Health, cardiovascular disease and their determinants in the Kazakh population

Background: The high and fluctuating mortality and rising health inequalities in post-Soviet countries have attracted considerable attention, but there are very few individual-level data on distribution of health outcomes in Central Asian countries of the former Soviet Union, including Kazakhstan. The main causes of death driving the low life expectancy (some 12 years shorter than in Western Europe) are chronic non-communicable diseases, particularly cardiovascular diseases (CVD). // Aim: The main aim of the thesis was to investigate the levels and distribution of risk factors of CVD and the associations between a range of risk factors and CVD in Kazakhstan. // Methods: This thesis describes a population-based cross-sectional survey and a case-control study of acute coronary syndrome (ACS) and stroke in the Astana (Kazakhstan capital city) region. The cross-sectional survey examined 977 men and women aged 50-74 years (493 in Astana city and 484 in a rural area) randomly selected from primary care registers. Subjects in the crosssectional survey served as controls for 348 cases of acute coronary syndrome (ACS) and 235 cases of stroke hospitalised during the study period in two hospitals covering over 80% of acute admissions for these two conditions in the Astana region. The examination of both sets of cases followed identical protocol, including a structured questionnaire, objective examination and collection of blood samples. // Results: The cross-sectional survey found high prevalence of cardiometabolic risk factors and differences in the prevalence of risk factors by socioeconomic and demographic characteristics, including less favourable pattern in urban vs. rural residents. The case-control study identified associations between ACS and stroke and cardio-metabolic risk factors, health behaviours and socioeconomic factors. A consistent finding was a less favourable risk profile in the Russian vs. Kazakh ethnicity. // Conclusions: The prevalence of cardio-metabolic risk factors in the Kazakh population is high compared to Western Europe. The associations of ACS and stroke with risk factors were as expected, and there were some specific associations with socio-demographic characteristics. The pronounced sociodemographic differences in prevalence of cardio-metabolic risk factors suggest that preventive strategies may target population groups at higher risk of CVD

Levels and distribution of self-rated health in the Kazakh population: results from the Kazakhstan household health survey 2012

The high and fluctuating mortality and rising health inequalities in post-Soviet countries have attracted considerable attention. However, there are very few individual-level data on distribution of health outcomes in Central Asian countries of the former Soviet Union. We analysed socioeconomic predictors of two self-rated health outcomes in a national survey in Kazakhstan

Health benefits of new symbiotic “NAR”

Introduction: The immune-modulatory effects of synbiotics and their ability to reduce free radical levels may be useful for functional food that is able to be active throughout whole period of colonization of the gastrointestinal tract.The aim of the present study was to investigate the immune-modulatory and antioxidant effects of the synbiotic product "N?R," a probiotic beverage.Methods: The presence of IL-2, IL-4, IL-6, IL-8, IL-10, ?TNF, ?IFN, Ig A, Ig M, and Ig E was studied in vitro using a solid immunosorbent analysis. The total antioxidant activities of superoxide dismutase and glutathione reductase were determined by a spectrophotometry using the Sigma-Aldrich sets.Results: Studies of the immune-modulatory properties of the synbiotic product NAR showed 1.7 fold increase of ?INF levels (p<0.01) in blood after consumption of the synbiotic product “NAR” in comparison to control values, whereas the concentrations of IL-4 and Ig E decreased 2.0 times (treatment: 9.3; control: 18.7; p<0.01) and 1.3 times (p<0.1), respectively. The consumption of the synbiotic product “NAR” caused an increase in the proportion of ?INF/IL 4 (treatment: 15.4; control: 4.4; p<0.01), which indicates a reduction in functional activity of Th2-type lymphocytes in comparison with the function of Th1 cells.Our study showed a high level of the total antioxidant activity of the synbiotic product (67.4 mmol/ml). The antioxidant activity of the intact cells of consortium (15.3 mM/ml), which was the basis for the preparation of the symbiotic product, is several times lower than the activity observed in the symbiotic samples.Expression of SOD is one of the mechanisms of antioxidant stress radicals inactivation by bacteria. The analysis identified a superoxide dismutase activity of synbiotic product (1.42 U/mg protein). A glutathione reductase activity of the synbiotic product was elevated (0.06 U/ml). Conclusion: The majority of the inflammatory mediators found in the blood after the consumption of symbiotic product NAR were inflammatory mediators that activate a cellular component of the resistance. Moreover, the symbiotic product has a high antioxidant activity.

