RESUMO
BACKGROUND: Chronic hepatitis C (CHC) virus infection is a global health concern that is associated with significant liver-related morbidity and mortality. Owing to the inflammatory pathway, CHC can causefatty liver, liver cirrhosis, and liver cancer and is associated with cardiometabolic diseases, such as hypertension and diabetes. Fatty liver is associated with metabolic disorders, cardiovascular diseases, diabetes, and liver cancer. Hence, the early detection of fatty liver through noninvasive screening in adults with CHC is important in primary healthcare settings. This study aimed to explore the prevalence of fatty liver and its association with metabolic syndrome amongrural adults with CHC. METHODS: This was a series of cohort studies related to the elimination of the CHC burden around the western coastal Yunlin County, Taiwan, between August 2018 and July 2021. A cross-sectional study was conducted after hepatitis C virus RNA confirmation in a hepatitis C- endemic area. A gastrointestinal physician or radiologist assessed fatty liver by ultrasonography. Fatty liver was classified into four grades: normal, mild, moderate, and severe. Three liver enzyme biomarkers were identified. According to the Taiwan national standard, metabolic syndrome was defined based on the presence of three or more of the five abnormal biomarkers, including increased waist circumference, elevated blood pressure, elevated fasting blood glucose level, elevated triglyceride level, and low high-density lipoprotein cholesterol level. RESULTS: A total of 256 rural adults with CHC were enrolled. The mean age of the participants was 67.5 (standard deviation = 11.8) years, with a low educational level. High prevalence of fatty liver (79%), central obesity (54.3%), elevated blood pressure (55.5%),elevated fasting blood glucose (FBG) level (44.9%), and metabolic syndrome (37.9%) were observed.The results showed that adults with CHC with moderate to severe fatty liver were significantly associated with an increased risk of increased waist circumference (P < 0.001), increased blood pressure (P < 0.001), low high-density lipoprotein cholesterol level (P < 0.05), and elevated liver enzyme biomarker levels (all P < 0.05) after adjusting for age, sex, and educational level. Furthermore, adults with CHC with moderate to severe fatty liver were significantly associated with a greater risk of metabolic syndrome (odds ratio = 2.85, 95% confidence interval = 1.66 to 4.92). CONCLUSIONS: The findings demonstrate a high prevalence of fatty liver in rural adults with CHC, which is significantly associated with obesity, metabolic syndrome, and elevated liver biomarker levels. Clinicians and primary healthcare providers must encourage patients with CHC to receive antiviral therapy combined with weight loss management and lifestyle modification, allowing general improvements in their liver and cardiometabolic health.
Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Fígado Gorduroso , Hepatite C Crônica , Hipertensão , Neoplasias Hepáticas , Síndrome Metabólica , Adulto , Humanos , Criança , Hepatite C Crônica/complicações , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/diagnóstico , Fatores de Risco , Prevalência , Glicemia , Estudos Transversais , Fígado Gorduroso/diagnóstico por imagem , Fígado Gorduroso/epidemiologia , Obesidade/epidemiologia , Hipertensão/complicações , Doenças Cardiovasculares/complicações , Biomarcadores , Colesterol , Lipoproteínas HDL , Atenção Primária à SaúdeRESUMO
BACKGROUND: Healthy aging with dignity and aging in place are important for Taiwanese individuals. Although Taiwan did not experience COVID-19 outbreaks prior to May 2021, many older adults have been encouraged to stay at home since the beginning of the global pandemic in January 2020. Such shelter-in-place recommendations have resulted in significant lifestyle changes, limiting activities associated with aging with dignity such as exercise and community engagement. Few studies have explored how to promote or maintain holistic health practices and physical fitness in older adults residing in rural communities during the COVID-19 pandemic. This pilot study aimed to establish an interdisciplinary collaboration with community care workers (CCWs) and evaluate the impact of an innovative summer camp (ISC) program for older adults residing in rural areas. METHODS: A quasi-experimental pre-post-test design with an interdisciplinary collaborative approach was implemented. The ISC program was based on a standardized protocol of modified Baduanjin exercise combined with three recreational breathing games. Participants were recruited from three community centers around the western coastal region of Yunlin County between June and August 2020. The ISC program was designed and executed by a nurse-led health promotion research team that collaborated with trained CCWs for 90 min per day, five days per week, for 12 weeks. Participants and CCWs wore facemasks during all activities. Paired t-test was used to measure changes in physical biomarkers, pulmonary lung function, and health-related fitness changes. RESULTS: Sixty-eight participants completed the ISC program. The ISC program significantly improved the participants' physiological biomarkers and health-related fitness, including reduced body weight, waistline, and systolic blood pressure, and increased forced vital capacity, biceps arm flexion, and ability to sit and stand from a chair, step with a knee up in situ, and stand on one foot with eyes open. Most participants reported that they felt happy, satisfied, and hoped that this program would be continued in their community center. CONCLUSIONS: This interdisciplinary, collaborative ISC program improved physical biomarkers and health-related fitness in older adults. Despite limitations, results strongly suggested that primary healthcare providers and CCWs can employ the described ISC program to promote wellness in older adults.
