Validity of self-reported hypertension: findings from the Thai Cohort Study compared to physician telephone interview

Effect of quick acupuncture combined with rehabilitation therapy on improving motor and swallowing function in patients with stroke

OBJECTIVE

To investigate the effect of quick acupuncture combined with rehabilitation therapy on motor and swallowing function of patients with stroke.

DESIGN

A retrospective study.

SETTING

Single center study.

PARTICIPANTS

One hundred and twenty patients with stroke were divided into control and observation group based on the therapeutic regimen.

INTERVENTION

Control group (n = 60) only received rehabilitation therapy, and observation group (n = 60) received rehabilitation therapy combined with quick acupuncture. Acupuncture was performed once a day, and 6 times/week for 4 consecutive weeks.

MAIN MEASURES

The simplified Fugl-Meyer assessment scale and Barthel index were used to assess limb motor function and daily living ability. The Dysphagia Outcome Severity Scale and Swallowing Quality of Life questionnaire were conducted to estimate the dysphagia severity and life quality of patients with swallowing disorders. The therapeutic efficacy and complications after treatment were analyzed and counted.

RESULTS

After treatment, the scores of the observation group were significantly improved compared with the control group (P < 0.05). In the observation group, the therapeutic efficacy was 93% (n = 56); the complication rate was 5% (n = 3); the therapeutic efficacy of the control group was 75% (n = 45); and the complication rate was 25% (n = 15), indicating that the therapeutic efficacy of the observation group is better and the incidence of complications is lower than that of the control group.

CONCLUSION

This study suggests that rehabilitation therapy combined with rapid acupuncture therapy has a potential therapeutic effect on the relief of swallowing and motor dysfunction after stroke.

Psychotic-like experiences are associated with physical disorders in general population: A cross-sectional study from the NESARC II

BACKGROUND

Psychotic-like experiences (PLEs) constitute subthreshold symptoms of psychotic disorders, and belong to five distinct dimensions: Positive, Negative, Depressive, Mania and Disorganization. PLEs are associated with various psychiatric disorders. However, few studies examined their association with physical disorders.

OBJECTIVE

Our aims were (1) to assess the associations between various physical disorders and PLEs in a U.S. representative sample, and (2) to examine these associations according to the five dimensions of PLEs.

METHOD

We used data from the wave II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-II), a large national sample representative of the US population (N = 34,653). Participants were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule 4. Twenty-two PLEs were examined. Lifetime prevalence and adjusted Odds-Ratio (aOR) reflecting the association of sixteen physical disorders (including notably metabolic conditions and heart diseases) with PLEs were calculated.

RESULTS

All studied physical disorders were associated with the presence of PLEs. Particularly the presence of any physical condition, any heart disease and diabetes were more frequent in participants with at least one PLE compared with the group without any PLE (aOR = 1.74, 95% CI = 1.62-1.87, aOR = 1.44, 95% CI = 1.33-1.55 and aOR = 1.38, 95% CI = 1.24-1.54, respectively). Almost all physical disorders were associated with the five dimensions of PLEs.

CONCLUSIONS

PLEs were associated with a large range of physical disorders, with a gradual dose effect. To assess PLEs in the general population could help with the screening of subjects with physical disorders.

Validity of self-reported hypertension and related factors in the adult population: Preliminary results from the cohort in the west of Iran

This study aimed to investigate the validity of self-reported hypertension and related factors in the Dehgolan Prospective Cohort Study (DehPCS). Data were obtained from 3996 participants aged 35-70 years in the enrolment phase of DehPCS. Self-reported hypertension and sociodemographic factors were collected by well-trained interviewers before hypertension diagnosis based on the reference criteria. The history of anti-hypertensive medication use and/or systolic blood pressure ≥140 (mmHg), or diastolic blood pressure ≥90 (mmHg) were considered as hypertension. Disagreement between self-reported and reference measures was assessed using sensitivity, specificity, positive, and negative predictive values (PPV and NPV), and kappa values. Binary and multinomial logistic regressions were used to investigate the correlates of validity of self-reported hypertension. The hypertension prevalence based on self-reports and the reference criteria was 19.49% and 21.60%, respectively. An acceptable percentage of kappa agreement value of 68.7% and relatively good overall agreement of 89.8% were found. Self-reported hypertension was guaranteed moderate sensitivity of 72.0% and high specificity of 94.5%, as well as the NPV and PPV of 92/7% and 77/9%, respectively. The chances of false-positive and false-negative reporting increased with older age, higher BMI, and a family history of hypertension. Being female, older age, higher BMI, concurrent diabetes, and stronger family ties to hypertension patients significantly increased the chance of reporting true positives relative to true negatives. Although, self-reported hypertension has an acceptable validity and can be used as a valid tool for screening epidemiological studies, it needs to be investigated because its validity is affected by age, gender, family history of hypertension, and other socio-demographic characteristics.

