Hypertension in a primary care setting in Buza, Tanzania & Malta

Introduction: Worldwide prevalence of hypertension (HT) in established market economy countries is estimated at 37.4% for males and 37.2% for females. Aim: To identify the frequency of HT in sample populations of Malta and Buza, Tanzania, looking specifically at gender differences, the rate of previous diagnosis and compliance to medication. Methods: A comparative cross-sectional population-based survey to calculate the frequency of hypertension of a sample of the Maltese population reviewed in 2010 and a sample of people reviewed in a primary care medical clinic Buza in that same year. Both samples were statistically matched and compared. Results: Frequency of HT in the Maltese sample was 32.8% (M:F - 32.8:32.8), and compliance rate was 48%. The frequency of HT in the Buza sample was 48.4% (M:F - 47.7:48.9) and the compliance rate was 8%. Frequency of stage II and malignant HT were significantly more prevalent in the Buza population. The frequency of HT increased with age in both populations studied. Conclusions: Prevalence of examined HT in the Maltese sample was higher than the self-reported survey carried out in 2008, but still lower than the Buza sample and within range of the established market economy countries. Education and awareness of HT will increase lifestyle changes and further reduce the frequency of HT and increase the compliance rates in both populations. Hypertension awareness and readily available treatment is a much needed public health service. Furthermore, it is cheap, easy to offer and significantly improves quality of life.peer-reviewe

Can we use the pharmacy data to estimate the prevalence of chronic conditions? a comparison of multiple data sources

<p>Abstract</p> <p>Background</p> <p>The estimate of the prevalence of the most common chronic conditions (CCs) is calculated using direct methods such as prevalence surveys but also indirect methods using health administrative databases.</p> <p>The aim of this study is to provide estimates prevalence of CCs in Lazio region of Italy (including Rome), using the drug prescription's database and to compare these estimates with those obtained using other health administrative databases.</p> <p>Methods</p> <p>Prevalence of CCs was estimated using pharmacy data (PD) using the Anathomical Therapeutic Chemical Classification System (ATC).</p> <p>Prevalences estimate were compared with those estimated by hospital information system (HIS) using list of ICD9-CM diagnosis coding, registry of exempt patients from health care cost for pathology (REP) and national health survey performed by the Italian bureau of census (ISTAT).</p> <p>Results</p> <p>From the PD we identified 20 CCs. About one fourth of the population received a drug for treating a cardiovascular disease, 9% for treating a rheumatologic conditions.</p> <p>The estimated prevalences using the PD were usually higher that those obtained with one of the other sources. Regarding the comparison with the ISTAT survey there was a good agreement for cardiovascular disease, diabetes and thyroid disorder whereas for rheumatologic conditions, chronic respiratory illnesses, migraine and Alzheimer's disease, the prevalence estimates were lower than those estimated by ISTAT survey. Estimates of prevalences derived by the HIS and by the REP were usually lower than those of the PD (but malignancies, chronic renal diseases).</p> <p>Conclusion</p> <p>Our study showed that PD can be used to provide reliable prevalence estimates of several CCs in the general population.</p

The dynamic behaviour of metabolic syndrome and its components in an eight-year population-based cohort from the Mediterranean