RESUMO
BACKGROUND: Early detection and prevention of cardiometabolic risk factors in an increasingly aging society are a global public health concern. Maintaining adequate lung function is important for healthy aging. Few studies exist on lung function impairment and decline in primary healthcare settings, especially among rural adults with cardiometabolic risks. This study aimed to explore the prevalence of impaired lung function and its association with cardiometabolic risks among rural adults. METHODS: A community-based, cross-sectional study was conducted between March and December 2019 in western coastal Yunlin County, Taiwan. The lung function test was measured by spirometry, based on the American Thoracic Society recommendations. Three lung function parameters were obstructive lung impairment, restrictive lung impairment, and mixed lung impairment. Restrictive, obstructive, and mixed type lung function was categorized as impaired. Cardiometabolic risk factors and metabolic syndrome were based on the national standard and include five abnormal biomarkers, including abdominal obesity, blood pressure, fasting plasma glucose, triglycerides, and decreased high-density cholesterol levels. RESULTS: The median age of the 1653 (92.9%) participants with complete data was 66 years (interquartile range: 55 to 75 years). The prevalence of impaired lung function was 37%, including 31.7% restrictive, 2.5% obstructive, and 2.7% mixed type. Adults with impaired lung function (86% restrictive type) engaged more in smoking and betel nut chewing, ate fewer vegetables and fruit, and drank less water compared to the normal lung function group. After adjusting for potential confounding variables, multivariate logistic regression analysis showed that cardiometabolic risk factors were independently associated with restrictive lung impairment, while cigarette smoking (OR = 2.27, 95% CI = 1.14-4.53) and betel nut chewing (OR = 2.33, 95% CI = 1.09-5.01) were significantly associated with the obstructive type of lung impairment. CONCLUSIONS: A high prevalence of restrictive lung impairment, cardiometabolic risks, and unhealthy lifestyles among rural adults were found in this study. For adults with cardiometabolic risks in rural areas, initiating lifestyle modifications with culture-tailored programs to improve lung function should be an important issue for clinicians and primary healthcare providers.
Assuntos
Doenças Cardiovasculares , Pulmão , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , TaiwanRESUMO
BACKGROUND/PURPOSE: The HCV core antigen (HCV Ag) assay displays high sensitivity and strong correlation with HCV RNA. However, the feasibility of anti-HCV reflex HCV Ag screening in a community-wide setting is rarely discussed. METHODS: We performed a two-phase community-based hepatitis C screen in an HCV-prone area of central Taiwan. During the training phase, all participants were test for anti-HCV, HCV Ag and HCV RNA to validate sensitivity, specificity, and accuracy of HCV Ag. During the validation phase, an anti-HCV reflex HCV Ag screen was conducted based on the results of training phase. Outcomes of the study were presented as positive and negative predictive values (PPV and NPV). RESULTS: Of 935 training phase participants, the rate of positive anti-HCV and HCV Ag were 175 (18.7%) and 78 (8.3%), respectively. Test sensitivity, specificity, and accuracy of HCV Ag were 97.1%, 98.6%, and 97.8%, respectively. During validation phase, only anti-HCV-positive serum samples were tested for HCV Ag. Of 1932 participant, 285 (14.8%) were anti-HCV-positive. 133 (46.7%) of the 285 anti-HCV-positive samples were HCV Ag-positive. PPV and NPV were 98.4% and 99.3%, respectively. Across the entire participant sample, a significant linear correlation between HCV Ag and HCV RNA concentration was noted (r2 = 0.93, p-value<0.001) following log-log transformation. CONCLUSION: Anti-HCV reflex HCV Ag screening is a feasible strategy for aiding HCV-prone communities.
