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1.  Awareness, treatment and control of hypertension among the elderly living in their home in Tunisia 
Hypertension is a cardiovascular disorder rapidly emerging as a major public health problem in developing countries. However, the acknowledgement of the prevalence and the significant impact of hypertension in elderly are very important for health policy. The objective of the present investigation was to evaluate the prevalence, awareness and treatment of hypertension among the elderly living in their home in Tunisia at Monastir City. We also examined the impact of socio-demographic characteristics and known risk factors for high blood pressure.
A community based sample of 598 non-institutionalized elderly (age ≥ 65 years), was selected using probabilistic multistage cluster sampling.
There was a predominance of female (66%) and mean age was 72.3 ± 7.4 years. The prevalence of hypertension was 52% (n = 311), awareness (81%, n = 252), treatment (78.4%, n = 244) and only 30.7% (n = 75) are correctly treated. The prevalence of hypertension was higher for the female population (55.5%) when compared to males (45%). No urban/rural differences were observed and no difference was observed by educational level. Multiple logistic regression analyses identified a higher body mass index, diabetes mellitus and disability as important correlates of the prevalence of hypertension.
These findings provide important information on the prevalence, awareness and control of hypertension in Monastir City and confirm their association with other cardio-vascular risk factors. Effective public health measures and strategies are needed to improve prevention, diagnosis and access to treatment of this elderly population.
PMCID: PMC3234182  PMID: 22044442
Hypertension; Elderly; Prevalence; Awareness; Tunisia; Home living
2.  Trends in Hypertension Prevalence, Awareness, Treatment and Control in Older Mexican Americans 1993 –2005 
Annals of epidemiology  2010;21(1):15-25.
To describe trends in hypertension prevalence, awareness, treatment, and control among older Mexican Americans living in the Southwestern United States from 1993-94 to 2004-05.
This is a comparison between two separate cross-sectional cohorts of non-institutionalized Mexican Americans aged ≥ 75 from the Hispanic Established Population for the Epidemiological Study of the Elderly (919 subjects from the 1993–1994 cohort and 738 from the 2004–2005 cohort). Data were collected on self-reported hypertension, measured blood pressure, medications, socio-demographic, and other health-related factors.
Hypertension prevalence increased from 73.0% in 1993-94, to 78.4% in 2004-05. Cross-cohort multivariate analyses showed that the higher odds of hypertension in 2004-05 cohort was attenuated by adding diabetes and obesity to the model. There was a significant increase in hypertension awareness among hypertensives (63.0% to 82.6%) and in control among treated hypertensives (42.5% to 55.4%). Cross-cohort multivariate analyses showed that the higher odds of control in 2004-05 cohorts was accentuated by adding diabetes to the model. There were no significant changes in treatment rates (62.2% to 65.6%)
Hypertension prevalence in very old Mexican Americans residing in the Southwestern United States was higher in 2004-05 than in 1993-94, and was accompanied by a significant increase in awareness and control rates.
PMCID: PMC2994956  PMID: 20727787
Trends; Hypertension; Awareness; Treatment; Control; Mexican American elders
3.  Hypertension and Related Morbidity among Geriatric Population of Eastern India 
Materia Socio-Medica  2012;24(1):29-33.
To assess the prevalence of hypertension among geriatric population and to find out its association with socio demographic parameters, non communicable diseases and level of daily activities.
Community based cross sectional study was conducted among geriatric population of Tarakeswar town, India. 402 persons were selected from total 2258 elderly persons by systematic random sampling and data was collected using pretested questionnaire followed by physical examination. Data was analyzed using SPSS Version 16.0.
53.5% respondents were hypertensive. Prevalence of hypertension was significantly more among higher age group (p=0.031). Hypertension was also associated with Diabetes mellitus (p<0.001), cardiovascular diseases (p<0.001), cerebrovascular accidents (p<0.001) and obesity (p<0.001). 38.46% hypertensives were not under medication. Practice of taking antihypertensive medicines was significantly lower in lower income group (30.8% versus 80.6%; p<0.001) and illiterates (34.0% versus 74.8%; p<0.001). Activities of daily living for self-maintenance and level of satisfaction over life were significantly lower among hypertensives.
More than half of the elderly are suffering from hypertension. Most of the hypertensives are suffering also from other diseases, resulting in significant reduction of daily activities and compromised satisfaction over life. Hypertension, being a treatable ailment, leaves a space for intervention to reduce these geriatric morbidities.
PMCID: PMC3732350  PMID: 23922513
Hypertension; Geriatric; Elderly; Activities of daily living.
4.  The Prevalence of Urinary Incontinence among the Elderly in a Rural Community in Selangor 
Urinary incontinence is a common but poorly understood problem in the elderly population. The aim of this study was to determine the prevalence of urinary incontinence and its associated factors among the elderly in a community setting.
