Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study

Importance: Little is known about adoption of healthy lifestyle behaviors among individuals with a coronary heart disease (CHD) or stroke event in communities across a range of countries worldwide. Objective: To examine the prevalence of avoidance or cessation of smoking, eating a healthy diet, and undertaking regular physical activities by individuals with a CHD or stroke event. Design, Setting, and Participants Prospective Urban Rural Epidemiology (PURE) was a large, prospective cohort study that used an epidemiological survey of 153 996 adults, aged 35 to 70 years, from 628 urban and rural communities in 3 high-income countries (HIC), 7 upper-middle-income countries (UMIC), 3 lower-middle-income countries (LMIC), and 4 low-income countries (LIC), who were enrolled between January 2003 and December 2009. Main Outcome: Measures smoking status (current, former, never), level of exercise (low, 600 metabolic equivalent task [MET]-min/wk; moderate, 600-3000 MET-min/wk; high, 3000 MET-min/wk), and diet (classified by the Food Frequency Questionnaire and defined using the Alternative Healthy Eating Index). Results: Among 7519 individuals with self-reported CHD (past event: median, 5.0 [interquartile range {IQR}, 2.0-10.0] years ago) or stroke (past event: median, 4.0 [IQR, 2.0-8.0] years ago), 18.5% (95% CI, 17.6%-19.4%) continued to smoke; only 35.1% (95% CI, 29.6%-41.0%) undertook high levels of work- or leisure related physical activity, and 39.0% (95% CI, 30.0%-48.7%) had healthy diets; 14.3% (95% CI, 11.7%-17.3%) did not undertake any of the 3 healthy lifestyle behaviors and 4.3% (95% CI, 3.1%-5.8%) had all 3. Overall, 52.5% (95% CI, 50.7%-54.3%) quit smoking (by income country classification: 74.9% [95% CI, 71.1%-78.6%] in HIC; 56.5% [95% CI, 53.4%-58.6%] in UMIC; 42.6% [95% CI, 39.6%-45.6%] in LMIC; and 38.1% [95% CI, 33.1%-43.2%] in LIC). Levels of physical activity increased with increasing country income but this trend was not statistically significant. The lowest prevalence of eating healthy diets was in LIC (25.8%; 95% CI, 13.0%-44.8%) compared with LMIC (43.2%; 95% CI, 30.0%- 57.4%), UMIC (45.1%, 95% CI, 30.9%-60.1%), and HIC (43.4%, 95% CI, 21.0%- 68.7%). Conclusion and Relevance: Among a sample of patients with a CHD or stroke event from countries with varying income levels, the prevalence of healthy lifestyle behaviors was low, with even lower levels in poorer countries.IS

Assessing Factors Associated with Non-Fatal Injuries from Road Traffic Accidents among Malaysian Adults: A Cross-Sectional Analysis of the PURE Malaysia Study

Non-fatal injuries (NFIs) due to road traffic accidents (RTAs) are a public health problem worldwide that significantly impacts the population morbidity and healthcare costs. As the demands for vehicles in developing countries, such as Malaysia, is increasing annually, the present study aims to determine the prevalence and factors associated with NFIs due to RTAs among Malaysia’s adult population. Methods: This was a cross-sectional study involving 15,321 participants from the Prospective Urban and Rural Epidemiological (PURE) study conducted in Malaysia. Participants reported whether they had experienced an NFI that limited their normal activities within the past 12 months. Data on risk factors for NFIs were elicited. Multiple logistic regression models were fitted to identify the associated factors. Results: Overall, 863 participants (5.6% of 15,321) reported at least 1 NFI in the past 12 months, with 303 caused by RTAs (35.1%), 270 caused by falls (31.3%) and 290 attributed to other causes (33.6%). The factors associated with higher odds of sustaining an NFI due to an RTA were being male (adjusted odd ratio (AOR) 2.08; 95% CI 1.33–3.26), having a primary (2.52; 1.40–4.55) or secondary (2.64; 1.55–4.49) level of education, being overweight to obese (1.40; 1.01–1.94), being currently employed (2.03; 1.31–3.13) and not practicing a noon nap/siesta (1.38; 1.01–1.89). Conclusions: The occurrence of NFIs due to RTAs is highly preventable with strategic planning aimed at reducing the risk of RTAs among the Malaysian population. Interventions focusing on protecting road users, especially those who drive two-wheelers, with proactive road safety awareness and literacy campaigns, combined with strict enforcement of the existing traffic laws and behavioural modifications, may reduce the risk of NFIs following RTAs

Depressive symptoms among adults: Baseline findings of PURE Malaysia cohort study

