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1.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(5): 548-553, 2019 May 10.
Artigo em Chinês | MEDLINE | ID: mdl-31177736

RESUMO

Objective: To analyze the blood pressure changes of adults aged 18-59 years in rural area of Shanxi province based on a cohort study, and provide reference for the study of the blood pressure level of rural residents and hypertension prevention and control in rural areas in China. Methods: Data were obtained from Shanxi Nutrition and Chronic Disease Family Cohort from 2002 to 2015. Subjects aged <18 years or ≥60 years and individuals with hypertension at baseline survey in 2002, and those who had taken antihypertensive drugs for nearly two weeks during the follow-up survey in 2015 were excluded from the study. A total of 1 629 subjects aged 18-59 years were included in the analyses of the blood pressure level and its change from the baseline survey in 2002 to follow-up survey in 2015. Results: The systolic blood pressure (SBP) of the subjects increased from (122.7±10.4) mmHg in 2002 to (132.8±17.6) mmHg in 2015 and the diastolic pressure (DBP) increased from (72.7±6.9) mmHg in 2002 to (78.8±10.3) mmHg in 2015. The SBP in men and women increased with growth rates of 6.7% and 9.5%. While DBP in men and women increased with growth rates of 9.3% and 7.8%. The SBP levels of those aged 18-, 30-, 40- and 50-59 years increased with growth rates of 5.0%, 6.7%, 9.4% and 11.8%. While the DBP of these age groups increased with growth rates of 12.2%, 8.2%, 8.2% and 6.5%. Conclusions: The blood pressure of adults aged 18-59 years old in rural area of Shanxi showed a substantially increasing trend. The mean increase level of SBP in women was higher than that in men, and increased with age. While the mean increase level of DBP in men is higher than that in women, and decreased with age.


Assuntos
Determinação da Pressão Arterial , Pressão Sanguínea/fisiologia , Hipertensão/prevenção & controle , População Rural , Adolescente , Adulto , China , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
2.
Sante Publique ; S1(HS): 135-143, 2019 05 13.
Artigo em Francês | MEDLINE | ID: mdl-31210473

RESUMO

Humans have enjoyed forest environments for ages because of the quiet atmosphere, beautiful scenery, mild climate, pleasant aromas, and fresh, clean air. In Japan, since 2004, serial studies have been conducted to investigate the effects of forest environments on human health. We have established a new medical science called Forest Medicine. The Forest Medicine is a new interdisciplinary science, belonging to the categories of alternative medicine, environmental medicine and preventive medicine, which encompasses the effects of forest environments on human health. It has been reported that forest environments have the following beneficial effects on human health:1. Increase human natural killer (NK) activity, the number of NK cells, and the intracellular levels of anti-cancer proteins, suggesting a preventive effect on cancers.2. Reduce blood pressure, heart rate, and stress hormones, such as urinary adrenaline and noradrenaline and salivary cortisol.3. Increase the activity of parasympathetic nerves and reduce the activity of sympathetic nerves.4. Increase the levels of serum adiponectin and dehydroepiandrosterone sulfate.5. In the Profile of Mood States (POMS) test, reduce the scores for anxiety, depression, anger, fatigue, and confusion, and increase the score for vigor, showing psychological effects as well.These findings suggest that forest environments may have preventive effects on lifestyle-related diseases.


Assuntos
Depressão/prevenção & controle , Florestas , Hipertensão/prevenção & controle , Terapia Recreacional/métodos , Estresse Psicológico/terapia , Humanos , Japão , Estilo de Vida , Árvores , Caminhada
3.
Reprod Health ; 16(1): 46, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046778

RESUMO

BACKGROUND: Calcium and low-dose aspirin are two potential approaches for primary prevention of hypertensive disorders of pregnancy (HDP). This study aimed to explore the acceptability, views and preferences of pregnant women and primary healthcare providers for a fixed-dose combined preparation of aspirin and calcium (a polypill) as primary prevention of HDP in an unselected pregnant population. METHODS: In this qualitative study eight in-depth semi-structured interviews were conducted with Dutch primary care midwives and general practitioners. Seven focus group discussions were organised with women with low-risk pregnancies. Topics discussed were: perceptions of preeclampsia; information provision about preeclampsia and a polypill; views on the polypill concept; preferences and needs regarding implementation of a polypill. Thematic analysis of the data transcripts was carried out to identify emerging themes. RESULTS: Two major themes shaped medical professionals' and women's views on the polypill concept: 'Informed Choice' and 'Medicalisation'. Both could be divided into subthemes related to information provision, personal choice and discussions with regard to the balance between 'unnecessary medicalisation' and 'scientific progress'. CONCLUSIONS: In general, women and healthcare practitioners expressed a positive attitude towards a polypill intervention as primary prevention strategy with aspirin and calcium, providing some conditions are met. The most important conditions for implementation of such a strategy were safety, effectiveness and the possibility to make a well-informed autonomous decision.