Assuntos
Hepatite C , Prata , Estudos de Viabilidade , Hepacivirus/genética , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Humanos , RNA Viral , Reflexo , Sensibilidade e Especificidade , Taiwan/epidemiologiaRESUMO
BACKGROUND/PURPOSE: Low viral load (LVL) of hepatitis B virus (HBV) is a predictor of chronic HBV infection. However, the usefulness of quantitative hepatitis B surface antigen (qHBsAg) in predicting LVL in community-based screening has not been well studied. We aimed to measure the prevalence of LVL in HBV carriers and validate the efficacy of qHBsAg in predicting LVL. METHODS: This community-based screening study was conducted in Taiwan. HBV DNA was assayed in HBsAg carriers. Participants were randomized to training and validation sets to determine the ability of qHBsAg to predict LVL. Receiver operating characteristic curves were used to identify the best cutoff values in the training set. RESULTS: Among the 2919 participants, 359 (12.2%) were HBsAg carriers. There were 132 and 137 carriers in the training and validation sets, respectively. Significant correlations were found between qHBsAg and HBV DNA in both training and validation sets. Thirty and 29 participants with qHBsAg <8 IU/mL in the training and validation sets, respectively, had LVL. Using 8 IU/mL as the cutoff, negative predictive value (NPV) of qHBsAg for HBV DNA levels >2000 IU/mL was 100%. The best cutoff level of qHBsAg to predict HBV LVL was 200 IU/mL, with a sensitivity, specificity, and accuracy of 75.0%, 76.1%, and 75.8%, respectively, in the training set. The positive predictive value and NPV were 70.0% and 77.9%, respectively, in the validation set. CONCLUSION: Approximately 60% of HBsAg carriers had HBV LVL, and qHBsAg <8 IU/mL accurately predicts LVL. This quantitative test provides additional information for community-based screening.
Assuntos
Hepatite B , DNA Viral , Hepatite B/diagnóstico , Antígenos de Superfície da Hepatite B , Antígenos E da Hepatite B , Vírus da Hepatite B/genética , Humanos , Taiwan , Carga ViralRESUMO
PURPOSE: To explore the prevalence of hepatitis C virus (HCV) infection as well as the levels of liver health literacy and association with the health status of people with HCV through the nurse-led community health development goal of global elimination. METHODS: A community-based, cross-sectional study was conducted between July 2018 and June 2019 in coastal Western Yunlin County, Taiwan. This study was conducted at five townships, and serum HCV antibody (anti-HCV) screening was used for the identification of potentially infected people by a collaborating local hospital. RESULTS: Of the 1,963 adults from rural areas enrolled in this study, 321 (16.4%) were anti-HCV positive, 237 (73.8%) reported that they were unaware of their HCV positivity, and none of them were provided information on direct-acting antiviral agent therapy. The levels of anti-HCV positivity were higher among female patients (p < .05), elderly people (p < .001), those with a low education level (p < .001), and those from the Sihu Township within Yunlin County (p < .001). Participants with anti-HCV positivity tended to have lower intakes of vegetables (p < .01) and fruit (p < .05), a greater number of comorbidities (p < .05), as well as a greater incidence of abnormal liver (p < .001) and renal function (p < .001) compared to those with anti-HCV negativity. Multivariable linear regression analysis showed that the presence of HCV infection and a greater number of metabolic syndrome components were associated with poor liver and renal function. CONCLUSIONS: These findings showed a high prevalence of HCV infection among adults living in rural areas, who had low literacy levels on hepatitis, unhealthy lifestyles, and abnormal liver and renal function. CLINICAL RELEVANCE: Clinicians and primary healthcare providers should initiate efforts to increase the levels of liver health literacy by increasing the accessibility to infection confirmation tests and reducing the number of barriers to the reception of antiviral treatment.
Assuntos
Letramento em Saúde , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/enfermagem , Enfermagem/métodos , Educação de Pacientes como Assunto/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Serviços de Saúde Comunitária/organização & administração , Estudos Transversais , Dieta , Erradicação de Doenças , Feminino , Saúde Global , Educação em Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Nível de Saúde , Hepacivirus , Anticorpos Anti-Hepatite C/sangue , Hepatite C Crônica/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , População Rural , Taiwan/epidemiologia , Adulto JovemRESUMO
AIM: The aim of this study was to explore the effectiveness of an oral hygiene program combined with home-phone health promoting counseling for rural adults with metabolic syndrome. BACKGROUND: Metabolic syndrome is an important risk factor for cardiometabolic diseases. Evidence indicates that the poor oral hygiene and unhealthy lifestyles are closely related to metabolic syndrome. METHODS: A prospective quasi-experimental design involved a total of 136 community adults, with metabolic syndrome living in two rural townships, were clustered and conveniently assigned to intervention and control group between June 2017 and December 2018. The primary outcome was the change in cardiometabolic biomarkers. The secondary outcome comprised changes in the health-promoting behaviors. The intervention effect was assessed using a generalized estimating equation model. RESULTS: There were 80 and 56 participants in the intervention and control group, respectively. The mean age was 56â¯years and ranged from 33 to 70â¯years. The intervention group exhibited a greater improvement in body mass index (Pâ¯<â¯0.01), waist circumference (Pâ¯<â¯0.05), body fat percentage (Pâ¯<â¯0.05), triglyceride level (Pâ¯<â¯0.05), use of dental floss (Pâ¯<â¯0.05), regular tooth scaling (Pâ¯<â¯0.05), physical activity (Pâ¯<â¯0.001), and total score of health-promoting behaviors (Pâ¯<â¯0.001) than the control group. CONCLUSION: This study supports the use of an oral hygiene program combined with home-phone counseling, which offers more advantages than its counterpart. Considering the global epidemic of cardiometabolic diseases, this is a community health nursing model worth to replicate and evaluate. Further study should consider innovative strategies to improve the awareness and adoption of a healthy lifestyle in residents with cardiometabolic risks.
