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Samanta AP, Ghosh A, Dutta K, Mandal D, Tudu S, Sarkar K, Das B, Ghosh SK, Chattopadhyay D. Biofabrication of aminated nanocellulose reinforced polyvinyl alcohol/chitosan nanofibrous scaffold for sustained release of diltiazem hydrochloride. Int J Biol Macromol 2024; 277:134395. [PMID: 39098668 DOI: 10.1016/j.ijbiomac.2024.134395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Abstract
In the modern environment conscious era, there has been a huge demand for the effective green method to fabricate biomaterials for sustained transdermal release of diltiazem hydrochloride to treat hypertension and cardiac failure. In this vein, the present study explores the amination of waste jute sourced nanocellulose (ANC) and its effect as a reinforcing filler to design electrospun polyvinyl alcohol (PVA)/chitosan based polymeric nanofibrous scaffold for drug delivery. The characterization results of FTIR (Fourier Transform Infrared Spectroscopy) confirm the successful chemical modification of nanocellulose (NCC). SEM (Scanning Electron Microscopy) results indicate the morphological modifications in ANC due to grafting. ANC enhances the mechanical properties of scaffold and sustains the release of the loaded drug to 67.89±3.39% as compared to the pure PVA/chitosan scaffold of 92.63±4.63% over a period of 72 h as shown by the results of in-vitro drug release study. Moreover, the incorporation of 0.5 % ANC improves the anti-bacterial activity against both gram-positive (97.4±4.87%, reduction in viable cells count) and gram-negative bacteria (98.5±4.93%, reduction in viable cells count). Further, the skin irritation and MTT assay authenticate the biocompatibility of the developed scaffold. The overall findings hence prove the efficacy of the engineered scaffold as a potential transdermal patch for sustained drug delivery applications.
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Affiliation(s)
- Arpita Priyadarshini Samanta
- Department of Jute and Fiber Technology, Institute of Jute Technology, University of Calcutta, 35 Ballygunge Circular Road, Kolkata 700 019, West Bengal, India; Department of Polymer Science and Technology, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, West Bengal, India
| | - Adrija Ghosh
- Department of Polymer Science and Technology, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, West Bengal, India
| | - Koushik Dutta
- Department of Polymer Science and Technology, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, West Bengal, India.
| | - Debashmita Mandal
- Center for Research in Nanoscience and Nanotechnology, Acharya Prafulla Chandra Roy Sikhsha Prangan, University of Calcutta, JD-2, Sector-III, Saltlake City, Kolkata 700 098, WB, India
| | - Surajit Tudu
- Center for Research in Nanoscience and Nanotechnology, Acharya Prafulla Chandra Roy Sikhsha Prangan, University of Calcutta, JD-2, Sector-III, Saltlake City, Kolkata 700 098, WB, India
| | - Kunal Sarkar
- Department of Zoology, University of Calcutta, 35, Ballygunge Circular Road, Kolkata 700019, India
| | - Beauty Das
- Department of Polymer Science and Technology, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, West Bengal, India
| | - Swapan Kumar Ghosh
- Department of Jute and Fiber Technology, Institute of Jute Technology, University of Calcutta, 35 Ballygunge Circular Road, Kolkata 700 019, West Bengal, India.
| | - Dipankar Chattopadhyay
- Department of Polymer Science and Technology, University of Calcutta, 92 A.P.C. Road, Kolkata 700009, West Bengal, India; Center for Research in Nanoscience and Nanotechnology, Acharya Prafulla Chandra Roy Sikhsha Prangan, University of Calcutta, JD-2, Sector-III, Saltlake City, Kolkata 700 098, WB, India.
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Eslamimehr F, Hosseini Z, Aghamolaei T, Nikparvar M, Ghanbarnejad A. Predictors of self-care behaviors in patients with hypertension: The integrated model of theories of "planned behavior" and "protection motivation". JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:213. [PMID: 39297099 PMCID: PMC11410171 DOI: 10.4103/jehp.jehp_592_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/24/2023] [Indexed: 09/21/2024]
Abstract
BACKGROUND Assessment of self-care behaviors in patients with hypertension may provide clinicians and practitioners with important information about how to better control hypertension. Therefore, the present study aimed to explore the predictors of self-care behaviors in patients with hypertension based on an integrated model of theories of planned behavior and protection motivation. MATERIALS AND METHODS The present cross-sectional study was part of a larger study, conducted in 2022 on 344 hypertensive patients from Khamir County in Hormozgan Province in Iran. The sample was selected through a systematic random sampling. The patients completed a researcher-made questionnaire based on constructs of the theory of planned behavior and protection motivation theory. They also completed, Hypertension Self-Care Activity Level Effects (H-SCALE), Hypertension Knowledge-Level Scale (HK-LS), and a demographic questionnaire. The data were analyzed in SPSS 21 using the Pearson correlation coefficient, independent-samples T test, one-way ANOVA, and linear regression analysis. RESULTS The participants' mean age was 47.34 ± 13.68 years. Adherence to medication, physical activity, weight management, diet, and nonsmoking scores were 42.7, 27.3, 66.3, 14.2, and 81.1, respectively. The linear regression model showed that behavioral beliefs (β = 0.366, P < 0.001), perceived rewards (β = -0.248, P < 0.001), control beliefs (β = 0.133, P = 0.013), and normative beliefs (β = 0.143, P = 0.025) were the major predictors of self-care behaviors in patients with hypertension. CONCLUSION In light of the present findings, it can be concluded that it is crucial to change patients' attitudes toward self-care behaviors and improve the social acceptance of behavior and its development in society, and improve patients' control beliefs through goal-oriented education that develops resistance against the perceived rewards of the unfavorable behavior. Considering these constructs can act as strategies to promote self-care behaviors among patients.
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Affiliation(s)
- Farnaz Eslamimehr
- Research Committee, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Zahra Hosseini
- Department of Health Promotion and Education, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Marzieh Nikparvar
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Ghanbarnejad
- Department of Health Promotion and Education, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Lwin MO, Malik S, Ng JS, Kang VBT. Intergenerational Hypertension Prevention Education for Children and Family Members: A Longitudinal Assessment. High Blood Press Cardiovasc Prev 2023; 30:135-143. [PMID: 36752984 DOI: 10.1007/s40292-023-00561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/09/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Many adults are unaware of hypertension risks. Fortunately, hypertension is preventable with lifestyle modifications and regular blood pressure (BP) monitoring. Through reverse socialization (RS), children, acting as information agents, can potentially influence adults' long-term health behaviours. AIM This study aimed to assess the longitudinal effects of a RS-based intervention, with and without experiential component of performing home BP measurement, in enhancing hypertension awareness and motivating regular BP measurement among children and their adult family members (AFMs). METHODS The intervention involves educating grade five children about hypertension and asking them to share this information with AFMs either using only information brochures (non-experiential intervention) or complemented with performing home BP measurement (experiential intervention). Hypertension knowledge and coping appraisals to perform regular BP measurement were assessed before, immediately post-program, and three-months post-program. RESULTS Children's (n = 514) BP knowledge and confidence in sharing BP knowledge improved post-intervention and sustained longitudinally, but the effect was more pronounced among those in the experiential intervention. AFMs' (n = 251) self-efficacy to perform regular BP measurement and intention to prevent hypertension improved only for those in the experiential intervention. Improvement was sustained for self-efficacy only. AFMs' response cost reduced long-term for both intervention types. However, AFMs' hypertension knowledge and response efficacy were unchanged. CONCLUSIONS Even one-off short RS-based interventions with children can be sufficient to increase hypertension awareness for AFMs. An experiential component in similar family-targeted RS programs can capitalize on improvements in self-efficacy and intention to effect sustained behaviour change in hypertension preventive behaviours.