Síndrome X de resistència a la insulina; Síndrome metabòlica; ObesitatSíndrome X de resistencia a la insulina; Síndrome metabólico; ObesidadInsulin Resistance Syndrome X; Metabolic syndrome; ObesityBACKGROUND The significant rise in the prevalence of obesity coincides with the considerable increase in the prevalence of metabolic syndrome (MS) currently being observed worldwide. The components of MS are not static and their dynamics, such as the order of their occurrence, or the time of exposure to them are, as yet, unknown but could well be clinically relevant. Our objective was to study the dynamic behaviour of MS and its components in a large population-based cohort from a Mediterranean region. METHODS AND FINDINGS Our study employed a retrospective cohort (between January 1, 2005 and December 31, 2012) made up of individuals from the general population in a region in the northeast of Catalonia, Spain. Given that most of the explicative variables of the risk of having MS were time dependent and, therefore, the risk was not proportional, we used the Andersen-Gill (AG) model to perform a multivariate survival analysis and inferences were performed using a Bayesian framework. Thirty-nine percent of the participants developed MS; 44.6% of them with a single limited episode. Triglycerides and low HDL cholesterol, together with obesity, are components associated with the first occurrence of MS. Components related to the metabolism of glucose are associated with a medium risk of having a first episode of MS, and those related to blood pressure are associated with a lower risk. When the components related to blood pressure and the metabolism of glucose appear first, they determine the appearance of the first episode of MS. The variables concerning the persistence of MS are those that correspond to clinical conditions that do not have well-established drug treatment criteria. CONCLUSIONS Our results suggest that the components related to the metabolism of glucose and to high blood pressure appear early on and act as biomarkers for predicting MS, while the components related to obesity and dyslipidaemia, although essential for the development of MS, appear later. Making lifestyle changes reduces the conditions associated with the persistence of MS

Use of anti-infective drugs during pregnancy : prevalence, predictors of use and the risk of preterm birth and small-for-gestational-age newborns