A cross-sectional study design was used. Stratified cluster sampling was used in this study. All elderly residents aged 60 years old and above who fulfilled the selection criteria were included as respondents. The translated Malay version of the Barthel’s Index (BI) was used to identify the presence of urinary incontinence.
The prevalence of urinary incontinence was 9.9% among the elderly respondents. Urinary incontinence among the elderly was significantly associated with age, gender, depression, functional dependence, and diabetes mellitus (P < 0.05).
PMCID: PMC3216159  PMID: 22135533
associated-factors; community; elderly; prevalence; urinary-incontinence; medical sciences
5.  Hypertension in the Elderly: Prevalence and Health Seeking Behavior 
Non-communicable diseases (NCDs) are major contributors of morbidity and mortality in the elderly. Estimating the prevalence of hypertension and studying the health seeking behavior is important.
This study was designed to estimate the prevalence of hypertension and understand the health seeking behavior among the elderly in rural Puducherry, south India.
Materials and Methods:
A total of 211 elderly from a rural community were selected by systematic random sampling. Blood pressure (BP) was measured. Socio-demographic characteristics and health seeking behavior were assessed by interviews.
Prevalence of hypertension among study participants was 40.5%. Prevalence of hypertension among elderly male subjects was 39.2% and in female subjects was 40.8%. About 62% (53 out of 85 hypertensives) were already aware of their hypertensive status. About 54.7% (29) were diagnosed at government health facilities either at primary health centers (PHCs) or a government hospital.
Burden of hypertension among the elderly is high in rural areas. Strategies to detect and treat hypertension in the elderly have to be implemented early.
PMCID: PMC3503373  PMID: 23181226
Community-based study; Elderly; Hypertension; Prevalence
6.  Profile of morbidity among elderly at home health care service in Southern Saudi Arabia 
This study aimed to determine the profile of morbidity among elderly registered at home health care service in the Armed Forces Hospital of Southern Region, Kingdom of Saudi Arabia.
Materials and Methods:
A retrospective study was conducted (over a period of 6 months during year 2011) and data was collected by reviewing of medical records of all elderly patients of elderly.
The total number of elderly ≥ 60 years were 880. The most prevalent morbidity is hypertension (59.1%) followed by diabetes mellitus (57.3%), stroke (34.9%), dementia (28.5%), osteoarthritis (24.2%) and Alzheimer (21.4%). Females are at higher risks of having many types elderly diseases compared to males. The highest risk was for obesity (OR = 9.1; 95% CI = 3.51- 12.8), followed by osteoporosis (OR = 8.7; 95% CI = 15.10 – 9.13) and fracture neck femur (OR = 3.9; 95 CI = 2.11 – 6.91). In addition, females were also at higher risks of having Osteoarthritis and thyroid disorder. On the other hand, males are more susceptible to hypertension (OR = 1.4; 95 % CI = 1.07 – 1.85), stroke (OR = 1.3; 95 % CI = 1.08 – 1.89) and renal diseases (OR = 2.4; 95% CI = 1.25 – 4.54).
It is concluded that there is a great need for preventive, curative and rehabilitative program in order to introduce high quality of health care services to elderly.
PMCID: PMC3663165  PMID: 23723732
Elderly population; morbidity; South of Saudi Arabia
7.  Prevalence of cardiovascular risk factors among rural population of elderly in Wardha district 
Cardiovascular diseases (CVD) are a leading cause of mortality among adults in India, and their risk factors (tobacco, hypertension, diabetes, overweight, and obesity) are common. Most risk-factor surveys have focused on young and middle aged adults. We measured the prevalence of risk factors for CVD among elderly (age 60 years or more) in rural India.
Methods and results
In a door-to-door cross-sectional survey we did a non-laboratory based assessment of risk factors (smoking or tobacco use in any form, diabetes mellitus, either known or newly detected hypertension, abnormal waist-hip-ratio, or a high body mass index) among elderly living in 23 villages in rural central India. Laboratory based assessment of risk factors was done in those who had two or more of the five measured conventional risk factors. We compared the distribution of risk factors between men and women. Among 2424 elderly included in the study (51% women, mean age 67), the prevalence of smokeless tobacco use was 50.8% (95% CI 48.1–52.8; smoking 10.5% (95% CI 9.3–11.8); and hypertension46.3% (95% CI 44.3–48.4). Only 10.2% participants were previously known to have had hypertension, and remaining 36.1% were detected to be hypertensive during the survey. A total of 8.2%(95% CI 7.0–9.5) participants were overweight and 4.1% (95% CI 3.3–4.9) had central obesity. The prevalence of dyslipidemia in those who underwent blood based tests was 40.6% (95% CI 36.5–44.9); and hyperglycemia 4.9% (95% CI 3.2–7.1).
Strategies to reduce the risk of cardiovascular disorders among elderly should be focused on reducing tobacco use and early detection and optimal control of hypertension.