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Affiliation(s)
- May Oo Lwin
- Nanyang Technological University, Singapore, Singapore
| | - Shelly Malik
- Nanyang Technological University, Singapore, Singapore.
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Prevalence and correlates of use of digital technology for managing hypertension among older adults. J Hum Hypertens 2023; 37:80-87. [PMID: 35140353 PMCID: PMC9832211 DOI: 10.1038/s41371-022-00654-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 01/31/2023]
Abstract
Hypertension is prevalent among older adults (60 years and above), but control of blood pressure (BP) remains suboptimal. While there is increasing interest in using digital technology for managing hypertension, information about the extent and potential correlates of such use among older adults remains scant. We assessed the prevalence and correlates of the use of digital technology for managing hypertension among older adults with hypertension. We also investigated if the use of digital technology was associated with BP or hypertension control. The use of digital technology (internet or digital apps) for information about or managing BP or hypertension was assessed among 1729 older adults diagnosed with hypertension participating in a national survey in Singapore. Regression analysis was used to assess the correlates (based on the Unified Theory of Use and Acceptance of Technology), and whether such use was associated with hypertension control or BP values. Digital technology for managing hypertension was used by 7.1% of older adults with hypertension. Those of higher age and with limitations in one or more activities or instrumental activities of daily living were less likely, while those with secondary education and above, and with stronger social network were more likely to use digital technology. There was no association between the use of digital technology and hypertension control. While users of digital technology had lower systolic (by 2.1 mmHg, adjusted p value = 0.12) and diastolic (by 1.6 mmHg, adjusted p value = 0.13) BP than non-users, the differences were not statistically significant. Given its low prevalence, there is potential for increased use of digital technology for managing hypertension among older adults with hypertension in Singapore. Initiatives to increase digital health use should target specific older adult subgroups.
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Attahiru M, Simon PL, Mutalub YB, Akangoziri MD, Grema BA. Predictors of blood pressure control amongst primary care patients of a teaching hospital in Bauchi, North-Eastern Nigeria. Niger Postgrad Med J 2023; 30:46-52. [PMID: 36814163 DOI: 10.4103/npmj.npmj_256_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background Poorly managed hypertension is still a serious global public health issue, despite medication. It is unclear what is causing treated hypertensive patients to have trouble achieving their target blood pressure (BP). Aim The goal of this study was to determine the predictors of BP control amongst hypertensive patients attending a teaching hospital in North-eastern Nigeria. Materials and Methods A cross-sectional study was conducted on 277 hypertensive patients from a tertiary healthcare institution. Data were analysed using version 20 of the Statistical Package for the Social Sciences (SPSS). Frequency and percentages were used to summarise data while Chi-square test was used to test for associations. To identify the factors linked to BP control, logistic regression was employed. At P < 0.05, predictors of BP control were found using adjusted odds ratios (AORs) with a 95% confidence interval (CI). Results The respondents' average age was 53.1 ± 14.6 years, of which 67.5% were female. The level of optimal BP control was 40.8%. Factors associated with reduced BP control include not currently married (AOR = 0.29 [95% CI: 0.16-0.53], P ≤ 0.0001), imperfect adherence (AOR = 0.37 [95% CI: 0.22-0.64], P ≤ 0.0001), taking more than two drugs (AOR = 0.3 [95% CI: 0.14-0.64], P = 0.001) and body mass index (BMI) ≥25 kg/m2 (AOR = 0.40 [95% CI: 0.22-0.72], P = 0.002). Conclusion The optimal BP control is alarmingly low in this setting. Marital status, medication adherence, increased pill burden and BMI ≥25 kg/m2 negatively affect the attainment of BP control.
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Affiliation(s)
- Muhammad Attahiru
- Department of Family Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Pitmang Labo Simon
- Department of Family Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Yahkub Babatunde Mutalub
- Department of Clinical Pharmacology and Therapeutics/Department of Family Medicine, Abubakar Tafawa Balewa University/Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Mark Divine Akangoziri
- Department of Family Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Bukar Alhaji Grema
- Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
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Moussouni A, Sidi-Yakhlef A, Hamdaoui H, Aouar A, Belkhatir D. Prevalence and risk factors of prehypertension and hypertension in Algeria. BMC Public Health 2022; 22:1571. [PMID: 35982441 PMCID: PMC9386961 DOI: 10.1186/s12889-022-13942-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/27/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Hypertension, also referred to as the silent killer, is known to be one of the most common chronic diseases in the world today. This study aimed to identify the prevalence and risk factors of prehypertension and hypertension among Algerian population. METHODS This is a descriptive cross-sectional epidemiological study involving individuals aged 18 to 69 years old who were identified in the database of the national survey on non-communicable diseases (NCDs) risk factors conducted in Algeria between 2016 and 2017 using the World Health Organization's (WHO) STEPwise approach. Differences in prevalence between normotensives, prehypertensives and hypertensives were assessed using the chi-square test. We also looked at the role of numerous socio-demographic, economic, geographical, and behavioural factors in blood pressure status using a logistic regression model. RESULTS The prevalence of prehypertension and hypertension was 36.2% (95% confidence interval: 35.2-37.5%) and 31.6% (95% CI: 30.5-32.7%) respectively. Prehypertension was shown to be substantially higher in males than in women, while hypertension was found to be higher in females compared to men. In addition, both sexes had a rise in the prevalence of blood pressure as they grew older. A according to multivariate logistic regression analysis, the main common risk factors for prehypertension and hypertension were ageing, obesity, and abdominal obesity. Moreover hypercholesterolemia, and marital status (separated/divorced) were correlated to hypertension. CONCLUSION Prehypertension and hypertension are high and epidemic in Algeria. Therefore, the urgent quantification and monitoring of their risk factors becomes a necessity to plan appropriate preventive measures, in order to fight against NCDs in general.
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Affiliation(s)
- Abdellatif Moussouni
- National Center for Prehistoric, Anthropological and Historical Research (CNRPAH, Tlemcen's station), Algeria, 03, Rue Franklin Roosevelt, 16500, Alger, Algeria.
