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Rajadhyaksha GC, Reddy H, Singh AK, Oomman A, Adhyapak SM. The Indian registry on current patient profiles & treatment trends in hypertension (RECORD): One year interim analysis. Indian J Med Res 2023; 158:244-255. [PMID: 37861623 PMCID: PMC10720968 DOI: 10.4103/ijmr.ijmr_3096_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Indexed: 10/21/2023] Open
Abstract
Background & objectives In India, hypertension constitutes a significant health burden. This observational, non-interventional, prospective study was conducted in five centres across India to evaluate the current clinical practices for the management of hypertension. Methods Participants were enrolled if they were newly diagnosed with essential hypertension or had pre-existing hypertension and were on the same therapeutic plan for the previous three months. At baseline, three months, six months, and one year, information on the patient and their treatment regimen was documented, and their quality of life (QoL) was evaluated. Results A total of 2000 individuals were enrolled in this study, with a mean age of 54.45 yr. Of these, 55.7 per cent (n=1114) were males, and 957 (47.85%) were newly diagnosed with hypertension, while 1043 (52.15%) had pre-existing hypertension. Stage 2 hypertension (systolic blood pressure (BP) >140 or diastolic BP ≥90 mmHg) accounted for more than 70 per cent of the participants (70.76% of pre-existing and 76.29% of newly diagnosed); the average duration of pre-existing hypertension was 68.72 months. Diabetes (31.6%) and dyslipidaemia (15.8%) were the most common comorbidities. In 43.3 per cent of the participants, monotherapy was used, and in 56.7 per cent (70.55% fixed-dose combination), combination therapy was used. Telmisartan (31.6%), amlodipine (35.2%), and a combination of the two (27.1%) were the most commonly prescribed treatment regimens. At three months, six months, and one year, treatment modifications were observed in 1.4, 1.05, and 0.23 per cent of the participants receiving monotherapy and 2.74, 4.78 and 0.35 per cent receiving combination therapy, respectively. In both groups, the proportion of individuals with controlled hypertension (≤140/90 mmHg) increased by more than 30 per cent after a year. At one year, physical and emotional role functioning, social functioning, and health improved considerably. Interpretation & conclusions Combination therapy for hypertension is increasingly preferred at the time of initial diagnosis. The efficacy, safety, and tolerance of the recommended medications were reflected by improvements in the QoL and the minimal changes in the therapeutic strategy required.
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Affiliation(s)
| | - Himanshu Reddy
- Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Amresh Kumar Singh
- Department of Cardiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abraham Oomman
- Department of Cardiology, Apollo Hospitals, Chennai, Tamil Nadu, India
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Kar MB, Aruna M, Kunar BM. Structural equation modelling of work related musculoskeletal disorders among dumper operators. Sci Rep 2023; 13:14055. [PMID: 37640737 PMCID: PMC10462743 DOI: 10.1038/s41598-023-40507-9] [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: 06/02/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
The aim of this study is to investigate the impact of personal factors, habitual factors, and work-related factors on work-related musculoskeletal disorders (WRMSDs) among dumper operators. In total, 248 dumper operators working in an iron ore mine were considered for this study. A questionnaire was developed and administered to collect dumper operators' personal, habitual, and work-related data. The reliability of the questionnaire was cross-checked by Cronbach alpha and the test-retest method. The values of Cronbach alpha for all latent variables were above 0.7, and the correlation coefficient of the questionnaire items at Time 1 and Time 2 was above 0.82. After verifying the validity (i.e., convergent and divergent) of the questionnaire data, the relationship between the factors under consideration was examined by structural equation modeling (SEM). The SEM demonstrated a moderate fit, with [Formula: see text] value of 1.386, comparative fit index (CFI) of 0.86, goodness-of-fit index (GFI) of 0.72, adjusted goodness-of-fit index (AGFI) of 0.69, Tucker-Lewis Index (TLI) of 0.83, normed fit index (NFI) of 0.71 and root mean square error of approximation (RMSEA) of 0.051. The SEM analysis revealed a positive relationship between WRMSDs and personal factors (with path coefficient = 0.313 and p < 0.05) as well as work-related factors (with path coefficient = 0.296 and p < 0.05). However, the relationship between WRMSDs and habitual factors was not statistically significant (with path coefficient = 0.142 and p > 0.05). Overall, this study provides valuable insights into the factors that influence the prevalence of WRMSDs among dumper operators. The findings highlight the significance of personal and work-related factors by which one can make a positive decision to prevent and reduce the incidence of WRMSDs among dumper operators.
