1
|
Mohammadi E, Yoosefi M, Shaker E, Shahmohamadi E, Ghasemi E, Ahmadi N, Azadnajafabad S, Rashidi MM, Rezaei N, Koolaji S, Dilmaghani-Marand A, Fateh SM, Kazemi A, Haghshenas R, Rezaei N. 'Inequalities in prevalence of hypertension, prehypertension, anti-hypertensive coverage, awareness, and effective treatment in 429 districts of Iran; a population-based STEPS 2016 small area spatial estimation model'. J Diabetes Metab Disord 2023; 22:1095-1103. [PMID: 37975079 PMCID: PMC10638340 DOI: 10.1007/s40200-023-01186-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/10/2023] [Indexed: 11/19/2023]
Abstract
Purpose While many studies have reported hypertension (HTN) and pre-hypertension (PHTN) in large geographic locations of Iran, information regarding district levels is missing. We aimed to examine inequalities in the prevalence of hypertension, prehypertension, anti-hypertensive coverage, awareness, and effective treatment of adults in districts of Iran. Methods We used 27,165 participants' data from the STEPS 2016 study in Iran. A small area estimation model was carried out to predict HTN in the 429 districts of Iran. HTN and PHTN were defined based on the American Heart Association Guideline. Awareness of being hypertensive, treatment coverage, and effective treatment were also estimated. Results HTN's crude prevalence was estimated to be in the range of 11.5-42.2% in districts. About PHTN, it was estimated to be 19.9-56.1%. Moreover, for awareness, treatment coverage, and effective treatment crude estimates ranged from 24.3 to 79.9%, 9.1 - 64.6%, and 19.5 - 68.3%, respectively, indicating inequalities in the distribution of aforementioned variables in 429 districts of Iran. Overall, better conditions were detected in central geographical locations and in females. Conclusion The inequality of increased blood pressure disorder and related measures are high in districts of Iran and pave the way for policymakers and local health organizers to use the findings of this study to address the inequity of existing resources and improve HTN control. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01186-5.
Collapse
Affiliation(s)
- Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| | - Elaheh Shaker
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| | - Elnaz Shahmohamadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sogol Koolaji
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| | - Arezou Dilmaghani-Marand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, 1411713136 Tehran, Iran
| |
Collapse
|
2
|
Ameli A, Sheikhy A, Tabatabaei-Malazy O, Ahmadi N, Ebrahimpur M, Fallahzadeh A, Rashidi MM, Golestani A, Yoosefi M, Farzi Y, Dilmaghani-Marand A, Rezaei N, Larijani B, Farzadfar F. The diabetes cascade of care through the 14 years in Iran: findings of nationwide STEPS surveys 2007-2021. J Diabetes Metab Disord 2023; 22:1731-1743. [PMID: 37975130 PMCID: PMC10638232 DOI: 10.1007/s40200-023-01308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
Background Diabetes as the leading cause of mortality and morbidity, have been increased by about 35% from 2011 to 2015 worldwide. The objective of this study was to assess the trend and pattern of diabetes and prediabetes prevalence in Iran and also evaluate the diagnosis and status of diabetes management. Methods The results of this study are extracted from the National Stepwise approach to non-communicable disease risk factor surveillance (STEPS), conducted in 2007, 2011, 2016, and 2021 in Iran. We evaluated all obtained data by questionnaires (demographic, epidemiologic, risk-related behavioral data), physical measurements, and laboratory measures. Results The prevalence of diabetes almost doubled from 2007 to 2021 among adults 25 years old and above. Diabetes prevalence increased from 10.85% (95% CI:10.30-11.40) in 2016 to 14.15% (13.42-14.87) in 2021. Prediabetes prevalence increased from 18.11% (17.46- 18,76) in 2016 to 24.81% (23.88-25.74) in 2021. Diabetes diagnosis stayed constant hence; diabetes coverage improved from 56.87% (54.21-59.52) to 65.04% (62.40- 67.69). Despite an enhancement in diabetes diagnosis and coverage, diabetes effective care did not improve significantly during 2016 and 2021, with a number of 35.98% (32.60- 39.36) in 2016 and 31.35% (28.20- 34.51) in 2021. Conclusion The prevalence of diabetes and prediabetes in Iran is almost doubled during the past 14 years. Although, several health policies had been developed to improve the screening and quality of diabetes care; there are still significant gaps in the effective control of diabetes. Accordingly, the current care plan should be reviewed. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01308-z.
Collapse
Affiliation(s)
- Aslan Ameli
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheikhy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ozra Tabatabaei-Malazy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahbube Ebrahimpur
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Fallahzadeh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Golestani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John’s, NL Canada
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Dilmaghani-Marand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Disease Research Center (DDRC), Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Efazati N, Hoseini Tavassol Z, khalagi K, Mahmudimanesh M, Tabatabaei-Malazy O, Khalili D, Ejtahed HS, Abbasi Sharghi S, Farzadfar F, Ostovar A, Larijani B, Hasani-Ranjbar S. General and abdominal obesity trends in the Iranian adult population from 2004 to 2021. J Diabetes Metab Disord 2023; 22:1745-1761. [PMID: 37975121 PMCID: PMC10638213 DOI: 10.1007/s40200-023-01310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/12/2023] [Indexed: 11/19/2023]
Abstract
Purpose The prevalence of overweight/obesity and abdominal obesity is increasing worldwide, accompanied by an increase in the incidence of non-communicable diseases. This study aims to determine the trends of Body Mass Index (BMI) and prevalence of overweight/obesity and abdominal obesity changes in Iranian adult population from 2004 to 2021. Methods We conducted this study based on the eight national surveys of noncommunicable disease risk factor surveillance (STEPS) from 2004 to 2021 in Iran. We estimated the crude and standardized mean of BMI and prevalence of general and abdominal obesity in these eight STEPS surveys data. Data weighted using post-stratification method and the trends depicted based on the standardized estimates. Results Between 2004 and 2021, and based on the standardized estimates, the mean of BMI increased from 25.19 kg/m2 in 2004 to 26.63 kg/m2 in 2021 (P-value for trend = 0.03). The standardized mean of WC increased from 86.38 cm in 2004 to 91.65 cm in 2021 (P-value for trend = 0.38). The standardized prevalence of obesity (class I and II) increased from 14.54% in 2004 to 20.17% in 2021 (P-value for trend = 0.01). The standardized prevalence of obesity class III increased from 0.82% in 2004 to 1.35% in 2021 (P-value for trend = 0.03). The standardized prevalence of abdominal obesity based on the national and international cut-points increased, but the trend was not statistically significant [(National cut-point: 27.53% in 2004 to 40.43% in 2021 (P-value for trend = 0.71)) (International cut-point: 27.58% in 2004 to 41.81% in 2021 (P-value for trend = 0.06))]. Conclusion The standardized mean of BMI and prevalence of overweight/obesity and abdominal obesity increased among Iranian adults between 2004 and 2021. Because of the negative public and clinical health implications of obesity, health policymakers should develop comprehensive programs to control this increasing trend of weight gain.