- University of Abou Bekr Belkaïd, Algeria. Laboratory of Anthropology, 22, Rue Abi Ayed Abdelkrim Fg Pasteur B. P 119, 13000, Tlemcen, Algeria.
| | - Adel Sidi-Yakhlef
- University of Abou Bekr Belkaïd, Algeria. Laboratory of Human Actions' Valorisation for Protection of Environment and Application in Public Health, 22, Rue Abi Ayed Abdelkrim Fg Pasteur B. P 119, 13000, Tlemcen, Algeria
| | - Houari Hamdaoui
- University of Abou Bekr Belkaïd, Algeria. Laboratory of Human Actions' Valorisation for Protection of Environment and Application in Public Health, 22, Rue Abi Ayed Abdelkrim Fg Pasteur B. P 119, 13000, Tlemcen, Algeria
| | - Amaria Aouar
- University of Abou Bekr Belkaïd, Algeria. Laboratory of Human Actions' Valorisation for Protection of Environment and Application in Public Health, 22, Rue Abi Ayed Abdelkrim Fg Pasteur B. P 119, 13000, Tlemcen, Algeria
| | - Djamel Belkhatir
- University of Abou Bekr Belkaïd, Algeria. Laboratory of Human Actions' Valorisation for Protection of Environment and Application in Public Health, 22, Rue Abi Ayed Abdelkrim Fg Pasteur B. P 119, 13000, Tlemcen, Algeria
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Thu WPP, Sundström-Poromaa I, Logan S, Kramer MS, Yong EL. Blood pressure and adiposity in midlife Singaporean women. Hypertens Res 2021; 44:561-570. [PMID: 33420474 DOI: 10.1038/s41440-020-00600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 01/29/2023]
Abstract
Hypertension is a major risk factor for cardiac events and stroke. Visceral adipose tissue (VAT) is known to increase the risk of incident hypertension in adults. Although adiposity has been linked to markers of inflammation, few studies have examined these markers as potential mediators of the association between visceral adiposity and elevated blood pressure. We evaluated sociodemographic, reproductive, and lifestyle risk factors for elevated blood pressure among midlife Singaporean women. A total of 1189 women, with a mean age of 56.3 ± 6.2 years, from the Integrated Women's Health Program (IWHP) at National University Hospital, Singapore were studied. Hypothesized risk factors and levels of inflammatory markers were examined in relation to systolic blood pressure (SBP) and diastolic blood pressure (DBP) using multivariable linear regression models. Prehypertension (SBP 120-139 mmHg and/or DBP 80-89 mmHg) and hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg) were observed in 518 (43.6%) and 313 (26.3%) women, respectively. Compared to women in the lowest tertiles, women in the middle and upper tertiles of VAT had 7.1 (95% CI, 4.4, 9.8) mmHg and 10.2 (95% CI, 6.7, 13.7) mmHg higher adjusted SBP, respectively. Nulliparous older women with a lower education level and those with no or mild hot flashes also had a significantly higher adjusted SBP. No significant independent risk factors were observed for DBP. Adjustments for IL-6, TNF-α, and hs-CRP did not attenuate the association between VAT and SBP. In summary, we found an independent positive association between VAT and SBP. Elevated levels of inflammatory markers did not mediate the increase in SBP in women with high VAT.
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Affiliation(s)
- Win Pa Pa Thu
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Singapore, 119228, Singapore
| | - Inger Sundström-Poromaa
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.,Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | - Susan Logan
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Singapore, 119228, Singapore
| | - Michael S Kramer
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.,Departments of Epidemiology, Biostatistics & Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Montreal, QC, H3G 1Y6, Canada
| | - Eu-Leong Yong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.
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Xiao L, Le C, Wang GY, Fan LM, Cui WL, Liu YN, Shen JR, Golden AR. Socioeconomic and lifestyle determinants of the prevalence of hypertension among elderly individuals in rural southwest China: a structural equation modelling approach. BMC Cardiovasc Disord 2021; 21:64. [PMID: 33530935 PMCID: PMC7851929 DOI: 10.1186/s12872-021-01885-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background This study examines the association between socioeconomic and lifestyle factors and the prevalence of hypertension among elderly individuals in rural Southwest China. Methods A cross-sectional survey of 4833 consenting adults aged ≥ 60 years in rural regions of Yunnan Province, China, was conducted in 2017. Data on individual socioeconomic status, sleep quality, physical activity level, and family history of hypertension were collected with a standardized questionnaire. Blood pressure, fasting blood glucose, height, weight, and waist circumference were also measured. An individual socioeconomic position (SEP) index was constructed using principal component analysis. Structural equation modelling (SEM) was applied to analyse the association between socioeconomic and lifestyle factors and the prevalence of hypertension. Results The overall prevalence of hypertension was 50.6% in the study population. Body fat distribution, including measures of obesity and central obesity, had the greatest total effect on hypertension (0.21), followed by family history of hypertension (0.14), biological sex (0.08), sleep quality (− 0.07), SEP (− 0.06), physical inactivity (0.06), and diabetes (0.06). Body fat distribution, SEP, and family history of hypertension had both direct and indirect effects on hypertension, whereas physical inactivity, diabetes, and sleep quality were directly associated with the prevalence of hypertension. Biological sex was indirectly associated with the prevalence of hypertension. Conclusions SEP, body fat distribution, physical inactivity, diabetes, and sleep quality critically influence the prevalence of hypertension. Future interventions to prevent and control hypertension should give increased attention to individuals with low SEP and should focus on controlling diabetes and obesity, increasing physical activity levels, and improving quality of sleep among older adults aged ≥ 60 years in rural Southwest China.
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Affiliation(s)
- Li Xiao
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China.,First Affiliated Hospital of Dali Medical University, Dali, China
| | - Cai Le
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China.
| | - Gui-Yi Wang
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Lu-Ming Fan
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Wen-Long Cui
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Ying-Nan Liu
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Jing-Rong Shen
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Allison Rabkin Golden
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
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Sharma JR, Mabhida SE, Myers B, Apalata T, Nicol E, Benjeddou M, Muller C, Johnson R. Prevalence of Hypertension and Its Associated Risk Factors in a Rural Black Population of Mthatha Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1215. [PMID: 33572921 PMCID: PMC7908535 DOI: 10.3390/ijerph18031215] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022]
Abstract
Background: The occurrence of hypertension has been increasing alarmingly in both low and middle-income countries. Despite acknowledging hypertension as the most common life-threatening risk factor for cardiovascular disease (CVD), a dearth of data is available on the prevalence, awareness, and determinants of hypertension in rural parts of South Africa. The principal aim of the current study is to determine the prevalence and associated risk factors of hypertension among a black rural African population from the Mtatha town of Eastern Cape Province. Methods: This was a cross-sectional study, and individuals over 18 years of age were randomly screened using a World Health Organization stepwise questionnaire. Sociodemographic information, anthropometric measurements, fasting blood glucose levels, and three independent blood pressure (BP) readings were measured. Blood pressure measurements were classified according to the American Heart Association guidelines. Univariate and multivariate analyses were performed to determine the significant predictors of hypertension. Results: Of the total participants (n = 556), 71% of individuals had BP scores in the hypertensive range. In univariate analysis, age, westernized diet, education, income, and diabetic status, as well as overweight/obese status were positively associated with the prevalence of hypertension. However, in a multivariate logistic regression analysis only, age, body mass index (BMI), diabetic status, and westernized diet were significantly associated with a higher risk of developing hypertension. Gender, age, and BMI were potential factors having a significant association with the treatment of hypertension. Individuals who did not consider the importance of medicine had higher chances of having their hypertension being untreated. Conclusions: Prevalence of hypertension was high among the black rural African population of Mthatha town. Gender, age, westernized diet, education level, income status, diabetic as well as overweight/obese status were the most significant predictors of hypertension.
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Affiliation(s)
- Jyoti Rajan Sharma
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (J.R.S.); (S.E.M.); (C.M.)
| | - Sihle E. Mabhida
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (J.R.S.); (S.E.M.); (C.M.)
- Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, Cape Town 7535, South Africa;
| | - Bronwyn Myers
- Division of Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa;
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Teke Apalata
- Division of Medical Microbiology, Department of Pathology and Laboratory-Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5117, South Africa;
| | - Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa;
- Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, South Africa
| | - Mongi Benjeddou
- Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, Cape Town 7535, South Africa;
| | - Christo Muller
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (J.R.S.); (S.E.M.); (C.M.)
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, South Africa
| | - Rabia Johnson
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (J.R.S.); (S.E.M.); (C.M.)