Assuntos
Atitude do Pessoal de Saúde , Hipertensão Induzida pela Gravidez/prevenção & controle , Hipertensão/prevenção & controle , Gestantes/psicologia , Adulto , Aspirina/uso terapêutico , Cálcio/uso terapêutico , Tomada de Decisões , Feminino , Clínicos Gerais/psicologia , Humanos , Gravidez , Pesquisa Qualitativa
4.
Rev Saude Publica ; 53: 45, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31066823

RESUMO

OBJECTIVE: To address the implementation of the Lab for Innovation in Chronic Conditions in Santo Antonio do Monte, indicating the main challenges and lessons of a new chronic condition model. METHODS: This is an observational study based on two sources of data: 1) two cross-sectional household surveys, 2013 (2012 as reference year) and 2015 (2014 as reference year), representative for the entire population and four target groups (pregnant women; children under two years old; individuals with hypertension and diabetes); medical records of individuals who self-reported having hypertension or diabetes in the household survey of 2013. A descriptive statistics analysis was performed. RESULTS: The main findings showed that the public health system is the main provider of health services, mainly primary care, in Santo Antonio do Monte. Besides, the implementation of Lab for Innovation in Chronic Conditions showed the importance of building a Primary Health Care network in small municipalities. CONCLUSIONS: Community health agents and health managers played a fundamental role in the Primary Health Care network. The case study of Santo Antonio do Monte poses some challenges and lessons that clarify future interventions on building a Primary Health Care network that is essential to provide an adequate and longitudinal care to chronic conditions.


Assuntos
Serviços de Saúde Comunitária/normas , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Atenção Primária à Saúde/normas , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Pré-Escolar , Doença Crônica , Agentes Comunitários de Saúde , Estudos Transversais , Características da Família , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Gravidez , Valores de Referência , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
5.
Nursing ; 49(6): 44-48, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31124855

RESUMO

Nurses have unique opportunities to influence patient outcomes and reduce healthcare expenditures. Health coaching is one patient-centered strategy nurses can use to improve the limited health literacy often associated with hypertension. This article describes the use of health coaching to help patients understand their medications and give them the knowledge, skills, and confidence to self-manage their hypertension.


Assuntos
Hipertensão/prevenção & controle , Tutoria , Relações Enfermeiro-Paciente , Autogestão/psicologia , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Conhecimentos, Atitudes e Prática em Saúde , Alfabetização em Saúde , Humanos , Hipertensão/economia
6.
BMC Public Health ; 19(1): 657, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31142294

RESUMO

BACKGROUND: Hypertension is a clinical condition highly prevalent in the elderly, imposing great risks to cardiovascular diseases and loss of quality of life. Current guidelines emphasize the importance of nonpharmacological strategies as a first-line approach to lower blood pressure. Exercise is an efficient lifestyle tool that can benefit a myriad of health-related outcomes, including blood pressure control, in older adults. We herein report the protocol of the HAEL Study, which aims to evaluate the efficacy of a pragmatic combined exercise training compared with a health education program on ambulatory blood pressure and other health-related outcomes in older individuals. METHODS: Randomized, single-blinded, multicenter, two-arm, parallel, superiority trial. A total of 184 subjects (92/center), ≥60 years of age, with no recent history of cardiovascular events, will be randomized on a 1:1 ratio to 12-week interventions consisting either of a combined exercise (aerobic and strength) training, three times per week, or an active-control group receiving health education intervention, once a week. Ambulatory (primary outcome) and office blood pressures, cardiorespiratory fitness and endothelial function, together with quality of life, functional fitness and autonomic control will be measured in before and after intervention. DISCUSSION: Our conceptual hypothesis is that combined training intervention will reduce ambulatory blood pressure in comparison with health education group. Using a superiority framework, analysis plan prespecifies an intention-to-treat approach, per protocol criteria, subgroups analysis, and handling of missing data. The trial is recruiting since September 2017. Finally, this study was designed to adhere to data sharing practices. TRIAL REGISTRATION: NCT03264443 . Registered on 29 August, 2017.


Assuntos
Promoção da Saúde/métodos , Hipertensão/prevenção & controle , Estilo de Vida , Idoso , Protocolos Clínicos , Humanos , Pessoa de Meia-Idade
7.
Indian Pediatr ; 56(4): 317-321, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-31064903

RESUMO

Childhood hypertension has become a significant health concern. There have been a slew of important new findings in this field over the last decade. This has led to an update by the American Academy of Pediatrics of the original recommendation of United States Fourth Working Group on blood pressure. We herein describe the important changes in the guideline, which include an updated normative data, change in blood pressure classification, strong endorsement of ambulatory blood pressure measurement and the reduction in the blood pressure target for both chronic kidney disease and non-chronic kidney disease hypertensive children.