Validity of self-reported hypertension in India: Evidence from nationally representative survey of adult population over 45 years

Self‐reported measures of health, in the context of developed countries, are well‐researched and commonly regarded as reliable predictors of the underlying health of the population. However, the validity of these measures is under‐researched and questionable in the context of low‐ and middle‐income countries. The authors used Longitudinal Ageing Study in India (LASI) survey data from India to compare self‐reported hypertension with biometrically‐measured hypertension. The results are reported in terms of sensitivity, specificity, and kappa as a measure of agreement. Logistic regression was undertaken to examine the characteristics of those who were unaware of their hypertensive status. Our analysis showed a low sensitivity of 56% and a high specificity of 90.5%. Agreement between self‐reported data and biometric measurement of hypertension was observed to be moderate (κ = 0.48). Large variations were observed among states and sub‐groups. The odds of false negative reporting of hypertension were lower in the individuals with higher age, high education, and greater wealth status. The authors conclude that self‐reported hypertension has important limitations and may be a source of systematic bias. It is recommended that planning and policy‐making in India be based more on an objective assessment of hypertension.

Waist circumference was associated with 2-year blood pressure change in community dwelling adults independently of BMI

OBJECTIVE

The present study aimed to analyze the association of 2-year changes in BMI and waist circumference with changes in blood pressure (BP) in a randomized sample of community-dwelling adults.

METHODS

A sample of 331 middle-aged and older adults (mean age of 59.6 ± 17.3 years) was randomly selected. Measurements of SBP and DBP, BMI, and waist circumference were collected at baseline and after 2-year follow-up. Chronological age, sex, socioeconomic status, ethnicity, and self-reported medical diagnosis and use of medication for hypertension, diabetes, and high low-density lipoprotein-cholesterol were covariates. Multiple linear regression models were adopted for statistical analysis.

RESULTS

SBP was positively associated with BMI (β = 0.48, P = 0.013) and waist circumference (β = 0.21, P = 0.005) at baseline and only with waist circumference at follow-up (β = 0.20, P = 0.007). DBP was positively associated with BMI (β = 0.31, P = 0.009) and waist circumference (β = 0.12, P = 0.006) values at baseline and at follow-up (BMI β = 0.42, P = 0.001; waist circumference β = 0.18, P = 0.001). Only the 2-year changes in waist circumference were associated to changes in SBP (β = 0.33, P = 0.013), regardless of confounding factors and BMI.

CONCLUSION

It is suggested that waist circumference is the main factor for control over the time in strategies focused on BP management in adult population.

Long-term air pollution exposure and self-reported morbidity: A longitudinal analysis from the Thai cohort study (TCS)

BACKGROUND

Several studies have shown the health effects of air pollutants, especially in China, North American and Western European countries. But longitudinal cohort studies focused on health effects of long-term air pollution exposure are still limited in Southeast Asian countries where sources of air pollution, weather conditions, and demographic characteristics are different. The present study examined the association between long-term exposure to air pollution and self-reported morbidities in participants of the Thai cohort study (TCS) in Bangkok metropolitan region (BMR), Thailand.

METHODS

This longitudinal cohort study was conducted for 9 years from 2005 to 2013. Self-reported morbidities in this study included high blood pressure, high blood cholesterol, and diabetes. Air pollution data were obtained from the Thai government Pollution Control Department (PCD). Particles with diameters ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) exposures were estimated with ordinary kriging method using 22 background and 7 traffic monitoring stations in BMR during 2005-2013. Long-term exposure periods to air pollution for each subject was averaged as the same period of person-time. Cox proportional hazards models were used to examine the association between long-term air pollution exposure with self-reported high blood pressure, high blood cholesterol, diabetes. Results of self-reported morbidity were presented as hazard ratios (HRs) per interquartile range (IQR) increase in PM10, O3, NO2, SO2, and CO.

RESULTS

After controlling for potential confounders, we found that an IQR increase in PM10 was significantly associated with self-reported high blood pressure (HR = 1.13, 95% CI: 1.04, 1.23) and high blood cholesterol (HR = 1.07, 95%CI: 1.02, 1.12), but not with diabetes (HR = 1.05, 95%CI: 0.91, 1.21). SO2 was also positively associated with self-reported high blood pressure (HR = 1.22, 95%CI: 1.08, 1.38), high blood cholesterol (HR = 1.20, 95%CI: 1.11, 1.30), and diabetes (HR = 1.21, 95%CI: 0.92, 1.60). Moreover, we observed a positive association between CO and self-reported high blood pressure (HR = 1.07, 95%CI: 1.00, 1.15), but not for other diseases. However, self-reported morbidities were not associated with O3 and NO2.

CONCLUSIONS

Long-term exposure to air pollution, especially for PM10 and SO2 was associated with self-reported high blood pressure, high blood cholesterol, and diabetes in subjects of TCS. Our study supports that exposure to air pollution increases cardiovascular disease risk factors for younger population.

Gender differences in the association between mental health status, hypertension, and emergency department visits in the United States

Hypertension has been found to be elevated in people with mental illness, and this comorbidity may lead to differential emergency department use by gender. Gender differences in this association were assessed using the 2016 Medical Expenditure Panel Survey ( n = 20,443). A combined effect variable for mental health and hypertension was created for stratified, multivariable logistic regression analysis. The likelihood of emergency department visits was higher for women compared to men in all categories of the combined effect variable. In particular, regardless of hypertension status, women with poor mental health had 35 percent and 39 percent increased likelihood of emergency department visits compared to men.

