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Ransome Y, Martinez-Brockman JL, Galusha D, Thompson TA, Adams OP, Nazario CM, Nunez M, Nunez-Smith M, Maharaj RG. Prevalence and correlates of alcohol use among the elderly in the Eastern Caribbean Health Outcomes Research Network (ECHORN) cohort study. Addict Behav 2024; 153:108001. [PMID: 38447411 DOI: 10.1016/j.addbeh.2024.108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/17/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Alcohol use is pervasive in the Caribbean; however, the prevalence and correlates of alcohol use and drinking problems in the elderly have not been extensively studied. METHODS Data were obtained from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study, a cohort study of Caribbean people from Puerto Rico, Barbados, Trinidad, and Tobago, and the U.S. Virgin Islands, collected between 2013 and 2018 (baseline study sample, ages 60+, n = 811). Descriptive statistics were used to compare the differences in drinking status (current vs. former vs. never), alcohol problems (Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) scale score ≥2 vs. <2), and binge drinking days (0 days vs. 1-2 days vs. ≥3 days) across sample characteristics. Logistic regression analyses estimated the association of these alcohol measures with sociodemographic (e.g., sex), psychological (depression), and cultural (e.g., religion) correlates. RESULTS Thirty-six percent were 70 + years of age, 64 % were female, and 41 % had less than a high school education. Alcohol problems (≥2 CAGE score) was 21 %. Binge drinking ≥3 days was 30.6 %. Never attending religious services (vs. attending once a week or more) was associated with almost three times higher odds of alcohol problems (adjusted Odds Ratio: OR = 2.88, 95 % CI = 1.02, 8.15) four times higher odds of increasing binge drinking days (aOR = 4.04, 95 % CI = 1.11, 14.96). College education was protective against both the outcomes. CONCLUSION We provide current estimates of alcohol problems among elderly Eastern Caribbean people. Among the sociodemographic, psychological, and cultural correlates examined, religious attendance was significant. Replicate longitudinal studies using DSM-5 alcohol dependence are recommended.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA.
| | - Josefa L Martinez-Brockman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT 06510, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Deron Galusha
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
| | | | - Oswald P Adams
- Department of Family Medicine, Faculty of Medical Sciences, University of the West Indies, Cave Hill BB11000, Barbados.
| | - Cruz M Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico at Medical Sciences Campus, San Juan 00936, PR, USA.
| | - Maxine Nunez
- School of Nursing, University of the Virgin Islands, St. Thomas, VI 00802, USA.
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT 06510, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Rohan G Maharaj
- Department of Paraclinical Sciences, University of the West Indies, Saint Augustine, Trinidad and Tobago.
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Martinez-Brockman JL, Hromi-Fiedler A, Galusha D, Oladele C, Acosta L, Adams OP, Maharaj RG, Nazario CM, Nunez M, Nunez-Smith M, Pérez-Escamilla R. Risk factors for household food insecurity in the Eastern Caribbean Health Outcomes Research Network cohort study. Front Public Health 2023; 11:1269857. [PMID: 38074748 PMCID: PMC10702572 DOI: 10.3389/fpubh.2023.1269857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
Background Globally, 1.3 billion people were considered food insecure as of 2022. In the Caribbean region, the prevalence of moderate or severe food insecurity was 71.3% as of 2020, the highest of all subregions in Latin America. Experienced based measurement scales, like the Latin American and Caribbean Food Security Scale, are efficient measurement tools of food insecurity used globally. The Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study is a population-based longitudinal cohort study in the two Caribbean U.S. territories of Puerto Rico and the U.S. Virgin Islands, as well as in Barbados and Trinidad & Tobago. The purpose of this research was to examine the demographic, psychosocial, behavioral, and environmental risk factors associated with household food insecurity (HFI) among adults ≥40 years of age in the ECHORN cohort. Methods A cross-sectional analysis of baseline ECHORN cohort study data was conducted. The primary outcome was household food insecurity (none, mild, moderate/severe). A total of 16 known and potential risk factors were examined for their association with HFI. The ANOVA and chi-square statistics were used in bivariate analysis. Ordinal logistic regression was used for the multivariable and sex stratified analyses. Results More than one-quarter of the sample (27.3%) experienced HFI. In bivariate analyses, all risk factors examined except for sex, were significantly associated with HFI status. In the multivariable analysis, all variables except sex, education, marital status, smoking status, and residing in Puerto Rico were significant predictors of HFI in the adjusted model. In sex stratified analysis, depression, food availability, self-rated physical health, and island site were significantly associated with increased odds of worsening HFI for women, but not for men. Source of potable water was an important risk factor for both men and women. Discussion The prevalence of HFI in the ECHORN cohort study is comparable to other studies conducted in the region. While women did not have an increased risk of HFI compared to men, a different set of risk factors affected their vulnerability to HFI. More research is needed to understand how water and food security are interrelated in the ECHORN cohort.
