1
|
Adnan MN, Ahmad WMAW, Shahzad HB, Awais F, Aleng NA, Noor NF, Mohd Ibrahim MSB, Noor NMM. The Evaluation of Ordinal Regression Model's Performance Through the Implementation of Multilayer Feed-Forward Neural Network: A Case Study of Hypertension. Cureus 2024; 16:e54387. [PMID: 38505445 PMCID: PMC10949101 DOI: 10.7759/cureus.54387] [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: 02/16/2024] [Indexed: 03/21/2024] Open
Abstract
Background Hypertension, or high blood pressure, is a common medical condition that affects a significant portion of the global population. It is a major risk factor for cardiovascular diseases (CVD), stroke, and kidney disorders. Objective The objective of this study is to create and validate a model that combines bootstrapping, ordered logistic regression, and multilayer feed-forward neural networks (MLFFNN) to identify and analyze the factors associated with hypertension patients who also have dyslipidemia. Material and methods A total of 33 participants were enrolled from the Hospital Universiti Sains Malaysia (USM) for this study. In this study, advanced computational statistical modeling techniques were utilized to examine the relationship between hypertension status and several potential predictors. The RStudio (Posit, Boston, MA) software and syntax were implemented to establish the relationship between hypertension status and the predictors. Results The statistical analysis showed that the developed methodology demonstrates good model fitting through the value of predicted mean square error (MSE), mean absolute deviance (MAD), and accuracy. To evaluate model fitting, the data in this study was divided into distinct training and testing datasets. The findings revealed that the results strongly support the superior predictive capability of the hybrid model technique. In this case, five variables are considered: marital status, smoking status, systolic blood pressure, fasting blood sugar levels, and high-density lipoprotein levels. It is important to note that all of them affect the hazard ratio: marital status (β1, -17.12343343; p < 0.25), smoking status (β2, 1.86069121; p < 0.25), systolic blood pressure (β3, 0.05037332; p < 0.25), fasting blood sugar (β4, -0.53880322; p < 0.25), and high-density lipoprotein (β5, 5.38065556; p < 0.25). Conclusion This research aims to develop and extensively evaluate the hybrid approach. The statistical methods employed in this study using R language show that regression modeling surpasses R-squared values in predicting the mean square error. The study's conclusion provides strong evidence for the superiority of the hybrid model technique.
Collapse
Affiliation(s)
- Mohamad N Adnan
- School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | | | - Hazik B Shahzad
- School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
- Department of Community and Preventive Dentistry, Rashid Latif Dental College, Lahore, PAK
| | - Faiza Awais
- Department of Community and Preventive Dentistry, Rashid Latif Dental College, Lahore, PAK
| | - Nor Azlida Aleng
- Faculty of Computer Science and Mathematics, Universiti Malaysia Terengganu, Kuala Terengganu, MYS
| | - Nor F Noor
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, MYS
| | | | - Noor Maizura M Noor
- Faculty of Computer Science and Mathematics, Universiti Malaysia Terengganu, Kuala Terengganu, MYS
| |
Collapse
|
2
|
Nik Ramli NN, Genasan D, Rossman NS. Assessing the Awareness on Symptoms and Risk Factors of Stroke amongst Rural Community in Central Region of Malaysia: A Cross-Sectional Survey. Malays J Med Sci 2024; 31:150-160. [PMID: 38456110 PMCID: PMC10917593 DOI: 10.21315/mjms2024.31.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/06/2023] [Indexed: 03/09/2024] Open
Abstract
Background As the third leading cause of mortality in Malaysia, stroke is recognised as a medical emergency which requires urgent medical attention within a limited timeframe to prevent exacerbation of the brain damage and death in patients. Recent report revealed a high prevalence of pre-hospital delay amongst the stroke patients due to the lack of awareness on symptoms and risk factors of stroke, as well as poor understanding on appropriate action towards stroke. A number of studies had assessed stroke awareness amongst urban population residing in central region of Malaysia but yet amongst rural population. Methods A cross-sectional survey was conducted amongst individuals residing in rural districts of Selangor by using a set of questionnaires assessing the sociodemographic characteristics, as well as the awareness and action towards stroke symptoms and risk factors. Results All 343 respondents were able to recognise at least one modifiable risk factor for stroke. Meanwhile, only 36.44% were able to identify all the stroke symptoms. Despite majority of them were familiar with the stroke term, less than half of the respondents were aware of calling the emergency medical service as the appropriate action towards stroke symptoms. Conclusion The present study indicated a poor level of awareness and action towards stroke symptoms and risk factors amongst rural population residing in Selangor.
Collapse
Affiliation(s)
| | - Deviga Genasan
- International Medical School, Management and Science University, Selangor, Malaysia
| | | |
Collapse
|
3
|
Alinaitwe B, Amanya C, A Muwanguzi P, Ngabirano TD. Prevalence of Risk Factors for Hypertension Among Faculty at an Urban University in Uganda. Integr Blood Press Control 2024; 17:1-11. [PMID: 38196839 PMCID: PMC10773241 DOI: 10.2147/ibpc.s440972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/23/2023] [Indexed: 01/11/2024] Open
Abstract
Purpose Hypertension is a major contributor to morbidity and mortality worldwide. Many people however are not aware of their possession of risk factors for hypertension. There is a paucity of literature in Uganda describing the risk profile of faculty at public universities. The purpose of this study was to determine the prevalence of hypertension risk factors among university teaching staff. Methods This study was conducted among faculty at Makerere University in Uganda. The modified World Health Organization STEP-wise approach for non-communicable disease surveillance was used in data collection. Hypertension was defined as having a systolic blood pressure of ≥140mmHg and/or a diastolic blood pressure of ≥90mmHg, or being on antihypertensive medications. Participants were enrolled from the faculty lists by proportionate to size systematic sampling until the sample size for each college was obtained. Data was collected from January to March 2018. Multivariate logistic regression was used to determine factors associated with hypertension. Results A total of 141 participants were recruited into the study. The prevalent risk factors for hypertension include physical inactivity (78.7%), overweight (46.8%), obesity (20.6%), addition of extra salt to food (46.8%), current alcohol consumption (33.3%), history of smoking (10.6%), inadequate fruit and vegetable servings per day (100%), family history of hypertension (40.4%) and a family history of diabetes (22.7%). Hypertension was prevalent at 26.2% (95% CI 18.94-33.46%). The risk factors significantly associated with hypertension included a family history of hypertension (p=0.009), obesity (p=0.008) and male gender (p = 0.029). Conclusion The prevalence of known hypertension risk factors among university teaching staff in urban Uganda is high. Majority of these risk factors are modifiable highlighting the need for continuous screening as well as introduction of prevention and health promotion strategies to reduce the risk burden.
Collapse
Affiliation(s)
- Businge Alinaitwe
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
- School of Nursing, Mount Kenya University, Thika, Kenya
| | - Charles Amanya
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Research, Hoima Regional Referral Hospital, Hoima, Uganda
| | - Patience A Muwanguzi
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tom Denis Ngabirano
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
4
|
Ab Hamid MR, Buhari SS, Noor HM, Azizan N‘A, Malek KA, Mohd Asmawi UM, Nor NM. Development and validation of D-PATH website to improve hypertension management among hypertensive patients in Malaysia. Digit Health 2024; 10:20552076241242661. [PMID: 38596405 PMCID: PMC11003341 DOI: 10.1177/20552076241242661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Objective This study aimed at developing and validating a web application on hypertension management called the D-PATH website. Methods The website development involved three stages: content analysis, web development, and validation. The model of Internet Intervention was used to guide the development of the website, in addition to other learning and multimedia theories. The content was developed based on literature reviews and clinical guidelines on hypertension. Then, thirteen experts evaluated the website using Fuzzy Delphi Technique. Results The website was successfully developed and contains six learning units. Thirteen experts rated the website based on content themes, presentation, interactivity, and instructional strategies. All experts reached a consensus that the web is acceptable to be used for nutrition education intervention. Conclusion D-PATH is a valid web-based educational tool ready to be used to help disseminate information on dietary and physical activity to manage hypertension. This web application was suitable for sharing information on dietary and physical activity recommendations for hypertension patients.
Collapse
Affiliation(s)
- Mohd Ramadan Ab Hamid
- Integrated Nutrition Science and Therapy Research Group (INSPiRE), Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia
- Centre for Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia
| | - Siti Sabariah Buhari
- Integrated Nutrition Science and Therapy Research Group (INSPiRE), Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia
- Centre for Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia
| | - Harrinni Md Noor
- Faculty of Education, Universiti Teknologi MARA, Selangor, Malaysia
| | - Nurul ‘Ain Azizan
- School of Biosciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
| | - Khasnur Abd Malek
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | | | - Norazmir Md Nor
- Centre for Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia
- Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA, Selangor, Malaysia
| |
Collapse
|
5
|
Ismail R, Ismail NH, Md Isa Z, Mohd Tamil A, Ja'afar MH, Mat Nasir N, Abdul-Razak S, Zainol Abidin N, Ab Razak NH, Joseph P, Yusof KH. Prevalence and Factors Associated with Prehypertension and Hypertension Among Adults: Baseline Findings of PURE Malaysia Cohort Study. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 10:100049. [PMID: 39035240 PMCID: PMC11256272 DOI: 10.1016/j.ajmo.2023.100049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/23/2024]
Abstract
Background Although prehypertension and hypertension can be detected at the primary healthcare level and low-cost treatments can effectively control its complications, hypertension is still the world's leading preventable risk factor. Therefore, the present study aimed to determine its prevalence and its risk factors among Malaysian adults. Methods A cross-sectional study involving 7585 adults was performed covering the rural and urban areas. Respondents with systolic blood pressure (SBP) of 120-139 mmHg and/or diastolic blood pressure (DBP) of 80-89 mmHg were categorized as prehypertensive, and hypertensive categorization was used for respondents with an SBP of ≥140 mmHg and/or DBP of ≥90 mmHg. Results Respondents reported to have prehypertension and hypertension were 40.7% and 38.0%, respectively. Those residing in a rural area, older age, male, family history of hypertension, and overweight or obese were associated with higher odds of prehypertension and hypertension. Unique to hypertension, the factors included low educational level (AOR: 1.349; 95% CI: 1.146, 1.588), unemployment (1.350; 1.16, 1.572), comorbidity of diabetes (1.474; 1.178, 1.844), and inadequate fruit consumption (1.253; 1.094, 1.436). Conclusions As the prehypertensive state may affect the prevalence of hypertension, proactive strategies are needed to increase early detection of the disease among specific group of those residing in a rural area, older age, male, family history of hypertension, and overweight or obese.
Collapse
Affiliation(s)
- Rosnah Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Noor Hassim Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Zaleha Md Isa
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Azmi Mohd Tamil
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Hasni Ja'afar
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Nafiza Mat Nasir
- Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA (UiTM), Selayang Campus, Selangor, Malaysia
| | - Suraya Abdul-Razak
- Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA (UiTM), Selayang Campus, Selangor, Malaysia
- Cardio Vascular and Lungs Research Institute (CaVaLRI), Pusat Perubatan UiTM, Kampus Sungai Buloh, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Najihah Zainol Abidin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- Department of Diagnostic and Allied Health Science, Faculty of Health and Life Sciences, Management and Science University, Shah Alam, Selangor, Malaysia
| | - Nurul Hafiza Ab Razak
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Philip Joseph
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Khairul Hazdi Yusof
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| |
Collapse
|
6
|
Ekpezu AO, Wiafe I, Oinas-Kukkonen H. Predicting Adherence to Behavior Change Support Systems Using Machine Learning: Systematic Review. JMIR AI 2023; 2:e46779. [PMID: 38875538 PMCID: PMC11041458 DOI: 10.2196/46779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/20/2023] [Accepted: 10/28/2023] [Indexed: 06/16/2024]
Abstract
BACKGROUND There is a dearth of knowledge on reliable adherence prediction measures in behavior change support systems (BCSSs). Existing reviews have predominately focused on self-reporting measures of adherence. These measures are susceptible to overestimation or underestimation of adherence behavior. OBJECTIVE This systematic review seeks to identify and summarize trends in the use of machine learning approaches to predict adherence to BCSSs. METHODS Systematic literature searches were conducted in the Scopus and PubMed electronic databases between January 2011 and August 2022. The initial search retrieved 2182 journal papers, but only 11 of these papers were eligible for this review. RESULTS A total of 4 categories of adherence problems in BCSSs were identified: adherence to digital cognitive and behavioral interventions, medication adherence, physical activity adherence, and diet adherence. The use of machine learning techniques for real-time adherence prediction in BCSSs is gaining research attention. A total of 13 unique supervised learning techniques were identified and the majority of them were traditional machine learning techniques (eg, support vector machine). Long short-term memory, multilayer perception, and ensemble learning are currently the only advanced learning techniques. Despite the heterogeneity in the feature selection approaches, most prediction models achieved good classification accuracies. This indicates that the features or predictors used were a good representation of the adherence problem. CONCLUSIONS Using machine learning algorithms to predict the adherence behavior of a BCSS user can facilitate the reinforcement of adherence behavior. This can be achieved by developing intelligent BCSSs that can provide users with more personalized, tailored, and timely suggestions.