Smoking Status and Well-Being of Underserved African American Older Adults

Purpose: This study investigated the association between current and past cigarette smoking, with four domains of well-being, namely, physical quality of life, mental quality of life, depressive symptoms, and self-rated health status (SRH), among older African American adults who lived in economically impoverished areas of South Los Angles. Methods: This community-based cross-sectional study included a convenience sample of economically-disadvantaged African Americans adults (n = 740) who were 55 years old and older residing in South Los Angeles. We conducted in-depth face-to-face interviews to collect data on the socioeconomic status (level of education and fiscal pressures), demographic factors (age and gender), physical health (number of chronic medical conditions), smoking (never smokers (reference group), past smokers, and current smokers), and well-being (quality of life, depressive symptoms, and self-rated health). Linear regressions were used to analyze the data. Results: Over 21% reported that they are current smokers, compared with 31% who identified as former smokers. Almost 40% perceived the quality of their health status to be fair or poor. Compared with non-smokers, current cigarette smokers reported a worse physical quality of life, depressive symptoms, and self-rated health. Current smokers also reported a marginally worse mental quality of life. Past smoker status was inconsistently associated with worse well-being in some, but not all, indicators. The association between smoking status and worse well-being was independent of gender, socioeconomic status, and physical health status. Conclusion: Current smoking is associated with worse well-being of older African American adults in economically constrained urban settings. As the same pattern could not be found for former smokers, quitting smoking may be a strategy for economically-disadvantaged African American individuals to enhance their well-being. This provides additional support for programs that help African American individuals who are smokers to quit smoking, particularly in economically-disadvantaged urban areas.

Validity of Self-reported Hypertension and Factors Related to Discordance Between Self-reported and Objectively Measured Hypertension: Evidence From a Cohort Study in Iran

OBJECTIVES

Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort.

METHODS

The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard.

RESULTS

Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency.

CONCLUSIONS

The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs.

Herpes zoster incidence in Germany - an indirect validation study for self-reported disease data from pretest studies of the population-based German National Cohort

Background

Until now, herpes zoster (HZ)-related disease burden in Germany has been estimated based on health insurance data and clinical findings. However, the validity of self-reported HZ is unclear. This study investigated the validity of self-reported herpes zoster (HZ) and its complication postherpetic neuralgia (PHN) using data from the pretest studies of the German National Cohort (GNC) in comparison with estimates based on health insurance data.

Methods

Data of 4751 participants aged between 20 and 69 years from two pretest studies of the GNC carried out in 2011 and 2012 were used. Based on self-reports of physician-diagnosed HZ and PHN, age- and sex-specific HZ incidence rates and PHN proportions were estimated. For comparison, estimates based on statutory health insurance data from the German population were considered.

Results

Eleven percent (95%-CI, 10.4 to 12.3, n = 539) of the participants reported at least one HZ episode in their lifetime. Our estimated age-specific HZ incidence rates were lower than previous estimates based on statutory health insurance data. The PHN proportion in participants older than 50 years was 5.9% (1.9 to 13.9%), which was in line with estimates based on health insurance data.

Conclusion

As age- and sex-specific patterns were comparable with that in health insurance data, self-reported diagnosis of HZ seems to be a valid instrument for overall disease trends. Possible reasons for observed differences in incidence rates are recall bias in self-reported data or overestimation in health insurance data.

Electronic supplementary material

The online version of this article (10.1186/s12879-019-3691-2) contains supplementary material, which is available to authorized users.

Dietary patterns associated with hypertension risk among adults in Thailand: 8-year findings from the Thai Cohort Study

Objective

Dietary intake is a leading risk factor for hypertension. We aimed to assess longitudinal associations between overall dietary patterns and incident hypertension among adults in Thailand.

Design

Prospective large Thai Cohort Study (TCS) conducted nationwide from 2005 to 2013. Dietary patterns were identified using factor analysis based on usual intake of fourteen food groups. Multivariable logistic regression assessed associations between dietary patterns and hypertension prevalence and incidence.

Setting

Emerging hypertension and changing diets in Thailand.

Subjects

TCS participants who were normotensive at baseline in 2005.

Results

Among 36293 participants without hypertension at baseline, 1831 reported incident hypertension (5·1 % incidence) at follow-up. Two dietary patterns were identified: ‘Modern’ and ‘Prudent’. The Modern dietary pattern (high intakes of roasted/smoked foods, instant foods, canned foods, fermented fruits/vegetables, fermented foods, soft drinks, deep-fried foods) was associated with increased incident hypertension (comparing extreme quartiles, OR for incident hypertension=1·51; 95 % CI 1·31, 1·75 in 2013). The Prudent dietary pattern (high intakes of soyabean products, milk, fruits, vegetables) was not associated with incident hypertension in a fully adjusted model. The association between the Modern dietary pattern and hypertension was attenuated by BMI.

Conclusions

Modern dietary pattern was positively associated with hypertension among Thai adults. BMI had a great impact on the relationship between the Modern dietary pattern and incidence of hypertension. Reduction of Modern diets would be expected to prevent and control hypertension. Such a strategy would be worth testing.

Low potassium and high sodium intakes: a double health threat to Cape Verdeans

BACKGROUND

Cape Verde presents a high rate of cardiovascular diseases. Low potassium and high sodium intakes are related to cardiovascular diseases. However, studies regarding these two micronutrients continue to be rare in African urban settings. This work aims to estimate potassium and sodium intakes and to analyse the self-reported salt intake by gender and by type of urban area in the city of Praia - the capital of Cape Verde.