PMCID: PMC3770113  PMID: 24027373
Cardiovascular; Elderly; Epidemiology; Risk factors
8.  Prevalence and comorbidity of diabetes mellitus among non-institutionalized older adults in Germany - results of the national telephone health interview survey ‘German Health Update (GEDA)’ 2009 
BMC Public Health  2013;13:166.
Despite the major public health impact of diabetes, recent population-based data regarding its prevalence and comorbidity are sparse.
The prevalence and comorbidity of diabetes mellitus were analyzed in a nationally representative sample (N = 9133) of the non-institutionalized German adult population aged 50 years and older. Information on physician-diagnosed diabetes and 20 other chronic health conditions was collected as part of the national telephone health interview survey ‘German Health Update (GEDA)’ 2009. Overall, 51.2% of contacted persons participated. Among persons with diabetes, diabetes severity was defined according to the type and number of diabetes-concordant conditions: no diabetes-concordant condition (grade 1); hypertension and/or hyperlipidemia only (grade 2); one comorbidity likely to represent diabetes-related micro- or macrovascular end-organ damage (grade 3); several such comorbidities (grade 4). Determinants of diabetes severity were analyzed by multivariable ordinal regression.
The 12-month prevalence of diabetes was 13.6% with no significant difference between men and women. Persons with diabetes had a significantly higher prevalence and average number of diabetes-concordant as well as diabetes-discordant comorbidities than persons without diabetes. Among persons with diabetes, 10.2%, 46.8%, 35.6% and 7.4% were classified as having severity grade 1–4, respectively. Determinants of diabetes severity included age (cumulative odds ratio 1.05, 95% confidence interval 1.03-1.07, per year) and number of discordant comorbidities (1.40, 1.25-1.55). With respect to specific discordant comorbidities, diabetes severity was correlated to depression (2.15, 1.29-3.56), respiratory disease (2.75, 1.72-4.41), musculoskeletal disease (1.53, 1.06-2.21), and severe hearing impairment (3.00, 1.21-7.41).
Diabetes is highly prevalent in the non-institutionalized German adult population 50 years and older. Diabetes comorbidities including diabetes-concordant and diabetes-discordant conditions need to be considered in epidemiological studies, in order to monitor disease burden and quality of diabetes care. Definitional standards of diabetes severity need to be refined and consented.
PMCID: PMC3599814  PMID: 23433228
Diabetes; Prevalence; Comorbidity; Germany
9.  The health status of African-American elderly. 
This article reviews the health status of African-American elderly, based on a computerized search of the medical literature from 1987 to 1991, as well as careful review of the report of the Secretary of Health's Task Force on Black and Minority Health. Black Americans have a higher prevalence of malignancies, diabetes, hypertension, obesity, homicide, and unintentional injury than white Americans. These problems contribute to a high mortality rate in young blacks and a greater prevalence of problems with activities of daily living in elderly blacks. Despite the high disease burden among young blacks, blacks are living progressively longer. As the number of elderly blacks increases, health-care practitioners will need to increase risk factor reduction in young-old blacks. Additionally, there will be a need for increased support of physical functioning in elderly African American.
PMCID: PMC2568150  PMID: 8350373
10.  Relationship Between Metabolic Syndrome and Familial History of Hypertension/Stroke, Diabetes, and Cardiovascular Disease 
Journal of Korean Medical Science  2006;21(4):701-708.
This research analyzes the prevalence of metabolic syndrome (MS) in Korea and examines how the presence of a familial history of diseases related to MS, such as hypertension/stroke, cardiovascular disease, and diabetes, affect the development of MS in Koreans. The prevalence of MS and its components, as defined by the National Cholesterol Education Program Adult Treatment Panel guidelines, were evaluated in nationally representative samples of non-institutionalized civilian Koreans. This analysis is based on the 2001 Korea National Health and Nutrition Examination Survey, which used a stratified multistage probability sampling design. The final study included 5,742 adults who had completed the necessary health examinations and met the diagnosis of MS. The prevalence of MS was 25.5% in men and 28.7% in women. Odds ratio for MS among men with a familial history of hypertension/stroke was higher than that among men who did not have this history. The OR for MS among women with a familial history of hypertension/stroke or diabetes was higher than that among women who had no familial history of these diseases. These results show that familial history of hypertension/stroke and diabetes was significantly related to the presence of MS in both young men and women.
PMCID: PMC2729894  PMID: 16891816
Metabolic Syndrome X; Causality; Predisposing Factor; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Korea
11.  Association among Education Level, Occupation Status, and Consanguinity in Tunisia and Croatia 
Croatian medical journal  2006;47(4):656-661.
To investigate the association between education level, occupation status (a proxy for socio-economic status), and consanguinity in 2 large data sets from Tunisia and Croatia countries with different attitudes toward consanguinity.
The sample of 1016 students, attending 5 university institutions in Monastir, Tunisia, were interviewed about the educational level and occupation status of their parents and the degree of parental relatedness. In Croatia, a sample of 1001 examinees from 9 isolated island populations was interviewed about their own educational level, occupation status, and consanguinity.
