Alcohol use patterns and hypertension among adults in the United States: findings from the 2015-2016 NHANES data.

OBJECTIVES: This study assessed the association between alcohol use patterns and the prevalence of hypertension. STUDY DESIGN: Data on alcohol use patterns and hypertension among 5918 adults from the 2015-2016 National Health and Nutrition Examination Survey was used for this study. METHODS: The association of alcohol use patterns; "ever-used alcohol", "binge drinking", "heavy drinking", and "everyday alcohol use" with hypertension were assessed using multivariable-adjusted logistic regression to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) at a two-sided P < 0.05. RESULTS: Overall, the mean age of respondents was 48.3 ± 18.5 years, 50.9% (n = 3034) were women, and 44.6% (n = 2132) were hypertensive. Also, 85.9% (n = 4177) had used alcohol in their lifetime, 51.9% (n = 1764) were heavy drinkers, 25.1% (n = 370) engaged in binge drinking, and 17.7% (n = 721) reported everyday alcohol use. Compared to those that have never used alcohol, the aOR (95%CI) of stage II hypertension was 1.570 (1.565, 1.575) for overall alcohol use, 1.370 (1.367, 1.373) for everyday alcohol use, 1.127 (1.125, 1.129) for heavy drinking, and 1.092 (1.087, 1.098) for binge drinking. Among current active smokers, the aOR (95%CI) of stage II hypertension was aggravated for everyday alcohol use; 2.583 (2.576, 2.590). CONCLUSION: Alcohol use patterns were associated with a higher prevalence of hypertension, particularly among smokers. A population-based longitudinal study should clarify whether these alcohol use phenotypes are predictive of hypertension at the population level in the United States.

Community-based Investigation of the Risk Factors for Cardiovascular Diseases in Ibadan and suburbs (COMBAT-CVDs): Design and Methods.

Africa is gradually becoming the epicentre for the burden of cardiovascular diseases (CVDs) worldwide, and community-based data alluding to the pattern and dynamics of escalating epidemiological thresholds of CVDs among indigenous Africans are limited. This manuscript focuses on the design and methods of Community-based Investigation of the Risk Factors for Cardiovascular Diseases in Ibadan and suburbs (COMBAT-CVDs), an ongoing community-based door-to-door study assessing the profile, burden and dynamics of CVDs risk factors among residents of Ibadan and suburbs. COMBAT-CVDs is a cohort of community-dwelling indigenous Africans, males and females, ≥18years from ten communities in Ibadan, Nigeria. The recruitment of participants for the first wave (W0) started in 2020, covering; questionnaire administration and physical examination. The World Health Organization's STEPS Instrument for Chronic Disease Risk Factor Surveillance was used for data collection. Data were collected on sociodemographic, socioeconomic and lifestyle-related characteristics, history of CVDs, stress, depression and sleep quality. Also, anthropometric and blood pressure measures were conducted by trained personnel using standard operating procedures and instruments. Data collection for the second wave is underway, and the collection of blood and other biological samples for genetic epidemiology is planned, subject to availability of funds. For the W0 recruitment, a total of 3638 community-dwelling adults (males - 54.6% and females - 45.4%) participated with a ≥99.7% response rate. The COMBAT-CVDs will likely provide novel data, insightful characterization of CVDs risk factors and evidence for context-specific and culturally relevant interventions for the community-based prevention and management of CVDs among Africans in this setting.

The Factor Structure of the Environmental Attitude Scale in a Community-Based Study in Lagos, Nigeria.

Environmental Attitude (EA) has been understood to be a complex multidimensional construct with minimal empirical evidence in developing countries. In the present study, psychometric properties of an EA scale was empirically assessed using data from a community based study conducted in Nigeria. Different measures of EA were aggregated into a single EA scale and administered to 1,858 individuals. Mean (Standard deviation) and proportions were used to describe the distribution of continuous and discrete data respectively. Reliability of the scale was assessed using Cronbach alpha. Varying hypothetical models of the EA were assessed using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Data were analysed using IBM SPSS version 20 and AMOS version 21 at 5% significant level. Overall mean score and alpha coefficient for the combined EA measure was 381.7 (49.0) and 0.928 respectively. A 3-factor structure accounting for 36% cumulative variance in the scale item was extracted in an EFA. A non-orthogonal 3-factor model was a significant improvement over the original none-correlated 5-factor model [χ2(1344)=29216.33, P<0.001; CAIC=9816.870]. The conceptualization of the EA as a non-orthogonal 3-factor structure provides a better fit to the present data. The 3-factor structure is advised in Nigeria and similar settings.