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Affiliation(s)
- Josefa L. Martinez-Brockman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Amber Hromi-Fiedler
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
| | - Deron Galusha
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Carol Oladele
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Lisbette Acosta
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
| | - O. Peter Adams
- Department of Family Medicine, Faculty of Medical Sciences, University of the West Indies, Cave Hill, Cave Hill, Barbados
| | - Rohan G. Maharaj
- Department of Paraclinical Sciences, University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Cruz M. Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico at Medical Sciences Campus, San Juan, Puerto Rico
| | - Maxine Nunez
- School of Nursing, University of the Virgin Islands, St. Thomas, US Virgin Islands
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
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Hu JR, Park DY, Agarwal N, Herzig M, Ormseth G, Kaushik M, Giao DM, Turkson-Ocran RAN, Juraschek SP. The Promise and Illusion of Continuous, Cuffless Blood Pressure Monitoring. Curr Cardiol Rep 2023; 25:1139-1149. [PMID: 37688763 PMCID: PMC10842120 DOI: 10.1007/s11886-023-01932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE OF REVIEW Blood pressure (BP) fluctuations outside of clinic are increasingly recognized for their role in the development of cardiovascular disease, syncope, and premature death and as a promising target for tailored hypertension treatment. However, current cuff-based BP devices, including home and ambulatory devices, are unable to capture the breadth of BP variability across human activities, experiences, and contexts. RECENT FINDINGS Cuffless, wearable BP devices offer the promise of beat-to-beat, continuous, noninvasive measurement of BP during both awake and sleep periods with minimal patient inconvenience. Importantly, cuffless BP devices can characterize BP variability, allowing for the identification of patient-specific triggers of BP surges in the home environment. Unfortunately, the pace of evidence, regulation, and validation testing has lagged behind the pace of innovation and direct consumer marketing. We provide an overview of the available technologies and devices for cuffless BP monitoring, considerations for the calibration and validation of these devices, and the promise and pitfalls of the cuffless BP paradigm.
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Affiliation(s)
- Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Nikita Agarwal
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthew Herzig
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - George Ormseth
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Milan Kaushik
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Ruth-Alma N Turkson-Ocran
- Section for Research, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stephen P Juraschek
- Section for Research, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- , 330 Brookline Avenue, CO-1309, #204, MA, 02215, USA.