Collapse
Affiliation(s)
- Akon Obu Ekpezu
- Oulu Advanced Research on Service and Information Systems, Department of Information Processing Science, University of Oulu, Oulu, Finland
| | - Isaac Wiafe
- Department of Computer Science, University of Ghana, Accra, Ghana
| | - Harri Oinas-Kukkonen
- Oulu Advanced Research on Service and Information Systems, Department of Information Processing Science, University of Oulu, Oulu, Finland
| |
Collapse
|
7
|
A. MH, C. A. R. N, S. M. C, S. R, P. M, R. H. WS, S. G. S, A. KH, A. NA. Ever-never heard of 'Malaysian Healthy Plate': How many people know and practice this healthy eating concept? PLoS One 2023; 18:e0288325. [PMID: 37459344 PMCID: PMC10351725 DOI: 10.1371/journal.pone.0288325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The current and simpler healthy eating concept 'Malaysian Healthy Plate', was introduced in 2016. This study aims to determine the prevalence of ever-never heard, understanding, and practice of this concept and also the associated factors to never-heard of Malaysian Health Plate after three years of the implementation. METHODOLOGY This study utilized the data from the National Health and Morbidity Survey (NHMS) 2019, a cross-sectional survey that applied two-stage stratified cluster sampling. Questionnaires pertained to ever heard, knowledge, and practised of Malaysian Healthy Plate were asked along with another questionnaire. Complex sample analysis was applied to fit with the study design. RESULTS Estimated 16.9 million (79.6%) adults in Malaysia were never heard of the Malaysian Healthy Plate Concept in 2019. Never heard of this concept was significantly associated with sex (men, aOR 0.265), ethnicity (other ethnicities, aOR 1.79), an education level (no education, aOR 9.59; primary, aOR 3.50; secondary, aOR 1.70), occupation (private, aOR 2.16; self-employed, aOR 2.31; retirees, aOR 1.69; student, aOR 2.31; unpaid workers, aOA 2.35; not working, aOR 2.86), non-diabetes aOR 1.43, and low fruit and vegetable intake person aOR 1.86. Meanwhile, another 20.4% or an estimated 4.3 million adults who were ever heard of Malaysian Healthy Plate. Among those who are ever heard, 80.8% (3.5 million) correctly interpreted or understood the concept and among those who ever heard and understood the concept, only 70.5% (2.5 million) have been practising it daily or occasionally. CONCLUSIONS Four-fifth of adults never heard of the 'Malaysian Healthy Plate' and among those who ever heard, the understanding and practising of the concept were probably unsatisfactory. Multisectoral collaboration is an urge to fasten the promotion to spark awareness and educate the public to practice the concept to promote healthy eating and a healthier nation.
Collapse
Affiliation(s)
- Mohamad Hasnan A.
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Norsyamlina C. A. R.
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
- Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
| | - Cheong S. M.
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Ruhaya S.
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Munawara P.
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Wan Shakira R. H.
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Shubash S. G.
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Khairul Hasnan A.
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Noor Ani A.
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| |
Collapse
|
8
|
Yeh EJ, Grigolon RB, Rodrigues SR, A Bueno AP. Systematic literature review and meta-analysis of cardiovascular risk factor management in selected Asian countries. J Comp Eff Res 2023; 12:e220085. [PMID: 36861459 PMCID: PMC10402804 DOI: 10.57264/cer-2022-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/20/2023] [Indexed: 03/03/2023] Open
Abstract
Aim: There is a need to understand the management status of hypertension, dyslipidemia/hypercholesterolemia, and diabetes mellitus in the Asia-Pacific region (APAC). Methods: We conducted a systematic literature review and meta-analysis to summarize the awareness, treatment, and/or control rates of these risk factors in adults across 11 APAC countries/regions. Results: We included 138 studies. Individuals with dyslipidemia had the lowest pooled rates compared with those with other risk factors. Levels of awareness with diabetes mellitus, hypertension, and hypercholesterolemia were comparable. Individuals with hypercholesterolemia had a statistically lower pooled treatment rate but a higher pooled control rate than those with hypertension. Conclusion: The management of hypertension, dyslipidemia, and diabetes mellitus was suboptimal in these 11 countries/regions.
Collapse
|
9
|
Chee SF, Chew CF, Zunaina E. The Twilight Zone Where Margins Are Blurred: A Retrospective Analysis of Unilateral and Bilateral Optic Disc Swelling in a Tertiary Center in Malaysia. Cureus 2023; 15:e35823. [PMID: 37033552 PMCID: PMC10075138 DOI: 10.7759/cureus.35823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/08/2023] Open
Abstract
Background To analyze the etiology of optic disc swelling (ODS) and compare the clinical features between non-arteritic anterior ischemic optic neuropathy (NA-AION) and optic neuritis (ON) at our center from January 2019 to January 2020. Methodology Clinical records of all patients who presented with ODS between January 2019 and January 2020 were reviewed. The collected data were analyzed using IBM SPSS Statistics for Windows (Version 23.0, IBM Corp., Armonk, NY, USA). Results A total of 70 eyes among 47 patients were included in this review. There were 24 patients (51%) who had unilateral ODS, while 23 patients (49.0%) had bilateral ODS. The most common etiology of unilateral ODS was ON (45.7%), NA-AION (25%), and neuroretinitis (12.5%). Among bilateral ODS, the most common cause was papilledema (30.4%), hypertensive retinopathy (21.7%), diabetic papillitis (13.1%), and optic disc drusen (13.1%). Among unilateral ODS, the mean onset age was significantly older in NA-AION cases than that in ON cases (57.5 years vs. 40.3 years, P = 0.016). Ocular pain was a significant clinical finding observed in ON cases (54.5%) and none in NA-AION cases (P = 0.043). Although there was no significant difference in the initial visual acuity (VA) between NA-AION and ON, the final VA was significantly improved in ON compared to NA-AION (0.31 ± 0.34 vs. 1.14 ± 1.00, P = 0.029). Conclusions Many differential diagnoses must be considered when a patient is presented with ODS. With the increased prevalence of hypertension and diabetes in Malaysia, it is not a surprise that both hypertensive retinopathy and diabetic papillitis together accounted for one-third of the bilateral ODS patients.
Collapse
|
10
|
Ab Hamid MR, Buhari SS, Md Noor H, Azizan N‘A, Md Nor N. Web-Based Nutrition and Physical Activity Education Intervention to Ameliorate Cardiometabolic Risks: A Single-Arm and Non-Randomized Feasibility Study. J Prim Care Community Health 2023; 14:21501319231214091. [PMID: 38041441 PMCID: PMC10693787 DOI: 10.1177/21501319231214091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the feasibility of the D-PATH website to improve dietary and physical activity management for patients with cardiometabolic risk. METHODS A website called D-PATH was developed, consisting of 6 learning units for managing hypertension. A 4-week program was implemented, and a pre- and post-intervention assessment was conducted to measure acceptability and changes in knowledge, attitude and practice, dietary intake, physical activity, and anthropometric status. RESULTS The D-PATH website was acceptable in terms of understandability, actionability and cognitive load. Knowledge, attitude and practice, and physical activity levels were improved, but no changes were noted for dietary intake and blood pressure level. CONCLUSION The D-PATH website was accepted and feasible for the intervention study. This study has shed light on using the website to promote behavioral change in patients with cardiometabolic risks.
Collapse
|
11
|
Baharudin N, Ramli AS, Ramland SS, Badlie-Hisham NI, Mohamed-Yassin MS. Factors Associated With Achievement of Blood Pressure, Low-Density Lipoprotein Cholesterol (LDL-C), and Glycemic Targets for Primary Prevention of Cardiovascular Diseases Among High Cardiovascular Risk Malaysians in Primary Care. J Prim Care Community Health 2023; 14:21501319231191017. [PMID: 37551146 PMCID: PMC10408317 DOI: 10.1177/21501319231191017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Cardiovascular diseases (CVD) remain the world's leading cause of death. About half of Malaysian adults have at least 2 risk factors; thus, rigorous primary preventions are crucial to prevent the first cardiovascular (CV) event. This study aimed to determine the achievement of treatment targets and factors associated with it among high CV risk individuals. METHODS This cross-sectional study included 390 participants from a primary care clinic in Selangor, Malaysia, between February and June 2022. The inclusion criteria were high-CV risk individuals, that is, Framingham risk score >20%, diabetes without target organ damage, stage 3 kidney disease, and very high levels of low-density lipoprotein cholesterol (LDL-C) >4.9 mmol/L or blood pressure (BP) >180/110 mmHg. Individuals with existing CVD were excluded. The treatment targets were BP <140/90 mmHg (≤135/75 for diabetics), LDL-C <2.6 mmol/L, and HbA1c ≤6.5%. Multiple logistic regressions determined the association between sociodemographic, clinical characteristics, health literacy, and medication adherence with the achievements of each target. RESULTS About 7.2% achieved all treatment targets. Of these, 35.1% reached systolic and diastolic (46.7%) BP targets. About 60.2% and 28.2% achieved optimal LDL-C and HbA1c, respectively. Working participants had lower odds of having optimal systolic (aOR = 0.34, 95% CI: 0.13-0.90) and diastolic (aOR = 0.41, 95% CI: 0.17-0.96) BP. Those who adhered to treatments were more likely to achieve LDL-C and HbA1c targets; (aOR = 1.72, 95% CI: 1.10-2.69) and (aOR = 2.46, 95% CI: 1.25-4.83), respectively. CONCLUSIONS The control of risk factors among high CV risk patients in this study was suboptimal. Urgent measures such as improving medication adherence are warranted.
Collapse
|
12
|
Nik-Nasir NM, Md-Yasin M, Ariffin F, Mat-Nasir N, Miskan M, Abu-Bakar N, Yusoff K. Physical Activity in Malaysia: Are We Doing Enough? Findings from the REDISCOVER Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16888. [PMID: 36554769 PMCID: PMC9779816 DOI: 10.3390/ijerph192416888] [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: 11/13/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Physical activity (PA) in the form of structured or unstructured exercise is beneficial for health. This paper aims to study PA levels across four domains according to the International Physical Activity Questionnaire (IPAQ) and its associated factors. A total of 7479 Malaysian adult participants between 18 to 90 years old from the REDISCOVER study who completed the IPAQ were analyzed. PA was calculated as MET-min per week and were categorized according to insufficiently active, sufficiently active and very active. Multinomial regression was used to determine the association between sociodemographic, clinical factors and the level of PA. The mean age of the participants was 51.68 (±9.5 SD). The total reported physical activity in median (IQR) was 1584.0 (0-5637.3) MET-min per week. The highest total for PA was in the domestic domain which is 490 (0-2400) MET-min per week. Factors associated with sufficiently active or very active PA include Malay ethnicity, no formal education, elementary occupation, current smokers and high HDL. Whereas low income, male and normal BMI are less likely to participate in sufficiently active or very active PA. Intervention to encourage higher PA levels in all domains is important to achieve recommended PA targets.
Collapse
Affiliation(s)
- Nik Munirah Nik-Nasir
- Primary Care Medicine Department, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47000, Malaysia
| | - Mazapuspavina Md-Yasin
- Primary Care Medicine Department, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47000, Malaysia
| | - Farnaza Ariffin
- Primary Care Medicine Department, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47000, Malaysia
| | - Nafiza Mat-Nasir
- Primary Care Medicine Department, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47000, Malaysia
| | - Maizatullifah Miskan
- Primary Care Medicine Unit, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur 57000, Malaysia
| | - Najmin Abu-Bakar
- Centre for Translational Research and Epidemiology (CenTRE), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47000, Malaysia
| | - Khalid Yusoff
- Centre for Translational Research and Epidemiology (CenTRE), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47000, Malaysia
| |
Collapse
|
13
|
Boro B, Banerjee S. Decomposing the rural-urban gap in the prevalence of undiagnosed, untreated and under-treated hypertension among older adults in India. BMC Public Health 2022; 22:1310. [PMID: 35799143 PMCID: PMC9264707 DOI: 10.1186/s12889-022-13664-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/20/2022] [Indexed: 12/30/2022] Open
Abstract
Background Although awareness and treatment rates of hypertension have significantly improved in recent years, the prevalence of undiagnosed and untreated hypertension remains a major public health concern for Indian policymakers. While the urban–rural variation in the prevalence, diagnosis, control, and treatment of hypertension is reasonably well-documented, the explanation behind such variation remains poorly understood given the dearth of studies conducted on exploring the determinants of the rural–urban gap in the prevalence of undiagnosed, untreated, and uncontrolled hypertension in India. In view of this research gap, our paper aims to decompose the inter-group differences between rural and urban areas in undiagnosed, untreated, and undertreated hypertension among older adults in India into the major contributing factors. Methods Nationally representative data collected in the Longitudinal Ageing Study of India, Wave-1 (2017–18), was utilized for this study. Maximum-likelihood binary logistic-regression models were employed to capture the crude and adjusted associations between the place of residence and prevalence of undiagnosed, untreated, and undertreated hypertension. Fairlie’s decomposition technique was used to decompose the inter-group differences between rural and urban residents in the prevalence of undiagnosed, untreated, and undertreated hypertension among the older population in India, into the major contributing factors, in order to explore the pathways through which these differences manifest. Results The overall prevalence rates of undiagnosed, untreated, and undertreated hypertension among older adults were 42.3%, 6%, and 18.7%, respectively. However, the prevalence of undiagnosed and untreated hypertension was higher in rural areas, by 12.4 and 1.7 percentage-points, respectively, while undertreated hypertension was more prevalent in the urban areas (by 7.2 percentage-points). The decomposition analysis explained roughly 41% and 34% of the urban advantage over rural areas in the case of undiagnosed and untreated hypertension, while it explained 51% of the urban disadvantage in respect of undertreated hypertension. The rural–urban differentials in education and comorbidities accounted for the majority of the explained rural disadvantage in the prevalence of undiagnosed hypertension, explaining 13.51% and 13.27% of the gap, respectively. The regional factor was found to be the major driver behind urban advantage in the prevalence of untreated hypertension, contributing 37.47% to the overall gap. In the case of undertreated hypertension, education, comorbidities, and tobacco consumption were the major contributors to the urban–rural inequality, which accounted for 12.3%, 10.6%, and 9.8% of the gap, respectively. Conclusion Socio-economic and lifestyle factors seemed to contribute significantly to the urban–rural gap in undiagnosed, untreated and undertreated hypertension in India among older adults. There is an urgent need of creating awareness programmes for the early identification of hypertensive cases and regular treatment, particularly in under-serviced rural India. Interventions should be made targeting specific population groups to tackle inequality in healthcare utilization.