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, South Africa
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Hasan M, Khan MSA, Sutradhar I, Hossain MM, Hossaine M, Yoshimura Y, Choudhury SR, Sarker M, Mridha MK. Prevalence and associated factors of hypertension in selected urban and rural areas of Dhaka, Bangladesh: findings from SHASTO baseline survey. BMJ Open 2021; 11:e038975. [PMID: 33472770 PMCID: PMC7818822 DOI: 10.1136/bmjopen-2020-038975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE We implemented this study to report the prevalence and associated risk factors of hypertension among adult men and women aged >30 years residing in selected urban and rural areas of Dhaka division, Bangladesh. DESIGN Cross-sectional study. SETTING Two urban (Dhaka city north and Dhaka city south) and two rural (Narsinghdi and Gazipur district) areas of the Dhaka division. PARTICIPANTS A total of 4856 male and female participants were included in the final analysis, of whom 2340 (48.2%) were from urban and 2516 (51.8%) were from rural areas. PRIMARY OUTCOME Hypertension was the dependent variable for this study and was operationally defined as systolic blood pressure >140 mm of Hg and/or diastolic blood pressure >90 mm of Hg, and/or persons with already diagnosed hypertension. RESULTS The overall prevalence of hypertension was 31.0%, and the prevalence was higher among urban participants (urban: 36.9%, rural: 30.6%). Age (across all categories), female (urban-adjusted OR (AOR): 1.3, 95% CI: 1.0 to 1.5 and rural-AOR: 1.7, 95% CI: 1.4 to 2.1)), higher educational status (urban-AOR: 1.7, 95% CI: 1.3 to 2.2 and rural-AOR: 2.1, 95% CI: 1.5 to 3.1), inadequate physical activity (urban-AOR: 1.3, 95% CI: 1.0 to 1.7 and rural-AOR: 1.5, 95% CI: 1.2 to 1.9) and overweight/obesity (urban-AOR: 2.7, 95% CI: 2.1 to 3.3 and rural-AOR: 2.1, 95% CI: 1.7 to 2.5) were associated with hypertension in both urban and rural areas. Women who were not currently married during the survey had higher odds of hypertension only in the rural areas (rural-AOR: 1.8, 95% CI: 1.3 to 2.4), and respondents who were not working during the survey had higher odds of hypertension only in the urban areas (AOR: 1.7, 95% CI: 1.0 to 2.6). CONCLUSION Since the prevalence of hypertension was high in urban and rural areas, the government of Bangladesh should consider implementing hypertension prevention programmes focusing young population of Dhaka division. In addition, early screening programmes and management of hypertension need to be strengthened for people with hypertension in both the areas.
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Affiliation(s)
- Mehedi Hasan
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Ipsita Sutradhar
- Centre for Science of Implementation and Scale-up, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Dhaka District, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Yukie Yoshimura
- Japan International Cooperation Agency, Chiyoda-ku, Tokyo, Japan
| | - Sohel Reza Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Malabika Sarker
- Centre for Science of Implementation and Scale-up, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Dhaka District, Bangladesh
| | - Malay Kanti Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
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11
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Ho BK, Omar MA, Sooryanarayana R, Ghazali SS, Zainal Abidin SBI, Krishnapillai A, Ariaratnam S, Tohit NM, Majid NLBA, Yusof MFBM. Trends in population blood pressure and prevalence, awareness, treatment and control of hypertension among older persons: The 2006 & 2015 National Health and Morbidity Survey in Malaysia. PLoS One 2020; 15:e0238780. [PMID: 32911521 PMCID: PMC7482969 DOI: 10.1371/journal.pone.0238780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 08/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypertension is one of the most important risk factors for cardiovascular diseases. Thus, it is an important public health challenge worldwide. In Malaysia, only a few studies have focused on the trends of hypertension specifically for the aging population. In view of the rapid growth of the elderly population in Malaysia, there is an urgent need to explore the condition of hypertension in this aging population. Hence, the objectives of this study were to determine the trends of population mean systolic and diastolic blood pressure (BP) levels, the prevalence, awareness, treatment and control of hypertension, and its' associated factors among older persons in two cross-sectional national surveys that were conducted in 2006 and 2015 in Malaysia. METHODS This was a subanalysis of secondary data collected from the two cross-sectional national population-based surveys conducted in Malaysia in 2006 and 2015. Adults aged 60 and older who had participated in these two surveys were included in the study. RESULTS A total of 4954 (2295 males and 2659 females) and 3790 (1771 males and 2019 females) respondents completed the hypertension module surveys in 2006 and 2015, respectively. The mean age of the respondents was 68.5±6.9 years in 2006 and 68.6±7.1 years in 2015 and the difference was not significant. The prevalence of hypertension significantly reduced from 73.8% in 2006 to 69.2% in 2015 (p<0.001). Among the respondents with hypertension, the awareness, treatment and control of hypertension significantly increased from 49.7% to 60.2%, 86.7% to 91.5% and 23.3% to 44.8%, respectively, from 2006 to 2015. Logistic regression analysis showed that female sex and unemployed/retiree were significantly associated with higher hypertension prevalence in both 2006 and 2015. Being unemployed/ retiree was significantly associated with higher awareness of hypertension in both 2006 and 2015. In both 2006 and 2015, Chinese ethnicity were significantly associated with higher awareness and control of hypertension. CONCLUSIONS The mean population BP levels and hypertension prevalence among the elderly population in Malaysia have reduced significantly over the past decade. Although the awareness, treatment and control of hypertension among older adults have improved significantly, the awareness and control rates remain suboptimal. As population aging is inevitable, appropriate public health programs and optimal treatment strategies targeting this vulnerable group are urgently needed to improve the overall awareness and control of hypertension and to prevent hypertension-related complications.
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Affiliation(s)
- Bee Kiau Ho
- Bandar Botanic Health Center, Bandar Botanic, Klang, Selangor, Malaysia
| | - Mohd Azahadi Omar
- Sector for Biostatistic & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | | | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
| | | | - Ambigga Krishnapillai
- Department of Family Medicine, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia
| | - Suthahar Ariaratnam
- Department of Psychiatry, Faculty of Medicine, Universiti Technologi MARA (UiTM), Selayang Campus, Batu Caves, Selangor, Malaysia
| | - Noorlaili Mohd Tohit
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nur Liana bt Abdul Majid
- Sector for Biostatistic & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Muhammad Fadhli bin Mohd Yusof
- Sector for Biostatistic & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
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12
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Muli S, Meisinger C, Heier M, Thorand B, Peters A, Amann U. Prevalence, awareness, treatment, and control of hypertension in older people: results from the population-based KORA-age 1 study. BMC Public Health 2020; 20:1049. [PMID: 32616004 PMCID: PMC7331188 DOI: 10.1186/s12889-020-09165-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/24/2020] [Indexed: 01/10/2023] Open
Abstract
Background Hypertension remains a significant modifiable risk factor for cardiovascular diseases and a major determinant of morbidity and mortality. We aimed to describe sex-stratified age-standardized estimates of prevalence, awareness, treatment and control of hypertension, and their associated factors in older adults. Methods The KORA-Age1 is a population-based cross-sectional survey carried out in 2008/2009 on individuals aged 65–94 years in Augsburg region, Germany. Blood pressure measurements were available for 1052 out of 1079 persons who participated in the physical examination. Factors associated with prevalence, awareness and control of hypertension were investigated by multivariable logistic regression. Results The overall prevalence of hypertension (≥140/90 mmHg) was 73.8% [95% confidence interval (CI), 69.3–77.9], representing 74.8% (95% CI, 68.4–80.2) in men and 73.5% (95% CI, 66.8–79.3) in women. Among those with hypertension, 80.2% (95% CI, 75.3–84.4) were aware of their hypertensive condition and 74.4% (95% CI, 69.2–79.1) were on treatment for hypertension. Among those aware of their hypertension status, 92.8% (95% CI, 88.8–95.6) were on treatment and 53.7% (95% CI, 47.0–60.1) had their blood pressure controlled. Hypertension was more frequent in individuals who were older, obese, or had diabetes. Higher education attainment or presence of comorbidities was associated with higher level of hypertension awareness. Individuals taking three antihypertensive drug classes were more likely to have controlled hypertension compared with those taking one antihypertensive drug class, odds ratio (OR), 1.85 (95% CI, 1.14–2.99). Conclusion Our findings identified high prevalence of hypertension and relevant health gaps on awareness, treatment and suboptimal control of hypertension in older adults in Germany. Screening for hypertension should especially target older adults with low educational attainment and ‘healthy’ elderly with less contact to physicians.
