Burden of Hypertensive Heart Disease and High Systolic Blood Pressure in Australia from 1990 to 2019: Results From the Global Burden of Diseases Study.

BACKGROUND: There is a dearth of comprehensive studies examining the burden and trends of hypertensive heart disease (HHD) and high systolic blood pressure (SBP) among the Australian population. We aimed to explore the burden of HHD and high SBP, and how they changed over time from 1990 to 2019 in Australia. METHODS: We analysed data from the Global Burden of Disease study in Australia. We assessed the prevalence, mortality, disability-adjusted life-years (DALY), years lived with disability (YLD) and years of life lost (YLL) attributable to HHD and high SBP. Data were presented as point estimates with 95% uncertainty intervals (UI). We compared the burden of HHD and high SBP in Australia with World Bank defined high-income countries and six other comparator countries with similar sociodemographic characteristics and economies. RESULTS: From 1990 to 2019, the burden of HHD and high SBP in Australia reduced. Age standardised prevalence rate of HHD was 119.3 cases per 100,000 people (95% UI 86.6-161.0) in 1990, compared to 80.1 cases (95% UI 57.4-108.1) in 2019. Deaths due to HDD were 3.4 cases per 100,000 population (95% UI 2.6-3.8) in 1990, compared to 2.5 (95% UI 1.9-3.0) in 2019. HHD contributed to 57.2 (95% UI 46.6-64.7) DALYs per 100,000 population in 1990 compared to 38.4 (95% UI 32.0-45.2) in 2019. Death rates per 100,000 population attributable to high SBP declined significantly over time for both sexes from 1990 (155.6 cases; 95% UI 131.2-177.0) to approximately one third in 2019 (53.8 cases; 95% UI 43.4-64.4). Compared to six other countries in 2019, the prevalence of HHD was highest in the USA (274.3%) and lowest in the UK (52.6%), with Australia displaying the third highest prevalence. Australia ranked second in term of lowest rates of deaths and third for lowest DALYs respectively due to high SBP. From 1990-2019, Australia ranked third best for reductions in deaths and DALYs due to HHD and first for reductions in deaths and DALYs due to high SBP. CONCLUSION: Over the past three decades, the burden of HHD in Australia has reduced, but its prevalence remains relatively high. The contribution of high SBP to deaths, DALYs and YLLs also reduced over the three decades.

Short-term effectiveness of a theory-based intervention to promote diabetes management behaviours among adults with type 2 diabetes in Iran: A randomised control trial.

BACKGROUND: Diet and physical activity are recommended for diabetes management. Evidence suggests theory-based interventions are more efficacious than non-theory approaches. This study aimed to test the short-term effectiveness of an integrated theoretical model-based intervention to encourage compliance for low-fat food consumption, carbohydrate counting and physical activity in adults with type 2 diabetes. METHODS: A 4-week parallel randomised control trial was conducted in Iran. Data were collected using a self-report questionnaire at baseline and 8-weeks post-intervention. This survey assessed the theory of planned behaviour (TPB) constructs of attitude, subjective norm (others' approval) and perceived behavioural control (PBC). We also assessed risk perceptions (motivational) and planning (volitional) from the health action process approach (HAPA). Furthermore, weight, body mass index, triglyceride (TG) and LDL-cholesterol were measured, with a sub-sample of participants providing haemoglobin A1c (HbA1c) assessments. RESULTS: For both low-fat food consumption and physical activity, only planning revealed a significant improvement over time for intervention rather than control participants (F = 8.78, P ≤ .001 for low-fat vs F = 11.26, P ≤ .001 for physical activity). For carbohydrate counting, significant effects were found for behaviour (F = 4.37, P = .03), intention (F = 8.14, P ≤ .001), PBC (F = 7.52, P ≤ .001) and planning (F = 4.54, P = .03), reflecting improvements over time in the intervention participants compared to controls. Furthermore, the effects of the intervention on behaviour were partially mediated via participants' degree of planning (B = 0.10, SE = 0.06, CI = 0.01 to 0.26). The serum TG level was significantly reduced from pre to post-intervention for intervention rather than for control participants (F = 18.69, P ≤ .001) as did Hb1Ac in a sub-sample of study participants. CONCLUSIONS: This intervention showed promising short-term effects for carbohydrate counting but did not show improvements for low-fat diet nor physical activity. Given the improvement in psychological measures and self-reported behaviour for carbohydrate counting, coupled with the findings for TG, future research is needed to demonstrate longer-term improvements.