METHODS

In the first stage (n = 1912), an intra-urban study was designed in two types of urban areas (formal and informal), using a sampling strategy based on random selection of geographical coordinates, in order to apply a questionnaire. In a second stage, a 24-h dietary recall and anthropometric measurements were performed by local nutritionists. Potassium and sodium intakes were estimated for 599 participants (149 men and 450 women). Non-parametric methods (including quantile regression) were used in the statistical analysis.

RESULTS

In informal areas, a higher percentage of women reported having hypertension (31.0%) compared to formal areas (19.7%). Based on 24-h dietary recall, median potassium intake for men was 2924.2 mg/day and for women and 2562.6 mg/day. Almost 70.0% of men and 80.0% of women ingested less than the recommended 3510 mg/day of potassium. In informal areas, men and women presented high medians of sodium intakes compared to formal areas (men: 4131.2 vs 3014.6 mg/day and women: 3243.4 vs 2522.4 mg/day). On the other hand, the percentage of participants exceeding 2000 mg/day for sodium was high (≥70.8%), even for participants that self-reported low-salt intake. Quantile regression models revealed effects of the type of urban area and gender in the potassium and sodium intakes, at least, in some quartiles, accounting for age, academic qualifications, and professional situation.

CONCLUSIONS

A low potassium intake and a high sodium intake were found in Praia. Thus, efficient health education campaigns and health promotion are needed and should be tailored considering gender and urban areas.

Magnitude and pattern of hypertension in the Niger Delta: a systematic review and meta-analysis of community-based studies

Background

Emerging evidence found that health inequality in the Niger Delta region in Nigeria has continued to worsen due to epidemiological and environmental risks transitions. This study aims to provide an up-to-date review and the secular trends of hypertension prevalence in Niger Delta.

Methods

We systematically searched databases of MEDLINE, EMBASE, African index Medicus and African Journal online from inception to December 30, 2016 for population-based studies providing prevalence estimates of hypertension in the Niger Delta. Eligible studies were included in a random-effect meta-analysis of prevalence and secular trend. The review was reported according to MOOSE guideline.

Results

Overall, 34 eligible studies comprising of data on 32715 participants with mean-age of 38.43 ± 2.0 years were identified and included in the meta-analysis. The pooled result showed that across study settings, the prevalence of hypertension in rural population tended to be higher than those in urban areas, 32.0% (95% confidence interval (CI) 25.13-39.28) vs 24.07% (95% CI 18.13-30.58), however, the difference did not reach a statistical significant level, (P < 0.183). The overall mean SBP was 130.15 (95% CI 126.85-133.45) mmHg, and the DBP was 80.72 (95% CI 78.45-82.95). The estimates also vary significantly in men compared to women; 30.26% (95% CI 23.76-37.17) vs 22.99% (17.60-28.86), P < 0.0001, and among those older than 65 years compared to those aged 45-64 years, and more than 2-fold compared to those between 15-44 years, P < 0.001. We also observed a continuous increase in prevalence of hypertension in the region (trend = 0.139, P = 0.0001), such that for every 10 years increase in participants’ mean age, the prevalence of hypertension increases by 10.43% (95% CI 5.73-15.14), P < 0.001.

Conclusions

This study found evidence that hypertension is a major public health issue in the Niger Delta communities suggesting a positive relationship between socio-economic and lifestyle factors. Improved surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure, remains an important public health priority.

Evaluation of the success of obstructive sleep apnea surgery using criteria based on long-term symptoms and incident hypertension

OBJECTIVE

To identify appropriate success criteria, based on long-term symptoms and incident hypertension, after surgery for obstructive sleep apnea (OSA).

METHODS

This observational cohort study included 97 adult OSA patients (90 men) who underwent surgical treatment at our tertiary medical center. Subjective symptoms [witnessed sleep apnea and snoring, and Epworth sleepiness scale (ESS) scores] were evaluated through a telephone survey, and incident hypertension was assessed from medical records. The subjects were divided into success and failure groups according to seven different criteria, and data were analyzed to identify the criteria that could significantly differentiate the success from failure groups.

RESULTS

The participants had a mean age of 48.8 ± 11.9 years and a mean preoperative body mass index of 26.5 ± 3.5 kg/m². The mean preoperative and postoperative apnea-hypopnea index (AHI) values were 36.1/h and 19.4/h, respectively. The mean follow-up duration was 77.0 ± 31.1 months. Postoperative witnessed apnea, snoring, and the ESS scores decreased significantly compared to preoperative scores in both the success and failure groups based on most of the seven criteria. Among the seven criteria, success and failure groups based on a postoperative AHI cutoff of 15 or 20/h differed significantly in witnessed apnea, snoring, or ESS scores. Kaplan-Meier survival analysis based on incident hypertension revealed that no criterion could significantly distinguish between the two groups.

CONCLUSIONS

Our results suggest that some of the success criteria analyzed may be more useful in differentiating between success and failure groups after surgery, in terms of long-term improvement of subjective OSA-related symptoms.

Nutrition label experience, obesity, high blood pressure, and high blood lipids in a cohort of 42,750 Thai adults

INTRODUCTION

Nutrition labels have been promoted for nearly two decades in Thailand to educate people about healthy eating and to combat nutrient-related non-communicable diseases (NCDs). But little is known about how nutrition labels are experienced and whether they are linked with better health. Our objective was to investigate the associations between nutrition label experience, obesity and nutrient-related NCDs in Thai consumers.

