182 research outputs found

    Prevention of chronic kidney disease and its consequences:The role of socioeconomic status

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    Preventie van chronische nierziekte en de gevolgen daarvan: de rol van sociaal-economische status Chronische nierziekte (CNZ) is een belangrijk oorzaak van de wereldwijde ziektelast, wat heeft geleid tot een pleidooi voor betere preventie van CNZ. Dit vereist een beter inzicht in andere risicofactoren voor CNZ, naast traditionele risicofactoren als diabetes en hypertensie. Een lage sociaaleconomische status (SES) is daarvan een voorbeeld. Dit proefschrift heeft als doel de huidige kennis over de rol van SES in het ontstaan van CNZ te vergroten en in te gaan op de consequenties daarvan voor preventie. Om dit doel te bereiken is alle kennis uit epidemiologische studies over dit onderwerp samengevat en zijn grote Amerikaanse en Nederlandse gegevensbestanden geanalyseerd. De resultaten suggereren dat het risico van CNZ bij een lage SES vrij groot is in vergelijking met een hoge SES (ongeveer 40% hoger). Om een beter inzicht te krijgen in de additionele risicoā€™s van mensen met een lage SES kan de methode om SES te meten worden verbeterd. In Nederland lijkt het risico het hoogst voor mensen met een laag opleidingsniveau, terwijl het risico in de Verenigde Staten (VS) het hoogst is voor mensen met een laag inkomen. Het extra risico op CNZ voor mensen met een laag inkomen in de VS kan een gevolg zijn van de kosten vanwege gebruik van gezondheidszorg. Het verbeteren van het meten van CNZ markers kan tevens bijdragen aan het identificeren van mensen met CNZ die veel risico lopen op schadelijke gevolgen voor hun gezondheid. Tot slot lijkt het gewenst de huidige screening op CNZ uit te breiden met mensen met een lage SES, hoewel aanvullend onderzoek nodig is om de kosteneffectiviteit van een dergelijke benadering te evalueren

    Areca nut chewing and dependency syndrome: Is the dependence comparable to smoking? a cross sectional study

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    <p>Abstract</p> <p>Background</p> <p>Areca nut is the seed of fruit oriental palm known as <it>Areca catechu</it>. Many adverse effects of nut chewing have been well documented in the medical literature. As these nuts are mixed with some other substances like tobacco and flavouring agents, it has been hypothesized that it might also cause some dependency symptoms among its users. Therefore, the objective of this study was to investigate dependency syndrome among areca nut users with and without tobacco additives and compare it with dependency associated with cigarette smoking among the male Pakistani population.</p> <p>Methods</p> <p>This was an observational cross sectional study carried out on healthy individuals, who were users of any one of the three products (areca nut only, areca nut with tobacco additives, cigarette smokers). Participants were selected by convenience sampling of people coming to hospital to seek a free oral check up. Information was collected about the socio-demographic profile, pattern of use and symptoms of dependency using the DSM-IV criteria for substance dependence. We carried out multiple logistic regressions to investigate association between socio-demographic profile, pattern of substance use and dependency syndrome.</p> <p>Results</p> <p>We carried out final analysis on 851 individuals, of which 36.8% (n = 314) were areca nut users, 28.4% (n = 242) were the chewers of areca with tobacco additives and 34.7% (n = 295) were regular cigarette smokers. Multivariate analyses showed that individuals using areca nut with tobacco additives were significantly more likely to have dependency syndrome (OR = 2.17, 95% CI 1.39-3.40) while cigarette smokers were eight times more likely to have dependency syndrome as compared to areca nut only users.</p> <p>Conclusions</p> <p>Areca nut use with and without tobacco additives was significantly associated with dependency syndrome. In comparison to exclusive areca nut users, the smokers were eight times more likely to develop dependence while areca nut users with tobacco additives were also significantly more likely to suffer from the dependence.</p

    Caste-based social inequalities and childhood anemia in India:results from the National Family Health Survey (NFHS) 2005-2006