Collapse
Affiliation(s)
- Bandita Boro
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Shreya Banerjee
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India.
| |
Collapse
|
14
|
Das S, Debnath M, Das S, Sarkar S, Rumana AS. Association of overweight and obesity with hypertension, diabetes and comorbidity among adults in Bangladesh: evidence from nationwide Demographic and Health Survey 2017-2018 data. BMJ Open 2022; 12:e052822. [PMID: 35793916 PMCID: PMC9260812 DOI: 10.1136/bmjopen-2021-052822] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/14/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The study aimed to determine the association of overweight and obesity with hypertension, diabetes and comorbidity among the adults of Bangladesh. STUDY DESIGN This study used cross-sectional data from the nationally representative Bangladesh Demographic and Health Survey conducted in 2017-2018. The main outcome variables were hypertension, diabetes and comorbidity. Comorbidity was defined as the coexistence of hypertension and diabetes. Overweight and obesity, as measured by body mass index, were the main explanatory variables. The strength of the association was determined using the adjusted multiple logistic regression models. SETTING Rural and urban areas in Bangladesh. PARTICIPANTS The study included a total of 11 881 adults (5241 men and 6640 women) aged 18 years or older. RESULTS The prevalence of hypertension, diabetes and comorbidity among the sample population were 28.5%, 9.9% and 4.5%, respectively. Among the respondents, 20.1% were overweight and 4.1% were obese. The risk of hypertension was 2.47 times more likely in the overweight group (adjusted OR (AOR) 2.47; 95% CI 2.22 to 2.75) and 2.65 times more likely in the obese group (AOR 2.65; 95% CI 2.16 to 3.26) compared with the normal or underweight group. Adults who were overweight and obese had 59% (AOR 1.59; 95% CI 1.37 to 1.84) and 88% (AOR 1.88; 95% CI 1.46 to 2.42) higher odds of having diabetes, respectively, than normal or underweight adults. Moreover, the risk of comorbidity was 2.21 times higher in overweight adults (AOR 2.21; 95% CI 1.81 to 2.71) and 2.86 times higher in obese adults (AOR 2.86; 95% CI 2.09 to 3.91) compared with normal or underweight adults. CONCLUSIONS Using large-scale nationally representative data, we found that overweight and obesity were significantly associated with hypertension, diabetes and comorbidity. So, nationally representative data can be used for programme planning to prevent and treat these chronic conditions.
Collapse
Affiliation(s)
- Sukanta Das
- Department of Statistics, Begum Rokeya University, Rangpur, Bangladesh
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Manabika Debnath
- Department of Marketing, Begum Rokeya University, Rangpur, Bangladesh
| | - Sunanda Das
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
- Department of Management Science and Statistics, The University of Texas, San Antonio, Texas, USA
| | - Snigdha Sarkar
- Department of Statistics, Begum Rokeya University, Rangpur, Bangladesh
| | - Afrin Sadia Rumana
- Department of Business Administration in Accounting and Information Systems, Faculty of Business Studies, Bangladesh University of Professionals, Dhaka, Bangladesh
| |
Collapse
|
15
|
Mohd Nor NS, Chua YA, Abdul Razak S, Ismail Z, Nawawi H. Identification of cardiovascular risk factors among urban and rural Malaysian youths. BMC Cardiovasc Disord 2022; 22:70. [PMID: 35196985 PMCID: PMC8867643 DOI: 10.1186/s12872-021-02447-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background Coronary artery disease (CAD) is one of the major causes of morbidity and mortality worldwide. Early identification of the cardiovascular risk factors (CRF) among youths assists in determining the high-risk group to develop CAD in later life. In view of the modernised lifestyle, both urban and rural residing youths are thought to be equally exposed to various CRF. This study aimed to describe the common CRF including obesity, dyslipidaemia, hypertension, smoking and family history of hypercholesterolaemia and premature CAD in youths residing in urban and rural areas in Malaysia. Methods We recruited 942 Malaysian subjects aged 15–24 years old [(males = 257, and urban = 555 vs. rural = 387, (mean age ± SD = 20.5 ± 2.1 years)] from the community health screening programmes organised in both rural and urban regions throughout Malaysia. Medical history and standardised anthropometric measurements were recorded. Laboratory investigations were obtained for fasting serum lipid profiles and plasma glucose levels. Results A total of 43.7% from the total study population was either obese or overweight. Youths in the rural were more overweight and obese (49.4% vs. 42.7%, p < 0.044) and have higher family history of hypercholesterolaemia (16.3% vs. 11.3%, p < 0.036) than youths in the urban areas. Low-density lipoprotein (LDL-c) (2.8 vs. 2.7 mmol/L) and total cholesterol (TC) (4.7 vs. 4.5 mmol/L) were significantly higher in urban compared to rural youths (p < 0.019 and p < 0.012). Overall, more youth in this study has CRF rather than not (Has ≥ 1 CRF = 69.9%). Significantly more rural youths have at least one CRF compared to urban youths (rural = 74.2% vs. urban = 66.8%, p = 0.016). Conclusion In conclusion, our study showed that a large number of youths had at least one or more CRF. Rural youths have significantly higher BMI with higher family history of hypercholesterolaemia compared to urban youths. However, urban youths have higher LDL-c and TC levels. Other coronary risk factors are not significantly different between urban and rural youths. Rural youths have more CRF compared to urban youths. A larger longitudinal study focusing on this population is important to better understand the effect of the area of residence on CRF in youth.
Collapse
Affiliation(s)
- Noor Shafina Mohd Nor
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Selangor, Malaysia.,Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor, Malaysia
| | - Yung-An Chua
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Selangor, Malaysia
| | - Suraya Abdul Razak
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Selangor, Malaysia.,Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor, Malaysia
| | - Zaliha Ismail
- Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor, Malaysia
| | - Hapizah Nawawi
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Selangor, Malaysia. .,Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor, Malaysia.
| | | |
Collapse
|
16
|
Dalal JJ, Kerkar P, Guha S, Dasbiswas A, Sawhney JPS, Natarajan S, Maddury SR, Kumar AS, Chandra N, Suryaprakash G, Thomas JM, Juvale NI, Sathe S, Khan A, Bansal S, Kumar V, Reddi R. Therapeutic adherence in hypertension: Current evidence and expert opinion from India. Indian Heart J 2021; 73:667-673. [PMID: 34861979 PMCID: PMC8642659 DOI: 10.1016/j.ihj.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 12/01/2022] Open
Abstract
Hypertension (HTN) is a globally prevalent non-communicable disease contributing significantly to cardiovascular (CV) morbidity and mortality. In achieving control of HTN, therapeutic adherence plays a crucial role. Studies from India identify varying rates of adherence to antihypertensive medications. Multiple factors determine treatment adherence in HTN. In India, factors such as lower socioeconomic status, health literacy, asymptomatic nature of disease, forgetfulness, cost of medications, and duration of HTN determine the adherence. An excellent physician-patient relationship incorporating adequate counseling along with the use of other methods can identify poor adherence. Improving adherence necessitates incorporating a multipronged approach with strategies directed at physicians, patients, and health systems. With innovation in therapeutics, the pharmaceutical sector can contribute significantly to improve adherence. Furthermore, increasing adherence to lifestyle interventions can help achieve better HTN control and improve CV outcomes. In the Indian context, more emphasis is necessary on patient education, enhanced physician-patient relationship and communication, increased access to health care, and affordability in improving therapeutic adherence in HTN.
Collapse
Affiliation(s)
- Jamshed J Dalal
- Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.
| | - Prafulla Kerkar
- Department of Cardiology, KEM Hospital, Mumbai, Maharashtra, India.
| | | | - Arup Dasbiswas
- Department of Cardiology, NRS Medical College, Kolkata, West Bengal, India.
| | - J P S Sawhney
- Dept. of Cardiology, Sir Ganga Ram Hospital, New Delhi, India.
| | | | | | | | | | | | - Joy M Thomas
- Dr. Joy Thomas Heart Care, Bharathi Salai, Mugappair West, Chennai, India.
| | - N I Juvale
- Department of Cardiology, Saifee Hospital, Mumbai, India.
| | | | - Aziz Khan
- Crescent Hospital & Heart Centre, Dhantoli, Nagpur, Maharashtra, India.
| | - Sandeep Bansal
- Department of Cardiology, Safdarjung Medical College, Delhi, India.
| | | | - Rajshekhar Reddi
- Department of Neurology, Max Superspecialty Hospital, Saket, New Delhi, India.
| |
Collapse
|
17
|
Brown MK, Shahar S, You YX, Michael V, Majid HA, Manaf ZA, Haron H, Sukiman NS, Chia YC, He FJ, MacGregor GA. Developing a policy to reduce the salt content of food consumed outside the home in Malaysia: protocol of a qualitative study. BMJ Open 2021; 11:e044628. [PMID: 34301647 PMCID: PMC8311303 DOI: 10.1136/bmjopen-2020-044628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Current salt intake in Malaysia is high. The existing national salt reduction policy has faced slow progress and does not yet include measures to address the out of home sector. Dishes consumed in the out of home sector are a known leading contributor to daily salt intake. This study aims to develop a salt reduction strategy, tailored to the out of home sector in Malaysia. METHODS AND ANALYSIS This study is a qualitative analysis of stakeholder views towards salt reduction. Participants will be recruited from five zones of Malaysia (Western, Northern, Eastern and Southern regions and East Malaysia), including policy-makers, non-governmental organisations, food industries, school canteen operators, street food vendors and consumers, to participate in focus group discussions or in-depth interviews. Interviews will be transcribed and analysed using thematic analysis. Barriers will be identified and used to develop a tailored salt reduction strategy. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Universiti Kebangsaan Malaysia Medical Research Ethics Committee (UKM PPI/1118/JEP-2020-524), the Malaysian National Medical Research Ethics Committee (NMRR-20-1387-55481 (IIR)) and Queen Mary University of London Research Ethics Committee (QMERC2020/37) . Results will be presented orally and in report form and made available to the relevant ministries for example, Ministry of Health, Ministry of Education and Ministry of Trade to encourage adoption of strategy as policy. The findings of this study will be disseminated through conference presentations, peer-reviewed publications and webinars.
Collapse
Affiliation(s)
- Mhairi Karen Brown
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Suzana Shahar
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yee Xing You
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Viola Michael
- Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - Hazreen Abdul Majid
- Centre for Population Health (CePH) and Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Zahara Abdul Manaf
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hasnah Haron
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noor Shahida Sukiman
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yook Chin Chia
- Department of Medical Science, Sunway University, Bandar Sunway, Malaysia
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
18
|
Wang Z, Shao Y, Jin J, Rong X, Qiu H, Wu R, Chu M. Clinical follow-up study of 166 cases of children with hypertension. Transl Pediatr 2021; 10:1834-1842. [PMID: 34430431 PMCID: PMC8349960 DOI: 10.21037/tp-20-446] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/24/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Childhood hypertension is a challenge for pediatricians to discover and diagnose. We sought to analyze its clinical characteristics and related risk factors in patients at a single center. METHODS From 2009 to 2019, 166 children with hypertension were retrospectively analyzed, and their clinical manifestations and relevant laboratory data were collected for statistical analysis. RESULTS A total of 120 males and 46 females were included in this study. Males were more common than females (P=0.012), and 86.7% were from rural areas. Hypertension appeared in all age groups, but most of them were puberty (52.4%). Most primary hypertension cases (57/91) had no obvious clinical symptoms, and BMI (OR 1.085, 95% CI: 1.004-1.173, P=0.038) and a family history of hypertension (OR 5.605, 95% CI: 2.229-14.092, P<0.001) were the risk factors. In the 75 secondary hypertension cases, renal hypertension (62.7%) was the main cause and headache and dizziness were the most common symptoms, and the serum urea is a risk factor (OR 1.524, 95% CI: 1.037-2.239, P=0.032). CONCLUSIONS BMI and a family history of hypertension were associated with primary hypertension. The serum urea was related to secondary hypertension. Emphasis on family history, strengthening family health management and education and publicity of hypertension, were important for diagnosis and detection of children with hypertension.