A systematic review of empirical studies on methodology and burden of informal patient payments in health systems.

INTRODUCTION: Informal patients' payments (IPPs) is a sensitive subject. The aim of current study was to assess the trends in informal payment studies and explore methods of IPPs measurement, prevalence, and features (payment type, volume, and receiver) in various contexts. METHODS: A search strategy was developed to identify peer-reviewed articles addressing informal payments on PubMed, Science Direct, Web of Science, Scopus, and CINAHL. A total of 1252 studies were identified initially. After screening process, 38 studies were included in the systematic review. The selected studies were appraised, and findings were synthesized. RESULT: Among selected studies, quantitative approaches were mostly used for measuring IPPs from general public and patients' perspective, and qualitative methods mainly targeted health care providers. Reported IPP prevalence in selected articles ranges between 2% and 80%, more prevalent in the inpatient sector than in outpatient. CONCLUSION: There are a number of strategies for the measurement of IPPs with different strengths and weaknesses. Most applied strategies for general public were quantitative surveys recruiting more than 1000 participants using a face-to-face structured interview, and then qualitative studies on less than 150 health care providers, with focus group discussion. This review provides a comprehensive picture of current informal patients' payments measurement tools, which helps researchers in future investigations.

Nigella sativa improves glucose homeostasis and serum lipids in type 2 diabetes: A systematic review and meta-analysis.

BACKGROUND & OBJECTIVE(S): Global prevalence of type 2 diabetes (T2D) is very high and is currently growing alarmingly. With respect to recent researchers' attention to the potential role of herbal medicine in disease prevention and management, the present meta-analysis review investigates the effectiveness of Nigella sativa (N. sativa), a popular herb, in T2D. METHODS: Literature search was conducted covering PubMed/Medline, Scopus, and Cochrane Registry of Clinical Trials up to February 2017 to obtain the relevant published intervention studies. Study selection, quality rating and data extraction of studies were investigated by two independent reviewers. Heterogeneity was assessed using I-squared (I2) statistics test. Subgroup analysis was done to assess type of N. sativa supplement as source of heterogeneity. Effect sizes of eligible studies were pooled using STATA software version 12 (STATA corp, College Station, TX, USA). RESULTS: Seven trials were included in the meta-analysis of glycemic and serum lipid profile end points. Supplementation with N. sativa significantly improved fasting blood sugar (FBS) [-17.84mg/dl, 95% CI: -21.19 to -14.49, p<0.001], HbA1c [-0.71%, 95% CI: -1.04 to -0.39, p<0.001], total-cholesterol (TC) [WMD: -22.99mg/dl, 95% CI: -32.16 to -13.83, p<0.001] and LDL-cholesterol (LDL-c) [-22.38mg/dl, 95% CI: -33.60 to -11.15, p<0.001]. The overall effects for triglyceride (TG) [-6.80mg/dl, 95% CI: -33.59 to 19.99, p=0.61] and HDL-cholesterol (HDL-c) [0.37mg/dl, 95% CI: -1.59 to 2.33, p=0.71] were insignificant. Subgroup analysis revealed significant reduction on TG with N. sativa seed oil [-14.8mg/dl, 95% CI: -23.1 to -6.5, p<0.001], while TG was increased with seed powder [29.4mg/dl, 95% CI: 16.9-42.0, p<0.001]. All measures, but HbA1c, showed no evidence of publication bias. CONCLUSION: Although, the meta-analysis conducted included a few number of studies, but has shown promising results on the effectiveness of N. sativa on glucose homeostasis and serum lipids. Current findings suggest N. sativa supplementation a suitable choice in managing the complications of T2D, although future researches are necessary.