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Cardiovascular Disease Risk Factors in Ghana during the Rural-to-Urban Transition: A Cross-Sectional Study

<div><p>Populations in sub-Saharan Africa are shifting from rural to increasingly urban. Although the burden of cardiovascular disease is expected to increase with this changing landscape, few large studies have assessed a wide range of risk factors in urban and rural populations, particularly in West Africa. We conducted a cross-sectional, population-based survey of 3317 participants from Ghana (≥18 years old), of whom 2265 (57% female) were from a mid-sized city (Sunyani, population ~250,000) and 1052 (55% female) were from surrounding villages (populations <5000). We measured canonical cardiovascular disease risk factors (BMI, blood pressure, fasting glucose, lipids) and fibrinolytic markers (PAI-1 and t-PA), and assessed how their distributions and related clinical outcomes (including obesity, hypertension and diabetes) varied with urban residence and sex. Urban residence was strongly associated with obesity (OR: 7.8, 95% CI: 5.3–11.3), diabetes (OR 3.6, 95% CI: 2.3–5.7), and hypertension (OR 3.2, 95% CI: 2.6–4.0). Among the quantitative measures, most affected were total cholesterol (+0.81 standard deviations, 95% CI 0.73–0.88), LDL cholesterol (+0.89, 95% CI: 0.79–0.99), and t-PA (+0.56, 95% CI: 0.48–0.63). Triglycerides and HDL cholesterol profiles were similarly poor in both urban and rural environments, but significantly worse among rural participants after BMI-adjustment. For most of the risk factors, the strength of the association with urban residence did not vary with sex. Obesity was a major exception, with urban women at particularly high risk (26% age-standardized prevalence) compared to urban men (7%). Overall, urban residents had substantially worse cardiovascular risk profiles, with some risk factors at levels typically seen in the developed world.</p></div

Physiologic and metabolic variables in the Ghanaian cohort.

<p>Physiologic and metabolic variables in the Ghanaian cohort.</p

Effect sizes of urban/rural environment and sex on dichotomous cardiovascular risk factors in Brong Ahafo, Ghana.

<p>(A) The increased odds of each outcome (with 95% confidence intervals) are depicted for the group with the higher odds; purple for higher urban odds and green for higher rural odds. Data were adjusted for age and sex. (B) The increased odds of each outcome (with 95% confidence intervals) are depicted for the group with the higher odds (female: red; male: blue). Data were adjusted for age and environment. Abbreviations as described in methods.</p

Prevalence by age group of obesity, hypertension, and diabetes in urban and rural men and women from Brong Ahafo, Ghana.

<p>In the left panels (A), (C), and (E), prevalence by age group is depicted for urban females (purple circles) and rural females (green circles). In the right panels (B), (D), and (F), prevalence by age group is depicted for urban males (purple triangles) and rural males (green triangles). Error bars denote 95% confidence intervals of estimates.</p

Age-standardized prevalence of dichotomous clinical outcomes by sex and urban/rural environment in Brong Ahafo, Ghana.

<p>(A) Urban (purple) and rural (green) females; (B) urban (purple) and rural (green) males. Error bars denote 95% confidence intervals of estimates. HTS: hypertension (SBP ≥140 or DBP ≥90); IFG: impaired fasting glucose (using the WHO cut-point of 110 mg/dL); DIAB: diabetes (glucose ≥126 mg/dL); OVWT: overweight (BMI ≥25); OBS: obesity (BMI ≥30); HIGH TC: hypercholesterolemia (cholesterol ≥200 mg/dL); HIGH TG: elevated triglycerides (≥ 110 mg/dL); HIGH LDL: elevated low-density lipoprotein cholesterol (≥130 mg/dL); LOW HDL: low high-density lipoprotein cholesterol (≤40 mg/dL). For UF, RF, UM, and RM, N = 1293, 583, 972, and 469 (except for HIGH LDL and LOW HDL: N = 955, 317, 722, 225), respectively. All data age-standardized to the WHO 2000–2025 standard population.</p

Effect sizes of urban/rural environment and sex on continuous cardiovascular risk factors in Brong Ahafo, Ghana.

<p>(A) Absolute differences between urban and rural standardized means (with 95% confidence intervals); purple lines indicate that the urban group has a higher mean and green lines indicate that the rural group has a higher mean. Data were adjusted for age and sex. (B) Absolute differences between male and female standardized means (with 95% confidence intervals); red lines indicate that the females have a higher mean and blue lines indicate that males have a higher mean. Data were adjusted for age and urban/rural residence. Abbreviations as described in methods.</p

Importance of being an Earnest translator

MA thesis - Daniela Cvachová - 2011 Abstract: This thesis compares two Czech translations of the drama The Importance of Being Earnest by Oscar Wilde. The comparison is based on findings of currently recognised theoreticians of translation (Levý, Knittlová, Králová, Reiss). The translation of Jiří Zdeněk Novák is half a century older than the translation by a team of young beginning translators led by Stanislav Rubáš and Zuzana Šťastná. The thesis focuses on the comparison of those aspects that are characteristic for Wilde's works and difficult for translators: lexicological problems like puns, bon mots, allusions to realia. In spite of the fact that the drama is not of a large extent, it offers a wide range of "tough nuts to crack" like that