Assuntos
Determinação da Pressão Arterial , Hipertensão , Adolescente , Criança , Humanos , Hipertensão/diagnóstico , Hipertensão/prevenção & controle , Hipertensão/terapia , Pediatria/métodos , Pediatria/organização & administração , Guias de Prática Clínica como Assunto , Estados Unidos
8.
Cochrane Database Syst Rev ; 5: CD009613, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31120549

RESUMO

BACKGROUND: There are a number of ways of monitoring blood glucose in women with diabetes during pregnancy, with self-monitoring of blood glucose (SMBG) recommended as a key component of the management plan. No existing systematic reviews consider the benefits/effectiveness of different techniques of blood glucose monitoring on maternal and infant outcomes among pregnant women with pre-existing diabetes. The effectiveness of the various monitoring techniques is unclear. This review is an update of a review that was first published in 2014 and subsequently updated in 2017. OBJECTIVES: To compare techniques of blood glucose monitoring and their impact on maternal and infant outcomes among pregnant women with pre-existing diabetes. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (1 November 2018), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs comparing techniques of blood glucose monitoring including SMBG, continuous glucose monitoring (CGM), automated telemedicine monitoring or clinic monitoring among pregnant women with pre-existing diabetes mellitus (type 1 or type 2). Trials investigating timing and frequency of monitoring were also eligible for inclusion. RCTs using a cluster-randomised design were eligible for inclusion but none were identified. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: This review update includes a total of 12 trials (863) women (792 women with type 1 diabetes and 152 women with type 2 diabetes). The trials took place in Europe, the USA and Canada. Three of the 12 included studies are at low risk of bias, eight studies are at moderate risk of bias, and one study is at high risk of bias. Four trials reported that they were provided with the continuous glucose monitors free of charge or at a reduced cost by the manufacturer.Continuous glucose monitoring (CGM) versus intermittent glucose monitoring, (four studies, 609 women)CGM may reduce hypertensive disorders of pregnancy (pre-eclampsia and pregnancy-induced hypertension) (risk ratio (RR) 0.58, 95% confidence interval (CI) 0.39 to 0.85; 2 studies, 384 women; low-quality evidence), although it should be noted that only two of the four relevant studies reported data for this composite outcome. Conversely, this did not translate into a clear reduction for pre-eclampsia (RR 0.65, 95% CI 0.39 to 1.08; 4 studies, 609 women, moderate-quality evidence). There was also no clear reduction in caesarean section (average RR 0.94, 95% CI 0.75 to 1.18; 3 studies, 427 women; I2 = 41%; moderate-quality evidence) or large-for-gestational age (average RR 0.84, 95% CI 0.57 to 1.26; 3 studies, 421 women; I2 = 70%; low-quality evidence) with CGM. There was not enough evidence to assess perinatal mortality (RR 0.82, 95% CI 0.05 to 12.61, 71 infants, 1 study; low-quality evidence), or mortality or morbidity composite (RR 0.80, 95% CI 0.61 to 1.06; 1 study, 200 women) as the evidence was based on single studies of low quality. CGM appears to reduce neonatal hypoglycaemia (RR 0.66, 95% CI 0.48 to 0.93; 3 studies, 428 infants). Neurosensory disability was not reported.Other methods of glucose monitoringFor the following five comparisons, self-monitoring versus a different type of self-monitoring (two studies, 43 women); self-monitoring at home versus hospitalisation (one study, 100 women), pre-prandial versus post-prandial glucose monitoring (one study, 61 women), automated telemedicine monitoring versus conventional system (three studies, 84 women), and constant CGM versus intermittent CGM (one study, 25 women), it is uncertain whether any of the interventions has any impact on any of our GRADE outcomes (hypertensive disorders of pregnancy, caesarean section, large-for-gestational age) because the quality of the evidence was found to be very low. This was due to evidence largely being derived from single trials, with design limitations and limitations with imprecision (wide CIs, small sample sizes, and few events). There was not enough evidence to assess perinatal mortality and neonatal mortality and morbidity composite. Other important outcomes, such as neurosensory disability, were not reported in any of these comparisons. AUTHORS' CONCLUSIONS: Two new studies (406 women) have been incorporated to one of the comparisons for this update. Although the evidence suggests that CGM in comparison to intermittent glucose monitoring may reduce hypertensive disorders of pregnancy, this did not translate into a clear reduction for pre-eclampsia, and so this result should be viewed with caution. No differences were observed for other primary outcomes for this comparison. The evidence base for the effectiveness of other monitoring techniques analysed in the other five comparisons is weak and based on mainly single studies with very low-quality evidence. Additional evidence from large well-designed randomised trials is required to inform choices of other glucose monitoring techniques and to confirm the effectiveness of CGM.