Collapse
Affiliation(s)
- Zhenquan Wang
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiping Shao
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiahui Jin
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xing Rong
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huixian Qiu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rongzhou Wu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Maoping Chu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| |
Collapse
|
19
|
Mosisa G, Regassa B, Biru B. Epidemiology of hypertension in selected towns of Wollega zones, Western Ethiopia, 2019: A community-based cross-sectional study. SAGE Open Med 2021; 9:20503121211024519. [PMID: 34178341 PMCID: PMC8202320 DOI: 10.1177/20503121211024519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/24/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Hypertension remains an emerging public health problem globally, particularly in developing countries. Age, income level, obesity, alcohol consumption, smoking, vegetables and fruit consumption, physical activity and chat chewing were some risk factors of hypertension. However, there are limited data on the epidemiology of hypertension in Ethiopia. This study aimed to assess Epidemiology of Hypertension among the community of selected towns of Wollega zones. Methods: A community-based cross-sectional study was conducted from 1 to 30 June 2019 in selected towns of Wollega zones. A multistage sampling technique was used to select 840 study participants. Data were collected using the WHO STEP wise approach. The data were coded and entered into EpiData 3, and exported to SPSS version 20.0 for analysis. Bivariate and multivariable logistic regression analyses were conducted. Statistical significance was declared at p-value < 0.05. Results: The study included a total of 838 respondents with a response rate of 99.7%. The prevalence of hypertension was found to be 189 (22.6%) (95% confidence interval = 19.9%–25.2%). Of this, 108 (12.9%) and 81 (9.7%) of female and male were hypertensive, respectively. Age groups of 30–44 years (adjusted odds ratio = 2.65 (1.43, 4.89)), 45–59 years (adjusted odds ratio = 3.55 (1.79, 7.04)), above 60 years (adjusted odds ratio = 2.97 (1.43, 6.18)), having history of alcohol consumption (adjusted odds ratio = 4.29 (2.4, 7.66)), involving in vigorous physical activity (adjusted odds ratio = 0.096 (0.028, 0.33)), not walking to and from the work (adjusted odds ratio = 13.12 (8.34, 20.67)), being overweight (adjusted odds ratio = 1.98 (1.21, 3.25)), inadequate fruits serving per day (adjusted odds ratio = 2.93 (1.75, 4.88)) were significantly associated with hypertension. Conclusion: The prevalence of hypertension was found to be high in the study area. Older age, alcohol consumption, not engaging in vigorous activity, physical inactivity, being overweight and inadequate intake of fruits were found to be risk factors for hypertension. Therefore, health care providers should provide extensive health education and promotion on recommended lifestyle modification to tackle the burden of hypertension.
Collapse
Affiliation(s)
- Getu Mosisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bikila Regassa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bayise Biru
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| |
Collapse
|
20
|
Hassanein M, Al Sifri S, Shaikh S, Raza SA, Akram J, Rudijanto A, Shaltout I, Fariduddin M, Mohamed WMIBW, Al Awadi F, Durocher A, Cortese V, Alessa T. Descriptive Regional Subanalysis of a Real-World Study in Patients with Type 2 Diabetes Treated with Gliclazide MR During Fasting: DIA-RAMADAN. Diabetes Ther 2021; 12:1703-1719. [PMID: 33974216 PMCID: PMC8179867 DOI: 10.1007/s13300-021-01067-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION To analyse the safety and effectiveness of gliclazide modified release (MR) in adults with type 2 diabetes mellitus participating in Ramadan from three geographically and culturally different regions of the world included in the DIA-RAMADAN study. METHODS DIA-RAMADAN was a real-world, observational, international, non-comparative study. The global study population was divided into three regional subgroups, with data gathered at inclusion 6-8 weeks prior to Ramadan (V0), during Ramadan (4.5 weeks) and 4-6 weeks after Ramadan (V1). Primary endpoint was the proportion of patients reporting ≥ 1 symptomatic hypoglycaemic events (HE), which were collected using a patient diary along with other adverse events. RESULTS Patient numbers from the three regions were n = 564 (46.5%; Indian sub-continent), n = 354 (29.1%; Middle East) and n = 296 (24.4%; South-East Asia). Patient baseline characteristics, demographics, fasting habits and antidiabetic treatments varied between regions. There were similar proportions of symptomatic HE between regions, with no severe HE. Significant weight reductions were observed in all regions following Ramadan, along with reductions in HbA1c and fasting plasma glucose. CONCLUSION These real-world study data indicate that gliclazide MR is safe and effective for management of type 2 diabetes during Ramadan in all three regions studied as part of DIA-RAMADAN. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT04132934. INFOGRAPHIC.
Collapse
Affiliation(s)
- Mohamed Hassanein
- Department of Endocrinology, Dubai Hospital, Dubai, United Arab Emirates
| | | | - Shehla Shaikh
- Department of Endocrinology, Saifee Hospital, Mumbai, Maharashtra, India
| | - Syed Abbas Raza
- Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Javed Akram
- University of Health Sciences, Lahore, Pakistan
| | - Achmad Rudijanto
- Department of Internal Medicine, Faculty of Medicine, Brawijaya University/Dr., Saiful Anwar Hospital, Malang, Indonesia
| | - Inass Shaltout
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Md Fariduddin
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Wan Mohd Izani Bin Wan Mohamed
- Department of Medicine, Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- School of Medical Sciences, Universiti Sains Malaysia (USM) Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Fatheya Al Awadi
- Department of Endocrinology, Dubai Hospital, Dubai, United Arab Emirates
| | - Alexandra Durocher
- Servier Global Medical and Patient Affairs-Diabetes, 35 rue de Verdun, 92284, Suresnes Cedex, France.
| | - Viviana Cortese
- Servier Global Medical and Patient Affairs-Diabetes, 35 rue de Verdun, 92284, Suresnes Cedex, France
| | | |
Collapse
|
21
|
Zaki NAM, Ambak R, Othman F, Wong NI, Man CS, Morad MFA, He FJ, MacGregor G, Palaniveloo L, Baharudin A. The prevalence of hypertension among Malaysian adults and its associated risk factors: data from Malaysian Community Salt Study (MyCoSS). JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:8. [PMID: 34059165 PMCID: PMC8166007 DOI: 10.1186/s41043-021-00237-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Hypertension is one of the most common risk factors for cardiovascular disease and leading cause of mortality globally. The aims of this study were to assess the prevalence of hypertension and its associated risk factors among Malaysian population using data from the Malaysian Community Salt Study (MyCoSS). METHODS This study was a cross-sectional study using multi-stage stratified sampling method. Data collection was carried out via face-to-face interview at the respondent's home from October 2017 until March 2018. A total of 1047 respondents aged 18 years and above completed the questionnaires and blood pressure measurement. A person who reported diagnosis of hypertension by a physician and had systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg on three readings was categorised as hypertensive. Risk factors of hypertension were analysed using multiple logistic regression. RESULTS The prevalence of hypertension in the present study was 49.39% (95% CI 44.27-54.51). There was no statistically significant difference in gender. Age, household income, BMI, and diabetes were significantly associated with hypertension. Hypertension found had inverse association with the level of education. Age was the strongest predictor of hypertension (35-44 years old; OR=2.39, 95% CI=1.39-4.09, 45-54 years old; OR=5.50, 95% CI=3.23-9.38, 55-64 years old OR=13.56, 95% CI=7.77-23.64 and 65 years old and above; OR=25.28, 95% CI=13.33-48.66). Those who had higher BMI more likely to be hypertensive as compared to respondents with normal weight (overweight, OR=1.84; 95% CI=1.18-2.86; obese, OR=4.29% CI=2.56-7.29). CONCLUSION The findings showed that hypertension is prevalent among adults in Malaysia. Those with older age, higher BMI, and diabetes are more likely to have hypertension. Efforts regarding lifestyle modification and education could be important in hypertension management and prevention.
Collapse
Affiliation(s)
| | - Rashidah Ambak
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Fatimah Othman
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Norazizah Ibrahim Wong
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Cheong Siew Man
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Mohamad Faizul Azham Morad
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Feng J. He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Graham MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Lalitha Palaniveloo
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Azli Baharudin
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| |
Collapse
|
22
|
Fan LM, Wang F, Zhao M, Cui WL, Cai L. Socioeconomic differentials in trends in the prevalence of hypertension and pre-hypertension and hypertension awareness, treatment, and control in rural Southwestern China. BMC Cardiovasc Disord 2021; 21:259. [PMID: 34039284 PMCID: PMC8157672 DOI: 10.1186/s12872-021-02062-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/14/2021] [Indexed: 01/23/2023] Open
Abstract
Background This study examines the socioeconomic differentials in trends in the prevalence of hypertension and pre-hypertension and hypertension awareness, treatment, and control in rural Southwestern China. Methods Two cross-sectional interviews and health examination surveys were administered in rural Yunnan Province, including 6,350 consenting participants in 2009 and 6,359 consenting participants in 2016 (aged ≥ 35 years). Participant demographics, socioeconomic status (SES), and ethnicity, along with information about hypertension awareness, treatment, and control, were collected using similar questionnaires in the two surveys. The participants’ blood pressure levels were also measured. Results From 2009 to 2016, the prevalence of hypertension substantially increased from 28.4% to 39.5% (P < 0.01), and awareness and control rose from 42.2 and 25.8% to 53.1 (P < 0.01) and 30.6% (P < 0.05), respectively. Although people with a higher education level also had higher awareness and control rates than the lower education level ones, there were no conspicuous differences in the improvement of awareness and control between publics with different education levels over the 7 years studied. Increases were observed in both rates of awareness and control in people with a high level of income (P < 0.01). However, only the awareness rate increased in participants with a low level of income. Furthermore, the prevalence (P < 0.01) and treatment (P < 0.05) of hypertension were higher in the Han people than in ethnic minorities. Conclusions Individual SES has clear associations with trends in the prevalence, awareness, and control of hypertension. Future interventions to improve hypertension prevention and control should be tailored to address individual SES.
Collapse
Affiliation(s)
- Lu-Ming Fan
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China
| | - Fang Wang
- Department of Science and Technology, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China
| | - Min Zhao
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China
| | - Wen-Long Cui
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China
| | - Le Cai
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China.
| |
Collapse
|
23
|
Ab Majid NL, Rodzlan Hasani WS, Mat Rifin H, Robert Lourdes TG, Jane Ling MY, Saminanthan TA, Ismail H, Ahmad A, Mohd Yusoff MF. Self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia. Geriatr Gerontol Int 2021; 20 Suppl 2:79-84. [PMID: 33370854 DOI: 10.1111/ggi.13968] [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] [Received: 03/11/2020] [Revised: 04/30/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022]
Abstract
AIM The objective of this study is to determine the prevalence of self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia and their associated factors. METHODS The study used data from the National Health and Morbidity Survey in 2018. It was a cross-sectional study with two-staged stratified cluster sampling design. In total, 3977 adults aged ≥60 years were selected for this study. Respondents were interviewed face to face using a structured questionnaire. Self-reported diabetes, hypertension or hypercholesterolemia was defined as having ever been told they have these diseases by a medical doctor or paramedic. Data were analyzed using SPSS version 25. The multiple logistic regression model was used to examine the factors associated with the prevalence of self-reporting. RESULTS The prevalence of self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia were 27.7%, 51.1% and 41.8% respectively. Presence of other comorbidities and being obese showed higher odds for all three diseases. Indians, unemployed, inactive had higher odds for diabetes. Other Bumiputras, unemployed, non-smoker, obese and inactive had higher odds for hypertension. Non-smoker had higher odds for hypercholesterolemia. CONCLUSIONS Health promotion, vigilance, attention and services targeting on the associated factors should be strengthened for older persons in Malaysia to ensure healthy aging. Geriatr Gerontol Int 2020; 20: 79-84.
Collapse
Affiliation(s)
- Nur Liana Ab Majid
- Institute for Public Health Malaysia, National Institutes of Health Malaysia, Ministry of Health, Selangor, Malaysia
| | - Wan Shakira Rodzlan Hasani
- Institute for Public Health Malaysia, National Institutes of Health Malaysia, Ministry of Health, Selangor, Malaysia
| | - Halizah Mat Rifin
- Institute for Public Health Malaysia, National Institutes of Health Malaysia, Ministry of Health, Selangor, Malaysia
| | - Tania Gayle Robert Lourdes
- Institute for Public Health Malaysia, National Institutes of Health Malaysia, Ministry of Health, Selangor, Malaysia
| | - Miaw Yn Jane Ling
- Institute for Public Health Malaysia, National Institutes of Health Malaysia, Ministry of Health, Selangor, Malaysia
| | - Thamil Arasu Saminanthan
- Institute for Public Health Malaysia, National Institutes of Health Malaysia, Ministry of Health, Selangor, Malaysia
| | - Hasimah Ismail
- Institute for Public Health Malaysia, National Institutes of Health Malaysia, Ministry of Health, Selangor, Malaysia
| | - Ahzairin Ahmad
- Institute for Public Health Malaysia, National Institutes of Health Malaysia, Ministry of Health, Selangor, Malaysia
| | - Muhammad Fadhli Mohd Yusoff
- Institute for Public Health Malaysia, National Institutes of Health Malaysia, Ministry of Health, Selangor, Malaysia
| |
Collapse
|
24
|
Haung Z, Hong SA, Tejativaddhana P, Puckpinyo A, Myint MNHA. Multiple self-care behaviors and associated factors in community-dwelling patients with hypertension in Myanmar. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:363-376. [PMID: 32581415 PMCID: PMC7276404 DOI: 10.18999/nagjms.82.2.363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aimed to identify the prevalence of self-care behaviors and the associated factors among hypertensive patients in primary care in Myanmar. This cross-sectional study was conducted from April to May 2019 among 410 hypertensive patients in Myitkyina Township, Kachin State, Myanmar. Hypertensive patients aged 30–70 years old and being registered at the community health centers in Myitkyina Township were selected using multi-stage cluster random sampling. Self-care behaviors were measured by Hypertensive Self-Care Activity Level Effect (H-SCALE). Chi-square test and multiple logistic regression analysis were used to explore the associated factors. Prevalence of adherence to multiple self-care behaviors were low: avoidance of tobacco use at 50.2%, followed by physical activity at 24.9%, medication at 24.1%, weight management at 9.5%, and healthy diet at 2.7%, while abstinence from harmful alcohol drinking was high at 97.8%. Multiple logistic regression analysis indicated that younger patients, low family income, inadequate knowledge, and no comorbidity were associated with non-adherence to medication. Living in rural area and having poor self-efficacy were associated with non-adherence to weight management, while being younger, female and having poor self-efficacy were also associated with non-adherence to physical activity. Compared with Kachin, other ethnics were more likely to be non-adherent to avoidance of tobacco use. Although a majority of respondents were not harmful drinkers, adherence to medication, healthy diet, physical activity, weight management and avoidance of tobacco use were very low. Health practitioners should provide education programs for hypertensive patients to direct them towards practical techniques in managing their blood pressure.