Prevalence of consanguinity (offspring of second cousins or closer) among 1016 Tunisian students was 20.1%, and 9.3% among 1001 Croatian isolates. In Tunisia, the association between consanguinity and both parental degree of education and parental occupation status was highly significant in women (P<0.001), but not significant in men. In Croatia, no statistically significant associations were noted, although there was a consistent trend of increased prevalence of consanguinity with lower education level or occupation status in both genders, but more pronounced in women.
Association between education level, socio-economic status, and consanguinity needs to be taken into account in inbreeding studies in human populations. The relationship may be specific for each studied population and highly dependent on the cultural context. It is generally more pronounced among women in most settings.
PMCID: PMC2080442  PMID: 16912991
12.  Study of Prevalence of Type 2 Diabetes Mellitus and Hypertension in Overweight and Obese People 
In recent years, there has been a marked change in life-style of South Asian countries caused by economic growth, affluence, urbanization and dietary westernization. Few studies on the prevalence of obesity, hypertension and diabetes in the Indian population have been reported. However, there has been scarce literature on the study of prevalence of type 2 diabetes mellitus (DM) and Hypertension in overweight and obese people in India with criteria suggested by World Health Organization (WHO) for Asians. Information on such public health issues would provide evidence based data to develop guidelines and policies on this subject.
The aim of this article is to determine the prevalence of hypertension and type 2 DM in overweight and obese people.
Setting and Design:
A cross-sectional study consisted of people selected from the out-patient department and indoors of a large defense hospital in a semi urban area of Assam.
Materials and Methods:
Patients with overweight and obesity, reporting for consultation and medical examination were taken into the study. The data collected was analyzed using the criteria for overweight, obesity, diabetes and hypertension defined by WHO, Joint National Committee VII and International Diabetes Federation, American Diabetes Association. A descriptive statistical analysis has been carried out in the study.
A total of 300 people were the subject population of this study. Among the subject population, there were 97 overweight and 203 obese. The 56 subjects were found to be diabetic. The prevalence of type 2 DM in overweight subjects was 15.5% and in obese was 20.2% and overall was 18.7%. Prevalence of hypertension in the overweight population was 8.2% and in obese was 22.2% and overall found to be 17.7%.
The prevalence of type 2 DM, hypertension in the obese group of the study population were found to be 20.2%, 22.2% and in the overweight population were 15.5% and 8.2%, respectively. This indicates that the prevalence of type 2 DM and hypertension increases with increasing weight of the individuals. The prevalence of type 2 DM and hypertension were relatively higher compared with other studies in India and abroad.
PMCID: PMC4005195  PMID: 24791232
Hypertension; obesity; overweight; type 2 diabetes mellitus
13.  Physical Activity, Smoking, and Alcohol Consumption in Association with Incidence of Type 2 Diabetes among Middle-Aged and Elderly Chinese Men 
PLoS ONE  2013;8(11):e77919.
Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease worldwide. The prevalence of T2DM is increasing rapidly in China. Understanding the contribution of modifiable lifestyle factors on T2DM risk is imperative to prevent the development of T2DM in China.
We examined associations between lifestyle factors including physical activity, smoking and alcohol consumption with incidence of T2DM among middle-aged and elderly men in urban Shanghai. Information on socio-demographics, lifestyle habits, dietary habits, and disease history was collected via in-person interviews. Anthropometric measurements were taken. A total of 51 464 Chinese men aged 40–74 years free of T2DM, coronary heart disease (CHD), and stroke at baseline were included in the current study. Incident T2DM was identified through follow-up surveys conducted every 2–3 years. Cox proportional hazard analyses were conducted to evaluate associations between lifestyle risk factors and incidence of T2DM.
We documented 1304 new cases of T2DM during 276 929 person-years of follow-up (average: 5.4 years). Physical activity was inversely associated with T2DM risk. Daily living, commuting, and total physical activity METs had inverse negative dose-response relationships with T2DM (P-trend = 0.0033, 0.0022, and <0.0001, respectively). Regular participation in exercise or sports reduced T2DM risk (HR = 0.86, 95%CI: 0.76–0.98). Moderate alcohol intake (1–3 drinks/day) was inversely related to T2DM risk (HR = 0.80, 95%CI: 0.67–0.94). Cigarette smoking, on the other hand, was associated with increased T2DM risk; HRs were 1.25 (95%CI: 1.00–1.56) for smoking more than 20 cigarettes per day and 1.28 (95%CI: 1.04–1.57) for smoking more than 40 pack-years.
Physical activity and moderate alcohol intake are inversely associated with T2DM risk, whereas smoking was positively associated with T2DM risk among middle-age and elderly Chinese men. Preventive measures should be developed to focus on these modifiable lifestyle habits to reduce the upward trend of T2DM.