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Affiliation(s)
- Samuel Muli
- Institute for Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Independent Research Group Clinical Epidemiology, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
| | - Christa Meisinger
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Independent Research Group Clinical Epidemiology, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T, Augsburg, Germany
| | - Margit Heier
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany.,University Hospital of Augsburg, KORA Study Centre, Augsburg, Germany
| | - Barbara Thorand
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany
| | - Ute Amann
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Independent Research Group Clinical Epidemiology, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T, Augsburg, Germany
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13
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Lee RZY, Yu J, Rawtaer I, Allen PF, Bao Z, Feng L, Feng Q, Lee JK, Lim CT, Ling LH, Thang LL, Naing T, Wang DY, Yap KZ, Kua EH, Mahendran R. CHI study: protocol for an observational cohort study on ageing and mental health in community-dwelling older adults. BMJ Open 2020; 10:e035003. [PMID: 32371513 PMCID: PMC7229981 DOI: 10.1136/bmjopen-2019-035003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Ageing is associated with a multitude of healthcare issues including dementia, depression, frailty, morbidity associated with chronic disease and high healthcare utilisation. With Singapore's population projected to age significantly over the next two decades, it has become increasingly important to understand the disease burden and etiological process among older adults. The Community Health and Intergenerational study aims to holistically examine ageing in place by investigating the resilience and vulnerability factors of the ageing process in the biological, psychological and social domains within the environment. METHODS AND ANALYSIS Using a cohort multiple randomised controlled trial design, comprehensive health profiles of community-dwelling older adults will be collected. The objective is to recruit 1000 participants (aged 60-99 years) living in the western region of Singapore within a period of 3 years (2018-2020). Assessments include basic sociodemographic, physical health and function (cardiac, oral and blood profiles and visual function), cognitive functioning, daily functioning, physical fitness, emotional state, free-flowing speech, sleep quality, social connectedness, caregiver burden, intergenerational communication, quality of life, life satisfaction, attitudes to ageing and gratitude and compassion. Results from the cohort will enable future studies to identify at-risk groups and develop interventions to improve the physical and mental health and quality of life of older adults. ETHICS AND DISSEMINATION Approval of the cohort study by the National University of Singapore Institutional Review Board (NUS-IRB Reference code: H-17-047) was obtained on 12 October 2017. Written consent will be obtained from all participants. Findings from the cohort study will be disseminated by publication of peer-reviewed manuscripts, presentations at scientific meetings and conferences with local stakeholders.
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Affiliation(s)
- Rachael Zhi Yi Lee
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Junhong Yu
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Iris Rawtaer
- Department of Psychiatry, Sengkang General Hospital, Singapore
| | - Patrick Finbarr Allen
- Dean, Faculty of Dentistry, National University of Singapore, Singapore
- Centre for Oral Health, National University Health System, Singapore
| | - Zhiming Bao
- Department of English Language and Literature, Faculty of Arts and Social Science, National University of Singapore, Singapore
| | - Lei Feng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Qiushi Feng
- Department of Sociology, National University of Singapore, Singapore
- Centre for Family and Population Research, National University of Singapore, Singapore
| | - Jeong Kyu Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chin Tat Lim
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lieng Hsi Ling
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Leng Leng Thang
- Centre for Family and Population Research, National University of Singapore, Singapore
- Department of Japanese Studies, National University of Singapore, Singapore
| | - Thet Naing
- Department of Ophthalmology, National University Health System, Singapore
| | - D Y Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai Zhen Yap
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - E H Kua
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Academic Development Department, Duke-NUS Medical School, Singapore
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14
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Hypertension, blood pressure control and diabetic retinopathy in a large population-based study. PLoS One 2020; 15:e0229665. [PMID: 32134944 PMCID: PMC7058315 DOI: 10.1371/journal.pone.0229665] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/11/2020] [Indexed: 01/22/2023] Open
Abstract
Background Clinical trials have shown beneficial effects of blood pressure (BP) control in reducing the risk of diabetic retinopathy (DR). However, association between BP control and DR in population-based studies is not clear. We aimed to examine the association of hypertension and BP control with DR. Methods We analysed data from a population-based cross-sectional study of Chinese, Malay and Indians adults with diabetes and hypertension (2004–2011, n = 2189, aged 40–80 years) in Singapore. DR severity was assessed from retinal photographs and graded for any- and vision-threatening DR (VTDR) using the modified Airlie House classification. Hypertension status was classified into (1) good control: on treatment (SBP < 130 and DBP < 80 mm Hg), (2) moderate control: on treatment, with BP levels other than group 1 and 3, (3) poor control: on treatment (SBP ≥140 and DBP ≥ 90 mm Hg), (4) untreated hypertension, any BP level. SBP, DBP and pulse pressure (PP) were analyzed as categories and as continuous variables. The association between BP and DR was assessed using multivariable logistic regression models. Results The prevalence of any-DR and VTDR in the study population was 33.8% and 9.0% respectively. Both poorly controlled and untreated hypertension were significantly associated with any-DR with odds ratio (OR) (95% confidence interval [CI]) of 1.97 (1.39–2.83), and 2.01 [1.34–3.05]. Among BP components, SBP and PP were associated with both any-DR and VTDR with OR (95% CI) of 1.45 (1.28–1.65) and 1.61 (1.41–1.84) for any-DR, and 1.44 (1.19–1.76) and 1.67 (1.37–2.06) for VTDR. Conclusion In a population-based sample of Asian adults with diabetes and hypertension, treated but poorly controlled as well as untreated hypertension were significantly associated with any-DR. Among the BP components, higher SBP and PP levels were associated with both any-DR and VTDR. Further longitudinal studies are necessary to confirm our findings.