Assuntos
Automonitorização da Glicemia/métodos , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Adulto , Canadá , Europa (Continente) , Feminino , Humanos , Hipertensão/prevenção & controle , Hipoglicemia/induzido quimicamente , Recém-Nascido , Mortalidade Perinatal , Pré-Eclâmpsia/prevenção & controle , Gravidez , Estados Unidos
9.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(5): 464-469, 2019 May 06.
Artigo em Chinês | MEDLINE | ID: mdl-31091602

RESUMO

Objective: To understand prevalence, control of hypertension and intake of sodium and potassium among residents aged 50-69 years old in Zhejiang Province. Methods: A multi-stage random cluster sampling method was used to select 3 032 residents aged 50-69 years old in Zhejiang Province. The demographic characteristics, prevalence and control of hypertension were collected through a questionnaire survey, and physical measurement was also performed. The stratified random sampling method was used to detect the level of sodium and potassium in the 24 h urine of 676 subjects. The total amount of 24 h urinary sodium ≥102.55 mmol and the ratio of 24 h urinary sodium and potassium content ≥2 were defined as excessive. Results: The prevalence of hypertension (95%CI) was 56.89% (54.39%-59.40%), and the awareness, treatment and control rate of hypertension were 58.25% (55.01%-61.49%), 45.37% (42.10%-48.65%) and 19.75% (17.01%-22.50%), respectively. 78.99% (n=534) of residents had excessive 24 h urinary sodium, and 95.41% (n=360) of residents had excessive ratio of 24 h urinary sodium and potassium. Conclusion: The prevalence of hypertension in residents aged 50-69 years old in Zhejiang Province was at a high level, and the control of hypertension was not satisfactory in 2017. Most of residents have excessive level of sodium intake and the level of sodium and potassium intake was not balanced.


Assuntos
Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Potássio na Dieta/administração & dosagem , Sódio na Dieta/administração & dosagem , Idoso , China/epidemiologia , Humanos , Pessoa de Meia-Idade , Potássio na Dieta/efeitos adversos , Prevalência , Sódio na Dieta/efeitos adversos
10.
BMC Public Health ; 19(1): 511, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060545

RESUMO

BACKGROUND: There is an increasing burden of hypertension (HTN) across sub-Saharan Africa where HIV prevalence is the highest in the world, but current care models are inadequate to address the dual epidemics. HIV treatment infrastructure could be leveraged for the care of other chronic diseases, including HTN. However, little data exist on the effectiveness of integrated HIV and chronic disease care delivery systems on blood pressure control over time. METHODS: Population screening for HIV and HTN, among other diseases, was conducted in ten communities in rural Uganda as part of the SEARCH study (NCT01864603). Individuals with either HIV, HTN, or both were referred to an integrated chronic disease clinic. Based on Uganda treatment guidelines, follow-up visits were scheduled every 4 weeks when blood pressure was uncontrolled, and either every 3 months, or in the case of drug stock-outs more frequently, when blood pressure was controlled. We describe demographic and clinical variables among all patients and used multilevel mixed-effects logistic regression to evaluate predictors of HTN control. RESULTS: Following population screening (2013-2014) of 34,704 adults age ≥ 18 years, 4554 individuals with HTN alone or both HIV and HTN were referred to an integrated chronic disease clinic. Within 1 year 2038 participants with HTN linked to care and contributed 15,653 follow-up visits over 3 years. HTN was controlled at 15% of baseline visits and at 46% (95% CI: 44-48%) of post-baseline follow-up visits. Scheduled visit interval more frequent than clinical indication among patients with controlled HTN was associated with lower HTN control at the subsequent visit (aOR = 0.89; 95% CI 0.79-0.99). Hypertension control at follow-up visits was higher among HIV-infected patients than uninfected patients to have controlled blood pressure at follow-up visits (48% vs 46%; aOR 1.28; 95% CI 0.95-1.71). CONCLUSIONS: Improved HTN control was achieved in an integrated HIV and chronic care model. Similar to HIV care, visit frequency determined by drug supply chain rather than clinical indication is associated with worse HTN control. TRIAL REGISTRATION: The SEARCH Trial was prospectively registered with ClinicalTrials.gov : NCT01864603.