Résumé: Les anti-infectieux sont parmi les médicaments les plus utilisés pendant la grossesse. Les indications pour l’utilisation de ces médicaments, telles que les infections bactériennes, figurent parmi les facteurs de risque les plus importants pour la prématurité et les enfants nés petits pour l'âge gestationnel («Small-for-gestational-age », SGA). Ces complications de la grossesse peuvent avoir des incidences sur la santé du nouveau né et sur son développement futur. Compte tenu des impacts sur la santé de la mère et de l’enfant, la prise en charge et le traitement efficace de ces infections sont impératifs. Cependant, l'utilisation des anti-infectieux, pour éviter des issues de grossesse défavorables, fait l’objet d’une controverse dans la littérature. Cette controverse est en partie liée à la qualité méthodologique discutable des études disponibles sur le sujet. Les quatre études présentées dans cette thèse ont donc pour objectif d’investiguer l’utilisation des anti-infectieux durant la grossesse ainsi que d’évaluer le risque de prématurité et de SGA après utilisation de ces médicaments en période gestationnelle. Une révision systématique de la littérature sur l’utilisation du métronidazole durant la grossesse est également présentée. Nous avons utilisé, comme source de données le Registre des Grossesses du Québec, une cohorte longitudinale conçue à partir du jumelage de trois bases de données administratives de la province du Québec (RAMQ, Med-Echo et ISQ). Le registre fournit des informations sur les prescriptions, les services pharmaceutiques et médicaux, ainsi que des donnés sur les soins d’hospitalisation de courte durée et démographiques. Les deux premières études présentées dans cette thèse ont eu pour objectif d’évaluer la prévalence, les tendances, les indications et les prédicteurs de l’utilisation des anti-infectieux dans une cohorte, extraite du registre, de 97 680 femmes enceintes. A l’aide d’un devis cas-témoins, les 2 dernières études ont mesuré l’association entre l’utilisation d’anti-infectieux durant les 2 derniers trimestres de grossesse et le risque de prématurité et de SGA, respectivement. Un cas de prématurité a été défini comme un accouchement survenu avant 37 semaines de gestation. Un cas de SGA a été défini comme l’accouchement d’un enfant dont le poids à la naissance se situe sous le 10ème percentile du poids normalisé à la naissance (compte tenu de l’âge gestationnel et du sexe du bébé). Les données ont été recueillies pour les agents systémiques oraux, ainsi que pour les classes et les agents individuels. Nos résultats ont montré que la prévalence de l’utilisation des anti-infectieux durant la grossesse était comparable à celle d’autres études déjà publiées (25%). Nous avons observé une augmentation de l’utilisation des agents plus anciens et ayant des profils d’innocuité connus. Les prédicteurs de l’usage en début de grossesse identifiés sont : avoir eu plus de deux différentes prescriptions (OR ajusté = 3,83, IC 95% : 3,3-4,3), avoir eu un diagnostic d’infection urinaire (OR= 1,50, IC 95% : 1,3-1,8) et un diagnostic d’infection respiratoire (OR= 1,40, IC 95% : 1,2-1,6). L’utilisation des macrolides a été associée à une diminution du risque de prématurité (OR =0,65, IC 95% : 0,50-0,85). En revanche, les femmes ayant été exposées au métronidazole ont vu leur risque augmenté de 80% (OR=1,81, IC 95% : 1,30-2,54). L’utilisation d’azithromycine a été associée à une diminution importante du risque chez les femmes ayant un diagnostic de rupture prématurée des membranes (OR=0,31, IC 95% : 0,10-0,93). Cependant, l'utilisation de sulfaméthoxazole-triméthoprime (SXT) a été significativement associée à une augmentation du risque de SGA (OR= 1,61, IC 95% : 1,16-2,23), tandis que celle des anti-infectieux urinaires a été associée à une diminution du risque (OR= 0,80, 95%CI : 0.65-0.97). Les conclusions de nos travaux suggèrent que l’utilisation des macrolides et des pénicillines diminuent le risque de prématurité et de SGA. Nous devons considérer l'utilisation de différents choix thérapeutiques tels que l’azithromycine, lors de la prise en charge des infections pouvant induire la prématurité et le SGA.Abstract: Anti-infective drugs are among the most used medications during pregnancy. Gestational infections are related to some adverse pregnancy outcomes, such as preterm birth and infants born small for their gestational age (SGA), which increases the risk of mortality and long-term morbidity. Given its health impacts, prompt management and treatment of these infections are warranted. However, there is some controversy on the use of anti-infective drugs to prevent adverse pregnancy outcomes, such as preterm birth. Furthermore, there is growing concern regarding its independent effects on these outcomes, when treatment of maternal infections is instituted. Therefore, we conducted 4 large population-based studies aimed to investigate the gestational use of anti-infective drugs during pregnancy and the risk of preterm birth and SGA. In addition, we systematically reviewed the available evidence on the use of metronidazole during gestation. We used data from the Quebec Pregnancy Registry, a longitudinal population-based cohort established with the linkage of three administrative databases from the province of Quebec (RAMQ, Med-Echo and ISQ). Data are available on prescriptions, pharmaceutical and healthcare services, acute care hospitalization and patient demographics. For study 1 and 2, we conducted a drug utilisation review within a cohort of 97 680 pregnant women. Study 3 and 4 were two independent case-control studies. Cases of preterm birth were defined as those with a delivery occurring before the 37th week of gestation (study 3). Cases of SGA were defined as a pregnancy resulting in a baby’s weigh adjusted for gestational age and gender <10th percentile, according to the Canadian gender-specific reference curves (Study 4). Oral use of anti-infective drugs during the last two trimesters of pregnancy was the exposure definition for both studies. Independent analyses were done to assess the risk for different classes of anti-infectives and individual agents. Our results indicate that the use of anti-infective drugs during pregnancy is prevalent (25%). Use of well-known agents increased once pregnancy was diagnosed, and the most frequent indications for use were respiratory and urinary infections. Predictors associated with use were having more that 2 different prescribers (adj. OR= 3.83, 95% CI: 3.3-4.3), having a diagnosis of urinary tract infections (adj. OR= 1.50, 95% CI: 1.3-1.8) and respiratory tract infection (adj. OR= 1.40, 95% CI: 1.2-1.6). The use of macrolides was associated with a decreased risk of preterm birth (adj. OR=0.65, 95% CI: 0.50-0.85), whereas metronidazole increased the risk (adj. OR=1.81, 95% CI: 1.30-2.54). Azithromycin had a protective effect in women with premature rupture of membranes (adj. OR=0.31, 95% CI: 0.10-0.93). Use of sulfamethoxazole/trimethoprim was associated with an increased risk of SGA (adj. OR= 1.61, 95%CI: 1.16-2.23), whereas the use of urinary anti-infectives decreased the risk (adj. OR= 0.80, 95%CI: 0.65-0.97).The results of this thesis suggest that the use of macrolides and penicillins decrease the risk of preterm birth and SGA. Health care professionals should consider other therapeutic alternatives to metronidazole and sulfonamides, such as azithromycin