Introduction: In Malaysia, the prevalence of depression has increased from 1.8 % to 2.3 % within a decade. Thus, this study was performed to identify depressive symptoms and its associated factors among Malaysian adults. Methods: A cross-sectional study was conducted among the adult population aged 35–70 residing in rural and urban areas in Malaysia. Depressive symptoms were assessed using the short form Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Composite International Diagnostic Interview (CIDI) questionnaire. Logistic regression models were fitted to identify the associated factors related to depressive symptoms. Results: About 3.7 % (95 % CI: 2.33–4.83) of the respondents reported having depressive symptoms. Younger adults aged 35–40 years old (AOR: 3.087; 95 % CI: 2.021–4.717), females (AOR: 2.318; 95 % CI: 1.669–3.219), widows and divorcees (AOR: 2.294; 95 % CI: 1.085–4.848), smokers (AOR: 1.843; 95 % CI: 1.334–2.545) and alcohol consumers (AOR: 1.843; 95 % CI: 1.264–2.688) showed a higher odds compared to their other counterparts. Underweight individuals (AOR: 1.899; 95 % CI: 1.177–3.065) and those diagnosed either with hypertension (AOR: 1.442; 95 % CI: 1.11–1.873), diabetes (AOR: 1.554; 95 % CI: 1.133–2.13), angina (AOR: 2.73; 95 % CI: 1.596–4.67), COPD (AOR: 4.187; 95 % CI: 1.528–11.472) or asthma (AOR: 1.906; 95 % CI: 1.309–2.774) were more likely to have depressive symptoms. Additionally, individuals with difficulty trusting people (AOR: 1.477; 95 % CI: 1.024–2.13) and those reported to experience either home or work-related stress (AOR: 2.584; 95 % CI: 2.003–3.331) were more prone to have depressive symptoms. Conclusion: In this broad population-based study, about 3.7 % (95 % CI: 2.33–4.83) of respondents reported having depressive symptoms. Timely and well targeted collaborative intervention on the identified risk factors by the relevant authorities, would mitigate their effect on the quality of life and retard the progression into depression, especially among younger adults

Prevalence, awareness, treatment, control and socio demographic determinants of hypertension in Malaysian adults

Abstract Background Hypertension is the leading cardiovascular risk factor globally as well as in Malaysia. This study aimed to estimate the prevalence, awareness, treatment, control and the socio demographic determinants of hypertension among Malaysian adults. Method The analytic sample consisted of 11,288 adults aged ≥ 30 years recruited at baseline in 2007–2011 from the REDISCOVER Study which is an ongoing, prospective cohort study involving 18 urban and 22 rural communities in Malaysia. Socio-demographics, anti-hypertensive treatment details and an average of at least two blood pressure measurements were obtained. Results The age-adjusted prevalence was 42.0 % (CI: 40.9–43.2) and was higher in men [43.5 % (CI: 41.2–45.0)] than women [41.0 % (CI: 39.8–42.3)]. Participants from rural areas (APR: 1.12, CI: 1.04–1.20); aged at least 40–49 years (APR: 1.86, CI: 1.62–2.14); who were overweight (APR: 1.24, CI: 1.15–1.34) and obese (APR: 1.54, CI: 1.43–1.6) were more likely to have hypertension. The Indigenous ethnic group was less likely to be aware (APR: 0.81, CI: 0.69–0.92) and to be on treatment (APR: 0.66, CI: 0.55–0.79). Those in rural areas were less likely to have their hypertension controlled (APR: 0.61, CI: 0.49–0.75). On the other hand, control was more likely in females (APR: 1.25, CI: 1.01–1.54) and Indigenous group (APR: 1.64, CI: 1.19–2.25). Conclusion Hypertension is common in the Malaysian adults. The control of hypertension has increased over the years but is still quite low. Public health measures, as well as individual interventions in primary care are crucial to reduce their risk of developing complications

Study protocol of EMPOWER Participatory Action Research (EMPOWER-PAR): a pragmatic cluster randomised controlled trial of multifaceted chronic disease management strategies to improve diabetes and hyp

Background Chronic disease management presents enormous challenges to the primary care workforce because of the rising epidemic of cardiovascular risk factors. The chronic care model was proven effective in improving chronic disease outcomes in developed countries, but there is little evidence of its effectiveness in developing countries. The aim of this study was to evaluate the effectiveness of the EMPOWER-PAR intervention (multifaceted chronic disease management strategies based on the chronic care model) in improving outcomes for type 2 diabetes mellitus and hypertension using readily available resources in the Malaysian public primary care setting. This paper presents the study protocol. Methods/Design A pragmatic cluster randomised controlled trial using participatory action research is underway in 10 public primary care clinics in Selangor and Kuala Lumpur, Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Each clinic consecutively recruits type 2 diabetes mellitus and hypertension patients fulfilling the inclusion and exclusion criteria over a 2-week period. The EMPOWER-PAR intervention consists of creating/strengthening a multidisciplinary chronic disease management team, training the team to use the Global Cardiovascular Risks Self-Management Booklet to support patient care and reinforcing the use of relevant clinical practice guidelines for management and prescribing. For type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving HbA1c < 6.5%. For hypertension without type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving blood pressure < 140/90 mmHg. Secondary outcomes include the proportion of patients achieving targets for serum lipid profile, body mass index and waist circumference. Other outcome measures include medication adherence levels, process of care and prescribing patterns. Patients’ assessment of their chronic disease care and providers’ perceptions, attitudes and perceived barriers in care delivery and cost-effectiveness of the intervention are also evaluated. Discussion Results from this study will provide objective evidence of the effectiveness and cost-effectiveness of a multifaceted intervention based on the chronic care model in resource-constrained public primary care settings. The evidence should instigate crucial primary care system change in Malaysia