L'attitude environnementale (AE) a été connu d'etre construit multidimensionnel et complexe avec des preuves empiriques minimales dans les pays en voie de développement. Dans l'etude actuelle, les propriétés psychométriques d'une échelle d'évaluation environnementale ont été évaluées de manière empirique à l'aide de données provenant d'une étude menée au niveau communautaire au Nigeria. Différentes mesures d'évaluation environnementale ont été regroupées dans une seule échelle d'évaluation et administrées à 1 858 personnes. La moyenne (type écart) et les proportions ont été utilisées pour décrire la distribution des données continues et discrètes, respectivement. La fiabilité de l'échelle a été évaluée à l'aide du coefficient alpha de Cronbach. Différents modèles hypothétiques de l'AE ont été évalués à l'aide d'une analyse factorielle exploratoire (AFE) et d'une analyse factorielle confirmatoire (AFC). Les données ont été analysées avec IBM SPSS version 20 et AMOS version 21 à un niveau significatif de 5%. Le score moyen global et le coefficient alpha de la mesure de l'EA combinée étaient respectivement de 381,7 (49,0) et 0,928. Une structure à 3 facteurs représentant une variance cumulée de 36% de l'élément d'échelle a été extraite dans un EFA. Un modèle à 3 facteurs non orthogonal constituait une amélioration significative par rapport au modèle original à 5 facteurs sans corrélation [χ2 (1344) = 29216,33, p <0,001; CAIC = 9816.870]. La conceptualisation de l'AE en tant que structure à 3 facteurs non orthogonale offre un meilleur ajustement aux données actuelles. La structure à 3 facteurs est conseillée au Nigeria et dans des contextes similaires.

Multilevel analysis of psychosocial functioning of Adolescents in families affected by HIV/AIDS in Benue state, Nigeria.

Psychosocial functioning is increasing a public health priority issue among young people. Previous reports have focused on the effect of personal health conditions on the psychosocial well-being of children but contextual analysis of environmental or social factors could provide relevant information for interventions. In the context of HIV/AIDS, the present study examined the personal- and contextual-level predictors of Psychosocial Functioning Index (PFI) among adolescents in Benue state, Nigeria. Data on 2,276 adolescents was extracted from a cross-sectional study in Benue State for secondary analysis. The PFI was obtained using the final score of an existing scale (Adolescents Psychosocial Functioning Inventory). Participant's characteristics were summarized using descriptive statistics and compared using Chi-square test. Multilevel logit models were used to assess the individual- and contextual-level predictors of the PFI of adolescents. A nominal p-value ≤0.05 was considered significant in all analyses. Participants were 14.77±2.04 years old and mostly female (53.9%). About 19% of the participants have single parents while 62.1% have self-employed mothers. Proportion with elevated PFI was significantly higher among adolescents who have self-employed mothers (84.4%) and alcohol/substance users (82.7%). In adjusted analysis, adolescents who reported alcohol/substance use (OR=1.65; 95%CI: 1.14 to 2.38) were twice more likely to have elevated psychosocial functioning index compared to non-users. The psychosocial functioning index is high among study participants and differs contextually. Adolescent's psychosocial functioning depends on their life styles and parents' marital and economic situations. Family empowerments and other family level intervention programmes will benefit adolescents in these categories.

Treatment Satisfaction and Medication Adherence Among Hypertensive Patients Seeking Care in Selected Hospitals in Ibadan, Nigeria.

Poor adherence to hypertension treatment is a major health-related problem, and a significant risk factor for complications, disability and hypertension associated mortality. There is a paucity of evidence on the impact of treatment satisfaction on medication adherence among hypertensive patients in Nigeria. This study aimed to determine the association between treatment satisfaction and medication adherence among hypertensive patients in Ibadan, Nigeria. A descriptive cross-sectional study was conducted, wherein hypertensive patients were consecutively recruited from 5 hospitals in Ibadan, Nigeria. A pre-tested, interviewer-administered questionnaire was used to collect data. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8), and treatment satisfaction using the 9-item Treatment Satisfaction Questionnaire for Medication (TSQM). Descriptive statistics were computed for all variables. Bivariate analysis was carried out using chi-square test, and multivariate analysis using binary logistic regression. Sensitivity analysis was conducted to adjust for unmeasured binary confounders. Statistical significance was set at p < 0.05 for a 2-tailed. A total of 342 respondents with the mean age of 59.6 ± 12.6 years participated in the study. The overall prevalence of medication adherence was 35.1% (MMAS-8 scores = 8). Treatment satisfaction (AOR=2.03, 95% CI: 1.21-3.43) was independently associated with medication adherence. Sensitivity analysis revealed that the observed association between treatment satisfaction and medication adherence was unlikely to be due to unmeasured confounding variables. Medication adherence was low, and treatment satisfaction independently increases medication adherence. Treatment satisfaction strategies should be part of any treatment intervention packages in this population.