Collapse
Affiliation(s)
- Ze Haung
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand.,Township Department of Public Health, Myitkyina, Myanmar
| | - Seo Ah Hong
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
| | | | - Apa Puckpinyo
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
| | | |
Collapse
|
25
|
Comparison of new implantation of cardiac implantable electronic device between tertiary and non-tertiary hospitals: a Korean nationwide study. Sci Rep 2021; 11:3705. [PMID: 33723278 PMCID: PMC7961055 DOI: 10.1038/s41598-021-83160-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/28/2021] [Indexed: 01/09/2023] Open
Abstract
This study compared the characteristics and mortality of new implantation of cardiac implantable electronic device (CIED) between tertiary and non-tertiary hospitals. From national health insurance claims data in Korea, 17,655 patients, who underwent first and new implantation of CIED between 2013 and 2017, were enrolled. Patients were categorized into the tertiary hospital group (n = 11,560) and non-tertiary hospital group (n = 6095). Clinical outcomes including in-hospital death and all-cause death were compared between the two groups using propensity-score matched analysis. Patients in non-tertiary hospitals were older and had more comorbidities than those in tertiary hospitals. The study population had a mean follow-up of 2.1 ± 1.2 years. In the propensity-score matched permanent pacemaker group (n = 5076 pairs), the incidence of in-hospital death (odds ratio [OR]: 0.76, 95% confidence interval [CI]: 0.43–1.32, p = 0.33) and all-cause death (hazard ratio [HR]: 0.92, 95% CI 0.81–1.05, p = 0.24) were not significantly different between tertiary and non-tertiary hospitals. These findings were consistently observed in the propensity-score matched implantable cardioverter-defibrillator group (n = 992 pairs, OR for in-hospital death: 1.76, 95% CI 0.51–6.02, p = 0.37; HR for all-cause death: 0.95, 95% CI 0.72–1.24, p = 0.70). In patients undergoing first and new implantation of CIED in Korea, mortality was not different between tertiary and non-tertiary hospitals.
Collapse
|
26
|
Keng ZY, Saw YM, Thung SC, Chong WW, Albert A, Kariya T, Yamamoto E, Hamajima N. Rate of achievement of therapeutic outcomes and factors associated with control of non-communicable diseases in rural east Malaysia: implications for policy and practice. Sci Rep 2021; 11:3812. [PMID: 33589659 PMCID: PMC7884395 DOI: 10.1038/s41598-021-83168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/25/2021] [Indexed: 12/02/2022] Open
Abstract
Non-communicable diseases (NCDs) are an increasing problem worldwide, including in Malaysia. National surveys have been performed by the government but had poor coverage in east Malaysia, particularly in rural regions. This study aimed to describe the achievement of target therapeutic outcomes in the control of diabetes mellitus (DM), hypertension (HPT), and dyslipidemia (DLP) among diabetic patients in rural east Malaysia. A cross-sectional study was conducted among DM patients who visited the NCDs clinic in Lundu Hospital, Sarawak, Malaysia, from Jan to March 2016. In total, 214 patients (male, 37.9%; female, 62.1%) were recruited using a systemic sampling method. Multiple logistic regression models were applied to estimate the adjusted odds ratio (AOR) and confidence interval (CI) for the target therapeutic achievement in the control of DM, HPT, and DLP. Compared to the national average, therapeutic target achievement in Lundu was higher for DM (43.0% vs. 23.8%), equal for DLP (35.8% vs. 37.8%) but lower for HPT (30.9% vs. 47.9%). DM patients who had at least yearly HbA1c monitoring (AOR 2.30, 95% CI 1.04–5.06, P = 0.039), and those 58.7 years or older (AOR 2.50, 95% CI 1.32–4.74, P = 0.005) were more likely to achieve the therapeutic target for DM. Health promotion and public education regarding HPT needs to be emphasized in rural Malaysia. HbA1c monitoring at least once a year was one of the important factors associated with achieving DM control in rural east Malaysia. Accessibility to HbA1c tests and monitoring should be ensured for diabetic patients.
Collapse
Affiliation(s)
- Zhi Yi Keng
- Department of Internal Medicine, Hospital Umum Sarawak, Sarawak, Malaysia.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan. .,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan.
| | - Senk Chung Thung
- Department of Family Medicine, Hospital University Sains Malaysia, Kelantan, Malaysia
| | - Woon Wee Chong
- Department of Emergency Medicine, Hospital University Sains Malaysia, Kelantan, Malaysia
| | - Amanda Albert
- Department of Psychiatry, Hospital Sentosa, Sarawak, Malaysia
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Eko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
27
|
Mohammed Nawi A, Mohammad Z, Jetly K, Abd Razak MA, Ramli NS, Wan Ibadullah WAH, Ahmad N. The Prevalence and Risk Factors of Hypertension among the Urban Population in Southeast Asian Countries: A Systematic Review and Meta-Analysis. Int J Hypertens 2021; 2021:6657003. [PMID: 33628485 PMCID: PMC7889387 DOI: 10.1155/2021/6657003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/07/2021] [Accepted: 01/25/2021] [Indexed: 12/18/2022] Open
Abstract
The trend of global prevalence for hypertension has been dramatically increasing for the past two decades in Southeast Asian countries. A systematic review aiming to assess the prevalence of hypertension and its risk factors among the urban population in Southeast Asian countries was conducted. We performed database searches of PubMed and Web of Science and performed meta-analysis to determine the pooled prevalence estimate. The overall pooled prevalence estimate of hypertension for Southeast Asian urban population was 33.82%. Among this, 33.98% of hypertension was reported in the community and 32.45% among adolescents in school. The common risk factors that we found were male, ethnicity, education and socioeconomic level, body mass index, waist circumference, smoking, and dyslipidaemia. The review indicates an urgent need for primary and secondary prevention activities. Therefore, a multisectoral and intersectoral approach and collaboration should be undertaken to improve the overall health outcomes of all populations in all Southeast Asian countries.
Collapse
Affiliation(s)
- Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Zulkefley Mohammad
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Health Services Division, Malaysian Armed Forces Headquarters, JalanTekpi, Off Jalan Padang Tembak, 50634 Kuala Lumpur, Malaysia
| | - Kavita Jetly
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Ministry of Health (Malaysia), Federal Government Administrative Centre, 62514 Putrajaya, Malaysia
| | - Mohamad Aznuddin Abd Razak
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Ministry of Health (Malaysia), Federal Government Administrative Centre, 62514 Putrajaya, Malaysia
| | - Nur Suhada Ramli
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Ministry of Health (Malaysia), Federal Government Administrative Centre, 62514 Putrajaya, Malaysia
| | - Wan Abdul Hannan Wan Ibadullah
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Ministry of Health (Malaysia), Federal Government Administrative Centre, 62514 Putrajaya, Malaysia
| | - Norfazilah Ahmad
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| |
Collapse
|
28
|
Ur Rehman I, Han LL, Khan TM, Alworafi Y, Suleiman A. Comparative Analysis of Chronic Kidney Disease-Associated Pruritus: A Multi-Ethnic Study among Patients on Hemodialysis. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/asmu6akyoy] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
29
|
Ismail A, Reffien MAM, Ibrahim NM, Sobri HNM, Abidin NDIZ, Rusli SASS, Selamat EM. Factors Associated With Length of Stay for Patients With Stroke in Malaysia. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2020; 3:134-138. [PMID: 37260578 PMCID: PMC10229015 DOI: 10.36401/jqsh-20-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 10/02/2020] [Indexed: 06/02/2023]
Abstract
Introduction Globally, stroke continues to become a significant public health issue contributing to one of the significant causes of morbidity and mortality. The study aimed to describe the characteristics of patients with stroke who were admitted to a teaching hospital in Malaysia and to determine the factors associated with length of stay (LOS). Methods This is a single-center, cross-sectional study using in-patient data maintained by the Case-Mix Unit of a teaching hospital in Malaysia from 2016 to 2017. The study included all patients with International Classification of Disease (ICD) code 164 (stroke, not specified as hemorrhage or infarct). The significance of association was determined using nonparametric tests in the form of the Mann-Whitney U test and the Kruskal-Wallis test. Results A total of 162 stroke patients from 2016 to 2017 from Case-Mix database were included in the study. The age ranged from 31 to 97 years old. The minimum and maximum LOS for patients with stroke ranged from 1 to 17 days. The severity of illness was found to be significantly associated with longer LOS (p < 0.001); however, age, sex, and presence of co-morbidities did not show any significant association. Conclusion Despite its limitations, this study is an essential first step to examine the characteristics of patients with stroke and to determine the factors associated with LOS.
Collapse
Affiliation(s)
- Aniza Ismail
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Muhammad Alimin Mat Reffien
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Norlinah Mohamed Ibrahim
- Department of Medicine, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Hanani Nabilah Mohd Sobri
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Noor Dalila Inche Zainal Abidin
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Sharifah Ain Shameera Syed Rusli
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Ellyana Mohd Selamat
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| |
Collapse
|
30
|
Soo MJ, Chow ZY, Ching SM, Tan CH, Lee KW, Devaraj NK, Salim HS, Ramachandran V, Lim PY, Sivaratnam D, Hoo FK, Cheong AT, Chia YC. Prevalence, awareness and control of hypertension in Malaysia from 1980-2018: A systematic review and meta-analysis. World J Meta-Anal 2020; 8:320-344. [DOI: 10.13105/wjma.v8.i4.320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/22/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypertension is a common public health problem worldwide and is a well-known risk factor for increased risk of cardiovascular diseases, contributing to high morbidity and mortality. However, there has been no systematic review and meta-analysis of a multiethnic population such as that of Malaysia.
AIM To determine the trend in prevalence, awareness and control rate of hypertension in Malaysia.
METHODS Systematic searches were conducted in six databases (PubMed, Scopus, Ovid, CINAHL, Malaysian Medical Repository and Malaysia Citation Index) for articles published between 1980 and 2018. Two authors reviewed the studies and performed quality assessment and data extraction independently. Pooled estimates of hypertension prevalence, awareness and control rate were calculated using the DerSimonian-Laird random-effects model. Subgroup and sensitivity analyses were performed.
RESULTS We included 56 studies involving a total of 241796 participants. The overall pooled prevalence of hypertension aged ≥ 18 years was 29.7%. The prevalence of hypertension was the lowest in the 1980s (16.2%, 95% confidence interval (CI): 13.4, 19.0), increasing up to 36.8% (95%CI: 6.1, 67.5) in the 1990s, then decreasing to 28.7% (95%CI: 21.7, 35.8) in the 2000s and 26.8% (95%CI: 21.3, 32.3) in the 2010s. The prevalence of awareness was 51.4% (95%CI: 46.6, 56.3), while 33.3% (95%CI: 28.4, 38.2) of those on treatment had achieved control of their blood pressure.
CONCLUSION In Malaysia, three in ten adults aged ≥ 18 years have hypertension, while four in ten adults aged ≥ 30 years have hypertension. Five out of ten people are aware of their hypertension status and only one-third of those under treatment achieved control of their hypertension. Concerted efforts by policymakers and healthcare professionals to improve awareness and control of hypertension should be of high priority.
Collapse
Affiliation(s)
- Man Jun Soo
- Department of Family Medicine, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | | | - Siew Mooi Ching
- Department of Family Medicine, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | | | - Kai Wei Lee
- Department of Family Medicine, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Navin Kumar Devaraj
- Department of Family Medicine, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Hani Syahida Salim
- Department of Family Medicine, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Vasudevan Ramachandran
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | | | - Fan Kee Hoo
- Department of Medicine, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Ai Theng Cheong
- Department of Family Medicine, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Yook Chin Chia
- Department of Medical Sciences, Sunway University, Bandar Sunway 47500, Malaysia
| |
Collapse
|
31
|
Teh XR, Lim MT, Tong SF, Husin M, Khamis N, Sivasampu S. Quality of hypertension management in public primary care clinics in Malaysia: An update. PLoS One 2020; 15:e0237083. [PMID: 32780769 PMCID: PMC7418969 DOI: 10.1371/journal.pone.0237083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Adequate control of hypertension is a global challenge and is the key to reduce cardiovascular disease risk factors. This study evaluates management of hypertensive patients in primary care clinics in Malaysia. METHODS A cross-sectional analysis of 13 784 medical records from 20 selected public primary care clinics in Malaysia was performed for patients aged ≥30 years old who were diagnosed with hypertension and had at least one visit between 1st November 2016 and 30th June 2019. Multivariable logistic regression adjusted for complex survey design was used to determine the association between process of care and blood pressure (BP) control among the hypertensive patients. RESULTS Approximately 50% of hypertensive patients were obese, 38.4% of age ≥65 years old, 71.2% had at least one comorbidity and approximately one-third were on antihypertensive monotherapy. Approximately two-third of the hypertensive patients with diabetic proteinuria were prescribed with the appropriate choice of antihypertensive agents. Approximately half of the patients received at least 70% of the target indicated care and 42.8% had adequately controlled BP. After adjusting for covariates, patients who received counseling on exercise were positively associated with adequate BP control. Conversely, patients who were prescribed with two or more antihypertensive agents were negatively associated with good BP control. CONCLUSIONS These findings indicated that BP control was suboptimal and deficient in the process of care with consequent gaps in guidelines and actual clinical practices. This warrants a re-evaluation of the current strategies and approaches to improve the quality of hypertension management and ultimately to improve outcome.