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Mortazavi BJ, Martinez-Brockman JL, Tessier-Sherman B, Burg M, Miller M, Nowroozilarki Z, Adams OP, Maharaj R, Nazario CM, Nunez M, Nunez-Smith M, Spatz ES. Classification of blood pressure during sleep impacts designation of nocturnal nondipping. PLOS DIGITAL HEALTH 2023; 2:e0000267. [PMID: 37310958 PMCID: PMC10263317 DOI: 10.1371/journal.pdig.0000267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/03/2023] [Indexed: 06/15/2023]
Abstract
The identification of nocturnal nondipping blood pressure (< 10% drop in mean systolic blood pressure from awake to sleep periods), as captured by ambulatory blood pressure monitoring, is a valuable element of risk prediction for cardiovascular disease, independent of daytime or clinic blood pressure measurements. However, capturing measurements, including determination of wake/sleep periods, is challenging. Accordingly, we sought to evaluate the impact of different definitions and algorithms for defining sleep onset on the classification of nocturnal nondipping. Using approaches based upon participant self-reports, applied definition of a common sleep period (12 am -6 am), manual actigraphy, and automated actigraphy we identified changes to the classification of nocturnal nondipping, and conducted a secondary analysis on the potential impact of an ambulatory blood pressure monitor on sleep. Among 61 participants in the Eastern Caribbean Health Outcomes Research Network hypertension study with complete ambulatory blood pressure monitor and sleep data, the concordance for nocturnal nondipping across methods was 0.54 by Fleiss' Kappa (depending on the method, 36 to 51 participants classified as having nocturnal nondipping). Sleep quality for participants with dipping versus nondipping was significantly different for total sleep length when wearing the ambulatory blood pressure monitor (shorter sleep duration) versus not (longer sleep duration), although there were no differences in sleep efficiency or disturbances. These findings indicate that consideration of sleep time measurements is critical for interpreting ambulatory blood pressure. As technology advances to detect blood pressure and sleep patterns, further investigation is needed to determine which method should be used for diagnosis, treatment, and future cardiovascular risk.
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Affiliation(s)
- Bobak J. Mortazavi
- Department of Computer Science & Engineering, Texas A&M University, College Station, Texas, United States of America
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, Texas, United States of America
- Yale/Yale New Haven Health System Corporation Center for Outcomes Research and Evaluation, New Haven, Connecticut, United States of America
| | - Josefa L. Martinez-Brockman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Baylah Tessier-Sherman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Matthew Burg
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Mary Miller
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Zhale Nowroozilarki
- Department of Computer Science & Engineering, Texas A&M University, College Station, Texas, United States of America
| | - O. Peter Adams
- Department of Family Medicine, Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados
| | - Rohan Maharaj
- Department of Paraclinical Sciences, University of the West Indies, Saint Augustine, Trinidad
| | - Cruz M. Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
| | - Maxine Nunez
- School of Nursing, University of the Virgin Islands, US Virgin Islands
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Erica S. Spatz
- Yale/Yale New Haven Health System Corporation Center for Outcomes Research and Evaluation, New Haven, Connecticut, United States of America
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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Almodóvar-Rivera IA, Rosario-Rosado RV, Nazario CM, Hernández-Santiago J, Ramírez-Marrero FA, Nunez M, Maharaj R, Adams P, Martinez-Brockman JL, Tessier-Sherman B, Nunez-Smith M. Development of the Anthropometric Grouping Index for the Eastern Caribbean Population Using the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10415. [PMID: 36012047 PMCID: PMC9408472 DOI: 10.3390/ijerph191610415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Improving public health initiative requires an accurate anthropometric index that is better suited to a specific community. In this study, the anthropometric grouping index is proposed as a more efficient and discriminatory alternative to the popular BMI for the Eastern Caribbean population. A completely distribution-free cluster analysis was performed to obtain the 11 categories, leading to AGI-11. Further, we studied these groups using novel non-parametric clustering summaries. Finally, two generalized linear mixed models were fitted to assess the association between elevated blood sugar, AGI-11 and BMI. Our results showed that AGI-11 tends to be more sensitive in predicting levels of elevated blood sugar compared to BMI. For instance, individuals identified as obese III according to BMI are (POR: 2.57; 95% CI: (1.68, 3.74)) more likely to have elevated blood sugar levels, while, according to AGI, individuals with similar characteristics are (POR: 3.73; 95% CI: (2.02, 6.86)) more likely to have elevated blood sugar levels. In conclusion, the findings of the current study suggest that AGI-11 could be used as a predictor of high blood sugar levels in this population group. Overall, higher values of anthropometric measures correlated with a higher likelihood of high blood sugar levels after adjusting by sex, age, and family history of diabetes.