Assuntos
Doenças Cardiovasculares , Síndrome Metabólica , Adulto , Idoso , Doenças Cardiovasculares/prevenção & controle , Aconselhamento , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Higiene Bucal , Estudos Prospectivos , Projetos de Pesquisa , Fatores de RiscoRESUMO
BACKGROUND: Although hepatitis C virus (HCV) is a known risk factor for cardiovascular disease, whether antiviral therapy (AVT) can reduce heart failure (HF) hospitalizations is unknown.MethodsâandâResults:In this population-based cohort study, we used data from the Taiwan National Health Insurance Research Database to evaluate the effect of interferon-based therapy (IBT) on cardiovascular events in patients with chronic HCV infection. Clinical outcomes evaluated included HF hospitalizations; a composite of acute myocardial infarction, ischemic stroke, and peripheral artery disease; all-cause death; and cardiovascular death. Of 83,229 eligible patients with chronic HCV infection, we compared 16,284 patients who received IBT with untreated subjects after propensity score matching. Patients who received IBT were less likely to be hospitalized for HF compared with untreated subjects (incidence density.ID, 0.9 vs. 1.5 events per 103person-years; hazard ratio.HR, 0.58; 95% confidence interval.CI, 0.42-0.79; P=0.001). Compared with untreated subjects, the treated group had significantly lower risk of composite vascular events (ID, 3.7 vs. 5.0 events per 103person-years; P<0.001), all-cause death (ID, 5.6 vs. 17.2 events per 103person-years; P<0.001), and cardiovascular death (ID, 0.2 vs. 0.6 events per 103person-years; P=0.001). CONCLUSIONS: AVT for chronic HCV infection might offer protection against HF hospitalizations, critical vascular events, and cardiovascular death beyond known beneficial effects.
Assuntos
Antivirais/farmacologia , Insuficiência Cardíaca/prevenção & controle , Hepatite C Crônica/tratamento farmacológico , Adulto , Antivirais/uso terapêutico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Feminino , Hepatite C Crônica/complicações , Hepatite C Crônica/epidemiologia , Hospitalização , Humanos , Interferons/farmacologia , Interferons/uso terapêutico , Masculino , Pessoa de Meia-Idade , TaiwanRESUMO
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a global problem and pediatric obesity has risen dramatically. Early NAFLD might progress to nonalcoholic steatohepatitis (NASH) or liver cirrhosis and significantly increase liver disease-related mortality. We looked for NAFLD predictors in children and adolescents. METHODS: This community-based, cross-sectional study ran from December 2012 to September 2013 in southwestern Taiwan. Children <10 and >19 years old, with detected hepatic diseases, or who drank alcohol were excluded. The diagnosis of NAFLD was based on ultrasound: age, sex, anthropometric measurements, and laboratory data were evaluated for associated risks by using logistic regression analysis. Receiver operating characteristic (ROC) curves were used to determine cutoff values. RESULTS: We enrolled one thousand, two hundred and ten children (594 males; 616 females; mean age: 15.5 ± 2.8 years). Age, anthropometric measurements, and laboratory data were significantly higher in children with NAFLD. The association between NAFLD and the waist-to-height ratio (WHtR) was significant (adjusted odds ratio: 2.6; 95% confidence interval: 1.909-3.549; P < 0.001). It indicated highly suspicion of NAFLD (sensitivity: 70.1%; specificity 76.9%) when the WHtR for children and adolescents is above the cutoff value of 0.469. CONCLUSIONS: The WHtR might be a powerful index of the severity of pediatric NAFLD.