Discordant rapid HIV tests: lessons from a low-resource community.

OBJECTIVES: HIV rapid antibody tests are widely used in Africa, but dual testing sometimes produces discordant results. It is not clear if discordant rapid HIV tests should always heighten suspicion by frontline health workers that early HIV infection is present. Some studies have reported that discordant rapid tests have value for identifying early HIV infection in high HIV prevalence populations. It is not known if rapid test performance influenced this conclusion, or if this observation will hold true for low HIV prevalence populations. We therefore explored the occurrence of discordant rapid HIV tests in a low-resource community. METHODS: A cross-sectional sample of HIV status-unaware adults with recent exposure to unsafe sex was assessed using a validated risk-based tool (University of North Carolina (UNC)-Malawi Risk Screening Score) for acute HIV infection. Participants received rapid testing with Determine™ HIV 1/2 and Uni-Gold™ HIV assays, plus plasma HIV-1 antigen testing with the COBAS® Ampliprep/COBAS® Taqman® HIV-1 assay, followed by western blot in those with detected HIV-1 antigen. RESULTS: Of 408 participants, 1.0% were confirmed to have established HIV infection. The discordance between rapid tests at initial screening was 2.45 and 2.94% when the two assays were used sequentially and simultaneously, respectively. Discordant rapid tests were strongly associated with risk scores > 2 [odds ratio (OR) 10.88; 95% confidence interval (CI) 2.35-50.43], and with detected HIV-1 RNA (OR 26.06; 95% CI 3.91-173.60). CONCLUSIONS: When the sample occurrence of discordance between the first and second tests is below 5%, discordant rapid tests in an adult with sexual risk behaviour should trigger strong suspicion of early HIV infection in low HIV prevalence populations.

Carotid IMT is more associated with stroke than risk calculators.

BACKGROUND: It is unclear whether a natural marker of atherosclerosis (carotid intima-media thickness: CIMT) or calculated risk score is more associated with stroke. We therefore comparatively examined the relationship between CIMT as well as two cardiovascular risk calculators (Omnibus Risk Score -ORS and Framingham Risk Score- FRS) and the occurrence of stroke among hypertensive African patients. METHODS: CIMT was measured in 555 consecutive consenting hypertensive adults (377 stroke patients and 178 stroke-free subjects). The 10-year cardiovascular risk was calculated for each participant with the FRS and ORS. The strengths of association between FRS, ORS, CIMT, and stroke occurrence were examined using logistic regression. The discriminative capacity of FRS, ORS, and CIMT for stroke occurrence was assessed with c-statistics. RESULTS: Higher average CIMT (OR 11.71; 95% CI 1.65-83.07; P = 0.01) was strongly associated with stroke after adjusting for age, sex, blood pressure, serum cholesterol, and blood sugar. Neither the FRS (OR: 1.03; CI: 0.89-1.19, P = 0.68) nor the ORS (OR: 1.08; CI: 0.90-1.30; P = 0.41) was significantly associated with stroke. CIMT had a higher c-statistic for differentiating stroke patients from hypertensive controls (right: c = 0.63, P < 0.001; left: c = 0.67, P < 0.001; average: c = 0.66, P < 0.001) than some conventional risk factors. Neither FRS (P = 0.39) nor ORS (P = 0.55) was able to independently differentiate between stroke and hypertensive patients. CONCLUSION: CIMT, but neither FRS nor ORS, is independently associated with stroke among Nigerian African hypertensive patients. CIMT may be a better tool for estimating the overall risk of stroke than FRS or ORS in this population.

Is there any relationship between hearing threshold levels and CD4 cell count of human immunodeficiency virus infected adults?