METHODS

A cross-sectional study was undertaken with a nationwide cohort of 42,750 distance learning Thai adult students enrolled in an Open University in 2013. We measured exposure as nutrition label experience (read, understand, use). Health outcomes were high blood pressure, high blood lipids, and high Body Mass Index (overweight at risk and obesity). Multivariate logistic regression was used to determine the association between nutrition label experience and health outcome adjusting for sociodemographic attributes, physical activity, smoking, and alcohol intake.

RESULTS

Frequent nutrition label use varied by cohort attributes and health outcomes and was least for those with low physical activity and high blood pressure. Being male, older, an urban resident or with low physical activity was associated with increasing high blood pressure and high blood lipids. Compared to those who read, understand and use nutrition labels, participants who did not (read, understand, and use), were more likely to report high blood pressure (Adjusted Odds Ratio 1.33; 1.17-1.51), high blood lipids (AOR 1.26; 1.14-1.39), and obesity (AOR 1.23; 1.13-1.33), but were not more likely to be overweight at risk (AOR 1.06; 0.97-1.16).

CONCLUSIONS

We found cross-sectional associations between low nutrition label experience and increased likelihood of high blood pressure, high blood lipids, and obesity among Thai adults. Nutrition label education should be promoted as part of a public health approach to appropriate food choices and better lifestyles to reduce obesity and nutrient-related NCDs.

Differences in the Prevalence of Non-Communicable Disease between Slum Dwellers and the General Population in a Large Urban Area in Brazil

Residents of urban slums are at greater risk for disease than their non-slum dwelling urban counterparts. We sought to contrast the prevalences of selected non-communicable diseases (NCDs) between Brazilian adults living in a slum and the general population of the same city, by comparing the age and sex-standardized prevalences of selected NCDs from a 2010 survey in Pau da Lima, Salvador Brazil, with a 2010 national population-based telephone survey. NCD prevalences in both populations were similar for hypertension (23.6% (95% CI 20.9⁻26.4) and 22.9% (21.2⁻24.6), respectively) and for dyslipidemia (22.7% (19.8⁻25.5) and 21.5% (19.7⁻23.4)). Slum residents had higher prevalences of diabetes mellitus (10.1% (7.9⁻12.3)) and of overweight/obesity (46.5% (43.1⁻49.9)), compared to 5.2% (4.2⁻6.1) and 40.6% (38.5⁻42.8) of the general population in Salvador. Fourteen percent (14.5% (12.1⁻17.0)) of slum residents smoked cigarettes compared to 8.3% (7.1⁻9.5) of the general population in Salvador. The national telephone survey underestimated the prevalence of diabetes mellitus, overweight/obesity, and smoking in the slum population, likely in part due to differential sampling inside and outside of slums. Further research and targeted policies are needed to mitigate these inequalities, which could have significant economic and social impacts on slum residents and their communities.

Nutrition label experience and consumption of transitional foods among a nationwide cohort of 42,750 Thai adults

PURPOSE

The purpose of this paper is to assess the usefulness of nutrition labels in Thailand during nutrition transition from traditional to modern diets that increase salt, sugar, and calorie intake and to note socio-demographic interactions and associations with consumption of transitional processed foods.

DESIGN/METHODOLOGY/APPROACH

The authors studied 42,750 distance learning Open University adults aged 23-96 years in 2013 residing nationwide and participating in an ongoing community-based prospective cohort study. The authors used multivariable logistic regression to relate nutrition label experiences ("read", "good understand", "frequent use"), socio-demographic factors, and consumption of four transitional foods. These foods included "unhealthy" instant foods, carbonated soft drinks, and sweet drinks, or "healthy" milk.

FINDINGS

Overall, two-thirds reported good understanding and frequent use of nutrition labels. Unhealthy transition-indicator processed foods were frequently consumed: instant foods (7 per cent), (carbonated) soft drinks (15 per cent), and sweet drinks (41 per cent). Frequent users of nutrition labels (e.g. females, older persons, professionals) were less likely to consume unhealthy indicator foods. Those with the most positive overall nutrition label experience ("read" + "good understanding" + "frequent use") had the best indicator food profiles: instant foods (odds ratio (OR) 0.63; 95%CI, 0.56-0.70); soft drinks (OR 0.56; 95%CI, 0.52-0.61); sweet drinks (OR 0.79; 95%CI, 0.74-0.85); milk (OR 1.87; 95%CI, 1.74-2.00).

ORIGINALITY/VALUE

Knowledge protected - those with most nutrition label experience were least likely to consume unhealthy foods. Results support government regulated nutrition labels, expanding to include sweet drinks. The study is remarkable for its large size and nationwide footprint. Study subjects were educated, represent Thais of the future, and show high awareness of transition-indicator foods.

A Comparison between The Effectiveness of Short Message Service and Reminder Cards Regarding Medication Adherence in Patients with Hypertension: A Randomized Controlled Clinical Trial

BACKGROUND

Hypertension is increasing rapidly in developing countries. Today, modern technologies are suggested as the tools used to enhance medication adherence. This study aimed to compare the effectiveness of short message service (SMS) to reminder cards with regard to medication adherence in patients with hypertension.