Assuntos
Hepatopatia Gordurosa não Alcoólica/diagnóstico , Índice de Gravidade de Doença , Razão Cintura-Estatura , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Curva ROC , Sensibilidade e Especificidade , TaiwanRESUMO
BACKGROUND: Oral cancer is the 2nd most common cause of death due to cancer in the south-western coastal region of Taiwan; the standardized mortality of oral cancer is higher than elsewhere in the world. According to the evidence, alcohol, betel-nut and cigarette (ABC) consumption cause oral, nasopharyngeal and related cancers. This study describes the relationships between ABC consumers and health promoting behaviors among community adults living around an area with a high prevalence of oral cancer. METHODS: A population-based, cross-sectional study design was conducted in oral cancer epidemic areas in south-western coastal Taiwan in 2010, 6,203 community residents over 20 years of age participated. Demographic data, ABC habits, and health-promoting behaviors were explored. A logistic regression analyses were used to identify factors associated with ABC consumers. RESULTS: A high percentage of participants consumed alcohol, betel-nut and cigarettes. Betel-nut and cigarette consumers took low levels of exercise, adopted a poor diet, and had poor oral hygiene. After adjusting for potential confounders, the logistic regression model indicated that middle aged males of poor education and low economic status, who did not exercise regularly and had poor oral hygiene, were more likely to chew betel quid and smoke cigarettes. CONCLUSIONS: It has identified that BC consumers are negatively associated with health promoting behaviors. Further research is required to understand the reasons why the subjects consume ABC, and explore ways to prevent initiation and enhance cessation of ABC habits in this population.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Areca , Promoção da Saúde , Neoplasias Bucais/epidemiologia , Fumar/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taiwan/epidemiologia , Adulto JovemRESUMO
Early detection and prompt linkage to care are critical for hepatocellular carcinoma (HCC) care. Chang Gung Memorial Hospital (CGMH) Yunlin branch, a local hospital in a rural area, undertakes health checkup programs in addition to its routine clinical service. Patients with HCC are referred to CGMH Chiayi branch, a tertiary referral hospital, for treatment. This study enrolled 77 consecutive patients with newly diagnosed HCCs between 2017 and 2022, with a mean age of 65.7 ± 11.1 years. The screening group included HCC patients detected through health checkups, and those detected by routine clinical service served as the control group. Compared to the 24 patients in the control group, the 53 patients in the screening group had more cases with early stage cancer (Barcelona Clinic Liver Cancer or BCLC stage 0 + A 86.8% vs. 62.5%, p = 0.028), better liver reserve (albumin-bilirubin or ALBI grade I 77.3% vs. 50%, p = 0.031) and more prolonged survival (p = 0.036). The median survival rates of the 77 patients were >5 years, 3.3 years, and 0.5 years in the BCLC stages 0 + A, B, and C, respectively, which were above the expectations of the BCLC guideline 2022 for stages 0, A, and B. This study provides a model of HCC screening and referral to high-quality care in remote viral-hepatitis-endemic areas.
Assuntos
Carcinoma Hepatocelular , Gastroenterologia , Hepatite C , Neoplasias Hepáticas , Humanos , Pessoa de Meia-Idade , Idoso , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Centros de Atenção Terciária , Hepatite C/epidemiologia , Hepatite C/terapia , Hepatite C/patologiaRESUMO
Background: Middle-aged adults often overlook critical modifiable risk factors that contribute to the emergence of cardiometabolic diseases (CMDs), including hypertension and diabetes. Many CMDs can be alleviated by addressing these modifiable risks. However, there has been insufficient research focused on rural adults with lower levels of health literacy in this regard. The aim of this study was to explore and develop an intuitive assessment tool for predicting cardiometabolic diseases (CMDs), which can be used for health education with adults of low health literacy. Methods: This was a community-based, cross-sectional study. A structured questionnaire on health-promoting habits, smoking, sleep, and physiological biomarkers was obtained via community health screening in the coastal region of Yunlin County, Taiwan. Multivariate logistic regression was used to screen for significant variables in the nomogram construction. Analysis with nonlinear restricted cubic spline was performed. Results: A total of 712 participants (60.9% females) aged 40-64 years, with middle school level or lower education, were included. The average age was 55.6 years (SD=7.3), and 220 individuals (31%) had CMDs. Multivariate logistic regression analysis revealed that age, lower scores of vegetables, fruit, water, and exercise (VFWE), smoking history, sleep deprivation, and being overweight were significantly associated with CMDs. The model incorporating these modifiable risk factors demonstrated good discriminatory ability, as indicated by an area under the receiver operating characteristic curve of 0.75 (0.73-0.76). A predictive nomogram was developed that presented modifiable risk factors in a simple graphical format to facilitate the prediction of CMDs. Conclusions: This study highlights a high prevalence of CMDs among middle-aged adults, along with the disregard for important risk factors that could be modified. The developed nomogram could be a practical and effective tool for community health education to enhance health literacy and prevent the progression of CMDs.