PMCID: PMC3817165  PMID: 24223743
14.  CKD and ESRD in the Elderly: Current Prevalence, Future Projections, and Clinical Significance 
The world’s population is aging, with the number of older adults projected to increase dramatically over the next two decades. This trend poses major challenges to health care systems, reflecting the greater healthcare utilization by and more comorbid conditions among elderly adults. Chronic kidney disease (CKD) is a substantial concern in the elderly, with both an increasing incidence of treated kidney failure with dialysis as well as a high prevalence of earlier stages of CKD. Given the high burden of risk factors for CKD, the high prevalence of CKD in the elderly is not surprising, with the rise in obesity, diabetes and hypertension in middle-aged adults likely foreshadowing further increases in CKD prevalence among the elderly. It is now commonly agreed that the presence of CKD identifies a higher risk state in the elderly, with increased risk for multiple adverse outcomes, including kidney failure, cardiovascular disease, cognitive impairment, and death. Accordingly, CKD in older adults is worthy of attention by both health care providers and patients, with the presence of a reduced GFR or albuminuria in the elderly potentially informing therapeutic and diagnostic decisions for these individuals.
PMCID: PMC3160131  PMID: 20610356
Chronic kidney disease; elderly; glomerular filtration rate; albuminuria; cardiovascular disease
15.  Diabetes mellitus in North West Ethiopia: a community based study 
BMC Public Health  2014;14:97.
Diabetes mellitus is recognized as one of the emerging public health problems in developing countries. However, its magnitude has not been studied at community levels, making the provision of appropriate services difficult in such countries. Hence, this study aimed to compare the magnitude and associated risks of diabetes mellitus among urban and rural adults in northwest Ethiopia.
A cross-sectional population based survey was performed using the WHO STEPwise method on adults aged 35 years and above. A multistage cluster random sampling strategy was used to select study participants from urban and rural locations. Fasting blood glucose levels were determined using peripheral blood samples by finger puncture. Prevalence was computed with a 95% confidence interval for each residential area. Selected risk factors were assessed using logistic regression.
The prevalence of diabetes mellitus among adults aged 35 years and above was 5.1% [95% CI: 3.8, 6.4] for urban and 2.1% [95% CI: 1.2, 2.9] for rural dwellers. The majority (69%) of the identified diabetic cases were not diagnosed prior to the survey. The highest proportion (82.6%) of the undiagnosed cases was noted among the rural population and 63% among the urban population. Family history of diabetes (AOR = 5.05; 2.43, 10.51), older age (AOR = 4.86; 1.99, 11.9) and physical inactivity (AOR = 1.92; 1.06, 3.45) were significantly associated with diabetes mellitus among the urban population. Alcohol consumption (AOR = 0 .24, 0 .06, 0.99) was inversely associated with diabetes mellitus in rural areas.
The prevalence of diabetes mellitus is considerably high among the urban compared to the rural population. Diabetes is largely undiagnosed and untreated, especially in rural settings. Appropriate actions need to be taken to provide access to early diagnosis and treatment in order to reduce associated complications.
PMCID: PMC3913966  PMID: 24479725
16.  Oman World Health Survey: Part 1 - Methodology, Sociodemographic Profile and Epidemiology of Non-Communicable Diseases in Oman 
Oman Medical Journal  2012;27(5):425-443.
The Oman World Health Survey (OWHS) is community-based household survey conducted in first half of 2008 for Omani and non-Omani population aged 18 years and above. It is a part of the World Health Survey (WHS) series which was developed by the World Health Organization (WHO) as a means to compile comprehensive information on the health of populations in different countries. A multi-stage stratified cluster sampling was designed to select about 5000 eligible subjects 18 years and above. The main objectives of the survey were to determine the national prevalence of Hypertension, Diabetes Mellitus, Obesity, Lipoproteins, Anemia, Visual ability and Cognitive functions. Among Omanis, the prevalence of Hypertension (40.3%), Diabetes Mellitus (12.3%), Obesity using BMI (24.1%), Total cholesterol (33.6%), Anemia in males 20% and in non-pregnant females was 32.2%. In Oman, the increase in lifestyle-related non communicable diseases has emerged as new health challenges to the country which need to be addressed.
PMCID: PMC3472575  PMID: 23074559
Oman; Gulf Arab countries, Prevalence; Non- communicable diseases; Hypertension; Diabetes Mellitus; Obesity; BMI; Lipoproteins; Cholesterol; Anemia; Visual ability
17.  High prevalence of cardiovascular risk factors among policemen in Puducherry, South India 
Diabetes mellitus and hypertension (HT) are common diseases in adulthood, pre-disposing to many cardiovascular complications, posing a major public health challenge. Few studies have reported increased prevalence of cardiovascular disease risk factors and type 2 diabetes in policemen. Hence, this study aims to assess the prevalence of cardiovascular risk factors such as diabetes, HT, smoking, alcohol intake, and obesity among policemen.