METHODS

The present study is a randomized controlled clinical trial. The subjects consisted of 123 patients with hypertension at the clinical-educational center of Sayyed-Al Shohada, Urmia, who met the study criteria. Selected based on the convenience method, the samples were randomly divided into three groups: the SMS group, the reminder-cards group, and the control group. The subjects in the SMS group were sent 6 text messages a week for three months, and the subjects in the reminder-cards group were trained in how and in what order to use their cards. Hill-Bone medication adherence scale was completed by all the participants before and three months after the intervention. Data analysis was performed in SPSS software, using one-way ANOVA. Hill-Bone medication adherence scale was completed by all the participants before and three months after the intervention. Data analysis was performed in SPSS software, using one-way ANOVA.

RESULTS

The results of ANOVA test demonstrated that the mean scores of medication adherence were statistically different among the three groups of control (46.63±2.99), SMS (57.70±2.75) and the reminder cards (57.51±2.69) after the intervention (P<0.001). However, after the intervention the means of the patients' medication adherence scores were not statistically different between the two groups trained via SMS and reminder cards (P>0.05).

CONCLUSION

The findings of the present research demonstrated that training and distance-monitoring via SMS and reminder cards promote medication adherence of patients. Therefore, healthcare teams and nurses are recommended to apply such training methods.

TRIAL REGISTRATION NUMBER

IRCT2015110917059N2.

Racial/Ethnic Differences in Knowledge of Personal and Target Levels of Cardiovascular Health Indicators

This study aimed to examine ethnic differences in knowledge of personal and target levels of cardiovascular health indicators between non-Hispanic whites and African Americans. A secondary objective was to evaluate the associations between knowledge of cardiovascular health indicators and health promotion behaviors. Participants (66.7% female) consisted of 265 whites and 428 African Americans, ages 18 and older recruited from primary care clinics and churches. Respondents completed a brief survey on blood pressure (BP), total cholesterol, blood glucose, body mass index (BMI), diet, and physical activity. Whites were more likely than African Americans to report knowing their personal and target levels of cardiovascular health indicators. Knowledge of personal BP and/or BMI was positively associated with actual physical activity, and awareness of personal blood glucose was positively associated with healthy dietary practices for participants in both groups. Among whites, awareness of personal BP and knowledge of target levels for BP, total cholesterol, and BMI were also associated with healthy diet. Results suggest there are racial/ethnic disparities in knowledge of personal and ideal levels of cardiovascular health indicators, and that this knowledge is related to health promotion behaviors. Targeted educational efforts are warranted to enhance knowledge of personal risk indicators among African Americans.

Gestational Weight Gain and Health Outcomes 18 Years Later in Urban Black Women

OBJECTIVES

Excessive gestational weight gain (GWG) is associated with higher body mass index (BMI) later in life. Increased BMI is associated with health problems, but there is limited evidence linking GWG directly to later health in black women. We examined the association between GWG and health conditions 18 years after a first birth.

METHODS

This study was a secondary data analysis of 467 urban black women, enrolled during pregnancy (1990-1991). GWG was the difference between self-reported pre-pregnancy weight and measured weight at delivery. Hypertension, diabetes, obesity, and self-reported health were assessed with self-report and measurements of blood pressure, height, and weight, approximately 18 years after first childbirth.

RESULTS

Higher pre-pregnancy BMI was associated with increased probability of each health condition. Higher GWG was associated with hypertension for women with a pre-pregnancy BMI under 21.3 kg/m(2) (P < .05) and obesity for women with a pre-pregnancy BMI under 25.9 kg/m(2) (P < .05). Diabetes and poor health were not associated with GWG.

CONCLUSIONS

GWG may impact a mother's hypertension and obesity status 18 years after childbirth for underweight and normal weight women.

Alcohol consumption patterns in Thailand and their relationship with non-communicable disease

BACKGROUND

Heavy alcohol consumption is an established risk factor for non-communicable diseases (NCDs) but few studies have investigated drinking and disease risk in middle income, non-western countries. We report on the relationship between alcohol consumption and NCDs in Thailand.

METHODS

A nationwide cross sectional survey was conducted of 87,151 Thai adult open university students aged 15 to 87 years (mean age 30.5 years) who were recruited into the Thai Cohort Study. Participants were categorized as never having drunk alcohol (n = 22,527), as being occasional drinkers who drank infrequently but heavily (4+ glasses/occasion - occasional heavy drinkers, n = 24,152) or drank infrequently and less heavily (<4 glasses/occasion - occasional light drinkers, n = 26,861). Current regular drinkers were subdivided into those who either drank heavily (4 + glasses per occasion - regular heavy drinkers, n = 3,675) or those who drank less (<4 glasses/occasion -regular light drinkers, n = 490). There were 7,548 ex-drinkers in the study. Outcomes were lifetime diagnoses of self-reported NCDs and obesity (body mass index ≥ 25).

RESULTS

Most women were never drinkers (40 % among females) or occasional light drinkers (39 %), in contrast to men (11 % and 22 %, respectively). Alcohol consumption was associated with urban in-migration and other recognized risks for NCDs (sedentary lifestyle and poor diet). After adjustment for these factors the odds ratios (ORs) for several NCDs outcomes - high cholesterol, hypertension, and liver disease - were significantly elevated among both occasional heavy drinkers (1.2 to 1.5) and regular heavy drinkers (1.5 to 2.0) relative to never drinkers.