Assuntos
Prestação Integrada de Cuidados de Saúde , Hipertensão/prevenção & controle , Adulto , Idoso , Doença Crônica/terapia , Feminino , Infecções por HIV/terapia , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Uganda/epidemiologia
11.
Wei Sheng Yan Jiu ; 48(2): 208-213, 2019 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-31133096

RESUMO

OBJECTIVE: To evaluate the effect of lifestyle intervention program among pre-hypertensive adults in Futian District, Shenzhen City. METHODS: A total of 12 communities were selected randomly from Futian District, Shenzhen City between October and November of 2013. A total of 1183 pre-hypertension population was screened and divided into intervention group(834) and control group(349) according to community sources. Comprehensive intervention including reducing sodium intake, weight control and exercise, quitting smoking and limiting alcohol consumption were implemented in intervention group. The form of intervention was a combination of group activities and individual follow-up, and at least one kind of activity and follow-up was carried out every quarter. The control group did not actively provide any intervention except routine work. The evaluation survey was taken both in intervention group and control group in 2015. RESULTS: In the intervention group, the proportion of oil control measures was increased from 36. 6% to 55. 7%(χ~2=44. 71, P<0. 01), the proportion of salt reduction measures was increased from 44. 8% to 61. 1%(χ~2=32. 72, P<0. 01), the regular exercise rate was increased from 24. 1% to 37. 1%(χ~2=24. 23, P<0. 01), adequate intake of fruits and vegetables rate rose from 44. 6% to 53. 5%(χ~2=9. 61, P<0. 01) after intervention. There was no statistical difference in these indicators in the control group before and after intervention(P>0. 05). After intervention, the blood pressure of 329(54. 2%) persons in the intervention group returned to healthy state, 244(40. 2%) persons remained in the pre-hypertensive state and 34(5. 6%) persons were converted to hypertensive patients. In the control group, the blood pressure of 55(16. 4%) persons returned to health, 236(70. 0%) persons maintain prehypertension, and 46(13. 6%) persons became hypertensive patients. Compared with the two groups, the difference was statistically significant(χ~2=130. 93, P<0. 01). The result showed that the systolic blood pressure of the pre-hypertensive group decreased by 7. 605 mmHg and the diastolic blood pressure decreased by 3. 727 mmHg. CONCLUSION: After 2 years of follow-up and intervention, the lifestyle of the pre-hypertension population in the intervention group has been improved. The comprehensive intervention has achieved good result.


Assuntos
Exercício , Comportamentos Relacionados com a Saúde , Hipertensão/prevenção & controle , Estilo de Vida , Cloreto de Sódio na Dieta , Sódio na Dieta/administração & dosagem , Adulto , Consumo de Bebidas Alcoólicas , Pressão Sanguínea , Determinação da Pressão Arterial , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hipertensão/epidemiologia , Resultado do Tratamento
12.
BMC Health Serv Res ; 19(1): 253, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023311

RESUMO

BACKGROUND: Uganda is experiencing a shift in major causes of death with cases of stroke, heart attack, and heart failure reportedly on the rise. In a study in Mukono and Buikwe in Uganda, more than one in four adults were reportedly hypertensive. Moreover, very few (36.5%) reported to have ever had a blood pressure measurement. The rising burden of CVD is compounded by a lack of integrated primary health care for early detection and treatment of people with increased risk. Many people have less access to effective and equitable health care services which respond to their needs. Capacity gaps in human resources, equipment, and drug supply, and laboratory capabilities are evident. Prevention of risk factors for CVD and provision of effective and affordable treatment to those who require it prevent disability and death and improve quality of life. The aim of this study is to improve health profiles for people with intermediate and high risk factors for CVD at the community and health facility levels. The implementation process and effectiveness of interventions will be evaluated. METHODS: The overall study is a type 2-hybrid stepped-wedge (SW) design. The design employs mixed methods evaluations with incremental execution and adaptation. Sequential crossover take place from control to intervention until all are exposed. The study will take place in Mukono and Buikwe districts in Uganda, home to more than 1,000,000 people at the community and primary healthcare facility levels. The study evaluation will be guided by; 1) RE-AIM an evaluation framework and 2) the CFIR a determinant framework. The primary outcomes are implementation - acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability. DISCUSSION: The study is envisioned to provide important insight into barriers and facilitators of scaling up CVD prevention in a low income context. This project is registered at the ISRCTN Registry with number ISRCTN15848572. The trial was first registered on 03/01/2019.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Promoção da Saúde/organização & administração , Adolescente , Adulto , Idoso , Determinação da Pressão Arterial/normas , Determinação da Pressão Arterial/estatística & dados numéricos , Assistência à Saúde/normas , Feminino , Instalações de Saúde/provisão & distribução , Planejamento em Saúde , Humanos , Hipertensão/prevenção & controle , Ciência da Implementação , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/normas , Qualidade de Vida , Fatores de Risco , Uganda , Adulto Jovem
13.
BMC Public Health ; 19(1): 421, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014288