Collapse
Affiliation(s)
- Xin Rou Teh
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institute of Health (NIH), Ministry of Health, Selangor, Malaysia
| | - Ming Tsuey Lim
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institute of Health (NIH), Ministry of Health, Selangor, Malaysia
| | - Seng Fah Tong
- Department of Family Medicine, University Kebangsaan Malaysia, Selangor, Malaysia
| | - Masliyana Husin
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institute of Health (NIH), Ministry of Health, Selangor, Malaysia
| | - Noraziani Khamis
- Center for Clinical Governance Development, Institute for Health Management, National Institutes of Health, Ministry of Health (NIH), Selangor, Malaysia
| | - Sheamini Sivasampu
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institute of Health (NIH), Ministry of Health, Selangor, Malaysia
| |
Collapse
|
32
|
Marques AP, Szwarcwald CL, Pires DC, Rodrigues JM, Almeida WDSD, Romero D. [Factors associated with arterial hypertension: a systematic review]. CIENCIA & SAUDE COLETIVA 2020; 25:2271-2282. [PMID: 32520271 DOI: 10.1590/1413-81232020256.26972018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/03/2018] [Indexed: 01/11/2023] Open
Abstract
A systematic review of demographic, socioeconomic, behavioral and anthropometric factors associated with hypertension. We included observational studies, of populations aged 18 or older, from the past ten years, published in English, Portuguese or Spanish from Pubmed, Web of Science, Scopus and Lilacs bases. The most found factors related to the greater chance of having hypertension were age and the Body Mass Index (BMI). Other factors associated with the disease were: gender (male), education (lower education), income (lower income) and waist circumference (high). Never having smoked, never having consumed alcohol and white skin color were characteristics related to a lower chance of having hypertension. As demonstrated, demographic, socioeconomic, behavioral and anthropometric characteristics are important factors associated with a greater chance of having hypertension in the adult population. However, while most of the factors associated with it are amenable to intervention, broader health promotion policies will be needed to reduce socioeconomic inequalities in the prevalence of the disease.
Collapse
Affiliation(s)
- Aline Pinto Marques
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-900, Rio de Janeiro, RJ, Brasil.
| | - Célia Landmann Szwarcwald
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-900, Rio de Janeiro, RJ, Brasil.
| | - Débora Castanheira Pires
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-900, Rio de Janeiro, RJ, Brasil.
| | - Jéssica Muzy Rodrigues
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-900, Rio de Janeiro, RJ, Brasil.
| | - Wanessa da Silva de Almeida
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-900, Rio de Janeiro, RJ, Brasil.
| | - Dalia Romero
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-900, Rio de Janeiro, RJ, Brasil.
| |
Collapse
|
33
|
Akl C, Akik C, Ghattas H, Obermeyer CM. The cascade of care in managing hypertension in the Arab world: a systematic assessment of the evidence on awareness, treatment and control. BMC Public Health 2020; 20:835. [PMID: 32493255 PMCID: PMC7268748 DOI: 10.1186/s12889-020-08678-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 04/08/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Hypertension is a leading risk factor for mortality and morbidity globally and in the Arab world. We summarize the evidence on awareness, treatment, and control of hypertension, to assess the extent of gaps in the hypertension continuum of care. We also assess the influence of gender and other social determinants at each level of the cascade of care. METHODS We searched MEDLINE and SSCI databases for studies published between 2000 and 2017, reporting the rates of awareness, treatment or control of hypertension and/or their determinants in the Arab region. We included sources on both general populations and on clinical populations. The review process was based on the PRISMA guidelines. We present rates on the three stages of the care cascade corresponding to (1) awareness (2) treatment and (3) control of blood pressure, and estimated the losses that occur when moving from one stage to another. We also take stock of the evidence on social determinants and assess the statistical significance of gender differences in awareness, treatment and control. RESULTS Data from 73 articles were included. Substantial proportions of hypertensives were lost at each step of the hypertension care continuum, with more missed opportunities for care resulting from lack of awareness of hypertension and from uncontrolled blood pressure. More than 40% and 19% of all hypertensive individuals were found to be unaware and to have uncontrolled blood pressure, respectively, but among individuals diagnosed with hypertension, less than 21% were untreated. Awareness rates were higher among women than men but this advantage was not consistently translated into better blood pressure control rates among women. CONCLUSIONS This analysis of the cascade of care indicates that barriers to proper diagnosis and adequate control are greater than barriers to delivery of treatment, and discusses potential factors that may contribute to the gaps in delivery.
Collapse
Affiliation(s)
- Christelle Akl
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107-2020 Lebanon
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107-2020 Lebanon
| | - Hala Ghattas
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107-2020 Lebanon
| | - Carla Makhlouf Obermeyer
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107-2020 Lebanon
| |
Collapse
|
34
|
Ong SK, Kahan SZ, Lai DTC, Si-Ramlee KA, Abdullah MA, Sidup N, Kamis Z, Chong CL. Prevalence of undetected hypertension and its association with socio-demographic and non-communicable diseases risk factors in Brunei Darussalam. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-020-01287-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
35
|
Aziz F, Malek S, Mhd Ali A, Wong MS, Mosleh M, Milow P. Determining hypertensive patients' beliefs towards medication and associations with medication adherence using machine learning methods. PeerJ 2020; 8:e8286. [PMID: 32206445 PMCID: PMC7075362 DOI: 10.7717/peerj.8286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 11/24/2019] [Indexed: 01/31/2023] Open
Abstract
Background This study assesses the feasibility of using machine learning methods such as Random Forests (RF), Artificial Neural Networks (ANN), Support Vector Regression (SVR) and Self-Organizing Feature Maps (SOM) to identify and determine factors associated with hypertensive patients' adherence levels. Hypertension is the medical term for systolic and diastolic blood pressure higher than 140/90 mmHg. A conventional medication adherence scale was used to identify patients' adherence to their prescribed medication. Using machine learning applications to predict precise numeric adherence scores in hypertensive patients has not yet been reported in the literature. Methods Data from 160 hypertensive patients from a tertiary hospital in Kuala Lumpur, Malaysia, were used in this study. Variables were ranked based on their significance to adherence levels using the RF variable importance method. The backward elimination method was then performed using RF to obtain the variables significantly associated with the patients' adherence levels. RF, SVR and ANN models were developed to predict adherence using the identified significant variables. Visualizations of the relationships between hypertensive patients' adherence levels and variables were generated using SOM. Result Machine learning models constructed using the selected variables reported RMSE values of 1.42 for ANN, 1.53 for RF, and 1.55 for SVR. The accuracy of the dichotomised scores, calculated based on a percentage of correctly identified adherence values, was used as an additional model performance measure, resulting in accuracies of 65% (ANN), 78% (RF) and 79% (SVR), respectively. The Wilcoxon signed ranked test reported that there was no significant difference between the predictions of the machine learning models and the actual scores. The significant variables identified from the RF variable importance method were educational level, marital status, General Overuse, monthly income, and Specific Concern. Conclusion This study suggests an effective alternative to conventional methods in identifying the key variables to understand hypertensive patients' adherence levels. This can be used as a tool to educate patients on the importance of medication in managing hypertension.
Collapse
Affiliation(s)
- Firdaus Aziz
- Bioinformatics Science Programme, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Sorayya Malek
- Bioinformatics Science Programme, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- Quality Use of Medicines Research Group, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mee Sieng Wong
- Quality Use of Medicines Research Group, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mogeeb Mosleh
- Software Engineering Department, Faculty of Engineering & Information Technology, Taiz University, Taiz, Yemen
| | - Pozi Milow
- Environmental Management Programme, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
36
|
Mahdavi M, Parsaeian M, Mohajer B, Modirian M, Ahmadi N, Yoosefi M, Mehdipour P, Djalalinia S, Rezaei N, Haghshenas R, Pazhuheian F, Madadi Z, Sabooni M, Razi F, Samiee SM, Farzadfar F. Insight into blood pressure targets for universal coverage of hypertension services in Iran: the 2017 ACC/AHA versus JNC 8 hypertension guidelines. BMC Public Health 2020; 20:347. [PMID: 32183754 PMCID: PMC7076938 DOI: 10.1186/s12889-020-8450-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/03/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We compared the prevalence, awareness, treatment, and control of hypertension in Iran based on two hypertension guidelines; the 2017 ACC/AHA -with an aggressive blood pressure target of 130/80 mmHg- and the commonly used JNC8 guideline cut-off of 140/90 mmHg. We shed light on the implications of the 2017 ACC/AHA for population subgroups and high-risk individuals who were eligible for non-pharmacologic and pharmacologic therapies. METHODS Data was obtained from the Iran national STEPS 2016 study. Participants included 27,738 adults aged ≥25 years as a representative sample of Iranians. Regression models of survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension. RESULTS The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) based on the 2017 ACC/AHA. The percentage of awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0), respectively, by applying the 2017 ACC/AHA. Based on the new guideline, adults aged 25-34 years had the largest increase in prevalence (from 7.3 to 30.7%). They also had the lowest awareness and treatment rate, contrary to the highest control rate (36.5%) between age groups. Compared with JNC8, based on the 2017 ACC/AHA, 24, 15, 17, and 11% more individuals with dyslipidaemia, high triglycerides, diabetes, and cardiovascular disease events, respectively, fell into the hypertensive category. Yet, based on the 2017 ACC/AHA, 68.2% of individuals falling into the hypertensive category were eligible for receiving pharmacologic therapy (versus 95.7% in JNC8). LDL cholesterol< 130 mg/dL, sufficient physical activity (Metabolic Equivalents≥600/week), and Body Mass Index were found to change blood pressure by - 3.56(- 4.38, - 2.74), - 2.04(- 2.58, - 1.50), and 0.48(0.42, 0.53) mmHg, respectively. CONCLUSIONS Switching from JNC8 to 2017 ACC/AHA sharply increased the prevalence and drastically decreased the awareness, treatment, and control in Iran. Based on the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category; these individuals might benefit from earlier interventions such as lifestyle modifications. The low control rate among individuals receiving treatment warrants a critical review of hypertension services.
Collapse
Affiliation(s)
- Mahdi Mahdavi
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mahboubeh Parsaeian
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohajer
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Modirian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parinaz Mehdipour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Forough Pazhuheian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Madadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sabooni
- Reference Health Laboratory, Ministry of Health and Medical Education, Tehran, Iran
| | - Farideh Razi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Mirab Samiee
- Reference Health Laboratory, Ministry of Health and Medical Education, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
37
|
Prevalence of Metabolic Syndrome and Cardiovascular Risk Factors among Community Health Workers in Selected Villages in the Philippines. J ASEAN Fed Endocr Soc 2019; 34:171-179. [PMID: 33442153 PMCID: PMC7784100 DOI: 10.15605/jafes.034.02.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/14/2019] [Indexed: 12/15/2022] Open
Abstract
Objective This study aimed to estimate the prevalence of cardiovascular risk factors and metabolic syndrome among community health workers (CHWs) in selected villages in the Philippines. It also determined the association of urbanization and socio-demographic characteristics with hypertension, diabetes mellitus and metabolic syndrome among CHWs. Methodology A cross-sectional study was conducted among CHWs who were actively rendering service from selected communities at the time of the study. Standardized interviews were conducted and clinical measurements were collected. Results Of the total of 457 CHWs who participated, 96% were females with a median age of 50 years. The prevalence of hypertension in this population was 32.4%. Hypertension was found to be associated with older age [adjusted odds ratio (aOR) 5.3, 95% CI: 3.2 to 8.8, p<0.001], obesity (aOR 2.4, 95% CI: 1.4 to 4.0, p=0.002) and alcohol consumption (aOR 1.7, 95% CI: 1.0 to 3.0, p<0.040). The prevalence of diabetes mellitus (DM) was 13.6%. It was found to be more prevalent among CHWs who were at least 50 years old (aOR 2.7, 95% CI: 1.4 to 5.1, p=0.002), and those who spent at least 5 hours a day in sedentary activities (aOR 3.8, 95% CI: 1.1 to 12.7, p<0.033). Borderline to high total cholesterol, low density lipoprotein cholesterol (LDL-c) and triglycerides (TG) were seen in 41%, 37% and 20%, respectively. Sixty percent had low high density lipoprotein cholesterol (LDL-c). The overall prevalence of metabolic syndrome was 52.3%. Conclusion Metabolic syndrome is prevalent among CHW participants, with obesity, hypertension and low LDL-c as the most common components present. The prevalence of cardiovascular risk factors in this population was not found to be significantly different between rural and urban areas after adjusting for other factors.