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Affiliation(s)
| | - Rosa V. Rosario-Rosado
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico at Medical Sciences Campus, San Juan 00936, Puerto Rico
| | - Cruz M. Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico at Medical Sciences Campus, San Juan 00936, Puerto Rico
| | - Johan Hernández-Santiago
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico at Medical Sciences Campus, San Juan 00936, Puerto Rico
| | - Farah A. Ramírez-Marrero
- Department of Exercise Physiology, University of Puerto Rico at Río Piedras, San Juan 00925, Puerto Rico
| | - Maxime Nunez
- School of Nursing, University of the Virgin Islands, St. Thomas, VI 00802, USA
| | - Rohan Maharaj
- Department of Paraclinical Sciences, University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Peter Adams
- Department of Family Medicine, Faculty of Medical Sciences, University of the West Indies, Cave Hill BB11000, Barbados
| | | | - Baylah Tessier-Sherman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT 06510, USA
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Medicine, Yale School of Medicine, New Haven, CT 06510, USA
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Hassan S, Magny-Normilus C, Galusha D, Adams OP, Maharaj RG, Nazario CM, Nunez M, Nunez-Smith M. Glycemic control and management of cardiovascular risk factors among adults with diabetes in the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study. Prim Care Diabetes 2022; 16:107-115. [PMID: 34253484 PMCID: PMC8743302 DOI: 10.1016/j.pcd.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
AIMS To determine the level of glycemic control and cardiovascular (CVD) risk among adults with diabetes in the Eastern Caribbean. METHODS Baseline data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were used for the analysis. ECS participants were 40 years of age and older, residing in the US Virgin Islands, Puerto Rico, Trinidad, or Barbados. Participants completed a survey, physical exam, and laboratory studies. CVD risk was calculated using the Atherosclerotic CVD risk equation. Bivariate analysis followed by multinomial logistic regression was used to assess social and biological factors (education, lifestyle, access to care, medical history) associated with level of glycemic control. RESULTS Twenty-three percent of participants with diabetes had an HbA1c ≥ 9% (>75 mmol/mol). Participants with diabetes had poorly controlled CVD risk factors: 70.2% had SBP ≥ 130 mmHg, 52.2% had LDL ≥ 100 mg/dl (2.59 mmol/L), and 73.2% had a 10-year CVD risk of more than 10%. Age and education level were significant, independent predictors of glycemic control. CONCLUSION There is a high prevalence of uncontrolled diabetes among adults in ECS. The high burden of elevated CVD risk explains the premature mortality we see in the region. Strategies are needed to improve glycemic control and CVD risk factor management among individuals with diabetes in the Caribbean.
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Affiliation(s)
- Saria Hassan
- Yale School of Medicine, Department of Medicine, 100 Church Street South, New Haven, CT 06510, United States; Emory University School of Medicine, Atlanta, GA 30322.
| | - Cherlie Magny-Normilus
- Yale School of Medicine, Department of Medicine, 100 Church Street South, New Haven, CT 06510, United States
| | - Deron Galusha
- Yale School of Medicine, Department of Medicine, 100 Church Street South, New Haven, CT 06510, United States
| | - Oswald P Adams
- University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Rohan G Maharaj
- University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad, Trinidad and Tobago
| | - Cruz M Nazario
- University of Puert Rico, Medical Sciences Campus, Graduate School of Public Health, San Juan, Puerto Rico 00921
| | - Maxine Nunez
- University of the Virgin Islands, School of Nursing, St. Thomas, US Virgin Islands
| | - Marcella Nunez-Smith
- Yale School of Medicine, Department of Medicine, 100 Church Street South, New Haven, CT 06510, United States
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