RESUMO

BACKGROUND: There has been a limited recognition of hypertension and diabetes in China which has compromised optimal treatment. It is not clear if a screening program implemented by a national health survey has improved awareness and management of these conditions. METHODS: The China Health and Retirement Longitudinal Study (CHARLS) is an ongoing longitudinal health survey conducted since 2011 among Chinese people aged 45 years and older. Participants have been assessed every two years by interviews, physical examinations, and fasting glucose samples were taken in 2011. In 2013 and 2015, participants were asked about awareness and management of selected chronic diseases, and they first became aware of these conditions. RESULTS: Of the 11,000+ participants screened in 2011, 4594 were identified with hypertension and 1703 with diabetes by medical examinations. Over 80% of the middle-aged and elderly Chinese diagnosed with hypertension and/or diabetes in 2011 reported in 2015 that they were unaware of the disease(s). Although some improvement was observed between 2011 and 2015, the main reason for the increase in awareness was a medical examination initiated by the study participant (over 75%), by their work unit or community (12-15%), and rarely (less than 3%) by the CHARLS examination. Participants with a rural household registration status and lower BMI were the most likely to be unaware and to remain unaware of their condition(s). CONCLUSIONS: Disease screening in CHARLS did not lead to significant improvements in awareness of hypertension and diabetes. Improvements should be made by the systematic feedback of screening results to survey participants and the monitoring of disease awareness over time. This will be essential to improve disease recognition and facilitate optimal management.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/epidemiologia , Idoso , China/epidemiologia , Doença Crônica , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/prevenção & controle , Estudos Longitudinais , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Prevalência , Aposentadoria , População Rural
14.
BMC Public Health ; 19(1): 409, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30991978

RESUMO

BACKGROUND: India accounts for more than two-third of mortality due to non-communicable diseases (NCDs) in south-east Asia. The burden is high in Karnataka, one of the largest states in southern India. There is a need for integration of disease prevention, health promotion, treatment and care within the national program at primary level. A public-private partnership initiative explored evidence gaps to inform a health system based, integrated NCD programme across care continuum with a focus on hypertension and diabetes. METHODS: The study was conducted during 2017-18 in urban parts of Mysore city, covering a population of 58,000. Mixed methods were used in the study; a population-based screening to estimate denominators for those with disease and at risk; cross-sectional surveys to understand distribution of risk factors, treatment adherence and out of pocket expenses; facility audits to assess readiness of public and private facilities; in-depth interviews and focus group discussions to understand practices, myths and perceptions in the community. Chi-square tests were used to test differences between the groups. Framework analysis approach was used for qualitative analysis. RESULTS: Twelve and 19% of the adult population had raised blood sugar and blood pressure, respectively, which increased with age, to 32 and 44% for over 50 years. 11% reported tobacco consumption; 5.5%, high alcohol consumption; 40%, inadequate physical activity and 81%, inappropriate diet consumption. These correlated strongly with elderly age and poor education. The public facilities lacked diagnostics and specialist services; care in the private sector was expensive. Qualitative data revealed fears and cultural myths that affected treatment adherence. The results informed intervention design across the NCD care continuum. CONCLUSIONS: The study provides tools and methodology to gather evidence in designing comprehensive NCD programmes in low and middle income settings. The study also provides important insights into public-private partnership driving effective NCD care at primary care level.


Assuntos
Diabetes Mellitus/prevenção & controle , Promoção da Saúde/organização & administração , Hipertensão/prevenção & controle , Doenças não Transmissíveis/prevenção & controle , Atenção Primária à Saúde/organização & administração , Adulto , Idoso , Continuidade da Assistência ao Paciente , Estudos Transversais , Assistência à Saúde/organização & administração , Diabetes Mellitus/epidemiologia , Feminino , Grupos Focais , Humanos , Hipertensão/epidemiologia , Índia , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/epidemiologia , Setor Privado , Avaliação de Programas e Projetos de Saúde
15.
Mar Drugs ; 17(4)2019 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-30934709

RESUMO

In this study, the antihypertensive activity of Purafect®-smooth hound viscera protein hydrolysate (VPH) and its peptide fraction with molecular weight (MW) below 1 kDa (VPH-I) was investigated. In addition, the lipase inhibitory activity, as well the anticoagulant potential, in vitro, were assessed. The antihypertensive effects of VPH and VPH-I were studied during 24 h (short-term effect) and 30 days (long-term effect) using high-salt (18% NaCl) and -fructose (10%) diet (HSFD)-induced hypertension. Data showed that, 4 h post-administration of VPH and VPH-I (200 mg/kg BW), the systolic blood pressure of rats was reduced by about 6 and 9 mmHg, respectively. These effects were similar to that obtained with Captopril (~9 mmHg at t = 4 h). On the other hand, exposing the rats to daily to HSFD, coupled to the administration of viscera peptides, was found to attenuate hypertension. In addition, the proteins' treatments were able to correct lipid and glycemic disorders, by reducing the total cholesterol and triglyceride contents and resorting to the plasma glucose level, compared to the HSFD group. Overall, the present findings demonstrated the preventive effect of VPH-peptides from hypertension complications, as a result of their biological properties.