Collapse
Affiliation(s)
- Neda Efazati
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hoseini Tavassol
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem khalagi
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ozra Tabatabaei-Malazy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Abbasi Sharghi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Hasani-Ranjbar
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Firima E, Retselisitsoe L, Leisa I, Manthabiseng M, Sematle MP, Bane M, Khomolishoele M, Gonzalez L, Gupta R, McCrosky S, Lee T, Chammartin F, Leigh B, Weisser M, Amstutz A, Burkard T, Labhardt ND. Head-to-head comparison of the WHO STEPwise approach with immediate unattended and delayed unattended automated blood pressure measurements during household-based screening: a diagnostic accuracy study in Lesotho. EClinicalMedicine 2023; 63:102197. [PMID: 37680951 PMCID: PMC10480531 DOI: 10.1016/j.eclinm.2023.102197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
Background WHO introduced the STEPwise approach to surveillance (STEPS) to monitor trends in non-communicable diseases. For arterial hypertension, the STEPS protocol takes the average of the last two out of three standard blood pressure measurements (SBPM). This study assesses the diagnostic accuracy of SBPM, same-day and next-day unattended automated measurement (uABP), with 24 h ambulatory measurement (24 h-ABPM) as reference. Methods This diagnostic accuracy study was done within a population-based household survey on cardiovascular risk factors in two districts in Northern Lesotho. Adults (aged ≥ 18 years) with elevated SBPM (defined as ≥140/90 mmHg), and 2:1 age- and sex-matched participants with normal SBPM during the survey were recruited. Following SBPM, first uABP readings were obtained on survey day. Afterwards, participants received a 24 h-ABPM device. Second uABP readings were taken 24 h later, after retrieval of the 24 h-ABPM. The main outcome was overall diagnostic accuracy of all screening measurements (SBPM, first uABP, and second uABP), determined using area under the receiver operating characteristic curve (AUROC), with 24 h-ABPM as a reference. Findings Between November 2, 2021 and August 31, 2022, 275 participants (mean age 58 years (SD: 16 years), 163 (59%) female) were enrolled, 183 of whom had elevated and 92 had normal SBPM. Mean difference between systolic daytime 24 h-ABPM and screening measurements was highest for SBPM (mean difference: -13 mmHg; 95% CI: -14 to -11). Mean difference between diastolic daytime 24 h-ABPM and diastolic SBPM was -2 mmHg (95% CI: -4 to -1), whereas no difference was found for mean diastolic first uABP (mean difference: -1 mmHg; 95% CI: -2.0 to 0.3); and mean diastolic second uABP (mean difference: 1.0 mmHg; 95% CI: -0.4 to 2.3). White coat hypertension was highest with SBPM (55 [20%]), followed by first uABP (27 [9.8%]), and second uABP (18 [6.5%]). Using systolic daytime 24 h-ABPM as a reference, the uABPs had higher AUROC (first uABP: 87% [95% CI: 83-91]; second uABP: 88% [95% CI: 84-92]); SBPM: (79% [95% CI: 74-85]). This difference was significant between first uABP and SBPM (P = 0.0024), and between second uABP and SBPM (P = 0.0017). Interpretation uABP had better diagnostic performance than SBPM. Integration of uABP into STEPS protocol should be considered. Funding Swiss Agency for Development and Cooperation under the ComBaCaL project, and the World Diabetes Foundation.
Collapse
Affiliation(s)
- Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | | | | | | | | | | | - Lucia Gonzalez
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Ravi Gupta
- SolidarMed, Partnerships for Health, Maseru, Lesotho
| | - Stephen McCrosky
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Tristan Lee
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Frédérique Chammartin
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Bailah Leigh
- College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Freetown, Sierra Leone
| | - Maja Weisser
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
| | - Alain Amstutz
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Niklaus Daniel Labhardt
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| |
Collapse
|
5
|
Shahmohamadi E, Yousefi M, Mohammadi E, Ghanbari A, Shaker E, Azadnajafabad S, Abbasi-Kangevari M, Rashidi MM, Rezaei N, Mohammadi Fateh S, Foroutan Mehr E, Rahimi S, Effatpanah M, Jamshidi H, Farzadfar F. National and Provincial Prevalence of Cigarette Smoking in Iran; A Systematic Analysis of 12 Years of STEPS Experience. Arch Iran Med 2023; 26:472-480. [PMID: 38310402 PMCID: PMC10862053 DOI: 10.34172/aim.2023.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/03/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Smoking is a modifiable risk factor for six of the eight leading causes of death. Despite the great burden, there is lack of data regarding the trend of cigarette smoking in Iran. We described the national and provincial prevalence of cigarette smoking and its 12-year time trend utilizing six rounds of Iranian stepwise approach for surveillance of non-communicable disease (STEPS) surveys. METHODS We gathered data from six STEPS surveys done in 2005, 2007, 2008, 2009, 2011, and 2016 in Iran. To estimate the data of missing years, we used two separate statistical models including the mixed model and spatio-temporal analysis. RESULTS The overall prevalence rate of cigarette smoking was 14.65% (12.81‒16.59) in 2005 and 10.63% (9.00‒12.57) in 2016 in Iran. The prevalence of cigarette smoking in 2005 and 2016 was 25.15% (23.18‒27.11) and 19.95% (17.93%‒21.97%) for men and 4.13% (2.43‒6.05) and 1.31% (0.06-3.18) for women, respectively. The prevalence of smoking in different provinces of Iran ranged from 20.73% (19.09‒22.47) to 9.67% (8.24‒11.34) in 2005 and from 15.34% (13.68‒17.12) to 6.41% (5.31‒7.94) in 2016. The overall trend of smoking was downward, which was true for both sexes and all 31 provinces. The declining annual percent change (APC) of the prevalence trend was -2.87% in total population, -9.91% in women, and -2.08% in men from 2005 to 2016. CONCLUSION Although the prevalence of smoking had a decreasing trend in Iran, this trend showed disparities among sexes and provinces and this epidemiological data can be used to modify smoking prevention programs.
Collapse
Affiliation(s)
- Elnaz Shahmohamadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yousefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Shaker
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Foroutan Mehr
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saral Rahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamidreza Jamshidi
- Research Institute for Endocrine Sciences, Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Nouri M, Shateri Z, Vali M, Faghih S. The relationship between the intake of fruits, vegetables, and dairy products with hypertension: findings from the STEPS study. BMC Nutr 2023; 9:99. [PMID: 37592349 PMCID: PMC10433612 DOI: 10.1186/s40795-023-00756-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The current research aimed to evaluate the relationship between fruit, vegetable (FV), and dairy consumption with the odds of developing hypertension based on nationwide Stepwise approach to surveillance (STEPS) data in Iran. METHODS This cross-sectional study was accomplished by the research center of non-communicable diseases (NCDs) in Tehran. In total, 29,378 individuals' data were analyzed. Participants were classified into normal, elevated BP, stage I, and stage II hypertension according to systolic blood pressure (SBP) and diastolic blood pressure (DBP) examinations. Based on the STEPS questionnaire, the consumption of FVs and dairy products was evaluated. Multinomial logistic regression was applied to assess the relationship between the consumption of FVs and dairy products with hypertension. RESULTS The findings revealed that only fruit consumption (≥ 2 servings/day) was negatively related to stage I hypertension (odds ratio (OR) = 0.81; 95% confidence interval (CI): 0.69-0.95) in two servings per day and OR = 0.81; 95% CI: 0.68-0.96 in > two servings per day) in the adjusted model. There was no significant relationship between consuming vegetables and dairy products with elevated BP and hypertension. CONCLUSION Our study showed that increasing fruit consumption was related to reducing hypertension odds. Regarding the consumption of dairy products and vegetables, no significant relationship was found with the odds of hypertension. More studies, especially cohorts, are needed to evaluate the impacts of FV and dairy products on the risk of hypertension.