Collapse
|
38
|
Song H, Feng D, Wang R, Yang J, Li Y, Gao J, Wang Z, Yan Z, Long C, Zhou J, Feng Z. The urban-rural disparity in the prevalence and risk factors of hypertension among the elderly in China-a cross-sectional study. PeerJ 2019; 7:e8015. [PMID: 31850155 PMCID: PMC6916758 DOI: 10.7717/peerj.8015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/09/2019] [Indexed: 01/14/2023] Open
Abstract
Introduction This study aimed to assess the prevalence of hypertension and to explore the disparities of its risk factors among urban and rural elderly. Method Data of hypertensive patients were collected from the China Health and Retirement Longitudinal Study (CHARLS) 2015. Stratified sample households were selected from 450 villages or communities of 150 counties from 28 provinces. Multivariable logistic regression was performed to analyze the factors correlated with hypertension. Results Prevalence of HBP was 47.6% (95% CI [45.2%-50.1%]) in total and it was close between urban and rural population (48.6% vs 47.2%). Factors associated with HBP were different between urban and rural areas. In urban areas, hypertension was significantly associated with literacy and diabetes in both genders, high BMI level and smoke quitters in males, and physical activity and dyslipidemia in females. In rural areas, hypertension was significantly associated with older age, higher BMI level in both males and females, and dyslipidemia in males. Conclusions The prevalence are about the same among urban and rural residents, but their risk factors vary from each other. Disparity in the risk factors between urban and rural population should be taken into consideration for further intervention.
Collapse
Affiliation(s)
- Hongxun Song
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province, People's Republic of China, Department of Health Management, Wuhan, Hubei, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province, People's Republic of China, Department of Health Management, Wuhan, Hubei, China
| | - Jian Yang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province, People's Republic of China, Department of Health Management, Wuhan, Hubei, China
| | - Yuanqing Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province, People's Republic of China, Department of Health Management, Wuhan, Hubei, China
| | - Junliang Gao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province, People's Republic of China, Department of Health Management, Wuhan, Hubei, China
| | - Zi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province, People's Republic of China, Department of Health Management, Wuhan, Hubei, China
| | - Ziqi Yan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province, People's Republic of China, Department of Health Management, Wuhan, Hubei, China
| | - Chengxu Long
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province, People's Republic of China, Department of Health Management, Wuhan, Hubei, China
| | - Jiawei Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province, People's Republic of China, Department of Health Management, Wuhan, Hubei, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province, People's Republic of China, Department of Health Management, Wuhan, Hubei, China
| |
Collapse
|
39
|
Impact of evacuation on trends in the prevalence, treatment, and control of hypertension before and after a disaster. J Hypertens 2019; 36:924-932. [PMID: 29227375 DOI: 10.1097/hjh.0000000000001626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE After the Great East Japan Earthquake in 2011, the prevalence of cardiovascular disease risk factors increased in victims. We examined the trends in the prevalence, treatment, and control of hypertension before and after the disaster, as well as the impact of evacuation. METHODS Study participants were approximately 10 000 men and 12 000 women aged 40-74 years in each year from 2008 to 2014. All of the participants had lived in radiation evacuation zones prior to the Fukushima nuclear crisis. The age-standardized prevalence, treatment, and control of hypertension were calculated using the direct method. In a comparison of evacuees with nonevacuees, the proportion ratios and 95% confidence intervals for hypertension, treatment, and control were calculated by Poisson regression with robust error variance adjusted for covariates in each year after the disaster. RESULTS The age-standardized prevalence of hypertension peaked in 2012 at 48.8% in men and 39.0% in women. By 2014, the treatment and control of hypertension had increased to 66.3 and 67.1% in men, and 70.6 and 68.1% in women, respectively. The multiadjusted proportion ratios for the prevalence, treatment, and control of hypertension in any given year were 1.02-1.03, 0.99-1.05, and 0.93-1.06 in men, and 0.96-1.00, 0.99-1.05, and 1.06-1.11 in women, respectively. CONCLUSION The prevalence of hypertension peaked 1 year after the disaster, while the treatment and control of hypertension increased thereafter. These results indicate that evacuation had little to no impact on the prevalence, treatment, and control of hypertension in the population of Fukushima Prefecture.
Collapse
|
40
|
Harris H, Ooi YBH, Lee JS, Matanjun P. Non-communicable diseases among low income adults in rural coastal communities in Eastern Sabah, Malaysia. BMC Public Health 2019; 19:554. [PMID: 31196012 PMCID: PMC6565525 DOI: 10.1186/s12889-019-6854-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Rural coastal communities in Sabah are still overly represented in the hardcore poor economic status. The aim of this study was to determine the prevalence of hypertension, diabetes mellitus and hypercholesterolemia among adults, in relation to economic status. Methods A cross-sectional study using stratified random sampling was conducted in seven coastal villages in Semporna, Sabah: Kabogan Laut, Salimbangun, Pekalangan, Pokas, Tampi-Tampi Timbayan, Sum Sum and Selinggit. Socio-demographic data were obtained via interviewer administered questionnaires in Sabah Malay creole. Anthropometric measurements, blood pressure, fasting blood glucose and blood lipids were obtained. Results A total of 330 adults (133 males, 197 females) completed the study. Mean age was 43.7 ± 15.8 years. Most participants (87%) were living below the Poverty Line Income. Median per capita household income was RM83.33/month (≈ USD20/month). The number of newly diagnosed cases of hypercholesterolemia was 40.6%, diabetes mellitus was 5.8%, and hypertension was 24.5%. Adults from the hardcore poor economic status (household income ≤RM760/month (≈USD183/month) were the most represented in those who did not have a blood pressure, blood sugar and blood lipids check in the 12 months preceding the study (Χ2, p < 0.01). Adults from hardcore poor economic status were also the most represented in undiagnosed hypertension and uncontrolled blood pressure among those diagnosed (Χ2, p = 0.013). Among diabetics from the hardcore poor group, the undiagnosed fasting blood glucose was 11.2 ± 4.5 compared to 5.1 ± 0.6 mmol/L for diagnosed diabetics (p < 0.001). Among hypercholesterolemics from the hardcore poor group, total cholesterol and LDL cholesterol values were significantly higher in the undiagnosed group compared to the diagnosed group (p < 0.001). Conclusion Many people in this rural coastal community were unaware that they had high cholesterol level (40.6%) and elevated blood pressure (24.5%). Routine health check is not common among low income adults in rural coastal communities in Semporna. The findings suggest public health initiatives should emphasize access to and the necessity of routine health checks for those aged 40 years.
Collapse
Affiliation(s)
- Hazriani Harris
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Yasmin B H Ooi
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia.
| | - Jau-Shya Lee
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Patricia Matanjun
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia
| |
Collapse
|
41
|
Liew SJ, Lee JT, Tan CS, Koh CHG, Van Dam R, Müller-Riemenschneider F. Sociodemographic factors in relation to hypertension prevalence, awareness, treatment and control in a multi-ethnic Asian population: a cross-sectional study. BMJ Open 2019; 9:e025869. [PMID: 31110091 PMCID: PMC6530395 DOI: 10.1136/bmjopen-2018-025869] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Literature suggested that multi-ethnic Western populations experienced differential hypertension outcomes, but evidence is limited in Asia. This study was aimed to determine sociodemographic correlates of hypertension and its awareness, treatment and control among a multi-ethnic Asian population living in Singapore. SETTING We used cross-sectional data of participants from the Multi-Ethnic Cohort (MEC) (n=14 530) recruited in Singapore between 2004 and 2010. PARTICIPANTS Participants who completed questionnaire and attended health examination, without cardiovascular diseases, cancer, stroke, renal failure, asthma and mental illnesses were included in the study. Multivariable logistic regression models were used to determine sociodemographics factors associated with hypertension, unawareness of having hypertension, untreated and uncontrolled hypertension. RESULTS Among 10 215 participants (47.2% Chinese, 26.0% Malay and 26.8% Indian), hypertension prevalence was estimated to be 31.1%. Older age, Malay ethnicity, male, lower educational level and being homemaker or retired/unemployed were factors significantly associated with hypertension. Stratified analysis suggested that age and education were consistently associated with hypertension across all ethnic groups. The proportions of being unaware, untreated and uncontrolled were 49.0%, 25.2% and 62.4%, respectively. Ethnicity and younger age were associated with unawareness; younger age, male and lower educational level were associated with untreated hypertension and older age was associated with uncontrolled hypertension. CONCLUSIONS In this study, ethnic differences in relation to hypertension were associated with sociodemographic variability in ethnic groups. Age and educational level were consistent correlates of hypertension in all ethnic groups. Unawareness and uncontrolled hypertension were common in this Asian population and associated with sociodemographic factors. More targeted strategies may be required to overcome the observed disparities.
Collapse
Affiliation(s)
- Seaw Jia Liew
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
| | - John Tayu Lee
- School of Population and Global Health, Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Chuen Seng Tan
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Choon Huat Gerald Koh
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Rob Van Dam
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Falk Müller-Riemenschneider
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
| |
Collapse
|
42
|
Chow ZY, Jun SM, Ching SM, Tan CH, Lee KW, Devaraj NK, Syahida H, Ramachandran V, Hoo FK, Cheong AT, Chia YC. Prevalence, awareness and control of hypertension in Malaysia 1980 – 2017: A Systematic Review and Meta-Analysis.. [DOI: 10.1101/625004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AbstractBackgroundHypertension is a common public health problem worldwide and is a well-known risk factor for increased risk of cardiovascular diseases, contributing to high morbidity and mortality. However, there is no systematic review and meta-analysis that has been done in a multi-ethnic population like Malaysia. This systematic review aims to determine the trend in prevalence, awareness and control of hypertension in Malaysia.MethodsSystematic searches were conducted in PubMed, Scopus, Ovid, Cumulative Index to Nursing and Allied Health Literature, Malaysian Medical Repository and Malaysia Citation Index published between 1980 and 2017. All original articles in English were included. Studies included were those on adults aged 18 years and above. Studies of prevalence in children and adolescents and pregnancy related hypertension were excluded. Two authors independently reviewed the studies, carried out data extraction and performed quality assessment. Heterogeneity between studies and publication bias was assessed and effect size was pooled by the random effect model.ResultsFifty-six studies with a total of 241,796 subjects were included. The prevalence of hypertension throughout Malaysia varied (I2= 99.3%). The overall pooled prevalence of hypertension over the past 4 decades was 28.2% in adults aged 18 years and older (95% CI: 26.1 – 33.3) and the prevalence in those 30 years and older was 40.0% (95% CI: 35.3-44.8).For subgroup analysis, the prevalence of hypertension in male aged 18 and above was 31.4% (95% CI: 26.5 - 36.2) and 27.8% in female (95% CI: 20.7 – 34.9). The prevalence of hypertension among the ethnic groups aged 18 years and above were 37.3% in Malays (95% CI: 32.9 – 41.7); 36.4% in Chinese (95% CI 31.6 - 41.2) and 34.8% in Indians (95% CI: 31.2-38.4). The prevalence of hypertension was the lowest in the 1980s (16.2%, 95% CI: 13.4-19.0%), increases up to 36.8% in the 1990s (95% CI: 6.1-67.5), then came down to 28.7% (95% CI: 21.7-35.8) in the 2000s and 29.2% (95% CI: 24.0-34.4) in the 2010s. The prevalence of awareness was 38.7% (95% CI: 31.7 – 45.8) whereas the control of hypertension of those on treatment was 33.3% (95% CI: 28.4 – 38.2).ConclusionThree in 10 adults aged 18 years old and above have hypertension, whereas four in 10 adults aged 30 years old and above have hypertension. Four out of 10 are aware of their hypertension status and only one-third of them who were under treatment achieved control of their hypertension. Concerted efforts by policymakers and healthcare professionals to improve the awareness and control of hypertension should be of high priority.
Collapse
|
43
|
Buang NFB, Rahman NAA, Haque M. Knowledge, attitude and practice regarding hypertension among residents in a housing area in Selangor, Malaysia. Med Pharm Rep 2019; 92:145-152. [PMID: 31086842 PMCID: PMC6510368 DOI: 10.15386/mpr-1227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/18/2019] [Accepted: 03/12/2019] [Indexed: 12/20/2022] Open
Abstract
Background and aims Hypertension is becoming a global epidemic and threat to the world population. This cross-sectional study was carried out at a housing area in Selangor, Malaysia to study the knowledge, attitude and practice (KAP) regarding hypertension among the residents. Methods A total of 110 respondents aged 18 years old and above were selected by convenience sampling. Data was collected using a structured interviewer-guided questionnaire with Likert-scale choices of answers. Results All respondents were Malay with the mean age of 41 years [Standard Deviation (SD)=11.828]. The total mean and SD of knowledge, attitude and practice scores were 74.33 (SD=6.25), 44.22 (SD=5.05) and 27.55 (SD=2.86), respectively. There were significant positive correlations between knowledge with attitude (r=+0.393; p<0.001) and practice (r=+0.378; p<0.001). However, there was no significant correlation between attitude and practice (r=+0.120; p=0.212). There were significant fair positive correlations between age with knowledge (r=+0.402; p<0.001), attitude (r=+0.265; p=0.005) and practice (r=+0.337; p<0.001) regarding hypertension. Meanwhile, gender, educational level, employment status and family history had no significant association with knowledge, attitude and practice regarding hypertension. Conclusion This study revealed that KAP regarding hypertension were associated with age, but not with other socio-demographic characteristics studied. The awareness, prevention and control programs of hypertension in their community should be increased, so that the residents could enjoy and maintain the healthy lifestyle.