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Affiliation(s)
- Mohith Bekal Kar
- Department of Mining Engineering, NITK Surathkal, Mangaluru, India.
| | - Mangalpady Aruna
- Department of Mining Engineering, NITK Surathkal, Mangaluru, India
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Amini F, Khajevand Khoshli A, Asadi J, Bahar A, Najafipour H, Mirzazadeh A. Obesity Mediates the Effect of Past and Current Mental Health on Diabetes Treatment Outcomes. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:2608-2618. [PMID: 36561260 PMCID: PMC9745415 DOI: 10.18502/ijph.v51i11.11180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022]
Abstract
Background Anxiety and depression (A&D) are common among patients with diabetes (DM). We assessed the mediatory effect of obesity on the pathway between past and current mental health (as measured by A&D) on self-care DM treatment adherence and DM treatment failure. Methods We used data collected in two rounds (2009-12, 2014-2018) of a population-based cohort study in Kerman, Iran (KERCADRS). By a random cluster sampling approach, 5900 residents of Kerman aged 15 to 75 yr were recruited to the study to measure demographic characteristics, body measures (to calculate BMI), adherence to DM treatment, and symptoms for A&D (Beck questionnaires). Fasting blood also collected for biochemical tests and glycemic control (as an indicator for treatment failure). We used path analysis and Structural Equation Modeling (SEM) for analysis. Results We analyzed data for 264 patients with diabetes who attended in both study rounds. While only 5.7% reported not adherence to DM treatment, 67.9% had diabetes treatment failure. Past mental health had a significant positive association with HbA1c (standard beta coefficient for total effect =0.148, P=0.044), of which 42% was indirect effect through obesity. Current mental health had a positive association with current no adherence to diabetes treatment (standard beta coefficient for total effect=0.077, P=0.001). Conclusion Our study showed an important indirect path from A&D to diabetes treatment failure outcome which mediated by obesity. Screening for A&D symptoms and treating those as well as obesity among patients with diabetes may improve glycemic control.
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Affiliation(s)
- Fatemeh Amini
- Department of Psychology, Gorgan Branch, Islamic Azad University, Gorgan, Iran,Corresponding Author:
| | | | - Javanshir Asadi
- Department of Psychology, Gorgan Branch, Islamic Azad University, Gorgan, Iran
| | - Adeleh Bahar
- Department of Internal Medicine, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Najafipour
- Department of Physiology, Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
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Structural modeling for Oxford histological classifications of immunoglobulin A nephropathy. PLoS One 2022; 17:e0268731. [PMID: 36084046 PMCID: PMC9462802 DOI: 10.1371/journal.pone.0268731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/16/2022] [Indexed: 12/03/2022] Open
Abstract
In immunoglobulin A nephropathy (IgAN), Cox regression analysis can select independent prognostic variables for renal functional decline (RFD). However, the correlation of the selected histological variables with clinical and/or treatment variables is unknown, thereby making histology-based treatment decisions unreliable. We prospectively followed 946 Japanese patients with IgAN for a median of 66 mo. and applied structural equation modeling (SEM) to identify direct and indirect effects of histological variables on RFD as a regression line of estimated glomerular filtration rate (eGFR) via clinical variables including amount of proteinuria, eGFR, mean arterial pressure (MAP) at biopsy, and treatment variables such as steroid therapy with/without tonsillectomy (ST) and renin–angiotensin system blocker (RASB). Multi-layered correlations between the variables and RFD were identified by multivariate linear regression analysis and the model’s goodness of fit was confirmed. Only tubular atrophy/interstitial fibrosis (T) had an accelerative direct effect on RFD, while endocapillary hypercellularity and active crescent (C) had an attenuating indirect effect via ST. Segmental sclerosis (S) had an attenuating indirect effect via eGFR and mesangial hypercellularity (M) had accelerative indirect effect for RFD via proteinuria. Moreover, M and C had accelerative indirect effect via proteinuria, which can be controlled by ST. However, both T and S had additional indirect accelerative effects via eGFR or MAP at biopsy, which cannot be controlled by ST. SEM identified a systemic path links between histological variables and RFD via dependent clinical and/or treatment variables. These findings lead to clinically applicable novel methodologies that can contribute to predict treatment outcomes using the Oxford classifications.
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Radziuk J. Prediction of incident diabetes risk and structural equation modelling. Am J Med Sci 2022; 364:249-250. [PMID: 35561812 DOI: 10.1016/j.amjms.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 04/22/2022] [Accepted: 05/04/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Jerry Radziuk
- Deptartment of Medicine, University of Ottawa and The Ottawa Hospital, 1053 Carling Ave, Ottawa K1Y 4E9, ON, Canada.