Collapse
Affiliation(s)
- Mehran Nouri
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zainab Shateri
- Department of Nutrition and Biochemistry, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohebat Vali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shiva Faghih
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
- Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
7
|
Gelaw YA, Koye DN, Alene KA, Ahmed KY, Assefa Y, Erku DA, Tegegn HG, Tesema AG, Zeleke BM, Melaku YA. Socio-demographic correlates of unhealthy lifestyle in Ethiopia: a secondary analysis of a national survey. BMC Public Health 2023; 23:1528. [PMID: 37568091 PMCID: PMC10416504 DOI: 10.1186/s12889-023-16436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Multiple lifestyle risk factors exhibit a stronger association with non-communicable diseases (NCDs) compared to a single factor, emphasizing the necessity of considering them collectively. By integrating these major lifestyle risk factors, we can identify individuals with an overall unhealthy lifestyle, which facilitates the provision of targeted interventions for those at significant risk of NCDs. The aim of this study was to evaluate the socio-demographic correlates of unhealthy lifestyles among adolescents and adults in Ethiopia. METHODS A national cross-sectional survey, based on the World Health Organization's NCD STEPS instruments, was conducted in Ethiopia. The survey, carried out in 2015, involved a total of 9,800 participants aged between 15 and 69 years. Lifestyle health scores, ranging from 0 (most healthy) to 5 (most unhealthy), were derived considering factors such as daily fruit and vegetable consumption, smoking status, prevalence of overweight/obesity, alcohol intake, and levels of physical activity. An unhealthy lifestyle was defined as the co-occurrence of three or more unhealthy behaviors. To determine the association of socio-demographic factors with unhealthy lifestyles, multivariable logistic regression models were utilized, adjusting for metabolic factors, specifically diabetes and high blood pressure. RESULTS Approximately one in eight participants (16.7%) exhibited three or more unhealthy lifestyle behaviors, which included low fruit/vegetable consumption (98.2%), tobacco use (5.4%), excessive alcohol intake (15%), inadequate physical activity (66%), and obesity (2.3%). Factors such as male sex, urban residency, older age, being married or in a common-law relationship, and a higher income were associated with these unhealthy lifestyles. On the other hand, a higher educational status was associated with lower odds of these behaviors. CONCLUSION In our analysis, we observed a higher prevalence of concurrent unhealthy lifestyles. Socio-demographic characteristics, such as sex, age, marital status, residence, income, and education, were found to correlate with individuals' lifestyles. Consequently, tailored interventions are imperative to mitigate the burden of unhealthy lifestyles in Ethiopia.
Collapse
Affiliation(s)
- Yalemzewod Assefa Gelaw
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia.
- School of Population Health, Curtin University, Perth, WA, Australia.
| | - Digsu N Koye
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kefyalew Addis Alene
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Kedir Y Ahmed
- Rural Health Research Institute, Charles Sturt University, Orange, NSW, 2800, Australia
- Department of Public Health, Samara University, Samara, Afar, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Daniel Asfaw Erku
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Henok Getachew Tegegn
- School of Rural Medicine, University of New England, Armidale, 2351, Australia
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Azeb Gebresilassie Tesema
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Berihun Megabiaw Zeleke
- Planetary Health Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yohannes Adama Melaku
- FHMRI Sleep Health, Flinders University, Adelaide, SA, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| |
Collapse
|
8
|
Krishna E, Pal A, Galhotra A, Shukla AK, Parija PP, Pathak VK, Rajath Rao UR, Naik BN. Undiagnosed hypertension and associated factors among adults in the urban field practice area of AIIMS Raipur: A community-based screening survey. J Family Med Prim Care 2023; 12:1540-1546. [PMID: 37767439 PMCID: PMC10521818 DOI: 10.4103/jfmpc.jfmpc_1819_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Undiagnosed hypertension (HTN) increases the risk of severe consequences such as chronic kidney disease (CKD), hypertensive retinopathy, heart failure, and stroke. Population-based screening can be used to expose the hidden diseased mass with active disease. Thus, a screening survey was conducted to estimate the proportion of people with HTN among apparently healthy adults of age ≥30 years residing at the urban field practice area (UHTC) of AIIMS, Raipur, and also determine the predictors of undiagnosed HTN among the study participants. Methodology This was a community-based cross-sectional study conducted over 2 months duration in the Ramnagar area, which comes under the urban field practice area of AIIMS Raipur using the STEPS tool is an acronym of study tool provided by WHO i.e. STEPwise approach to NCD risk factor surveillance consisting of three steps viz. questionnaire for behavioural risk factors, physical measurements and biochemical measurements. Results In this study, 24.2% (95%, confidence interval [CI]: 20.1-28.2) of participants screened positive for HTN. The proportion of males who screened positive for HTN was 28.8% (95% CI: 22.6-35), whereas the proportion of females who screened positive for HTN was 19.6% (95% CI: 14.3-25). In this study, elderly (>60 years), male gender, daily tobacco use, greater waist circumference (male >90 cm and female >80 cm), and daily salt intake of more than 5 g were found to have higher odds of having HTN. Conclusion The prevalence of undiagnosed HTN in the UHTC of AIIMS Raipur was quite high.