Assuntos
Hipertensão , Nomogramas , Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Masculino , Estudos Transversais , Fatores de Risco , Educação em SaúdeRESUMO
Background: Chronic dehydration is associated with complications and mortality in acute ischemic stroke patients. Prior literature indicates that farmers and fishery workers are commonly affected by cardiometabolic diseases and there is a need for early prevention of stroke. This study explores the prevalence of dehydration and the association of cardiometabolic risk profiles in agricultural and aquaculture workers. Methods: We conducted a community-based, cross-sectional study of agriculture and aquaculture workers in Yunlin County of Taiwan between August 1 and December 31, 2021. Data on demographic characteristics and health-related lifestyles were collected through one-on-one interviews using a questionnaire. The threshold for dehydration is defined as serum osmolality ≥295 mOsm/kg, and physiological biomarkers were collected from a collaborating hospital. Multivariable logistic regression analyses adjusted for demographic characteristics were performed to investigate the association between dehydration levels, cardiometabolic risks, and health-related behaviors. Results: A total of 962 Taiwanese agriculture and aquaculture workers who were predominantly women (65%) with a mean age of 64 years (SD = 13.8) were enrolled. The findings showed a high prevalence of dehydration (36%), metabolic syndrome (44.5%), abnormal waist circumference (64.4%), and abnormal blood pressure (68.5%). Multivariate logistic regression demonstrated that dehydration was significantly associated with metabolic syndrome (p < 0.001), 10-year stroke risk prediction (p < 0.001), and an unhealthy lifestyle (p < 0.001). Conclusion: The prevalence of chronic dehydration was higher in Taiwanese agriculture and aquaculture workers, which was significantly associated with cardiometabolic risks and unhealthy lifestyles.
Assuntos
AVC Isquêmico , Síndrome Metabólica , Acidente Vascular Cerebral , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Prevalência , Estudos Transversais , Desidratação , Síndrome Metabólica/epidemiologia , Aquicultura , AgriculturaRESUMO
Background: Serum carcinoembryonic antigen (CEA) is a biomarker commonly used to detect colorectal cancer. CEA levels are affected by many factors, including cardiometabolic diseases, such as cardiovascular diseases (CVDs) and diabetes. Cardiometabolic diseases and cancer share a similar pathological inflammatory pathway, which correlates with an unhealthy lifestyle. Hence, establishing an adequate CEA cut-off value might be a valuable reference for developing precision healthcare programs for cardiometabolic disease prevention. This study aimed to investigate the association between cardiometabolic risks and serum CEA and the underlying factors. Methods: A community-based, cross-sectional study was conducted between March and December 2021 on the western coast of Taiwan. Lifestyle data were assessed using a structured questionnaire. The cardiometabolic biomarkers, serum CEA, urine malondialdehyde, and 1-hydroxypyrene were quantified by the central laboratory of the collaborating hospital. Chi-square and binary multivariable logistic regression implemented in R version 4.0.2 were used to identify factors defining the risk of high serum CEA levels. Results: A total of 6,295 adult residents without cancer-related diseases completed the study. The mean age was 48.6 (SD = 16.4) years, 56% were female, 32% had metabolic syndrome, and 23% and 10% had CVDs and diabetes, respectively. Multivariate logistic regression showed that age ≥ 65 years, male sex, alcohol consumption, smoking, infrequent use of dental floss, fewer remaining teeth, CVDs, diabetes, and oxidative stress were significantly associated with serum CEA ≥ 3 ng/mL. The discriminatory performance of the area under the receiver operating characteristic curve was 0.75 (0.73-0.76), showing that this model was suitable for distinguishing high CEA levels. Conclusion: Our findings highlight the importance of understanding cardiometabolic diseases, unhealthy lifestyles, and oxidative stress, which contribute to high serum CEA. This study demonstrates that CEA, a well-known tumor marker, can help the early detection and prevention of cardiometabolic diseases via personalized lifestyle modification.