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Al-Harrasi A, Pinto AD, Jayapal SK, Morsi M, Al-Mawali A. Structural Equation Modeling to Identify the Direct and Indirect Risk Factors of Diabetes in Adults: Findings from a National Survey. Am J Med Sci 2022; 364:274-280. [DOI: 10.1016/j.amjms.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/01/2022] [Accepted: 03/08/2022] [Indexed: 12/14/2022]
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Ho YCL, Lee VSY, Ho MHR, Lin GJ, Thumboo J. Towards a Parsimonious Pathway Model of Modifiable and Mediating Risk Factors Leading to Diabetes Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010907. [PMID: 34682644 PMCID: PMC8536137 DOI: 10.3390/ijerph182010907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022]
Abstract
Modifiable risk factors are of interest for chronic disease prevention. Few studies have assessed the system of modifiable and mediating pathways leading to diabetes mellitus. We aimed to develop a pathway model for Diabetes Risk with modifiable Lifestyle Risk factors as the start point and Physiological Load as the mediator. As there are no standardised risk thresholds for lifestyle behaviour, we derived a weighted composite for Lifestyle Risk. Physiological Load was based on an index using clinical thresholds. Sociodemographics are non-modifiable risk factors and were specified as covariates. We used structural equation modeling to test the model, first using 2014/2015 data from the Indonesian Family Life Survey. Next, we fitted a smaller model with longitudinal data (2007/2008 to 2014/2015), given limited earlier data. Both models showed the indirect effects of Lifestyle Risk on Diabetes Risk via the mediator of Physiological Load, whereas the direct effect was only supported in the cross-sectional analysis. Specifying Lifestyle Risk as an observable, composite variable incorporates the cumulative effect of risk behaviour and differentiates this study from previous studies assessing it as a latent construct. The parsimonious model groups the multifarious risk factors and illustrates modifiable pathways that could be applied in chronic disease prevention efforts.
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Affiliation(s)
- Yi-Ching Lynn Ho
- Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore; (V.S.Y.L.); (G.J.L.); (J.T.)
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd., Singapore 169857, Singapore
- Correspondence:
| | - Vivian Shu Yi Lee
- Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore; (V.S.Y.L.); (G.J.L.); (J.T.)
| | - Moon-Ho Ringo Ho
- School of Social Sciences, Nanyang Technological University, 48 Nanyang Ave., Singapore 639818, Singapore;
| | - Gladis Jing Lin
- Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore; (V.S.Y.L.); (G.J.L.); (J.T.)
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd., Singapore 169857, Singapore
| | - Julian Thumboo
- Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore; (V.S.Y.L.); (G.J.L.); (J.T.)
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Rd., Singapore 169608, Singapore
- Medicine Academic Clinical Programme, Duke-NUS Medical School, 8 College Rd., Singapore 169857, Singapore
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Xiao L, Le C, Wang GY, Fan LM, Cui WL, Liu YN, Shen JR, Golden AR. Socioeconomic and lifestyle determinants of the prevalence of hypertension among elderly individuals in rural southwest China: a structural equation modelling approach. BMC Cardiovasc Disord 2021; 21:64. [PMID: 33530935 PMCID: PMC7851929 DOI: 10.1186/s12872-021-01885-y] [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: 10/26/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background This study examines the association between socioeconomic and lifestyle factors and the prevalence of hypertension among elderly individuals in rural Southwest China. Methods A cross-sectional survey of 4833 consenting adults aged ≥ 60 years in rural regions of Yunnan Province, China, was conducted in 2017. Data on individual socioeconomic status, sleep quality, physical activity level, and family history of hypertension were collected with a standardized questionnaire. Blood pressure, fasting blood glucose, height, weight, and waist circumference were also measured. An individual socioeconomic position (SEP) index was constructed using principal component analysis. Structural equation modelling (SEM) was applied to analyse the association between socioeconomic and lifestyle factors and the prevalence of hypertension. Results The overall prevalence of hypertension was 50.6% in the study population. Body fat distribution, including measures of obesity and central obesity, had the greatest total effect on hypertension (0.21), followed by family history of hypertension (0.14), biological sex (0.08), sleep quality (− 0.07), SEP (− 0.06), physical inactivity (0.06), and diabetes (0.06). Body fat distribution, SEP, and family history of hypertension had both direct and indirect effects on hypertension, whereas physical inactivity, diabetes, and sleep quality were directly associated with the prevalence of hypertension. Biological sex was indirectly associated with the prevalence of hypertension. Conclusions SEP, body fat distribution, physical inactivity, diabetes, and sleep quality critically influence the prevalence of hypertension. Future interventions to prevent and control hypertension should give increased attention to individuals with low SEP and should focus on controlling diabetes and obesity, increasing physical activity levels, and improving quality of sleep among older adults aged ≥ 60 years in rural Southwest China.