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    Background: Caste is one of the traditional measures of social segregation in India and differs from other indicators as it is both, endogamous and hereditary. Evidence suggests that belonging to lower castes exposes one to social inequalities and affects health adversely. We examined the association of caste with childhood anemia in India and explored the effect modifying role of adult education and household wealth. Methods: A cross-sectional analysis of National Family Health Survey (NFHS) data of 43,484 children aged 6-59 months was performed. Poisson regression analysis was conducted to study the association between caste and childhood anemia accounting for various maternal, child, and household related variables. Caste was categorized as "other caste" (least disadvantageous), "other backward caste", "scheduled tribe" and "scheduled caste" (most disadvantageous). Anemia was defined as mild (hemoglobin level 7-11 g/dL), moderate (hemoglobin level 5-7 g/dL) and severe (hemoglobin level Results: We found that children in scheduled caste had higher risk of having anemia [mild anemia: RR = 1.10, 95 % CI = 1.05-1.15; moderate anemia: RR = 1.19, 95 % CI = 1.14-1.24; severe anemia: RR = 1.87, 95 % CI = 1.51 - 2.31] after accounting for child, maternal and household covariates including adult education and household wealth. The interaction of caste with adult education and household wealth was not statistically significant for any level of anemia. Sensitivity analyses for children born to mothers of age >= 18 years at first child birth and body mass index (BMI) >= 18.5 kg/m(2), resulted in similar findings. Conclusion: Caste is an independent determinant of childhood anemia in India. The level of adult education and household wealth did not modify the association between caste and childhood anemia. The findings may be used for countering childhood anemia and it may be beneficial to target future public health actions towards disadvantageous castes in India

    Shared decision making and medication adherence in patients with COPD and/or asthma:the ANANAS study

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    Background: Medication adherence to inhalation medication is suboptimal in patients with COPD and asthma. Shared decision making (SDM) is proposed as an intervention to improve medication adherence. Despite its wide promotion, evidence of SDM's association with greater medication adherence is scarce. Also, it is unknown to what degree patients presently experience SDM and how it is associated with medication adherence.Objective: To (i) assess the level of SDM and (ii) medication adherence, (iii) explore the relation between SDM and medication adherence and iv) investigate possible underlying mechanisms.Methods: Cross-sectional observational study. A survey was distributed among Dutch patients with COPD and/or asthma using inhaled medication. Medication adherence was measured using the Test of Adherence to Inhalers (TAI-10), and SDM by the 9-item Shared Decision-Making questionnaire (SMD-Q-9). Feeling of competence, relatedness and feeling of autonomy from the Self-Determination Theory (SDT) were considered as possible mechanisms. The primary outcome was adherence.Results: A total of 396 patients with complete information on relevant covariates were included. Mean SDM-Q-9 score was 26.7 (SD 12.1, range 0-45) and complete adherence was 41.2%. The odds ratio for the association of SDM with adherence was 1.01 (95% CI: 0.99, 1.02). This only changed minimally when adjusted for mediators (mediating effect &lt;3%).Conclusion: The patient experienced level of SDM in daily practice and medication adherence have room for improvement. No association between SDM and medication adherence was observed. Factors related to feeling of competence, relatedness and feeling of autonomy did not meaningfully explain this finding. </p

    Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population

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    <p>Abstract</p> <p>Background</p> <p>Preliminary evidence has suggested the role of inflammation in development and prognosis of cardiovascular diseases and cancers. Most of the prognostic studies failed to account for the effects of co-morbid conditions as these might have raised the systemic inflammation. We used neutrophil lymphocyte ratio (NLR) as a measure of systemic inflammation and investigated its association with prevalent chronic conditions.</p> <p>Methods</p> <p>Present study is a cross sectional study conducted on population of Karachi, Pakistan. A detailed questionnaire about the demographic details of all subjects was filled and an informed consent obtained for blood sampling. Multinomial regression analyses were carried out to investigate the relationship between NLR and prevalent chronic conditions.</p> <p>Results</p> <p>1070 apparently healthy individuals participated in the study. Proportion of individuals with hypertension was higher in middle and highest tertile of NLR as compared to the lowest tertile (18.2% & 16.1% compared to 11.8%). Individuals with hypertension were 43% (RRR = 1.43, 95% CI 0.94-2.20) and 66% (RRR = 1.69, 95% CI 1.09-2.54) more likely to be in the middle and highest tertile of NLR respectively compared to the baseline group. Similarly, individuals with diabetes mellitus were 53% (RRR = 1.53, 95% CI 0.93-2.51) and 65% (RRR = 1.65, 95% CI 1.01-2.71) more likely to be in the middle or highest tertile of NLR as compared to the baseline NLR group.</p> <p>Conclusions</p> <p>Systemic inflammation measured by NLR has a significant association with prevalent chronic conditions. Future research is needed to investigate this relationship with longitudinal data to establish the temporal association between these variables.</p
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