Materials and methods
A cross-sectional study was carried out in 2008–2009 among 256 policemen in Puducherry, South India. Policemen were selected by simple random sampling. Socio-demographic details and some of the risk factors such as alcohol intake and smoking history were obtained using a pre-tested, structured questionnaire. Presence of stress was measured using the professional life stress score questionnaire. Blood pressure, waist circumference, and hip circumference were measured by standard methods. Fasting blood sugar was estimated using a glucometer. Serum cholesterol was also measured. Lipid profile was measured for a randomly chosen subgroup of 50 participants.
Mean age of study participants was 40.9 years (SD ± 10.9). Out of the study subjects, 23% (n = 60) were known diabetic and 16.8% (n = 43) were known hypertensive. Prevalence of diabetes among study participants was 33.6% (CI: 27.8%–39.6%). Prevalence of HT among study participants was 30.5% (CI: 24.9%–36.5%). Seventy percent (n = 178) had at least moderate range of stress in their life related to their profession and 4% (n = 11) had stress as a “problem” in their life.
Burden of cardiovascular risk factors such as diabetes and HT was high among police personnel of Puducherry.
PMCID: PMC3770116  PMID: 24027367
Cardiovascular risk factors; Diabetes; Hypertension; Policemen
18.  ‘You get the quickest and the cheapest stuff you can’: Food security issues among low-income earners living with diabetes 
The Australasian Medical Journal  2011;4(12):683-691.
Diabetes prevalence is increasing worldwide. More than 800,000 Australians live with diabetes, and there are stark inequities in prevalence and clinical outcomes among Indigenous people and low socio-economic groups.
This paper focuses on food security issues experienced by low-income earners living with type 2 diabetes in Perth, Western Australia. The results presented here are part of a broader qualitative study exploring the impact of socioeconomic disadvantage on diabetes.
Data was collected through focus groups and semistructured interviews conducted from October 2008 to November 2009. The sample, comprising 38 participants ( Indigenous and non-Indigenous), was recruited from areas with high indices of socio-economic disadvantage in Perth. Deductive data analysis identified categories from an existing conceptual framework for the relationship between socio-economic position and diabetes health outcomes, while an inductive approach was adopted to identify new themes.
Participants had a good understanding of their dietary requirements. However, access to healthy food was not always realised, as many participants depended on others for food provision and meal preparation and had little control over their diets. Furthermore, the majority struggled to accommodate the price of healthy food within a limited budget.
In this study, low-income earners living with diabetes faced food security issues. Participants reported cost barriers, but also physical barriers relating to functional limitations and lack of transport. This study highlights that the socioeconomic circumstances in which vulnerable populations experience their disease need to be understood and addressed in order to reduce the inequities surrounding diabetes outcomes.
PMCID: PMC3413968  PMID: 22905044
Diabetes; food security; access; disadvantage; low income; Indigenous health
19.  Socioeconomic Inequalities in the Prevalence of Nine Established Cardiovascular Risk Factors in a Southern European Population 
PLoS ONE  2012;7(5):e37158.
The evaluation of the gender-specific prevalence of cardiovascular risk factors across socioeconomic position (SEP) categories may unravel mechanisms involved in the development of coronary heart disease. Using a sample of 1704 community dwellers of a Portuguese urban center aged 40 years or older, assessed in 1999–2003, we quantified the age-standardized prevalence of nine established cardiovascular risk factors (diabetes mellitus, hypertension, hypercholesterolemia, smoking, sedentariness, abdominal obesity, poor diet, excessive alcohol intake and depression) across SEP and gender categories. Data on individual education and occupation were collected by questionnaire and used to characterize SEP. The prevalence of seven out of nine well-established risk factors was higher in men. Among women, the prevalence of most of the studied risk factors was higher in lower SEP groups. The main exception was smoking, which increased with education and occupation levels. Among men, socioeconomic gradients were less clear, but lower SEP was associated with a higher prevalence of diabetes, excessive alcohol intake and depression in a graded mode. The historical cultural beliefs and practices captured throughout the lifecourse frame the wide socioeconomic gradients discernible in our study conducted in an unequal European developed population. While men were more exposed to most risk factors, the clearer associations between SEP and risk factors among women support that their adoption of particular healthy behaviors is more dependent on material and symbolic conditions. To fully address the issue of health inequalities, interventions within the health systems should be complemented with population-based policies specifically designed to reduce socioeconomic gradients.