CONCLUSIONS

Heavy alcohol consumption of 4 or more glasses per occasion, even if the occasions were infrequent, was associated with elevated risk of NCDs in Thailand. These results highlight the need for strategies in Thailand to reduce the quantity of alcohol consumed to prevent alcohol-related disease. Thailand is fortunate that most of the female population is culturally protected from drinking and this national public good should be endorsed and supported.

Determinants of hypertension in a young adult Ugandan population in epidemiological transition-the MEPI-CVD survey

BACKGROUND

High blood pressure is the principal risk factor for stroke, heart failure and kidney failure in the young population in Africa. Control of hypertension is associated with a larger reduction in morbidity and mortality in younger populations compared with the elderly; however, blood pressure control efforts in the young are hampered by scarcity of data on prevalence and factors influencing awareness, treatment and control of hypertension. We aimed to describe the prevalence of prehypertension and hypertension among young adults in a peri-urban district of Uganda and the factors associated with occurrence of hypertension in this population.

METHODS

This cross-sectional study was conducted between August, 2012 and May 2013 in Wakiso district, a suburban district that that encircles Kampala, Uganda's capital city. We collected data on socio-demographic characteristics and hypertension status using a modified STEPs questionnaire from 3685 subjects aged 18-40 years selected by multistage cluster sampling. Blood pressure and anthropometric measurements were performed using standardized protocols. Fasting blood sugar and HIV status were determined using a venous blood sample. Association between hypertension status and various biosocial factors was assessed using logistic regression.

RESULTS

The overall prevalence of hypertension was 15% (95% CI 14.2 - 19.6) and 40% were pre-hypertensive. Among the 553 hypertensive participants, 76 (13.7%) were aware of their diagnosis and all these participants had initiated therapy with target blood pressure control attained in 20% of treated subjects. Hypertension was significantly associated with the older age-group, male sex and obesity. There was a significantly lower prevalence of hypertension among participants with HIV OR 0.6 (95% CI 0.4-0.8, P = 0.007).

CONCLUSION

There is a high prevalence of high blood pressure in this young periurban population of Uganda with sub-optimal diagnosis and control. There is previously undocumented high rate of treatment, a unique finding that may be exploited to drive efforts to control hypertension. Specific programs for early diagnosis and treatment of hypertension among the young should be developed to improve control of hypertension. The relationship between HIV infection and blood pressure requires further clarification by longitudinal studies.

Risk factors for cardiovascular disease mortality among 86866 members of the Thai Cohort Study, 2005-2010

Thailand is experiencing a development-associated health-risk transition with increasing prominence of chronic diseases. We aim to determine the risk factors for cardiovascular disease (CVD) deaths in Thailand. We conducted longitudinal analyses of deaths in the nationwide Thai Cohort Study from 2005 to 2010 (n=86866) using national vital registration data. Multivariate logistic regression models were used to calculate mutually adjusted estimates of association between dying from CVD and various risk factors measured at baseline in 2005. For three important risks, population attributable fractions were calculated. There were 78 CVD deaths. The probability of dying from CVD for males was 0.15% and for females was 0.04%. Multivariate modelling showed that current smoking (OR=4.01, CI=2.02-7.93), hypertension (OR=1.91, CI=0.95-3.85), and diabetes (OR=2.51, CI=1.01-6.25) are major risk factors of CVD deaths. For males, 54% of CVD deaths can be attributed to smoking. Females are protected by very low rates of smoking. Ischaemic heart disease (OR=6.85, CI=2.47-19.01) is also a strong predictor of CVD deaths. As CVD is a top cause of death, reducing CVD mortality by controlling smoking, hypertension, and hyperglycaemia will substantially improve life expectancy in Thailand today. The low smoking rates among females need to be actively maintained and confer great benefit.

Health-Risk Factors and the Prevalence of Chronic Kidney Disease: Cross-Sectional Findings from a National Cohort of 87,143 Thai Open University Students

BACKGROUND

Chronic kidney disease (CKD) is becoming a major health challenge worldwide as its aetiology has transferred from predominantly infectious disease to emerging chronic diseases, especially diabetes and hypertension. A rapid health-risk transition driven by economic development is transforming Thailand which is now becoming an ageing country where chronic diseases are a major health burden.

METHODS

This study used the 2005 baseline cross-sectional dataset of 87,143 Thai Cohort Study members to investigate risk factors associated with CKD. Using multivariate logistic regression, we looked into the relationship between CKD and demographic and socioeconomic factors, personal health status and various health-related behaviours.

RESULTS

The prevalence of CKD in men was lower than that in women (2.5% vs 2.7%). In both sexes, CKD is associated with ageing, cigarette smoking and drinking alcohol, having diabetes, high lipids and hypertension. In men, CKD was associated with living in rural areas, having a low income, a higher BMI, short sleeping and having Western fast food. In women, marriage is associated with a higher risk of CKD.

CONCLUSIONS

CKD is strongly associated with ageing, underlying diseases, smoking and drinking. Hypertension, elevated lipids, or diabetes are all risk factors that could be prevented or detected and treated. The Ministry of Public Health should encourage Thai people to consume healthy food, maintain a normal weight, stop smoking and drink alcohol in moderation, all of which will help prevent CKD.