Assuntos
Doenças Cardiovasculares , Neoplasias , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Antígeno Carcinoembrionário , Estudos Transversais , Biomarcadores TumoraisRESUMO
BACKGROUND: The association between the biomarkers of environmental exposure, oxidative stress, and health-related behaviors in community residents living in an endemic viral hepatitis area and near petrochemical industrial complexes remains unclear. From a health promotion perspective, healthcare providers must know what to do for residents concerned about their health and living environment, especially for individual-level and modifiable risk factors. Therefore, we aimed to explore the factors associated with urinary 1-hydroxypyrene (1-OHP) and malondialdehyde (MDA). METHODS: A community-based, cross-sectional study was conducted between July 2018 and February 2019 in western coastal Yunlin County, Taiwan. All participants lived within a 10 km radius of a large petrochemical complex and did not work in the factory. This study was conducted with the local hospital through annual community health screening. Biological samples were collected and biomarkers determined and quantified in the central laboratory of the collaborating hospital. RESULTS: A total of 6335 adult residents completed the study. The mean age was 47.7 (SD = 16) years. Out of the total population, 56.4% were female, 30.1% had metabolic syndrome (MetS), and 16.8% and 14.3% had hepatitis B virus antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) positivity, respectively. The median 1-OHP and MDA level was 0.11 and 0.9 µg/g creatinine with an interquartile range of 0.07-0.18, and 0.4-1.5, respectively. The MDA levels correlated with specific diseases. The multivariable ordinal logistic regression model revealed that female sex, smoking, betel nut use, HBsAg, and anti-HCV positivity were associated with higher 1-OHP levels. In men, MetS was associated with higher 1-OHP levels and regular exercise with lower 1-OHP levels. High MDA levels were associated with smoking, betel nut users, HBsAg, and anti-HCV positivity. CONCLUSIONS: The findings highlight the importance of initiating individualized health promotion programs for residents near petrochemical factories, especially for adults with substance-use and cardiometabolic risk factors. Furthermore, it is crucial to provide further treatment to patients with viral hepatitis.
Assuntos
Hepatite B , Hepatite C , Adulto , Estudos Transversais , Feminino , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Estilo de Vida , Masculino , Malondialdeído , Pessoa de Meia-Idade , Pirenos , Taiwan/epidemiologiaRESUMO
Background: Owing to specific working environments, it is important to attain sustainable development goals for the health of fishery workers during climate change. Fishery workers have a hazardous working environment, leading to specific injuries and fatal events. However, limited studies have investigated the health status of fishery workers through long-term longitudinal follow-up and compared it with that of farmers and employed workers with similar socioeconomic status. Methods: The Longitudinal Health Insurance Database 2000, a subset of the Taiwan National Health Insurance Research Database was used for this retrospective cohort study. Only fishery workers, farmers, and employed workers were included. Based on the majority of causes of death and related diseases, participants newly diagnosed with 18 diseases, classified into cardiometabolic diseases, mental illness, chronic kidney disease, infection, and malignancy, were included. Participants with an old diagnosis of these diseases were excluded. All included participants were followed up from 1 July 2000 to the diagnosis and withdrawal date, or 31 December 2012, whichever occurred first. Due to the substantial difference in the baseline demographics, we executed a cohort study with propensity score-matched and applied the Cox model to explore the participants' health status. Results: After matching, there were negligible differences in the baseline demographics of fishery workers, farmers, and employed workers. Compared to farmers and employed workers, fishery workers were more frequently diagnosed with 11 and 14 diseases, respectively, such as hypertension (hazard ratio [HR]: 1.11, p < 0.01), diabetes (HR: 1.21, p < 0.001), dyslipidemia (HR: 1.18, p < 0.001), depression (HR: 1.38, p < 0.001), peptic ulcer (HR: 1.17, p < 0.001), chronic viral hepatitis (HR: 2.06, p < 0.001), hepatocellular carcinoma (HR: 1.67, p < 0.001), and total malignancy (HR: 1.26, p < 0.001). Conclusions: Compared to farmers and employed workers, fishery workers were more impacted by cardiometabolic diseases, mental illness, infection, and malignancy. Therefore, it is imperative to specifically focus on health policies for fishery workers, such as providing curable antiviral treatment and initiating culture-tailored health promotion programs, to mitigate health inequality.
Assuntos
Carcinoma Hepatocelular , Doenças Cardiovasculares , Neoplasias Hepáticas , Mudança Climática , Estudos de Coortes , Pesqueiros , Disparidades nos Níveis de Saúde , Humanos , Estudos Longitudinais , Estudos Retrospectivos , Fatores de RiscoRESUMO
The prevalence of chronic kidney disease (CKD) is increasing, and it brings an enormous healthcare burden. The traditional measurement of kidney function needs invasive blood tests, which hinders the early detection and causes low awareness of CKD. We recently designed a device with miniaturized coplanar biosensing probes for measuring salivary conductivity at an extremely low volume (50 µL). Our preliminary data discovered that the salivary conductivity was significantly higher in the CKD patients. This cross-sectional study aims to validate the relationship between salivary conductivity and kidney function, represented by the estimated glomerular filtration rate (eGFR). We enrolled 214 adult participants with a mean age of 63.96 ± 13.53 years, of whom 33.2% were male. The prevalence rate of CKD, defined as eGFR < 60 mL/min/1.73 m2, is 11.2% in our study. By multivariate linear regression analyses, we found that salivary conductivity was positively related to age and fasting glucose but negatively associated with eGFR. We further divided subjects into low, medium, and high groups according to the tertials of salivary conductivity levels. There was a significant trend for an increment of CKD patients from low to high salivary conductivity groups (4.2% vs. 12.5% vs. 16.9%, p for trend: 0.016). The receiver operating characteristic (ROC) curves disclosed an excellent performance by using salivary conductivity combined with age, gender, and body weight to diagnose CKD (AUC equal to 0.8). The adjusted odds ratio of CKD is 2.66 (95% CI, 1.10−6.46) in subjects with high salivary conductivity levels. Overall, salivary conductivity can serve as a good surrogate marker of kidney function; this real-time, non-invasive, and easy-to-use portable biosensing device may be a reliable tool for screening CKD.