Collapse
Affiliation(s)
- Ekta Krishna
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Anjali Pal
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Abhiruchi Galhotra
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Arvind Kumar Shukla
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | | | - Vineet Kumar Pathak
- Department of Community Medicine, SGT Medical College, Gurugram, Haryana, India
| | - UR Rajath Rao
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Bijaya Nanda Naik
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| |
Collapse
|
9
|
Nouri M, Shateri Z, Faghih S. The relationship between intake of fruits, vegetables and dairy products with overweight and obesity in a large sample in Iran: Findings of STEPS 2016. Front Nutr 2023; 9:1082976. [PMID: 36733471 PMCID: PMC9886861 DOI: 10.3389/fnut.2022.1082976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Background The present study aimed to investigate the association between fruits and vegetables (FVs) and dairy product intake with body weight based on the data from the nationwide Stepwise approach to surveillance (STEPS) survey in Iran. Methods STEPS is a national-based cross-sectional study conducted on 3,0541 people selected by stratified cluster random sampling in Iran from April to November 2016. The outcome of the current study was body mass index (BMI) which was classified as normal weight, underweight, overweight, and obese. Also, as exposure variables, dietary intakes of fruits, vegetables and dairy products were extracted from the STEPS questionnaires. Multinomial logistic regression was used to evaluate the association between dairy products, FVs consumption, and BMI category in the crude and adjusted models. Results In the adjusted model, we observed 41% [odd ratio (OR) = 0.59; 95% confidence intervals (CI): 0.50, 0.68, P < 0.001], 27% (OR = 0.73; 95% CI: 0.62, 0.84, P < 0.001), and 26% (OR = 0.74; 95% CI: 0.63, 0.87, P < 0.001) lower odds of being overweight, and 46% (OR = 0.54; 95% CI: 0.46, 0.64, P < 0.001), 29% (OR = 0.71; 95% CI: 0.60, 0.84, P < 0.001), and 21% (OR = 0.79; 95% CI: 0.65, 0.95, P = 0.014) decrease in obesity odds among the participants who consumed 1, 2, and more than 2 servings of fruits per day in comparison to less than one serving, respectively. Also, we observed participants who consumed 1, 2, and more than 2 servings in comparison to less than one serving of dairy products per day had 31% (OR = 0.69; 95% CI: 0.58, 0.81, P < 0.001), 23% (OR = 0.77; 95 %CI: 0.65, 0.91, P = 0.002), and 21% (OR = 0.79; 95% CI: 0.67, 0.94, P = 0.011) lower odds of being overweight and 47% (OR = 0.53; 95% CI: 0.44, 0.64, P < 0.001), 36% (OR = 0.64; 95% CI: 0.53, 0.77, P < 0.001), and 32% (OR = 0.68; 95% CI: 0.56, 0.83, P < 0.001) lower odds of obesity, respectively. In addition, compared to participants who consumed less than 2 servings of vegetables per day, participants who consumed 2, 3, and more than 3 servings had 40% (OR = 0.60; 95% CI: 0.47, 0.76, P < 0.001), 29% (OR = 0.71; 95% CI: 0.56, 0.90, P = 0.006), and 26% (OR = 0.74; 95% CI: 0.57, 0.96, P = 0.027) lower odds of being overweight, respectively. Furthermore, we observed 36% lower odds of obesity among participants who ate 2 servings of vegetables per day compared to less than 2 serving (OR = 0.64; 95% CI: 0.49, 0.84, P = 0.002). Conclusion Our findings showed that intake of FVs and dairy products is associated with a healthier weight status in adults. Further studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Mehran Nouri
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran,Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zainab Shateri
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shiva Faghih
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran,Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,*Correspondence: Shiva Faghih,
| |
Collapse
|
10
|
Djalalinia S, Azadnajafabad S, Ghasemi E, Yoosefi M, Rezaei N, Farzi Y, Kazemi A, Ahmadi N, Nasserinejad M, Fattahi N, Rezaei S, Abdolhamidi E, Foroutan Mehr E, Haghshenas R, Rezaei N, Abdi J, Moghisi A, Mahdavihezaveh A, Akbari Sari A, Raeisi A, Jamshidi H, Larijani B, Farzadfar F. Protocol Design for Surveillance of Risk Factors of Non-communicable Diseases During the COVID-19 Pandemic: An Experience from Iran STEPS Survey 2021. Arch Iran Med 2022; 25:634-646. [PMID: 37543889 PMCID: PMC10685773 DOI: 10.34172/aim.2022.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/08/2022] [Indexed: 08/07/2023]
Abstract
BACKGROUND Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present. METHODS In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey. RESULTS By amending the required changes, we could include a total of 27874 individuals in the first step of the survey. This number was 27745 and 18119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants. CONCLUSION The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources.
Collapse
Affiliation(s)
- Shirin Djalalinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasserinejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Fattahi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahabeddin Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Ohio State University, Columbus, OH, USA
| | - Elham Abdolhamidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Foroutan Mehr
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Abdi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Moghisi
- Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Ali Akbari Sari
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Raeisi
- Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamidreza Jamshidi
- Research Institute for Endocrine Sciences, School of Medicine, Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Mansoor NM, Vanniyasingam T, Malone I, Hobbs NZ, Rees E, Durr A, Roos RAC, Landwehrmeyer B, Tabrizi SJ, Johnson EB, Scahill RI. Validating Automated Segmentation Tools in the Assessment of Caudate Atrophy in Huntington's Disease. Front Neurol 2021; 12:616272. [PMID: 33935934 PMCID: PMC8079754 DOI: 10.3389/fneur.2021.616272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Neuroimaging shows considerable promise in generating sensitive and objective outcome measures for therapeutic trials across a range of neurodegenerative conditions. For volumetric measures the current gold standard is manual delineation, which is unfeasible for samples sizes required for large clinical trials. Methods: Using a cohort of early Huntington's disease (HD) patients (n = 46) and controls (n = 35), we compared the performance of four automated segmentation tools (FIRST, FreeSurfer, STEPS, MALP-EM) with manual delineation for generating cross-sectional caudate volume, a region known to be vulnerable in HD. We then examined the effect of each of these baseline regions on the ability to detect change over 15 months using the established longitudinal Caudate Boundary Shift Integral (cBSI) method, an automated longitudinal pipeline requiring a baseline caudate region as an input. Results: All tools, except Freesurfer, generated significantly smaller caudate volumes than the manually derived regions. Jaccard indices showed poorer levels of overlap between each automated segmentation and manual delineation in the HD patients compared with controls. Nevertheless, each method was able to demonstrate significant group differences in volume (p < 0.001). STEPS performed best qualitatively as well as quantitively in the baseline analysis. Caudate atrophy measures generated by the cBSI using automated baseline regions were largely consistent with those derived from a manually segmented baseline, with STEPS providing the most robust cBSI values across both control and HD groups. Conclusions: Atrophy measures from the cBSI were relatively robust to differences in baseline segmentation technique, suggesting that fully automated pipelines could be used to generate outcome measures for clinical trials.