Background The role of viral load level and/or CD4 (Cluster of differentiation 4) cell count in the aetiopathogenesis of hearing loss in HIV infection is unclear. Therefore, we investigated the relationship between CD4 cell counts, viral load and hearing threshold of HIV (Human immunodeficiency virus) infected adults. METHODS: This cohort audiometric study involved consecutive HIV-infected and HIV-uninfected adults as controls. Clinical data relating to hearing loss, HIV status, and highly -active antiretroviral therapy (HAART) were obtained. Audiornetric evaluation was performed. The most recent CD4 cell counts and RNA viral load-of HIV-infected participants were obtained from clinic records. RESULTS: There were 299(66.7%) HIV-infected adults and 149(33.3%) controls with mean age of 39.64± 12.45 years and 39.60±12.45 years respectively (p=0.98). In both groups, there were more participants with left hearing loss. Mild to profound hearing loss was found in 65.9% HIV- infected participants and 53.7% controls. Majority (86.3%) of the HIV-infected participants were on HAART. The mean CD4 cell count was 654.58±289.15 in 41 HIV-infected participants not on HAART and 523.95±300.17 in 258 participants on HAART (p=0.01). Majority,- 197 (62%) HIV- infected participants with hearing loss had CD4 cell count ≤200 cells/mm3. Higher viral load significantly correlated with low CD4 cell counts (p<0.0 1; r=0. 18) and low CD4 cell count significantly correlated with high hearing threshold (p

Can common carotid intima media thickness serve as an indicator of both cardiovascular phenotype and risk among black Africans?

BACKGROUND: It is not known whether common carotid intima media thickness (CIMT) can serve as a surrogate marker of cardiovascular risk among black Africans. Therefore, we examined whether CIMT differed significantly among individuals with distinct cardiovascular phenotype and correlated significantly with traditional cardiovascular risk factors in a black African population. METHODS: CIMT was measured in 456 subjects with three distinct cardiovascular phenotypes - 175 consecutive Nigerian African stroke patients, 161 hypertensive patients without stroke and 120 normotensive non-smoking adults. For each pair of cardiovascular phenotypes, c-statistics were obtained for CIMT and traditional vascular risk factors (including age, gender, weight, waist circumference, smoking, alcohol, systolic and diastolic blood pressures, fasting plasma glucose, fasting total cholesterol). Pearson's correlation coefficients were calculated to quantify bivariate relationships. FINDINGS: Bilaterally, CIMT was significantly different among the three cardiovascular phenotypes (right: p < 0.001, F = 33.8; left: p < 0.001, F = 48.6). CIMT had a higher c-statistic for differentiating stroke versus normotension (c = 0.78 right; 0.82 left, p < 0.001) and hypertension versus normotension (c = 0.65 right; 0.71 left, p < 0.001) than several traditional vascular risk factors. Bilaterally, combining all subjects, CIMT was the only factor that correlated significantly (right: 0.12 ≤ r ≤ 0.41, 0.018 ≤ p < 0.0001; left: 0.18 ≤ r ≤ 0.41, 0.005 ≤ p < 0.0001) to all the traditional cardiovascular risk factors assessed. CONCLUSION: Our findings support CIMT as a significant indicator of both cardiovascular risk and phenotype among adult black Africans. However, specific thresholds need to be defined based on prospective studies.

Mathematical modeling of the epidemiology and the transmission dynamics of HIV/AIDS infections in Nigeria.

Many of the already proposed models for the transmission of HIV/AIDS do not fit the situations in Nigeria. This is in part due to the fact that many of the models pay more attention to either homogeneity of sexual contact or population of homosexuals. Although some notable models have also been studied by different authors in times and places for heterosexual transmission of HIV/AIDS epidemics, none of these models addressed the peculiar transmission dynamics in Nigeria. In this study, we grouped the population into susceptible, infected and AIDS men and women with sexual contact as the major route for HIV transmission. Assuming a strong sexual network between the groups and with the AIDS group unable to contribute to infection, we formulated mathematical models for the heterosexual transmission dynamics of HIV/AIDS in Nigeria. Our models incorporated parameters and variables that describe the nature and the strength of the transmission across the groups. We also presented model predictions on pattern of mixing between and within the groups and how these in turn determine the global dynamics of the epidemics in Nigeria. Our simulation results show that, an increase in the transmission probability as well as in the number of sexual partnership poses more treat to the population than other parameters. The model predictions show that the epidemics tend to level up after year 2010. The number of sexual partners change per year and the probability of an effective contact are among the most critical variables in the HIV/AIDS epidemics in a community of heterosexual Nigerians. Our results agree with recent findings of similar models for some Sub-Saharan African countries. Also, results from the predictions based on the most recent National HIV Seroprevalence Surveillance Survey conducted in Nigeria agree with our findings.