Prevalence of hypertension in member countries of South Asian Association for Regional Cooperation (SAARC): systematic review and meta-analysis

Hypertension is a leading attributable risk factor for mortality in South Asia. However, a systematic review on prevalence and risk factors for hypertension in the region of the South Asian Association for Regional Cooperation (SAARC) has not carried out before.The study was conducted according to the Meta-Analysis of Observational Studies in Epidemiology Guideline. A literature search was performed with a combination of medical subject headings terms, "hypertension" and "Epidemiology/EP". The search was supplemented by cross-references. Thirty-three publications that met the inclusion criteria were included in the synthesis and meta-analyses. Hypertension is defined when an individual had a systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg, was taking antihypertensive drugs, or had previously been diagnosed as hypertensive by health care professionals. Prehypertension is defined as SBP 120-139 mm Hg and DBP 80-89 mm Hg.The overall prevalence of hypertension and prehypertension from the studies was found to be 27% and 29.6%, respectively. Hypertension varied between the studies, which ranged from 13.6% to 47.9% and was found to be higher in the studies conducted in urban areas than in rural areas. The prevalence of hypertension from the latest studies was: Bangladesh: 17.9%; Bhutan: 23.9%; India: 31.4%; Maldives: 31.5%; Nepal: 33.8%; Pakistan: 25%; and Sri Lanka: 20.9%. Eight out of 19 studies with information about prevalence of hypertension in both sexes showed that the prevalence was higher among women than men. Meta-analyses showed that sex (men: odds ratio [OR] 1.19; 95% confidence interval [CI]: 1.02, 1.37), obesity (OR 2.33; 95% CI: 1.87, 2.78), and central obesity (OR 2.16; 95% CI: 1.37, 2.95) were associated with hypertension.Our study found a variable prevalence of hypertension across SAARC countries, with a number of countries with blood pressure above the global average. We also noted that studies are not consistent in their data collection about hypertension and related modifiable risk factors.

Self-reported health and subsequent mortality: an analysis of 767 deaths from a large Thai cohort study

Background

Few studies have examined the link between self-reported health (SRH) and subsequent mortality in developing countries, and very few considered mortality effects of changes in SRH. We examined the relationship between SRH and subsequent all cause or cause-specific mortality in Thailand. We also noted if mortality varied after people changed their SRH.

Methods

We used longitudinal data including SRH from a nationwide Thai Cohort Study (baseline 2005 - follow-up 2009) and linked to official death records (2005–2012). Cox regression examined the association between SRH in 2005 and subsequent all-cause mortality or cause-specific mortality, with results given as confounder-adjusted hazard ratios (HR). We further assessed association between changes in SRH during 2005–2009 and mortality from 2009 to 2012.

Results

Poor SRH at baseline independently relates strongly with subsequent cardiovascular disease (CVD) mortality (HR = 2.8, CI: 1.3-5.9) and “other” causes of death (HR = 1.9, CI: 1.1-3.3) but moderately with cancer mortality (HR = 1.4, CI: 0.7-3.0). SRH did not exhibit a relationship with injury mortality (HR = 1.0, CI: 0.5-2.1). Worsening SRH from 2005 to 2009 associated with increased mortality in 2009–2012 for females but not for males.

Conclusions

In Thailand, SRH is a good predictor of population mortality due to internal causes (e.g. CVD). SRH is holistic, simple to measure and low cost; when repeated it measures dynamic health status. In many developing countries chronic diseases are emerging and morbidity information is limited. SRH could help monitor such transitions in burdens and trends of population health.

Timing of urbanisation and cardiovascular risks in Thailand: evidence from 51 936 members of the thai cohort study, 2005-2009

Background

Urban populations usually have higher levels of cardiovascular risk factors than rural populations in developing countries. However, association between cardiovascular risk factors and duration of urban dwelling, particularly for early stages of urban migrations, has not yet been adequately studied. We examined cardiovascular risks in relation to timing of urbanization in Thailand, paying attention to recent internal migrants.

Methods

Our study base was a large national cohort (n = 87 151) of distance-learning Thai open university students recruited in 2005 and followed up in 2009. After exclusion of longitudinal dropouts and reverse migrants, 51 936 remained for analyses. The information collected included historical residence, urban migration and its lifecycle timing, self-reported doctor-diagnosed diseases, and socio-demographic and personal attributes that could influence health. To relate cardiovascular outcomes (prevalence and incidence of hypertension and hyperlipidaemia) and life-course urbanization status (ie at age 12, 4 years ago [2005] and at present [2009]), we applied logistic regression. Included in the models were 10 other covariates that could confound the urbanization effect.

Results

Recent migration (arriving within four years) among young cohort members (born after 1980) was associated with higher risk of hypertension (OR 1.80 for prevalence and 1.68 for four-year incidence). Higher hyperlipidaemia prevalence (and incidence) was associated with any urban dwelling. Recent migrants quickly developed hyperlipidaemia, particularly the youngest (born after 1980) and oldest participants (born before 1960).

Conclusions

Increased cardiovascular risks appear among rural-urban migrants within four years after they arrive. Given the scale of continuing urbanization, interventions are needed to support and educate recent migrants in Thai cities.