Collapse
Affiliation(s)
- Nina M Mansoor
- Department of Neurodegenerative Disease, Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tishok Vanniyasingam
- Department of Neurodegenerative Disease, Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Ian Malone
- Department of Neurodegenerative Disease, Dementia Research Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Nicola Z Hobbs
- Department of Neurodegenerative Disease, Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Elin Rees
- IXICO plc, Griffin Court, Long Lane, London, United Kingdom
| | - Alexandra Durr
- Sorbonne Université, Institut du Cerveau/Paris Brain Institute AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Sarah J Tabrizi
- Department of Neurodegenerative Disease, Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Eileanoir B Johnson
- Department of Neurodegenerative Disease, Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rachael I Scahill
- Department of Neurodegenerative Disease, Huntington's Disease Centre, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| |
Collapse
|
12
|
Al-Mawali A, Al-Harrasi A, Jayapal SK, Morsi M, Pinto AD, Al-Shekaili W, Al-Kharusi H, Al-Balushi Z, Idikula J. Prevalence and risk factors of diabetes in a large community-based study in the Sultanate of Oman: STEPS survey 2017. BMC Endocr Disord 2021; 21:42. [PMID: 33673840 PMCID: PMC7934365 DOI: 10.1186/s12902-020-00655-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Type 2 diabetes in the Gulf Cooperation Council countries, including Oman, is currently the fastest growing health crisis and is a significant cause of premature mortality and disability. There is currently insufficient up-to-date information available on prevalence of type 2 diabetes. This study aimed to assess the latest prevalence of type 2 diabetes mellitus and its associated demographic, behavioural, and clinical risk factors. METHODS Using the WHO STEPwise approach to chronic disease surveillance, a nationally representative population-based survey was conducted from January to April 2017 of adults aged 18 years and above. A multi-stage, stratified, geographically clustered random sampling surveyed 9053 households including Omani nationals and non-Omani residents. Univariate and multiple logistic regression analysis was performed to determine the predictors of diabetes. RESULTS Overall prevalence of diabetes among the population was 15.7% (95% CI: 14.0-17.5%) whereas prevalence of prediabetes was 11.8% (95% CI: 11.4-12.2%). Age, educational level, raised blood pressure, family history of diabetes, abnormal waist-to-hip ratio, and hypertriglyceridemia were found to be significantly associated with diabetes mellitus. Of the cases of diabetes mellitus, 17% were newly diagnosed and 13.2% were on medication and had an uncontrolled glucose level while 55.5% were not taking medication (although diagnosed) and had an uncontrolled blood glucose level. CONCLUSIONS The present study provides reliable information regarding the high prevalence of diabetes mellitus among the adult population in Oman with urgent attention needed to address this significant burden on the health system. The high proportion of uncontrolled cases warrants further research, awareness programmes, and community interventions.
Collapse
Affiliation(s)
- Adhra Al-Mawali
- Centre of Studies & Research, Ministry of Health, Muscat, Sultanate of Oman.
- Strategic Research Program for Non-Communicable Diseases, Ministry of Higher Education, Research and Innovation, Muscat, Sultanate of Oman.
| | - Ayaman Al-Harrasi
- Centre of Studies & Research, Ministry of Health, Muscat, Sultanate of Oman
| | | | - Magdi Morsi
- Centre of Studies & Research, Ministry of Health, Muscat, Sultanate of Oman
| | | | - Waleed Al-Shekaili
- Centre of Studies & Research, Ministry of Health, Muscat, Sultanate of Oman
| | - Hilal Al-Kharusi
- Centre of Studies & Research, Ministry of Health, Muscat, Sultanate of Oman
| | - Zainab Al-Balushi
- Centre of Studies & Research, Ministry of Health, Muscat, Sultanate of Oman
| | - John Idikula
- Centre of Studies & Research, Ministry of Health, Muscat, Sultanate of Oman
| |
Collapse
|
13
|
Selvaraj K, Kar SS, Ramaswamy G, Premarajan KC, Saya GK, Kalidoss V. Clustering of cardiovascular disease risk factors - Syndemic approach: Is sit a time to shift toward integrated noncommunicable disease clinic? Indian J Public Health 2020; 63:186-193. [PMID: 31552846 DOI: 10.4103/ijph.ijph_158_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The concurrent occurrence of many noncommunicable disease (NCD) risk factors is common, and it can play a synergistic role in occurrence of NCDs. Objectives This study aimed to identify the magnitude of clustering of NCD risk factors, patterns of risk factors emerged in clustering, and variations in clustering of risk factors based on socioeconomic factors. Methods A cross-sectional survey was undertaken in an urban area of Puducherry among 2399 adults during 2014-2015. Sociodemographic and behavioral risk factors were assessed through a validated STEPS survey tool. Individuals with three or more risk factors were classified to have clustering of NCD risk factors. Socioeconomic positions in relation to clustering were identified through Chi-square analysis followed by multiple logistic regression where clustering at family and area was adjusted through multilevel modeling techniques. Results Of the 2399 adults, 1741 (73%) had clustering of NCD risk factors. Inadequate consumption of fruits and vegetables, high salt intake, and high waist circumference are the three predominant risk factors across all subgroups. Adults belonging to Christian religion (adjusted odds ratio [adjOR]: 2.8, 95% confidence interval [CI]: 1.5-5.2), aged 35 years and over (adjOR: 2.0, 95% CI: 1.4-6.0), and illiterates (adjOR: 1.8, 95% CI: 1.1-5.5) are more likely to have clustered NCD risk factors compared to others. Conclusions Clustering of NCD risk factors is highly prevalent in this region and mainly driven by dietary practices and obesity measures. There is an urgent need to reorient the health system toward integrated approach with mandated inclusion of nutritionist in NCD health service delivery.
Collapse
Affiliation(s)
- Kalaiselvi Selvaraj
- Assistant Professor, Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Sitanshu Sekahr Kar
- Additional Professor, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Institute of Medical Research (JIPMER), New Delhi, India
| | - Gomathi Ramaswamy
- Research Assistant, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - K C Premarajan
- Additional Professor, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Institute of Medical Research (JIPMER), New Delhi, India
| | - Ganesh Kumar Saya
- Additional Professor, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Institute of Medical Research (JIPMER), New Delhi, India
| | - Vinodhkumar Kalidoss
- Tutor, Department of Community Medicine, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| |
Collapse
|
14
|
Louison Vang M, Ali SA, Christiansen DM, Dokkedahl S, Elklit A. The role of age and mode of delivery in the STEPS intervention: a longitudinal pilot-study in treatment of posttraumatic stress symptoms in Danish survivors of sexual assault. Eur J Psychotraumatol 2020; 11:1701778. [PMID: 32082508 PMCID: PMC7006682 DOI: 10.1080/20008198.2019.1701778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/22/2019] [Accepted: 11/11/2019] [Indexed: 11/05/2022] Open
Abstract
Background: The STEPS programme has been succesfully implemented as a group-based treatment of trauma symptoms after rape for adolescents. The STEPS intervention was translated from Dutch to Danish and offered to adults in addition to adolescents as well as an individual intervention in addition to a group-based intervention at a Danish Centre for Rape Victims through 2011 to 2014. The programme was translated from Dutch to Danish and expanded to adults in addition to adolescents as well as to an individual intervention in addition to a group-based intervention at a Danish Centre for Rape Victims through 2011 to 2014. Objective: The present study observes development in trauma symptoms and ICD-11 diagnostic status during an adapted version of the intervention programme 'STEPS' for survivors of sexual assault. Methods: A prospective uncontrolled study was conducted, monitoring symptoms of posttraumatic stress and other trauma-related symptomatology before treatment, after treatment and at 6 and 12 months' follow up for 103 referrals receiving individual or group-based STEPS. Tentative diagnoses of posttraumatic stress disorder (PTSD) and complex PTSD were assigned to participants according to the ICD-11 to observe the development in diagnostic status across time, and multilevel modelling was used to assess the development of symptom severity and to assess the moderating effect of age-group and mode of delivery. Results: A loglinear function representing large and statistically significant decline in symptomatology over time provided the best fit for all measures of trauma-related symptomatology. The decline was not moderated by age-group or mode of intervention. Dropout rates were independent of mode of intervention and age. Conclusion: The adaption of the STEPS programme to adults and as an individual intervention is feasible and maintains effect sizes comparable to those observed in the original intervention. Further research using randomized controlled trials is needed to ascribe the observed effect to the STEPS programme.