Assuntos
Anti-Hipertensivos/farmacologia , Colesterol/metabolismo , Hipertensão/tratamento farmacológico , Hipertensão/prevenção & controle , Hidrolisados de Proteína/farmacologia , Animais , Glicemia/metabolismo , Pressão Sanguínea/efeitos dos fármacos , Dieta , Frutose/administração & dosagem , Metabolismo dos Lipídeos/efeitos dos fármacos , Masculino , Ratos , Ratos Wistar , Cloreto de Sódio/administração & dosagem
16.
Nutrients ; 11(4)2019 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-30970648

RESUMO

While dietary patterns are related to the age-related progression of chronic diseases, to what extent different dietary patterns influence inflammatory and metabolic risk factors in older adults remains to be elucidated. Additionally, potential moderating effects by physical activity (PA) become important to clarify. Here, we hypothesize that dietary patterns are linked to inflammatory and metabolic biomarkers and that these links are independent of PA. The present study aims to explore links between two dietary constructs and biomarkers of systemic inflammation and metabolic health in older women, while considering time spent in moderate-to-vigorous PA (MVPA). A cross-sectional analysis of a sample of 112 community-dwelling older women (65­70 years old) was performed. Dietary constructs based on the Dietary Approach to Stop Hypertension (DASH) and the dietary inflammatory index (DII) were determined from food records. MVPA was objectively assessed using accelerometry. Metabolic outcomes (waist circumference, systolic/diastolic blood pressures and levels of glucose, triglycerides and high-density lipoprotein (HDL)-cholesterol) and inflammatory biomarkers (C-reactive protein (CRP), fibrinogen and adiponectin) were determined using standardized procedures and a clustered metabolic risk score was derived. Adherence to DASH-style diet was significantly (p < 0.05) associated with a lower clustered metabolic risk, where women in the highest adherence group had a significantly (p < 0.05) lower waist circumference and blood glucose level compared to those in the lowest group. Further, a significantly higher (p < 0.05) adiponectin level was observed in the high DASH adherence group compared to those with low adherence. Notably, adjustment by waist circumference did not alter links with either adiponectin or blood glucose level. Importantly, all observed links remained significant after further adjustment for time in MVPA. Finally, no significant associations were observed when the dietary pattern was defined by the DII. The findings of this study demonstrate that DASH-style diets promote a systemic anti-inflammatory environment, while also mitigating clustered metabolic risk in older women. A key finding is that favourable impacts of the DASH-style diet are independent of time spent in moderate-to-vigorous PA, which further strengthens healthy eating behaviours as a key target for clinical and public health interventions designed to prevent age-related metabolic abnormalities.


Assuntos
Adiponectina/sangue , Dieta/efeitos adversos , Abordagens Dietéticas para Conter a Hipertensão/métodos , Doenças Metabólicas/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Idoso , Biomarcadores/sangue , Proteína C-Reativa/análise , HDL-Colesterol/sangue , Estudos Transversais , Abordagens Dietéticas para Conter a Hipertensão/psicologia , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/prevenção & controle , Vida Independente , Doenças Metabólicas/etiologia , Fatores de Risco , Triglicerídeos/sangue , Circunferência da Cintura
17.
Environ Health Prev Med ; 24(1): 19, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-30857519

RESUMO

Risk factors for hypertension consist of lifestyle and genetic factors. Family history and twin studies have yielded heritability estimates of BP in the range of 34-67%. The most recent paper of BP GWAS has explained about 20% of the population variation of BP. An overestimation of heritability may have occurred in twin studies due to violations of shared environment assumptions, poor phenotyping practices in control cohorts, failure to account for epistasis, gene-gene and gene-environment interactions, and other non-genetic sources of phenotype modulation that are suspected to lead to underestimations of heritability in GWAS. The recommendations of hypertension guidelines in major countries consist of the following elements: weight reduction, a healthy diet, dietary sodium reduction, increasing physical activity, quitting smoking, and moderate alcohol consumption. The hypertension guidelines are mostly the same for each country or region, beyond race and culture. In this review, we summarize gene-environmental interactions associated with hypertension by describing lifestyle modifications according to the hypertension guidelines. In the era of precision medicine, clinicians who are responsible for hypertension management should consider the gene-environment interactions along with the appropriate lifestyle components toward the prevention and treatment of hypertension. We briefly reviewed the interaction of genetic and environmental factors along the constituent elements of hypertension guidelines, but a sufficient amount of evidence has not yet accumulated, and the results of genetic factors often differed in each study.


