC). The collected data were subjected to statistical analysis using the Statistical Package for Social Sciences (SPSS) version 25 (IBM). Results: The participants demonstrated a mean BMI of 28.2 ± 5.5 kg/m2, body fat of 26 ± 7.6 %, and LBM of 58.6 ± 10 kg. Significant differences were seen in height (170.5 ± 6.2 vs. 160.7 ± 5.3 cm), BF% (22.5 ± 5.3 vs. 34.2 ± 6.2 %), and LBM (62.3 ± 8 vs. 49.2 ± 8.2 kg) between males and females (P ≤ 0.05). Mean systolic BP was 122 ± 15 mmHg, and diastolic BP was 81 ± 10 mmHg. Mean WC was 90.8 ± 11.4 cm. Other health parameters included mean FBG of 5.1 ± 2.4 mmol/L and mean TC of 4.9 ± 0.7 mmol/L. Significant differences were seen in WHR (0.88 ± 0.04 vs. 0.79 ± 0.06) between males and females (P ≤ 0.05). Conclusions: A significant number of ECPs presented with cardiovascular and other NCD risk factors such as hypertension, obesity, high WC, elevated FBG, and abnormal levels of TC. This can be attributed to the nature of their occupation such as working irregular shifts leading to sleep deprivation, being exposed to psychological trauma, poor nutrition during shifts, and/or lack of exercise. Stress management is an important part of these workers’ rehabilitation program. A well-formulated employee wellness program is required to set remedial measures in place.
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Elbarbary M, Honda T, Morgan G, Guo Y, Guo Y, Kowal P, Negin J. Ambient Air Pollution Exposure Association with Anaemia Prevalence and Haemoglobin Levels in Chinese Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093209. [PMID: 32380747 PMCID: PMC7246731 DOI: 10.3390/ijerph17093209] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Health effects of air pollution on anaemia have been scarcely studied worldwide. We aimed to explore the associations of long-term exposure to ambient air pollutants with anaemia prevalence and haemoglobin levels in Chinese older adults. METHODS We used two-level linear regression models and modified Poisson regression with robust error variance to examine the associations of particulate matter (PM) and nitrogen dioxide (NO2) on haemoglobin concentrations and the prevalence of anaemia, respectively, among 10,611 older Chinese adults enrolled in World Health Organization (WHO) Study on global AGEing and adult health (SAGE) China. The average community exposure to ambient air pollutants (PM with an aerodynamic diameter of 10 μm or less (PM10), 2.5 μm or less (PM2.5), 1 μm or less (PM1) and nitrogen dioxide (NO2)) for each participant was estimated using a satellite-based spatial statistical model. Haemoglobin levels were measured for participants from dried blood spots. The models were controlled for confounders. RESULTS All the studied pollutants were significantly associated with increased anaemia prevalence in single pollutant model (e.g., the prevalence ratios associated with an increase in inter quartile range in three years moving average PM10 (1.05; 95% CI: 1.02-1.09), PM2.5 (1.11; 95% CI: 1.06-1.16), PM1 (1.13; 95% CI: 1.06-1.20) and NO2 (1.42; 95% CI: 1.34-1.49), respectively. These air pollutants were also associated with lower concentrations of haemoglobin: PM10 (-0.53; 95% CI: -0.67, -0.38); PM2.5 (-0.52; 95% CI: -0.71, -0.33); PM1 (-0.55; 95% CI: -0.69, -0.41); NO2 (-1.71; 95% CI: -1.85, -1.57) respectively. CONCLUSIONS Air pollution exposure was significantly associated with increased prevalence of anaemia and decreased haemoglobin levels in a cohort of older Chinese adults.
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Affiliation(s)
- Mona Elbarbary
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (G.M.); (J.N.)
- Correspondence: ; Tel.: +61-416405016
| | - Trenton Honda
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84108, USA;
| | - Geoffrey Morgan
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (G.M.); (J.N.)
- School of Public Health, University Centre for Rural Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine at School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3800, Australia;
| | - Yanfei Guo
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China;
| | - Paul Kowal
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Joel Negin
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (G.M.); (J.N.)
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Dwane N, Wabiri N, Manda S. Small-area variation of cardiovascular diseases and select risk factors and their association to household and area poverty in South Africa: Capturing emerging trends in South Africa to better target local level interventions. PLoS One 2020; 15:e0230564. [PMID: 32320425 PMCID: PMC7176123 DOI: 10.1371/journal.pone.0230564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 03/03/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Of the total 56 million deaths worldwide during 2012, 38 million (68%) were due to noncommunicable diseases (NCDs), particularly cardiovascular diseases (17.5 million deaths) cancers (8.2 million) which represents46.2% and 21.7% of NCD deaths, respectively). Nearly 80 percent of the global CVD deaths occur in low- and middle-income countries. Some of the major CVDs such as ischemic heart disease (IHD) and stroke and CVD risk conditions, namely, hypertension and dyslipidaemia share common modifiable risk factors including smoking, unhealthy diets, harmful use of alcohol and physical inactivity. The CVDs are now putting a heavy strain of the health systems at both national and local levels, which have previously largely focused on infectious diseases and appalling maternal and child health. We set out to estimate district-level co-occurrence of two cardiovascular diseases (CVDs), namely, ischemic heart disease (IHD) and stroke; and two major risk conditions for CVD, namely, hypertension and dyslipidaemia in South Africa. METHOD The analyses were based on adults health collected as part of the 2012 South African National Health and Nutrition Examination Survey (SANHANES). We used joint disease mapping models to estimate and map the spatial distributions of risks of hypertension, self-report of ischaemic heart disease (IHD), stroke and dyslipidaemia at the district level in South Africa. The analyses were adjusted for known individual social demographic and lifestyle factors, household and district level poverty measurements using binary spatial models. RESULTS The estimated prevalence of IHD, stroke, hypertension and dyslipidaemia revealed high inequality at the district level (median value (range): 5.4 (0-17.8%); 1.7 (0-18.2%); 32.0 (12.5-48.2%) and 52.2 (0-71.7%), respectively). The adjusted risks of stroke, hypertension and IHD were mostly high in districts in the South-Eastern parts of the country, while that of dyslipidaemia, was high in Central and top North-Eastern corridor of the country. CONCLUSIONS The study has confirmed common modifiable risk factors of two cardiovascular diseases (CVDs), namely, ischemic heart disease (IHD) and stroke; and two major risk conditions for CVD, namely, hypertension and dyslipidaemia. Accordingly, an integrated intervention approach addressing cardiovascular diseases and associated risk factors and conditions would be more cost effective and provide stronger impacts than individual tailored interventions only. Findings of excess district-level variations in the CVDs and their risk factor profiles might be useful for developing effective public health policies and interventions aimed at reducing behavioural risk factors including harmful use of alcohol, physical inactivity and high salt intake.
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Affiliation(s)
- Ntabozuko Dwane
- Empilweni Services Research Unit, Department of Paediatrics and Child Health, University of Witwatersrand, Johannesburg, South Africa
| | - Njeri Wabiri
- Human Sciences Research Council, Pretoria, South Africa
| | - Samuel Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Statistics, University of Pretoria, Pretoria, South Africa
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