Collapse
Affiliation(s)
- M Louison Vang
- School of Psychology, Ulster University, Northern Ireland, UK.,The Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT).,National Center for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - S A Ali
- National Center for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - D M Christiansen
- National Center for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - S Dokkedahl
- National Center for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - A Elklit
- National Center for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
15
|
Haregu TN, Wekesah FM, Mohamed SF, Mutua MK, Asiki G, Kyobutungi C. Patterns of non-communicable disease and injury risk factors in Kenyan adult population: a cluster analysis. BMC Public Health 2018; 18:1225. [PMID: 30400901 PMCID: PMC6219050 DOI: 10.1186/s12889-018-6056-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-communicable diseases and unintentional injuries are emerging public health problems in sub-Saharan Africa. These threats have multiple risk factors with complex interactions. Though some studies have explored the magnitude and distribution of those risk factors in many populations in Kenya, an exploration of segmentation of population at a national level by risk profile, which is crucial for a differentiated approach, is currently lacking. The aim of this study was to examine patterns of non-communicable disease and injury risk through the identification of clusters and investigation of correlates of those clusters among Kenyan adult population. METHODS We used data from the 2015 STEPs survey of non-communicable disease risk factors conducted among 4484 adults aged between 18 and 69 years in Kenya. A total of 12 risk factors for NCDs and 9 factors for injury were used as clustering variables. A K-medians Cluster Analysis was applied. We used matching as the measure of the similarity/dissimilarity among the clustering variables. While clusters were described using the risk factors, the predictors of the clustering were investigated using multinomial logistic regression. RESULTS We have identified five clusters for NCDs and four clusters for injury based on the risk profile of the population. The NCD risk clusters were labelled as cluster hypertensives, harmful users, the hopefuls, the obese, and the fat lovers. The injury risk clusters were labelled as helmet users, jaywalkers, the defiant and the compliant. Among the possible predictors of clustering, age, gender, education and wealth index came out as strong predictors of the cluster variables. CONCLUSION This cluster analysis has identified important clusters of adult Kenyan population for non-communicable disease and injury risk profiles. Risk reduction interventions could consider these clusters as potential target in the development and segmentation of a differentiated approach.
Collapse
Affiliation(s)
- Tilahun Nigatu Haregu
- African Population and Health Research Center (APHRC), 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787, Kitisuru, Nairobi, GPO 00100, Kenya.,Non-communicable Diseases Unit, University of Melbourne, Melbourne, Australia
| | - Frederick M Wekesah
- African Population and Health Research Center (APHRC), 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787, Kitisuru, Nairobi, GPO 00100, Kenya. .,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands.
| | - Shukri F Mohamed
- African Population and Health Research Center (APHRC), 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787, Kitisuru, Nairobi, GPO 00100, Kenya.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin K Mutua
- African Population and Health Research Center (APHRC), 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787, Kitisuru, Nairobi, GPO 00100, Kenya
| | - Gershim Asiki
- African Population and Health Research Center (APHRC), 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787, Kitisuru, Nairobi, GPO 00100, Kenya
| | - Catherine Kyobutungi
- African Population and Health Research Center (APHRC), 2nd Floor APHRC Campus, Manga Close Off Kirawa Road, P.O. Box 10787, Kitisuru, Nairobi, GPO 00100, Kenya
| |
Collapse
|
16
|
Mwenda V, Mwangi M, Nyanjau L, Gichu M, Kyobutungi C, Kibachio J. Dietary risk factors for non-communicable diseases in Kenya: findings of the STEPS survey, 2015. BMC Public Health 2018; 18:1218. [PMID: 30400904 PMCID: PMC6219002 DOI: 10.1186/s12889-018-6060-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Burden of non-communicable diseases (NCD) is increasing worldwide. Risk factor surveillance informs public health interventions in NCD control. This study describes the dietary risk factors for NCD found in the Kenya STEPS survey, 2015. METHODS We performed secondary analysis of the STEPS dataset to determine prevalence of dietary NCD risk factors and their determinants. New variables were created; high dietary salt, defined as addition of salt while eating or intake of processed foods high in salt and high dietary sugar, defined as intake of processed foods or drinks high in sugar in most meals or addition of sugar to beverages already with sugar, on a daily basis. We used the World Health Organization definition of minimum required intake of fruits and vegetables as consumption of less than five servings of fruits and vegetables per day. Perceptions of respondents on diet and health were also assessed. Accounting for complex survey sampling, we calculated prevalence of the various dietary modifiable determinants and adjusted odds ratios (AOR) to identify factors independently associated with dietary NCD risk factors. RESULTS Of the 4484 individuals surveyed; mean age was 40.5 years (39.9-41.1 years), 60% were female. Prevalence of high reported dietary salt intake was 18.3% (95% CI 17.2%, 19.5%) and sugar 13.7% (95% CI 11.7-15.8%). Awareness of health risk from dietary salt was 88% and 91% for dietary sugar. Approximately 56% of the respondents were implementing strategies to reduce dietary salt and 54% were doing the same for dietary sugar. Only 6.0% (95% CI 4.3-7.6%) of the respondents reported intake of a minimum of five servings of both fruits and vegetables daily. Unhealthy diet was associated with being male (AOR 1.33, 95% CI 1.04, 1.70,), age below 46 years (AOR 1.78, 95% CI 1.42, 2.12) and being a student (AOR 15.6, 95% CI 2.44, 99.39). CONCLUSION Dietary risk communication should be targeted to males and people under 45 years of age, especially students. Further research is necessary to understand the knowledge: practice mismatch on unhealthy diets.