Collapse
Affiliation(s)
- Nurul Fatin Binti Buang
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang, Malaysia
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah Of Allied Health Sciences, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang, Malaysia
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan National Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
| |
Collapse
|
44
|
Blood pressure lowering effect of Ficus deltoidea var kunstleri in spontaneously hypertensive rats: possible involvement of renin-angiotensin-aldosterone system, endothelial function and anti-oxidant system. Mol Biol Rep 2019; 46:2841-2849. [PMID: 30977084 DOI: 10.1007/s11033-019-04730-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/28/2019] [Indexed: 12/20/2022]
Abstract
This study investigated the effects of a standardised ethanol and water extract of Ficus deltoidea var. Kunstleri (FDK) on blood pressure, renin-angiotensin-aldosterone system (RAAS), endothelial function and antioxidant system in spontaneously hypertensive rats (SHR). Seven groups of male SHR were administered orally in volumes of 0.5 mL of either FDK at doses of 500, 800, 1000 and 1300 mg kg- 1, or captopril at 50 mg kg- 1 or losartan at 10 mg kg- 1 body weight once daily for 4 weeks or 0.5 mL distilled water. Body weight, systolic blood pressures (SBP) and heart rate (HR) were measured every week. 24-hour urine samples were collected at weeks 0 and 4 for electrolyte analysis. At week 4, sera from rats in the control and 1000 mg kg- 1 of FDK treated groups were analyzed for electrolytes and components of RAAS, endothelial function and anti-oxidant capacity. SBP at week 4 was significantly lower in all treatment groups, including captopril and losartan, when compared to that of the controls. Compared to the controls, ACE activity and concentrations of angiotensin I, angiotensin II and aldosterone were lower whereas concentrations of angiotensinogen and angiotensin converting enzyme 2 were higher in FDK treated rats. Concentration of eNOS and total anti-oxidant capacity were higher in FDK treated rats. Urine calcium excretion was higher in FDK treated rats. In conclusion, it appears that ethanol and water extract of FDK decreases blood pressure in SHR, which might involve mechanisms that include RAAS, anti-oxidant and endothelial system.
Collapse
|
45
|
Evaluation of a group-based hypertension self-management education programme among hypertensive community dwellers. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
46
|
Lv X, Niu H, Qu Y, Li M, Li L, Ma X, Jiang S, Gao C, Wang R, Zhang P, Li B. Awareness, treatment and control of hypertension among hypertensive patients aged 18 to 59 years old in the northeast of China. Sci Rep 2018; 8:17019. [PMID: 30451878 PMCID: PMC6243001 DOI: 10.1038/s41598-018-34923-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 10/26/2018] [Indexed: 01/22/2023] Open
Abstract
Hypertension not only has a high prevalence, but also brings disease burden to the affected patients. To assess the level of awareness, treatment and control of hypertension in the northeast of China, we investigated the rates of awareness, treatment and control of hypertension and identified its related factors among hypertensive patients aged 18 to 59 years old in Jilin, China. The data (n = 4632) for the present study were extracted from a cross-sectional study in Jilin. Among individuals with hypertension, the standardized rates of awareness, treatment and control of hypertension were 44.9%, 36.5%, 24.3%, respectively. The rates of awareness and treatment of hypertension among middle aged patients were higher than those among young patients. Compared to patients with normal Body Mass index (BMI), obese hypertensive patients had a higher rate of treatment (43.7% vs. 25.9%) and a lower rate of control (18.9% vs. 29.6%). Compared to patients with normal BMI, patients who were obese were more likely to take measures to treat hypertension (OR = 2.50, 95%CI: 2.05-3.05); but were less likely to have well-controlled blood pressure (OR = 0.55, 95%CI: 0.40-0.78). BMI is one of the influencing factors of hypertension awareness, treatment and control among patients 18 to 59 years old with hypertension.
Collapse
Affiliation(s)
- Xin Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
- Jilin Women and Children Health Hospital, Changchun, 130061, China
| | - Huikun Niu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Yangming Qu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Meiqi Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Lu Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Xiaoyu Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Shan Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Chunshi Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Rui Wang
- Department of Thoracic Surgery, the First Hospital of Jilin University, Changchun, 130021, China
| | - Peng Zhang
- Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, 130021, China
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China.
| |
Collapse
|
47
|
Ab Majid NL, Omar MA, Khoo YY, Mahadir Naidu B, Ling Miaw Yn J, Rodzlan Hasani WS, Mat Rifin H, Abd Hamid HA, Robert Lourdes TG, Mohd Yusoff MF. Prevalence, Awareness, Treatment and Control of hypertension in the Malaysian population: findings from the National Health and Morbidity Survey 2006-2015. J Hum Hypertens 2018; 32:617-624. [PMID: 29899376 PMCID: PMC6150908 DOI: 10.1038/s41371-018-0082-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 01/27/2023]
Abstract
Hypertension is strongly associated with chronic diseases such as myocardial infarction, stroke, heart failure, and renal failure. The objective of this study is to determine the trend of prevalence, awareness, treatment, and control of hypertension among Malaysian population since 2006 to 2015. The study used the data from National Health and Morbidity Survey (NHMS) 2006, 2011, and 2015. It was a cross-sectional with two-stage stratified random sampling throughout Malaysia for eligible respondents 18 years old and above. Respondents were interviewed face to face and blood pressure was recorded as the average reading from two electronic pressure monitoring measurements. Data was analyzed using the Complex sample module in SPSS Version 20. The prevalence of hypertension in Malaysia was 34.6% (95% CI: 33.9, 35.3) in 2006, 33.6% (95% CI: 32.6, 34.6) in 2011 and 35.3% (95% CI: 34.5, 36.3) in 2015. Awareness of hypertension in 2006, 2011, and 2015 was 35.6% (95% CI: 34.6, 36.6), 40.7% (95% CI: 39.3, 42.1), and 37.5% (95% CI: 36.1, 38.9) respectively. The trend of receiving treatment from 2006 to 2015 was 78.9% (95% CI: 77.5, 80.2) to 83.2% (95% CI: 81.3, 84.8). The control of hypertension increased significantly from 27.5% (95% CI: 25.9, 29.2) in 2006 to 37.4% (95% CI: 35.3, 39.5) in 2015. Despite higher proportions receiving treatment over time, the control of hypertension remained below 40% since NHMS 2006 until 2015. The strategies to further reduce the prevalence and increase awareness of hypertension should be enhanced particularly among the targeted age group to ensure early detection, treatment, and control thus preventing from long-term complications.
Collapse
Affiliation(s)
| | | | - Yi Yi Khoo
- University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Understanding the Relationship between Atherogenic Index of Plasma and Cardiovascular Disease Risk Factors among Staff of an University in Malaysia. J Nutr Metab 2018; 2018:7027624. [PMID: 30116641 PMCID: PMC6079547 DOI: 10.1155/2018/7027624] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/20/2018] [Indexed: 11/17/2022] Open
Abstract
Background Atherogenic index of plasma (AIP) was found to be one of the strongest markers in predicting the cardiovascular disease (CVD) risk. This study was to determine the AIP and its relationship with other CVD risk factors. Materials and Methods This cross-sectional study was done among 349 staff of a public university in Sarawak. Data were collected using questionnaire, blood sampling, and anthropometric and blood pressure measurement. Data were analyzed using IBM SPSS version 20. Results A total of 349 respondents participated with majority females (66.8%), aged 38.5 ± 7.82 years. Nearly 80% of the respondents were overweight and obese, 87.1% with high and very high body fat, and 46.9% with abnormal visceral fat. For AIP category, 8.9% were found to be in intermediate and 16.4% were at high risk. Elevated lipid profile showed that total cholesterol (TC) is 15.5%, low density lipoprotein (LDL) is 16.1%, and triglyceride (TG) is 10.6%. AIP was significantly correlated with body mass index (r=0.25), visceral fat (r=0.37), TC (r=0.22), LDL (0.24), HDL (r=-0.72), TG (r=0.84), glucose (r=0.32), systolic blood pressure (r=0.22), and diastolic blood pressure (r=0.28). Conclusion It indicated that AIP is associated with other CVD risk factors. Modification of lifestyle is strongly recommended.
Collapse
|
49
|
Zhao L, Sun W, Wang J, Wu J, Zhang Y, Liu Y, Liu B. Differences in the treatment and control of hypertension in urban and rural residents of the northeastern region of the People's Republic of China: a cross-sectional study. Clin Exp Hypertens 2018; 41:366-372. [PMID: 29939765 DOI: 10.1080/10641963.2018.1489544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Hypertension is a significant global public health problem and an important risk factor for cardiovascular diseases. We aimed to determine treatment and control rates of hypertension and to explore related risk factors by urban and rural areas. METHODS A cross-sectional survey of 14,956 participants (≥ 15 years) was conducted in Jilin Province, China from July 2014 to December 2015 using questionnaire forms and physical measurements. RESULTS Total rates of hypertension treatment, control, and controlled blood pressure among treated subjects were 31.7%, 8.8%, and 27.9% in the Jilin Province. Rates of hypertension treatment, control, and controlled blood pressure among treated subjects were 35.9%, 13.7%, and 38.3% in urban areas and 28.4%, 5.0%, and 17.5% in rural areas, respectively. Higher treatment of hypertension was associated with older age, female sex, other races (except Han), and higher body fat percentage in both areas. Among urban residents, higher education was additionally associated with higher treatment of hypertension; among rural residents, a family history of coronary artery disease and unemployment were associated with higher treatment of hypertension. Higher control of hypertension was associated with unemployment, married status, higher education, healthy body mass index, lower abdominal waist circumference, non-smoking status, and lower visceral adiposity index in urban residents; higher control of hypertension was associated with younger age in rural residents. CONCLUSION Treatment and control rates of hypertension in urban and rural areas were lower than the national average; blood pressure control in patients taking antihypertensive drugs needs further improvement.
Collapse
Affiliation(s)
- Lei Zhao
- a Department of Cardiology , the Second Hospital of Jilin University , Changchun , China
| | - Wei Sun
- a Department of Cardiology , the Second Hospital of Jilin University , Changchun , China
| | - Junnan Wang
- a Department of Cardiology , the Second Hospital of Jilin University , Changchun , China
| | - Junduo Wu
- a Department of Cardiology , the Second Hospital of Jilin University , Changchun , China
| | - Yangyu Zhang
- b Department of Epidemiology and Biostatistics, School of Public Health , Jilin University , Changchun , China
| | - Yingyu Liu
- b Department of Epidemiology and Biostatistics, School of Public Health , Jilin University , Changchun , China
| | - Bin Liu
- a Department of Cardiology , the Second Hospital of Jilin University , Changchun , China
| |
Collapse
|
50
|
Wang J, Sun W, Wells GA, Li Z, Li T, Wu J, Zhang Y, Liu Y, Li L, Yu Y, Liu Y, Qi C, Lu Y, Liu N, Yan Y, Liu L, Hui G, Liu B. Differences in prevalence of hypertension and associated risk factors in urban and rural residents of the northeastern region of the People's Republic of China: A cross-sectional study. PLoS One 2018; 13:e0195340. [PMID: 29621328 PMCID: PMC5886571 DOI: 10.1371/journal.pone.0195340] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/20/2018] [Indexed: 02/01/2023] Open
Abstract
Background Hypertension is a significant global public health problem and recognized as an important risk factor for cardiovascular diseases. This study was designed to assess the current prevalence of hypertension and to explore risk factors associated with hypertension by urban and rural status to guide the prevention and control of hypertension in Jilin province. Methods A multi-stage stratified random cluster sampling method was used to obtain data on hypertension, which was investigated by physical examination and face-to-face questionnaire in July 2014-December 2015. Sample data were analyzed by complex weighted statistical analysis to estimate blood pressure levels and prevalence of hypertension in the province. Multivariable logistic regression analysis was used to identify factors influencing hypertension rates. Results The prevalence of hypertension was significantly higher in rural areas than urban areas (25.93% versus 22.73%, respectively). The rates of hypertension known (46.7% versus 38.1%, respectively), control (13.7% versus 5.0%, respectively), and controlled among treated subjects (38.3% versus 17.5%, respectively) were higher in urban areas than in rural areas (all p < 0.001), while the treatment rate was not statistically significantly different between urban and rural areas (35.9% versus 28.4%, respectively). After adjusting for demographic covariates, hypertension prevalence in rural areas was still significantly greater than in urban areas (adjusted OR = 1.22; 95%CI: 1.10, 1.36; p < 0.001). Common risk factors for hypertension among urban and rural residents included older age; male; married; employed; less education; overweight/obese; greater abdominal waist circumference; family history of hypertension, stroke, or coronary heart disease; current smoker; alcohol consumption; higher visceral adiposity index; and higher body fat percentage. Conclusions This study identified an increased risk for hypertension in rural regions of Jilin province, suggesting that rural hypertension screening and treatment guidelines should receive greater attention.
Collapse
Affiliation(s)
- Junnan Wang
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Sun
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - George A. Wells
- Department of Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Zhibo Li
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Tianyi Li
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Junduo Wu
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yangyu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yingyu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Longbo Li
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yunpeng Yu
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yihang Liu
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Chao Qi
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yang Lu
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Ning Liu
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Youyou Yan
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Lulu Liu
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Gang Hui
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Bin Liu
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
- * E-mail:
| |
Collapse
|