Assuntos
Interação Gene-Ambiente , Hipertensão/terapia , Estilo de Vida , Guias de Prática Clínica como Assunto , Humanos , Hipertensão/epidemiologia , Hipertensão/genética , Hipertensão/prevenção & controle , Medicina de Precisão/normas , Fatores de Risco
18.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(3): 290-295, 2019 Mar 10.
Artigo em Chinês | MEDLINE | ID: mdl-30884606

RESUMO

Objective: To investigate blood pressure level, hypertension prevalence and control status in the oldest old in China. Methods: A cross-sectional data set of Chinese Longitudinal and Health Longevity Study (CLHLS) in 2014 was used to investigate the blood pressure level and hypertension prevalence and control status in the oldest old. Results: A total of 4 587 elderly people aged ≥80 years were surveyed with mean age (91.3±7.8) years old, including 1 896 males (41.3%). The mean SBP was (139.5±22.0) mmHg, DBP was (79.6±11.8) mmHg, and the pulse pressure difference was (60.0±18.7) mmHg. The prevalence rate of hypertension was 56.5% (95%CI: 55.1%- 58.0%), the awareness rate of hypertension was 52.2% (95%CI: 50.3%-54.1%), the control rate was 11.5% (95%CI: 10.3%-12.5%), and the control rate of those with awareness of hypertension was 22.2% (95%CI: 19.9%-24.4%). Age, gender, BMI, residence place and living area were related to blood pressure level and control status of the oldest old. Conclusions: The blood pressure level and the prevalence of hypertension in the oldest old in China were different from those in developing countries and adults in China, while similar to that in the younger elderly in China. The prevalence rate of hypertension was high and the control rate was low. Age, gender, BMI, residence place and living area were related with blood pressure level, hypertension prevalence and control status.


Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência
19.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(3): 296-300, 2019 Mar 10.
Artigo em Chinês | MEDLINE | ID: mdl-30884607

RESUMO

Objective: To understand the prevalence, awareness, treatment and control of hypertension in elderly residents in Hebei province. Methods: Elderly residents aged ≥60 were selected though multistage clustering sampling during August to December, 2015. Design based methods were adopted to analyze the prevalence, awareness, treatment and control of hypertension in local residents of Hebei. Results: A total of 2 501 elderly adults were included in the study. The overall prevalence rate of hypertension was 63.7% (58.3% in males, 69.0% in females), the awareness rate of hypertension was 42.4% (35.7% in males, 48.0% in females), the treatment rate was 38.2% (32.0% in males, 43.3% in females), and the control rate was 9.0% (8.1% in males, 9.7% in females). The results of multivariate analysis indicated that age, sex, degree of education, BMI and central obesity were the factors influencing the prevalence, awareness, treatment and control of hypertension in elderly population in Hebei. Conclusions: The prevalence of hypertension was high, but the rates of awareness, treatment and control of hypertension were low in elderly residents in Hebei. The influences of overweight, obesity and central obesity on hypertension were significant in the elderly. It is necessary to standard the management of hypertension and reduce the risk factors for hypertension in elderly population to improve the control of hypertension.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Idoso , China/epidemiologia , Feminino , Humanos , Masculino , Prevalência
20.
Int J Equity Health ; 18(1): 38, 2019 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819193

RESUMO

BACKGROUND: The prevalence of hypertension and diabetes are expected to increase in sub-Saharan Africa over the next decade. Some studies have documented that lifestyle factors and lack of awareness are directly influencing the control of these diseases. Yet, few studies have attempted to understand the barriers to control of these conditions in rural settings. The main objective of this study was to understand the challenges to hypertension and diabetes care in rural Uganda. METHODS: We conducted semi-structured interviews with 24 patients with hypertension and/or diabetes, 11 health care professionals (HCPs), and 12 community health workers (known as village health team members [VHTs]) in Nakaseke District, Uganda. Data were coded using NVivo software and analyzed using a thematic approach. RESULTS: The results replicated several findings from other settings, and identified some previously undocumented challenges including patients' knowledge gaps regarding the preventable aspects of HTN and DM, patients' mistrust in the Ugandan health care system rather than in individual HCPs, and skepticism from both HCPs and patients regarding a potential role for VHTs in HTN and DM management. CONCLUSIONS: In order to improve hypertension and diabetes management in this setting, we recommend taking actions to help patients to understand NCDs as preventable, for HCPs and patients to advocate together for health system reform regarding medication accessibility, and for promoting education, screening, and monitoring activities to be conducted on a community level in collaboration with village health team members.


Assuntos
Diabetes Mellitus/prevenção & controle , Acesso aos Serviços de Saúde , Hipertensão/prevenção & controle , Serviços de Saúde Rural/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Agentes Comunitários de Saúde/psicologia , Agentes Comunitários de Saúde/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pacientes/psicologia , Pacientes/estatística & dados numéricos , Pesquisa Qualitativa , Uganda/epidemiologia , Adulto Jovem
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