Collapse
Affiliation(s)
- Valerian Mwenda
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
- Non-communicable disease division, Ministry of Health, Nairobi, Kenya
| | - Martin Mwangi
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
- Non-communicable disease division, Ministry of Health, Nairobi, Kenya
| | - Loise Nyanjau
- Non-communicable disease division, Ministry of Health, Nairobi, Kenya
| | - Muthoni Gichu
- Non-communicable disease division, Ministry of Health, Nairobi, Kenya
| | | | - Joseph Kibachio
- Non-communicable disease division, Ministry of Health, Nairobi, Kenya
- The Institute of Global Health, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| |
Collapse
|
17
|
Chimeddamba O, Gearon E, Brilleman SL, Tumenjargal E, Peeters A. Increases in waist circumference independent of weight in Mongolia over the last decade: the Mongolian STEPS surveys. BMC Obes 2017; 4:19. [PMID: 28491328 PMCID: PMC5422882 DOI: 10.1186/s40608-017-0155-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 04/27/2017] [Indexed: 11/30/2022]
Abstract
Background In Mongolia, mean waist circumference (WC) has increased dramatically over the last decade, however, it is unknown whether these increases have been greater than corresponding increases in weight. In this study we aimed to assess whether recent increases in WC were greater than expected from changes in weight in Mongolian adults. Methods We used data on 13260 Mongolian adults, aged between 18 and 64 years, who participated in one of three (2005, 2009, 2013) nationally representative cross-sectional surveys. Linear regression was used to estimate changes in mean WC over time, adjusted for age, sex, height and weight. We also estimated the age-standardised prevalence for four obesity classification categories (not obese; obese by WC only; obese by body mass index (BMI) only; obese by both BMI and WC) at each survey year. Results The estimated mean WC in 2009 and 2013, respectively, was 1.26 cm (95% CI: 0.35 to 2.17) and 1.88 cm (95% CI: 1.09 to 2.67) greater compared to 2005, after adjusting for age, sex, height and weight. Between 2005 and 2013, the age-standardised prevalence of those obese according to both BMI and WC increased from 8.0 to 13.6% for men and from 16.5 to 25.5% for women. During the same period, the percentage who were obese by WC only increased from 1.8 to 4.8% for men and from 16.5 to 26.8% for women. In contrast, the percentage who were obese by BMI only remained relatively stable (women: 2.4% in 2005 to 1.0% in 2013; men: 2.7% in 2005 to 4.0% in 2013). Conclusion Over the last decade, among Mongolian adults, there has been substantially greater increase in WC and the prevalence of abdominal obesity than would be expected from increases in weight. Women are at greater risk than men of being misclassified as not obese if obesity is defined using BMI only. Obesity should be monitored using WC in addition to BMI to ensure the prevalence of obesity is not underestimated.
Collapse
Affiliation(s)
- Oyun Chimeddamba
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC 3004 Australia.,Deakin University, Geelong, Victoria, School of Health and Social Development, Faculty of Health, Melbourne, Australia
| | - Emma Gearon
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC 3004 Australia.,Deakin University, Geelong, Victoria, School of Health and Social Development, Faculty of Health, Melbourne, Australia
| | - Samuel L Brilleman
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC 3004 Australia.,Victorian Centre for Biostatistics (ViCBiostat), Melbourne, VIC Australia
| | - Enkhjargal Tumenjargal
- Department of Health Development, National Center of Public Health, Peace Avenue 17, Bayanzurkh District-3, Ulaanbaatar, Mongolia
| | - Anna Peeters
- Deakin University, Geelong, Victoria, School of Health and Social Development, Faculty of Health, Melbourne, Australia
| |
Collapse
|
18
|
Chen W, De Schutter E. Parallel STEPS: Large Scale Stochastic Spatial Reaction-Diffusion Simulation with High Performance Computers. Front Neuroinform 2017; 11:13. [PMID: 28239346 PMCID: PMC5301017 DOI: 10.3389/fninf.2017.00013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/27/2017] [Indexed: 11/13/2022] Open
Abstract
Stochastic, spatial reaction-diffusion simulations have been widely used in systems biology and computational neuroscience. However, the increasing scale and complexity of models and morphologies have exceeded the capacity of any serial implementation. This led to the development of parallel solutions that benefit from the boost in performance of modern supercomputers. In this paper, we describe an MPI-based, parallel operator-splitting implementation for stochastic spatial reaction-diffusion simulations with irregular tetrahedral meshes. The performance of our implementation is first examined and analyzed with simulations of a simple model. We then demonstrate its application to real-world research by simulating the reaction-diffusion components of a published calcium burst model in both Purkinje neuron sub-branch and full dendrite morphologies. Simulation results indicate that our implementation is capable of achieving super-linear speedup for balanced loading simulations with reasonable molecule density and mesh quality. In the best scenario, a parallel simulation with 2,000 processes runs more than 3,600 times faster than its serial SSA counterpart, and achieves more than 20-fold speedup relative to parallel simulation with 100 processes. In a more realistic scenario with dynamic calcium influx and data recording, the parallel simulation with 1,000 processes and no load balancing is still 500 times faster than the conventional serial SSA simulation.
Collapse
Affiliation(s)
- Weiliang Chen
- Computational Neuroscience Unit, Okinawa Institute of Science and Technology Graduate UniversityOkinawa, Japan
| | | |
Collapse
|
19
|
Choudhury GR, Kim J, Frost PA, Bastarrachea RA, Daadi MM. Nonhuman primate model in clinical modeling of diseases for stem cell therapy. Brain Circ 2016; 2:141-145. [PMID: 30276291 PMCID: PMC6126269 DOI: 10.4103/2394-8108.192524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 08/16/2016] [Accepted: 09/06/2016] [Indexed: 01/11/2023] Open
Abstract
Nonhuman primates (NHPs) are alike humans in size, behavior, physiology, biochemistry, and immunology. Given close similarities to humans, the NHP model offers exceptional opportunities to understand the biological mechanisms and translational applications with direct relevance to human conditions. Here, we evaluate the opportunities and limitations of NHPs as animal models for translational regenerative medicine. NHP models of human disease propose exceptional opportunities to advance stem cell-based therapy by addressing pertinent translational concerns related to this research. Nonetheless, the value of these primates must be carefully assessed, taking into account the expense of specialized equipment and requirement of highly specialized staff. Well-designed initial fundamental studies in small animal models are essential before translating research into NHP models and eventually into human trials. In addition, we suggest that applying a directed and collaborative approach, as seen in the evolution of stroke NHP models, will greatly benefit the translation of stem cell therapy in other NHP disease models.