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15
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Wang Y, Nguyen FNHL, Allen JC, Lew JQL, Tan NC, Jafar TH. Validation of the kidney failure risk equation for end-stage kidney disease in Southeast Asia. BMC Nephrol 2019; 20:451. [PMID: 31801468 PMCID: PMC6894117 DOI: 10.1186/s12882-019-1643-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/25/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are at high risk of end-stage kidney disease (ESKD). The Kidney Failure Risk Equation (KFRE), which predicts ESKD risk among patients with CKD, has not been validated in primary care clinics in Southeast Asia (SEA). Therefore, we aimed to (1) evaluate the performance of existing KFRE equations, (2) recalibrate KFRE for better predictive precision, and (3) identify optimally feasible KFRE thresholds for nephrologist referral and dialysis planning in SEA. METHODS All patients with CKD visiting nine primary care clinics from 2010 to 2013 in Singapore were included and applied 4-variable KFRE equations incorporating age, sex, estimated glomerular filtration rate (eGFR), and albumin-to-creatinine ratio (ACR). ESKD onset within two and five years were acquired via linkage to the Singapore Renal Registry. A weighted Brier score (the squared difference between observed vs predicted ESKD risks), bias (the median difference between observed vs predicted ESKD risks) and precision (the interquartile range of the bias) were used to select the best-calibrated KFRE equation. RESULTS The recalibrated KFRE (named Recalibrated Pooled KFRE SEA) performed better than existing and other recalibrated KFRE equations in terms of having a smaller Brier score (square root: 2.8% vs. 4.0-9.3% at 5 years; 2.0% vs. 6.1-9.1% at 2 years), less bias (2.5% vs. 3.3-5.2% at 5 years; 1.8% vs. 3.2-3.6% at 2 years), and improved precision (0.5% vs. 1.7-5.2% at 5 years; 0.5% vs. 3.8-4.2% at 2 years). Area under ROC curve for the Recalibrated Pooled KFRE SEA equations were 0.94 (95% confidence interval [CI]: 0.93 to 0.95) at 5 years and 0.96 (95% CI: 0.95 to 0.97) at 2 years. The optimally feasible KFRE thresholds were > 10-16% for 5-year nephrologist referral and > 45% for 2-year dialysis planning. Using the Recalibrated Pooled KFRE SEA, an estimated 82 and 89% ESKD events were included among 10% of subjects at highest estimated risk of ESKD at 5-year and 2-year, respectively. CONCLUSIONS The Recalibrated Pooled KFRE SEA performs better than existing KFREs and warrants implementation in primary care settings in SEA.
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Affiliation(s)
- Yeli Wang
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, Singapore
| | | | - John C Allen
- Center for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Medical School, Singapore, Singapore
| | | | - Ngiap Chuan Tan
- Health Services Research Centre, SingHealth, Singapore, Singapore.,SingHealth Polyclinics, Singapore, Singapore.,SingHealth-Duke NUS Family Academic Clinical Program, Singapore, Singapore
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, Singapore. .,Health Services Research Centre, SingHealth, Singapore, Singapore. .,Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore. .,Duke Global Health Institute, Duke University, Durham, NC, USA.
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16
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Liew SJ, Lee JT, Tan CS, Koh CHG, Van Dam R, Müller-Riemenschneider F. Sociodemographic factors in relation to hypertension prevalence, awareness, treatment and control in a multi-ethnic Asian population: a cross-sectional study. BMJ Open 2019; 9:e025869. [PMID: 31110091 PMCID: PMC6530395 DOI: 10.1136/bmjopen-2018-025869] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Literature suggested that multi-ethnic Western populations experienced differential hypertension outcomes, but evidence is limited in Asia. This study was aimed to determine sociodemographic correlates of hypertension and its awareness, treatment and control among a multi-ethnic Asian population living in Singapore. SETTING We used cross-sectional data of participants from the Multi-Ethnic Cohort (MEC) (n=14 530) recruited in Singapore between 2004 and 2010. PARTICIPANTS Participants who completed questionnaire and attended health examination, without cardiovascular diseases, cancer, stroke, renal failure, asthma and mental illnesses were included in the study. Multivariable logistic regression models were used to determine sociodemographics factors associated with hypertension, unawareness of having hypertension, untreated and uncontrolled hypertension. RESULTS Among 10 215 participants (47.2% Chinese, 26.0% Malay and 26.8% Indian), hypertension prevalence was estimated to be 31.1%. Older age, Malay ethnicity, male, lower educational level and being homemaker or retired/unemployed were factors significantly associated with hypertension. Stratified analysis suggested that age and education were consistently associated with hypertension across all ethnic groups. The proportions of being unaware, untreated and uncontrolled were 49.0%, 25.2% and 62.4%, respectively. Ethnicity and younger age were associated with unawareness; younger age, male and lower educational level were associated with untreated hypertension and older age was associated with uncontrolled hypertension. CONCLUSIONS In this study, ethnic differences in relation to hypertension were associated with sociodemographic variability in ethnic groups. Age and educational level were consistent correlates of hypertension in all ethnic groups. Unawareness and uncontrolled hypertension were common in this Asian population and associated with sociodemographic factors. More targeted strategies may be required to overcome the observed disparities.
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Affiliation(s)
- Seaw Jia Liew
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
| | - John Tayu Lee
- School of Population and Global Health, Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Chuen Seng Tan
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Choon Huat Gerald Koh
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Rob Van Dam
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Falk Müller-Riemenschneider
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
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17
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Deborah OML, Chiu MYL, Cao K. Geographical Accessibility of Community Health Assist System General Practitioners for the Elderly Population in Singapore: A Case Study on the Elderly Living in Housing Development Board Flats. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1988. [PMID: 30213094 PMCID: PMC6163585 DOI: 10.3390/ijerph15091988] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 11/17/2022]
Abstract
Accessible primary healthcare is important to national healthcare in general and for older persons in particular, in societies where the population is ageing rapidly, as in Singapore. However, although much policy and research efforts have been put into this area, we hardly find any spatial perspective to assess the accessibility of these primary healthcare services. This paper analyzes the geographical accessibility of one major healthcare service in Singapore, namely, General Practitioners (GPs) services under the Community Health Assist Scheme (CHAS) for older persons. A Python script was developed to filter the website data of the Housing Development Board (HDB) of Singapore. The data derived was comprehensively analyzed by an Enhanced 2-Step Floating Catchment Area (E2SFCA) method based on a Gaussian distance-decay function and the GIS technique. This enabled the identification of areas with relatively weak geographical accessibility of CHAS-GPs. The findings are discussed along with suggestions for health practitioners, service planners and policy makers. Despite its initial nature, this study has demonstrated the value of innovative approaches in data collection and processing for the elderly-related studies, and contributed to the field of healthcare services optimization and possibly to other human services.
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Affiliation(s)
- Ong Ming Lee Deborah
- Department of Geography, National University of Singapore, Singapore, Singapore.
| | - Marcus Yu Lung Chiu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China.
| | - Kai Cao
- Department of Geography, National University of Singapore, Singapore, Singapore.
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18
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Tianyi FL, Agbor VN, Njamnshi AK. Prevalence, awareness, treatment, and control of hypertension in Cameroonians aged 50 years and older: A community-based study. Health Sci Rep 2018; 1:e44. [PMID: 30623073 PMCID: PMC6266375 DOI: 10.1002/hsr2.44] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/18/2018] [Accepted: 04/02/2018] [Indexed: 01/11/2023] Open
Abstract
AIMS To assess the prevalence of hypertension (HTN) in a rural elderly population (50 y and older) in Cameroon; evaluate the rates of awareness, treatment, and control of HTN in this population; and describe factors associated with HTN in this population. METHODS AND RESULTS A total of 501 participants aged 50 years and older were randomly recruited from May to July 2013 in a house-to-house survey of the Batibo Health District. Data were measured using standardized methods modelled after the World Health Organization STEPwise approach to Surveillance. The Statistical Package for the Social Sciences version 20.0 was used for statistical analysis. Chi-square, Fisher's exact or Student T test were used to compare variables. A multivariable logistic regression analysis was used to identify factors associated with HTN in this population. In our study population, 31% of the participants were men, with a mean age of 65.4 ± 8 years; women had a mean age of 61.4 ± 9 years. The prevalence of HTN was 57.3% (95% CI, 52.9-61.6). The awareness rate was 63.4%, treatment rate 96.7%, and control rate 32.4%. Being overweight/obese was independently associated with HTN in this group (odds ratio = 3.46; 95% CI, 2.38-5.03; P < .001). CONCLUSION The prevalence of HTN amongst the elderly in the Batibo Health District is high. Emphasis should be on patient education to improve the rates of blood pressure control amongst patients on treatment for HTN. Healthy lifestyle measures such as reduction in salt intake and increase in physical exercise should be encouraged amongst the elderly.