PMCID: PMC3362583  PMID: 22666343
20.  Preventive Care Use among the Belgian Elderly Population: Does Socio-Economic Status Matter? 
Objective: To analyze the association between influenza and pneumococcus vaccination and blood cholesterol and blood sugar measurement by Belgian elderly respondents (≥65 years) and socio-demographic characteristics, risk factors, health status and socio-economic status (SES). Methods: A cross-sectional study based on 4,544 non-institutionalized elderly participants of the Belgian Health Interview Surveys 2004 and 2008. Multivariate logistic regression models were constructed to examine the independent effect of socio-demographic characteristics, risk factors, health status and SES on the four preventive services. Results: After adjustment for age, sex, region, survey year, living situation, risk factors (body mass index, smoking status, physical activity) and health status (self-assessed health and longstanding illness) lower educated elderly were significantly less likely to report a blood cholesterol and blood sugar measurement. For instance, elderly participants with no degree or only primary education were less likely to have had a cholesterol and blood sugar measurement compared with those with higher education. Pneumococcus vaccination was not related to educational level, but lower income groups were more likely to have had a pneumococcus immunization. Influenza vaccination was not significantly related to SES. Conclusion: The results highlight the need to promote cholesterol and blood sugar measurement for lower SE groups, and pneumococcus immunization for the entire elderly population. Influenza immunization seems to be equally spread among different SE groups.
PMCID: PMC3924448  PMID: 24368427
preventive care; socioeconomic status; elderly population; Belgium
21.  Relationship between height, glucose intolerance, and hypertension in an urban African black adult population: a case for the "thrifty phenotype" hypothesis? 
An association between the factors of low birth weight and fetal growth retardation and subsequent risk of cardiovascular disease has been proposed; this is the basis of the "thrifty phenotype" hypothesis described in relation to type 2 diabetes mellitus. The relationship between height, presumably an indicator of early life experience, and glucose intolerance and hypertension was examined in a sample survey of noncommunicable disease in an urban African adult population. Height, other anthropometric measurements, and biosocial data were obtained in the study of 998 civil servants selected by multistage sampling in Ibadan, a major Nigerian city. Ibadan is a low-prevalence region for diabetes, with a rate of 0.8% and 2.2% for an impaired glucose tolerance. The prevalence rate of hypertension was 10.3% in the population. A significant negative correlation was found between height and blood glucose level (r = -0.14, p < 0.001), whereas there was no correlation with blood pressures. Multiple regression analyses did not demonstrate height as a determinant of either blood pressure or plasma glucose. However, in a logistic model height was found to be associated with abnormal glucose tolerance (diabetes and impaired glucose tolerance) (odds ratio, 0.01; p < 0.003). In the logistic model of the blood pressure data there was no association between height and hypertension. There was some association between height and blood glucose level and also glucose intolerance in the urban African population sample, but none with elevated blood pressure. The significance of the observed inverse relationship, though uncertain, deserves further exploration.
PMCID: PMC2640520  PMID: 10918760
22.  Assessment of primary health care received by the elderly and health related quality of life: a cross-sectional study 
BMC Public Health  2013;13:605.
Population aging leads to increased burden of chronic diseases and demand in public health. This study aimed to assess whether the score of Primary Health Care (PHC) is associated with a) the model of care - Family Health Strategy (FHS) vs. traditional care model (the Basic Health Units; BHU); b) morbid conditions such as - hypertension, diabetes mellitus, mental disorders, chronic pain, obesity and central obesity; c) quality of life in elderly individuals who received care in those units.
A survey was conducted among the elderly between August 2010 and August 2011, in Ilheus, Bahia. We interviewed elderly patients - 60 years or older - who consulted at BHU or FHS units in that day or participated in a group activity, and those who were visited at home by the staff of PHC, selected through a random sample. Demographic and socioeconomic characteristics, services’ attainment of primary care attributes, health problems and quality of life were investigated. The Short Form Health Survey (SF-12) was used to assess quality of life and PCATool to generate PHC scores. In addition, weight, height and waist circumference were measured. Trained research assistants, under supervision performed the data collection.
A total of 511 elderly individuals were identified, two declined to participate, resulting in 509 individuals interviewed. The health care provided by the FHS has higher attainment of PHC attributes, in comparison to the BHU, resulting in lower prevalence of score below six. Except for hypertension and cardiovascular disease, other chronic problems were not independently associated with low scores in PHC. It was observed an independent and positive association between PHC score and the mental component of quality of life and an inverse association with the physical component.
This study showed higher PHC attributes attainment in units with FHS, regardless of the health problem. The degree of orientation to PHC increased the mental component score of quality of life.
PMCID: PMC3704970  PMID: 23800179
Primary health care; Elderly; Quality of life; Family health; Family health strategy; Hypertension; Family medicine
23.  Depressive states and health problems in caregivers of the disabled elderly at home 
This study investigated the prevalence of depression and health problems in caregivers for the disabled elderly at home, and identified factors associated with the risk of depression. Four hundred thirty-four caregivers for disabled elderly persons in a suburban city were surveyed by in-home interviews. Two hundred ten non-caregivers were also interviewed as an age and gender-matched control group. Overall, 16.8% of caregivers met the DSM-III-R criteria for major depression and 10.6% met the criteria for depressive disorders not otherwise specified, for a total of 27.4% meeting the criteria for affective disorders, while 8.6% of controls met the criteria for depressive disorders not otherwise specified. The prevalence of major depression in caregivers was associated with mental problems and ADL limitations of the elderly. Moreover, non-cooperation by other family members or relatives contributed to an increase in the prevalence of depression. Caregivers who met the criteria for major depression had a higher frequency and longer duration of upper respiratory infections than other caregivers or controls, and showed greater fatigue than the other caregivers or controls. Approximately 90% of caregivers who met the criteria for major depression had also insomnia. Overall, it was shown that caregivers who met the criteria for major depressin had not only emotional distress but also higher morbidity.