Collapse
Affiliation(s)
- Gourav R Choudhury
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Jeffrey Kim
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Patrice A Frost
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Raul A Bastarrachea
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Marcel M Daadi
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA.,Department of Cellular and Structural Biology, UT Health Science Center, San Antonio, Texas, USA.,Department of Radiology, Medical School, UT Health Science Center, San Antonio, Texas, USA
| |
Collapse
|
20
|
Gurung MS, Pelzom D, Dorji T, Drukpa W, Wangdi C, Chinnakali P, Goel S. Current tobacco use and its associated factors among adults in a country with comprehensive ban on tobacco: findings from the nationally representative STEPS survey, Bhutan, 2014. Popul Health Metr 2016; 14:28. [PMID: 27507928 PMCID: PMC4977656 DOI: 10.1186/s12963-016-0098-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite a comprehensive ban on cultivation, manufacture, distribution, and sale of tobacco products since 2004, two nationwide surveys conducted in 2012 and 2013 reported high tobacco use in Bhutan. National Health Survey 2012 reported that 4 % of the population aged 15-75 years used smoked tobacco and about 48 % used smokeless tobacco. Similarly, Global Youth Tobacco Survey (GYTS) of Bhutan reported tobacco use prevalence of 30.3 % in 2013. However, factors associated with this high tobacco use were not systematically studied. Hence, we assessed the prevalence of tobacco use and its associated sociodemographic, behavioral, and environmental factors. METHODS This cross-sectional analytical study used secondary data collected in a nationally representative Non-communicable Disease Risk Factors Surveillance STEPS Survey 2014 conducted among Bhutanese adults (18-69 years). The survey included a total of 2820 adults; selected using multistage stratified cluster sampling. Weighted analysis was done to calculate the prevalence of tobacco use. Unadjusted and adjusted prevalence ratios were calculated using log binomial regression. RESULTS The prevalence of current overall tobacco use was 24.8 % (95 % CI: 21.4-28.3) and that of smoked, smokeless, and dual forms (smoked and smokeless forms) were 7.4 % (95 % CI: 5.8-9.0), 19.7 % (95 % CI: 16.5-22.9), and 2.3 % (95 % CI: 1.8-2.9), respectively. Significantly higher prevalence of tobacco use in all forms was found among males, younger age groups, and alcohol users. The prevalence of smoked form was higher in urban areas compared to rural areas (11 % vs 6 %; aPR 1.8, 95 % CI: 1.5-2.0). Among individuals who reported having a non-communicable disease, the prevalence of smoked tobacco use was significantly lower than those who did not have disease (3.5 % vs. 8.3 %; aPR 0.5, 95 % CI: 0.3-0.9). Exposure to health warnings was protective for current tobacco use and smokeless tobacco use, while exposure to tobacco warnings through the media was helpful among smokers and overall tobacco users. CONCLUSIONS Despite a comprehensive ban on tobacco, tobacco use was high in Bhutan, especially the smokeless form. Males, younger age groups, and alcohol users should be targeted with behavioral interventions along the stricter implementation of tobacco control measures.
Collapse
Affiliation(s)
| | | | | | | | | | - Palanivel Chinnakali
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sonu Goel
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
21
|
Abstract
STEPS is a stochastic reaction-diffusion simulation engine that implements a spatial extension of Gillespie's Stochastic Simulation Algorithm (SSA) in complex tetrahedral geometries. An extensive Python-based interface is provided to STEPS so that it can interact with the large number of scientific packages in Python. However, a gap existed between the interfaces of these packages and the STEPS user interface, where supporting toolkits could reduce the amount of scripting required for research projects. This paper introduces two new supporting toolkits that support geometry preparation and visualization for STEPS simulations.
Collapse
Affiliation(s)
- Weiliang Chen
- Computational Neuroscience Unit, Okinawa Institute of Science and Technology Okinawa, Japan
| | - Erik De Schutter
- Computational Neuroscience Unit, Okinawa Institute of Science and Technology Okinawa, Japan
| |
Collapse
|
22
|
Roth GA, Murray CJL. The Global Burden of Disease Study 2010 does not show a rise in the age-standardized mortality rate for cardiovascular disease in sub-Saharan Africa. Prog Cardiovasc Dis 2013; 56:278-80. [PMID: 24267435 DOI: 10.1016/j.pcad.2013.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
High-quality information on the distribution of disease, disability, and death should be available to all governments tasked with making decision regarding the judicious use of limited resources. GBD 2010 was a systematic effort to quantify disease and disability by age and sex in 187 countries from 1990 to 2010, including all the countries of sub-Saharan Africa. The study adopted the perspective that all available epidemiological information should be used and adjusted for known limitations, an approach that is particularly important for Africa. Despite Cooper and Bovet's concern that studies like GBD 2010 report a "tsunami of cardiovascular disease" in sub-Saharan Africa, GBD showed a trend toward a decline in age-standardized rates of death due to cardiovascular disease in sub-Saharan Africa but confidence intervals were broad, reflecting the limited available data. Scientific efforts should work toward making measures of bias and uncertainty more rigorous and transparent in reporting measures of public health.
Collapse
Affiliation(s)
- Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA.
| | | |
Collapse
|
23
|
Lapchak PA, Zhang JH, Noble-Haeusslein LJ. RIGOR guidelines: escalating STAIR and STEPS for effective translational research. Transl Stroke Res 2013; 4:279-85. [PMID: 23658596 PMCID: PMC3644408 DOI: 10.1007/s12975-012-0209-2] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 08/14/2012] [Indexed: 01/10/2023]
Abstract
Stroke continues to be a serious and significant health problem in the USA and worldwide. This article will emphasize the need for good laboratory practices, transparent scientific reporting, and the use of translational research models representative of the disease state to develop effective treatments. This will allow for the testing and development of new innovative strategies so that efficacious therapies can be developed to treat ischemic and hemorrhagic stroke. This article recommends guidelines for effective translational research, most importantly, the need for study blinding, study group randomization, power analysis, accurate statistical analysis, and a conflict of interest statement. Additional guidelines to ensure reproducibility of results and confirmation of efficacy in multiple species are discussed.
Collapse
Affiliation(s)
- Paul A. Lapchak
- Department of Neurology, Cedars-Sinai Medical Center, Davis Research Building, D-2091, 110 N. George Burns Road, Los Angeles, CA 90048 USA
| | - John H. Zhang
- Department of Neurosurgery, Anesthesiology, Neurology, and Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350 USA
| | - Linda J. Noble-Haeusslein
- Department of Neurological Surgery, Physical Therapy and Rehabilitation Science, and Brain and Spinal Injury Center (BASIC), University of California, San Francisco, Box 0112, 513 Parnassus Avenue, HSE-722, San Francisco, CA 94143-0112 USA
| |
Collapse
|
24
|
Abstract
The approval of new therapies to treat neurodegenerative disease conditions by the Food and Drug administration (FDA) has been hindered by many failed clinical trials, which were based upon "significant" efficacy in preclinical or translational studies. Additional problems during drug development related to significant adverse events and unforeseen toxicity have also hampered drug development. Recent reviews of preclinical data suggests that many studies have over-estimated efficacy due to poor or inadequate study design, exclusion of important data (negative or neutral) and lack of study randomization and blinding. This article describes in detail a set of recommendations to improve the quality of science being conducted in laboratories worldwide, with the goal of documenting in the peer-reviewed literature, including Journal of Neurology and Neurophysiology, the scientific basis for the continued development of specific strategies to treat neurodegenerative diseases such as Stroke, Alzheimer's disease, Huntington's disease, Parkinson's disease, Spinal cord injury, and Amyotrophic lateral sclerosis. The minimum recommendations for effective translational research include the need for model justification, study group randomization and blinding, power analysis calculations, appropriate statistical analysis of all data sets, and a conflict of interest statement by investigators. It will also be beneficial to demonstrate reproducible efficacy in multiple species and in studies done by independent laboratories.
Collapse
Affiliation(s)
- Paul A. Lapchak
- Director of Translational Research, Cedars-Sinai Medical Center, Department of Neurology, Davis Research Building, D-2091, 110 N, George Burns Road, Los Angeles, CA 90048, USA
| |
Collapse
|