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Affiliation(s)
- Frank L. Tianyi
- Mayo‐Darlé Sub‐divisional HospitalBanyoAdamawa RegionCameroon
| | | | - Alfred K. Njamnshi
- Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
- Brain Research Africa Initiative (BRAIN)YaoundeCameroon
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19
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Wong EYS, Lee AH, James AP, Jancey J. Physical activity and nutrition intervention for Singaporean women aged 50 years and above: study protocol for a randomised controlled trial. Trials 2018; 19:257. [PMID: 29703218 PMCID: PMC5923190 DOI: 10.1186/s13063-018-2562-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/22/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The majority of the older Singaporean women aged 50 years and above are physically inactive and have unhealthy dietary habits, placing them at 'high risk' of non-communicable diseases (NCDs). The adoption of regular physical activity (PA) and a healthy diet are essential lifestyle behaviours to reduce this risk. This randomised controlled trial (RCT) involves the development, implementation and evaluation of a PA and nutrition programme for community-dwelling Singaporean women who currently attend recreational centres (RCs are public facilities supporting social leisure activities) in their local area. The intervention will be developed after conducting formative evaluation with RC attendees and managers through focus group discussions and pilot testing of resources (i.e. surveys, accelerometers, and health booklets). Programme ambassadors (trained, certified fitness instructors and nutritionists) will deliver all sessions in English and Mandarin; implement classes to meet participants' varying needs; and conduct sessions at different times at convenient venues. Social Cognitive Theory (SCT) has been selected as the theoretical framework to inform intervention strategies as it explores the interactions of human behaviour with the environment and has been found to be valuable when developing behavioural change interventions particularly in older adults (J Gerontol B Psychol Sci Soc Sci 67B(1):18-26, 2012; Obesity Reviews 15(12):983-95, 2014). Its major construct, self-efficacy, is invaluable in achieving successful behaviour change, such as increasing levels of PA or improving dietary intake (Trials. 2017; https://doi.org/10.1186/s13063-016-1771-9 ; Psychol Health Med 18(6):714-24, 2013). METHODS The development and implementation of the PA and nutrition intervention strategies will be guided by SCT and Motivational interviewing (MI) and implemented by trained programme ambassadors at the RCs. Sixty RCs located in Singapore will be selected from five major geographical districts and randomly allocated to the intervention (n = 30) or control (n = 30) cluster. A sample of 600 (intervention n = 300; control n = 300) women aged 50 years and above will then be recruited from these 60 centres and only the intervention group will be enrolled into the PA and nutrition intervention. It is hypothesised that by the end of the intervention, the intervention group participants compared to the control group will show significantly greater improvements in the following outcome variables: PA and dietary behaviours, health-related quality of life, objective measures of PA, anthropometric, lipid and glucose profiles. Data will be collected at baseline and 6 months and analysed using mixed regression models. DISCUSSION It is anticipated that recruitment, retention and compliance of participants will be challenging due to the target group being unfamiliar with such community-based research programmes. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry, ACTRN12617001022358. Registered on 14 July 2017. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372984&isReview=true.
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Affiliation(s)
| | - Andy H. Lee
- School of Public Health, Curtin University, Perth, WA Australia
| | | | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, (CERIPH), School of Public Health, Curtin University, Perth, WA Australia
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20
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Li Z, Fu C, Yang F, Mao Z. Prevalence and risk factors of hypertension for the middle-aged population in China — results from the China Health and Retirement Longitudinal Study (CHARLS). Clin Exp Hypertens 2018; 41:80-86. [DOI: 10.1080/10641963.2018.1445751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Zhen Li
- Department of Social Medicine and Health Management, School of Health Sciences, Wuhan University, Wuhan, HUB, China
- Global Health Institute, Wuhan University, Wuhan, HUB, China
| | - Chang Fu
- Department of Social Medicine and Health Management, School of Health Sciences, Wuhan University, Wuhan, HUB, China
| | - Fan Yang
- Information Center, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, HUB, China
| | - Zongfu Mao
- Department of Social Medicine and Health Management, School of Health Sciences, Wuhan University, Wuhan, HUB, China
- Global Health Institute, Wuhan University, Wuhan, HUB, China
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21
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Dutta K, Das B, Orasugh JT, Mondal D, Adhikari A, Rana D, Banerjee R, Mishra R, Kar S, Chattopadhyay D. Bio-derived cellulose nanofibril reinforced poly(N-isopropylacrylamide)-g-guar gum nanocomposite: An avant-garde biomaterial as a transdermal membrane. POLYMER 2018. [DOI: 10.1016/j.polymer.2017.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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22
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Lew QLJ, Allen JC, Nguyen F, Tan NC, Jafar TH. Factors Associated with Chronic Kidney Disease and Their Clinical Utility in Primary Care Clinics in a Multi-Ethnic Southeast Asian Population. Nephron Clin Pract 2017; 138:202-213. [PMID: 29253844 DOI: 10.1159/000485110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/08/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a major global public health challenge. We investigated determinants of CKD and their clinical utility in an ethnically diverse Southeast Asian population. METHODS Electronic health records (EHR) of adults ≥40 years who visited any one of 4 government polyclinics in Singapore from January 1, 2012 to -December 31, 2015 were analyzed. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 or 1+ dipstick proteinuria excretion, based on 2 measurements ≥3 months apart. CKD-associated factors and their clinical utility for predicting odds of CKD were investigated using multiple logistic regression analysis. RESULTS Based on the study criteria, 25.9% (95% CI 25.6-26.2) of the 88,765 eligible study individuals had CKD. The factors (OR and 95% CI) independently associated with CKD were older age ≥65 years (2.54 [2.44-2.64] vs. ≤65 years), respectively; men (1.13 [1.09-1.18]); Malay (1.27 [1.20-1.33]) and Indian (0.77 [0.71-0.83]) vs. Chinese ethnicity; overweight (body mass index [BMI] ≥27.5 kg/m2; 1.10 [1.04-1.16]) vs. normal weight (BMI 18 to <23 kg/m2); government (1.22 [1.15-1.31]) vs. private housing; and with hypertension (3.32 [3.09-3.56]), diabetes (6.93 [6.67-7.20]) or stroke (1.46 [1.36-1.56]) vs. without each co-morbidity, respectively. The area under the receiver operating characteristic curve (95% CI) for the model to predict the probability of CKD using hypertension, diabetes, and age was 0.808 (0.805-0.811). Only 28.5% (27.9-29.1%) of individuals with CKD had physician documentation of their CKD status. However, documentation of CKD status was associated with age ≥65 years (1.11 [1.04-1.20] vs. <65 years), men (1.35 [1.26-1.44]) vs. women, with vs. without hypertension (1.24 [1.07-1.44]), Indian (0.80 [0.69-0.92]) compared to Chinese ethnicity, ever smokers (0.89 [0.81-0.99]) vs. non-smokers, and those with vs. without stroke (0.83 [0.75-0.93]). CONCLUSIONS CKD prevalence in our Southeast Asian population is high and under-documented even in high-risk patients. Our findings highlight factors associated with CKD, and the predictive value of hypertension, diabetes, and advancing age as EHR-based screening targets for CKD. Our results also suggest that complementary educational efforts will be needed to increase physician detection and optimize the management of CKD, especially in high risk and marginalized groups across all clinics in Singapore, and possibly in the region.