Assuntos
Técnicas Biossensoriais , Insuficiência Renal Crônica , Adulto , Idoso , Estudos Transversais , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Insuficiência Renal Crônica/diagnósticoRESUMO
OBJECTIVES: Community-based screening for hepatitis B virus (HBV) and hepatitis C virus (HCV) is essential for hepatitis elimination. This study attempted to increase screening accessibility and efficacy by using alternative tools. DESIGN: Population-based prospective cohort study. SETTING: Hepatitis elimination program at Yunlin County, Taiwan. PARTICIPANTS: All 4552 individuals participated in 60 screening sessions of a community-based HBV and HCV screening project in five rural townships with approximately 95 000 inhabitants in central-western Taiwan. INTERVENTIONS: To increase accessibility, 60 outreach screening sessions were conducted in 41 disseminative sites. Quantitative HBV surface antigen (qHBsAg) and anti-HCV testing with reflex HCV core antigen (HCV Ag) tests were employed as alternative screening tools. MAIN OUTCOME MEASURES: Calculate village-specific prevalence of HBsAg, anti-HCV and HCV Ag and establish patient allocation strategies according to levels of qHBsAg HCV Ag and alanine aminotransferase (ALT). RESULTS: Of 4552 participants, 553, 697 and 290 were positive for HBsAg, anti-HCV and HCV Ag, respectively; 75 of them had both HBsAg and anti-HCV positivity. The average (range) number of participants in each screening session was 98 (31-150). The prevalence rates (range) of HBsAg, anti-HCV and HCV Ag were 12.1% (4.3%-19.4%), 15.3% (2.6%-52.3%) and 6.4% (0%-30.2%), respectively. The HCV Ag positivity rate among anti-HCV-positive participants was 42% (0%-100%). Using cut-off values of >200 IU/mL for qHBsAg, >3 fmol/L for HCV Ag and >40 IU/mL for ALT as criteria for patient referral, we noted an 80.2% reduction in referral burden. Three villages had high anti-HCV prevalences of 52.3%, 53.8% and 63.4% with corresponding viraemic prevalences of 23.2%, 30.1% and 22% and thus constituted newly identified HCV-hyperendemic villages. CONCLUSION: Outreach hepatitis screening increases accessibility for residents in rural communities. Screening HBV and HCV through qHBsAg and HCV Ag tests provides information concerning viral activities, which might be conducive to precise patient allocation in remote communities.
Assuntos
Hepatite B , Hepatite C , Estudos de Coortes , Hepacivirus , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Antígenos de Superfície da Hepatite B , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Humanos , Estudos Prospectivos , Reflexo , Taiwan/epidemiologiaRESUMO
[This corrects the article DOI: 10.3892/etm.2019.7995.].
RESUMO
BACKGROUND: Individuals with disabilities have health needs similar to the general population. Smoking and metabolic syndrome have emerged as major cardiovascular risks that contribute to systemic inflammation and mortality. However, few studies have focused on the association between smoking and cardiometabolic risks in adult men with disabilities. AIMS: This study explored the prevalence of smoking and its association with cardiometabolic risk and associated factors among male adults with disabilities. METHODS: This study was part of a nurse-led health-promotion program designed to examine the health needs in health programs for adults with disabilities. A community-based, cross-sectional study was conducted between July 2013-December 2014, in Chiayi County, Taiwan. RESULTS: Of the total of 964 male participants enrolled in this study, 874 (90.7%) participants had complete data sets. The prevalence of cigarette smoking and metabolic syndrome were 42%, and 33.3%, respectively. More than half (62.7%) had high blood pressure and 43.5% had central obesity. Compared with non-smokers, smokers tended to engage in less frequent regular exercise ( p<0.001), eat fewer vegetables and fruit ( p<0.05), and drink less water ( p<0.05). After adjusting for potential confounding variables, multivariable logistic regression analysis showed that smoking was an independent factor for cardiometabolic risk. CONCLUSION: The present findings show a high prevalence of cigarette smoking, unhealthy lifestyle, and cardiometabolic risk among adult men with disabilities. Clinicians and primary healthcare providers should reduce the consequences thereof by initiating innovative health promotion programs.