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Affiliation(s)
- Li Xiao
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China.,First Affiliated Hospital of Dali Medical University, Dali, China
| | - Cai Le
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China.
| | - Gui-Yi Wang
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Lu-Ming Fan
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Wen-Long Cui
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Ying-Nan Liu
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Jing-Rong Shen
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Allison Rabkin Golden
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
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Paudel S, Tran T, Owen AJ, Smith BJ. The contribution of physical inactivity and socioeconomic factors to type 2 diabetes in Nepal: A structural equation modelling analysis. Nutr Metab Cardiovasc Dis 2020; 30:1758-1767. [PMID: 32636120 DOI: 10.1016/j.numecd.2020.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Type 2 diabetes mellitus (T2DM) is emerging as a significant public health challenge in Nepal. Behavioural, social and economic changes are likely to play a part in the rise of this chronic disease, as they are in many developing countries. A better understanding of the relationship between physical activity (PA), socioeconomic factors and T2DM can inform the design of prevention programs. This study aimed to identify the path relationships between PA, socioeconomic position, anthropometric and metabolic variables and T2DM. METHODS AND RESULTS This study analysed data from 1977 Nepalese adults aged 40-69 years from the cross-sectional WHO STEPS survey undertaken in 2013. The latent variable "PA" was created using the information on domains of PA while the latent variable "socioeconomic position" was created using the variables education, occupation and ethnicity. Participants' fasting blood glucose was used to determine their diabetes status. Structural equation modelling was conducted, and correlations and adjusted regression coefficients are reported. Individuals with higher education, in paid employment and from advantaged ethnic groups were more likely to have T2DM. Waist circumference, triglycerides and hypertension were found to have a statistically significant positive direct effect on T2DM. PA had indirect effects on T2DM, mediated by waist circumference. The indirect effects of socioeconomic position on T2DM were mediated by body mass index, waist circumference, triglycerides and total cholesterol. CONCLUSION Among Nepalese adults, higher socioeconomic position had a significant direct effect on T2DM, while both PA and higher socioeconomic position had significant indirect effects. Policies and programs to address T2DM in Nepal should address the factors contributing to unhealthy weight status, particularly among those of higher socioeconomic status.
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Affiliation(s)
- Susan Paudel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ben J Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Oruganti A, Kavi A, Walvekar PR. Risk of developing Diabetes Mellitus among urban poor South Indian population using Indian Diabetes Risk Score. J Family Med Prim Care 2019; 8:487-492. [PMID: 30984660 PMCID: PMC6436280 DOI: 10.4103/jfmpc.jfmpc_388_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Diabetes mellitus is increasing its share of burden to the health-related problems in developing countries such as India. Urban slum residents constitute the “vulnerable population” who lack the basic health amenities. Lack of effective screening for primary prevention has been one of the reasons for the rising burden. Materials and Methods: The cross-sectional study was conducted among 400 adults aged between 30 and 60 years residing in a settled slum of Rukmini Nagar area of Belagavi city, Karnataka. Data were collected after taking written informed consent from each participant using a pretested questionnaire that included demographic information and details of the risk factors. Risk of developing diabetes was assessed by using Indian Diabetes Risk Score. Results are expressed as proportions, and analysis was done using Chi-square test and multiple logistic regression analysis. Results: The mean age of participants was 44.3 ± 8.7 years. The proportion of low, moderate, and high risk of developing diabetes mellitus was 7%, 63%, and 30%, respectively. The prevalence of newly diagnosed cases was 10.25%. Moreover, 57.1% of them with positive family history were in the high risk category; 76.9% of the sedentary workers were at higher risk; overweight and obese individuals had higher proportion of the high and moderate risk (P < 0.0001). Correlation coefficient (R) was 0.782, and coefficient of determination (R2) was 0.61. Conclusions: Our study demonstrated that advancing age, low physical activity, family history, overweight, and obesity were the prominent factors that predicted the risk of diabetes in the near future. Hence, focused interventions for urban slum dwellers are imperative and draw special attention.
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Affiliation(s)
- Aditya Oruganti
- Department of Community Medicine, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi, Karnataka, India
| | - Avinash Kavi
- Department of Community Medicine, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi, Karnataka, India
| | - Padmaja R Walvekar
- Department of Community Medicine, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi, Karnataka, India
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