Prevalencia de la hipertensión arterial y factores asociados en población adulta de la Comunitat Valenciana

La hipertensión es el principal factor de riesgo en términos de mortalidad atribuible y el principal factor de riesgo cardiovascular modificable. Los objetivos del estudio han sido: estimar la prevalencia de hipertensión arterial en población adulta de la Comunitat Valenciana, describir el grado de conocimiento, tratamiento y control de la hipertensión y la fuerza de asociación entre determinados factores y la presencia de hipertensión arterial. El punto de partida ha sido una submuestra de 413 hombres y 415 mujeres de edades comprendidas entre los 16 y los 90 años del estudio transversal de base poblacional (encuesta de nutrición) realizado en la Comunitat Valenciana entre 2010 y 2011. Como criterio para definir hipertensión se ha optado por el establecido en 2007 por la Sociedad Europea de Hipertensión Arterial y la Sociedad Europea de Cardiología: presión arterial sistólica (PAS) ≥140 mm Hg y/o presión arterial diastólica (PAD) ≥90 mm Hg o seguir tratamiento farmacológico. Los resultados muestran una prevalencia de HTA de 38,2%, que el 51,4% de la población hipertensa conocía su condición, que el 88,8% estaba siendo tratado con medicación y que el 45,1% mantenía su presión arterial bajo control. La fuerza de asociación de determinados factores y la variable hipertensión se ha analizado mediante regresión logística binaria para diversas variables explicativas relacionadas con factores sociodemográficos, antecedentes familiares y personales estilos de vida, variables antropométricas y otras mediciones, permaneciendo como variables explicativas para la hipertensión, el grupo de edad, el índice de masa corporal y la diabetes. En general, los resultados obtenidos son consistentes con los publicados en la literatura revisada. Nuestro estudio pone en evidencia que en la Comunitat Valenciana queda margen para mejorar el control efectivo de la población hipertensa, lo que podría lograrse mediante estrategias dirigidas a mejorar el diagnóstico de la hipertensión y a identificar y prevenir los factores modificables relacionados con la HTA así como con la incorporación de los criterios de las guías de manejo de la HTA a la práctica médica habitual.Hypertension is the main risk factor in terms of attributable mortality and the main modifiable cardiovascular risk factor. The objectives of the study were to estimate the prevalence of hypertension in adult population of Valencia region, describe the status of awareness, treatment and control of hypertension and the strength of association between certain factors and the presence of hypertension. The starting point has been a subsample of 413 men and 415 women aged between 16 and 90 years of population-based cross-sectional study (nutrition survey) conducted in Valencia region between 2010 and 2011. We have chosen as a criterion for defining hypertension, that established in 2007 by the European Society of Hypertension and the European Society of Cardiology: Systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg or being in pharmacological treatment. The prevalence of hypertension was 38,2%; 51,4% of the hypertensive population were aware of their condition, 88,8% were being treated with medication and 45,1% kept their blood pressure under control. The strength of association of specific factors and hypertension variable has been analyzed using binary logistic regression for various explanatory variables related to sociodemographic factors, personal and family background, lifestyle, anthropometric measurements and other variables. Remain as explanatory variables for hypertension, the group of age, body mass index and diabetes. Overall, the results are consistent with those published in the literature reviewed. Our study shows that in Valencia region the effective control of the hypertensive population is susceptible of improvement, which could be achieved through strategies to improve the diagnosis of hypertension and to identify and prevent the modifiable factors associated with hypertension as well as incorporating criteria guidelines for the management of hypertension in regular medical practice