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Affiliation(s)
| | - John C Allen
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Medical School, Singapore, Singapore
| | - Francis Nguyen
- Health Services Research Centre, SingHealth, Singapore, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore.,Health Services Research Centre, SingHealth, Singapore, Singapore.,SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore
| | - Tazeen H Jafar
- Health Services Research Centre, SingHealth, Singapore, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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23
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Anirudhan T, Nair SS, Sekhar. V C. Deposition of gold-cellulose hybrid nanofiller on a polyelectrolyte membrane constructed using guar gum and poly(vinyl alcohol) for transdermal drug delivery. J Memb Sci 2017. [DOI: 10.1016/j.memsci.2017.05.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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24
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Ong HL, Abdin E, Seow E, Pang S, Sagayadevan V, Chang S, Vaingankar JA, Chong SA, Subramaniam M. Prevalence and associative factors of orthostatic hypotension in older adults: Results from the Well-being of the Singapore Elderly (WiSE) study. Arch Gerontol Geriatr 2017. [PMID: 28647615 DOI: 10.1016/j.archger.2017.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Orthostatic hypotension (OH) is commonly reported among older adults and is associated with an increased risk of mortality. This study aimed to describe the prevalence and investigate the possible associations between OH with sociodemographic variables, chronic medical conditions, health service utilisation, dementia and cognitive status among older adults residing in Singapore. METHODS Data was collected from 2266 participants aged 60 years and older who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013. Face-to-face interviews were conducted and data collected includes sociodemographic information, blood pressure measurements, medical history, health services utilisation, and cognitive status. RESULTS The prevalence of OH among older adults in Singapore was 7.8%. OH was highest in participants aged 85 years and above (OR: 2.33; 1.26-4.30; p=0.007) compared to those aged 75-84 years (OR: 1.76; 1.08-2.85; p=0.023). Participants with hypertension were more likely to have OH (OR: 3.03; 1.56-5.88, p=0.001) than those without hypertension. Those with dementia were also more likely to have OH than those with normal cognitive status (p=0.007). CONCLUSIONS Older age, hypertension, and dementia were independently associated with OH in the older adult population in Singapore. Interventions such as home safety assessment and preventive measures should be implemented to improve older adult's functional capacity and quality of life to prevent injury.
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Affiliation(s)
- Hui Lin Ong
- Research Division, Institute of Mental Health, Singapore
| | | | - Esmond Seow
- Research Division, Institute of Mental Health, Singapore
| | - Shirlene Pang
- Research Division, Institute of Mental Health, Singapore
| | | | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore
| | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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25
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Abdin E, Chong SA, Peh CX, Vaingankar JA, Chua BY, Verma S, Jeyagurunathan A, Shafie S, Subramaniam M. The mediational role of physical activity, social contact and stroke on the association between age, education, employment and dementia in an Asian older adult population. BMC Psychiatry 2017; 17:98. [PMID: 28320363 PMCID: PMC5359944 DOI: 10.1186/s12888-017-1272-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 03/15/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Our study aimed to investigate the pathways by which socio-demographic factors, modifiable health and lifestyle risk factors influence each other, and subsequently, lead to dementia. METHODS We used data from the Well-being of the Singapore Elderly study, a nationally representative survey of the older adult population aged 60 years and above in Singapore. Dementia diagnosis was established using 10/66 dementia criteria. Structural equation modelling (SEM) without latent variable was applied to confirm the hypothesized model. RESULTS The results of SEM supported the hypothesized model (χ 2 = 14.999, df = 10, p = 0.132). The final model showed that those aged 75-84 years and 85 years and over (vs. 60-74 years), having no formal education, who had completed primary or secondary education (vs. completed tertiary), who were homemakers and retired (vs. paid work), and with a history of stroke were directly associated with higher odds of having dementia, while those who had more frequent contact with friends and neighbors as well as being physically active were directly associated with lower odds of having dementia diagnosis. The study also found that physical activity, more frequent contact with friends and stroke played a significant role as mediators in these relationships. The overall pathways model explained 57.7% of the variance in dementia. CONCLUSION Our results suggest that physical activity, social contact and stroke were potential mediators in the relationship between age, education, employment and dementia. Intervention programmes focusing on physical activity such as exercise and social contact may be useful in reducing the risk of dementia among older adults.
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Affiliation(s)
- Edimansyah Abdin
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Chao Xu Peh
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Swapna Verma
- Early Psychosis Intervention Programme, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Anitha Jeyagurunathan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Saleha Shafie
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
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26
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Perkins JM, Lee HY, James KS, Oh J, Krishna A, Heo J, Lee JK, Subramanian SV. Marital status, widowhood duration, gender and health outcomes: a cross-sectional study among older adults in India. BMC Public Health 2016; 16:1032. [PMID: 27716203 PMCID: PMC5045657 DOI: 10.1186/s12889-016-3682-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 09/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has demonstrated health benefits of marriage and the potential for worse outcomes during widowhood in some populations. However, few studies have assessed the relevance of widowhood and widowhood duration to a variety of health-related outcomes and chronic diseases among older adults in India, and even fewer have examined these relationships stratified by gender. METHODS Using a cross-sectional representative sample of 9,615 adults aged 60 years or older from 7 states in diverse regions of India, we examine the relationship between widowhood and self-rated health, psychological distress, cognitive ability, and four chronic diseases before and after adjusting for demographic characteristics, socioeconomic status, living with children, and rural-urban location for men and women, separately. We then assess these associations when widowhood accounts for duration. RESULTS Being widowed as opposed to married was associated with worse health outcomes for women after adjusting for other explanatory factors. Widowhood in general was not associated with any outcomes for men except for cognitive ability, though men who were widowed within 0-4 years were at greater risk for diabetes compared to married men. Moreover, recently widowed women and women who were widowed long-term were more likely to experience psychological distress, worse self-rated health, and hypertension, even after adjusting for other explanatory variables, whereas women widowed 5-9 years were not, compared to married women. CONCLUSIONS Gender, the duration of widowhood, and type of outcome are each relevant pieces of information when assessing the potential for widowhood to negatively impact health. Future research should explore how the mechanisms linking widowhood to health vary over the course of widowhood. Incorporating information about marital relationships into the design of intervention programs may help better target potential beneficiaries among older adults in India.
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Affiliation(s)
- Jessica M Perkins
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Massachusetts Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Hwa-Young Lee
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea
| | - K S James
- Jawaharlal Nehru University, New Delhi, India
| | - Juhwan Oh
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea
| | - Aditi Krishna
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jongho Heo
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea.,Public Health Joint Doctoral Program, San Diego State University & University of California, San Diego, CA, USA
| | - Jong-Koo Lee
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea. .,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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