PMCID: PMC2723527  PMID: 21432469
Caregiver; Disabled elderly persons; Home care; Depression
24.  Depression in the elderly: Does family system play a role? A cross-sectional study 
BMC Psychiatry  2007;7:57.
The most common geriatric psychiatric disorder is depression. The role of family systems in depression among the elderly has not been studied extensively. It has been suggested that urbanization promotes nucleation of family systems and a decrease in care and support for the elderly. We conducted this study in Karachi, a large urban city of Pakistan, to determine the relationship between the type of family system and depression. We also determined the prevalence of depression in the elderly, as well as correlation of depression with other important socio-demographic variables.
A cross-sectional study was carried out in the premises of a tertiary care hospital in Karachi, Pakistan. Questionnaire based interviews were conducted among the elderly people visiting the hospital. Depression was assessed using the 15-item Geriatric Depression Scale.
Four hundred subjects aged 65 and above were interviewed. The age of majority of the subjects ranged from 65 to 74 years. Seventy eight percent of the subjects were male. The prevalence of depression was found to be 19.8%. Multiple logistic regression analysis revealed that the following were significant (p < 0.05) independent predictors of depression: nuclear family system, female sex, being single or divorced/widowed, unemployment and having a low level of education. The elderly living in a nuclear family system were 4.3 times more likely to suffer from depression than those living in a joint family system (AOR = 4.3 [95% CI = 2.4–7.6]).
The present study found that residing in a nuclear family system is a strong independent predictor of depression in the elderly. The prevalence of depression in the elderly population in our study was moderately high and a cause of concern. The transition in family systems towards nucleation may have a major deleterious effect on the physical and mental health of the elderly.
PMCID: PMC2194680  PMID: 17961255
25.  Epidemiological trends of RF/RHD in school children of Shimla in north India 
The Indian Journal of Medical Research  2013;137(6):1121-1127.
Background & objectives:
There are no active surveillance studies reported from South East Asian Region to document the impact of change in socio-economic state on the prevalence of rheumatic fever/rheumatic heart disease (RF/RHD) in children. Therefore, we conducted a study to determine the epidemiological trends of RF/RHD in school children of Shimla city and adjoining suburbs in north India and its association with change in socio-economic status.
Active surveillance studies were conducted in 2007-2008 in urban and rural areas of Shimla, and 15145 school children, aged 5-15 yr were included and identical screening methodology as used in earlier similar survey conducted in 1992-1993 was used. The study samples were selected from schools of Shimla city and adjoining rural areas by multistage stratified cluster sampling method in both survey studies. After a relevant history and clinical examination by trained doctor, echocardiographic evaluation of suspected cases was done. An updated Jones (1992) criterion was used to diagnose cases of acute rheumatic fever (ARF) and identical 2D-morphological and Doppler criteria were used to diagnose RHD in both the survey studies. The socio-economic and healthcare transitions of study area were assessed during the study interval period.
Time trends of prevalence of RF/RHD revealed about five-fold decline from 2.98/1000 (95% C.I. 2.24-3.72/1000) in 1992-1993 to 0.59/1000 (95% C.I. 0.22-0.96/1000) in 2007-2008. (P<0.0001). While the prevalence of ARF and RHD with recurrence of activity was 0.176/1000 and 0.53/1000, respectively in 1992-1993, no case of RF was recorded in 2007-2008 study. Prevalence of RF/RHD was about two- fold higher in rural school children than urban school children in both the survey studies (4.42/1000 vs. 2.12/1000) and (0.88/1000 vs. 0.41/1000), respectively. The indices of socio-economic development revealed substantial improvement during this interim period.
Interpretation & conclusions:
The prevalence of RF/RHD has declined by five-fold over last 15 yr and appears to be largely contributed by improvement in socio-economic status and healthcare delivery systems. However, the role of change in the rheumatogenic characteristics of the streptococcal stains in the study area over a period of time in decline of RF/RHD cannot be ruled out. Policy interventions to improve living standards, existing healthcare facilities and awareness can go a long way in reducing the morbidity and mortality burden of RF/RHD in developing countries.
PMCID: PMC3734717  PMID: 23852293
Environmental factors; GABHS; heart disease; India; prevalence; rheumatic fever; time trends

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