The state of hypertension care in 44 low-income and middle-income countries:a cross-sectional study of nationally representative individual-level data from 1·1 million adults

Evidence from nationally representative studies in low-income and middle-income countries (LMICs) on where in the hypertension care continuum patients are lost to care is sparse. This information, however, is essential for effective targeting of interventions by health services and monitoring progress in improving hypertension care. We aimed to determine the cascade of hypertension care in 44 LMICs-and its variation between countries and population groups-by dividing the progression in the care process, from need of care to successful treatment, into discrete stages and measuring the losses at each stage. In this cross-sectional study, we pooled individual-level population-based data from 44 LMICs. We first searched for nationally representative datasets from the WHO Stepwise Approach to Surveillance (STEPS) from 2005 or later. If a STEPS dataset was not available for a LMIC (or we could not gain access to it), we conducted a systematic search for survey datasets; the inclusion criteria in these searches were that the survey was done in 2005 or later, was nationally representative for at least three 10-year age groups older than 15 years, included measured blood pressure data, and contained data on at least two hypertension care cascade steps. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or reported use of medication for hypertension. Among those with hypertension, we calculated the proportion of individuals who had ever had their blood pressure measured; had been diagnosed with hypertension; had been treated for hypertension; and had achieved control of their hypertension. We weighted countries proportionally to their population size when determining this hypertension care cascade at the global and regional level. We disaggregated the hypertension care cascade by age, sex, education, household wealth quintile, body-mass index, smoking status, country, and region. We used linear regression to predict, separately for each cascade step, a country's performance based on gross domestic product (GDP) per capita, allowing us to identify countries whose performance fell outside of the 95% prediction interval. Our pooled dataset included 1 100 507 participants, of whom 192 441 (17·5%) had hypertension. Among those with hypertension, 73·6% of participants (95% CI 72·9-74·3) had ever had their blood pressure measured, 39·2% of participants (38·2-40·3) had been diagnosed with hypertension, 29·9% of participants (28·6-31·3) received treatment, and 10·3% of participants (9·6-11·0) achieved control of their hypertension. Countries in Latin America and the Caribbean generally achieved the best performance relative to their predicted performance based on GDP per capita, whereas countries in sub-Saharan Africa performed worst. Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru performed significantly better on all care cascade steps than predicted based on GDP per capita. Being a woman, older, more educated, wealthier, and not being a current smoker were all positively associated with attaining each of the four steps of the care cascade. Our study provides important evidence for the design and targeting of health policies and service interventions for hypertension in LMICs. We show at what steps and for whom there are gaps in the hypertension care process in each of the 44 countries in our study. We also identified countries in each world region that perform better than expected from their economic development, which can direct policy makers to important policy lessons. Given the high disease burden caused by hypertension in LMICs, nationally representative hypertension care cascades, as constructed in this study, are an important measure of progress towards achieving universal health coverage. Harvard McLennan Family Fund, Alexander von Humboldt Foundation

Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries:A multicountry analysis of survey data

BackgroundCardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care.Methods and findingsWe did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases ('NCD readiness indicators' from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility preparedness for diabetes were positively associated with outcomes. Associations were inconsistent between indicators and quality clinical care outcomes. For hypertension, GDP and HDI were both positively associated with each outcome. Of the 33 relationships tested between NCD readiness indicators and outcomes, only two showed a significant positive association: presence of guidelines with being diagnosed (odds ratio [OR], 1.86 [95% CI 1.08-3.21], p = 0.03) and availability of funding with being controlled (OR, 2.26 [95% CI 1.09-4.69], p = 0.03). Hospital beds (OR, 1.14 [95% CI 1.02-1.27], p = 0.02), nurses/midwives (OR, 1.24 [95% CI 1.06-1.44], p = 0.006), and physicians (OR, 1.21 [95% CI 1.11-1.32], p ConclusionIn this study, we observed that indicators of country preparedness to deal with CVDRFs are poor proxies for quality clinical care received by patients for hypertension and diabetes. The major implication is that assessments of countries' preparedness to manage CVDRFs should not rely on proxies; rather, it should involve direct assessment of quality clinical care

MRI-BASED STUDY OF VARIOUS COGNITIVE IMPAIRMENTS: CROSS-SECTIONAL STUDY

Introduction: Clinical and diagnostic criteria for cognitive impairments are based neurophysiological tests or the presence of a history of vascular disease and stroke following the MRI scan. Materials and methods: The clinical data of 497 respondents collected in the form of standardized questionnaires and protocol, MRI data were examined. Respondents were divided by age groups (50- 54, 55-59, 60-64, 65-69, 70-75) with approximately the same sex ratio in each group. Cognitive function was evaluated according to the results of neurophysiological tests. Verbal memory was evaluated by reminding a list of 10 nouns. Immediate recall was evaluated using correctly recalled words summarized over 3 consecutive 1-minute trials (range 0-30). Delayed feedback was evaluated after the interval during which other cognitive tests were introduced (range 0-10). Fluency was assessed by the number of animals named by the respondents within 1minute. To assess attention, mental speed and concentration, participants were instructed to cross out two target letters embedded in a random letter grid, as quickly and accurately as possible, within 1minute (range 0-65). Brain MRI was performed with cognitive test. Results: When analyzing the assessment of verbal memory (range 0-30), the gradient of memory decline after 59 years per 1word was clearly expressed. The analysis of verbal fluency and the assessment of attention and concentration also showed a decrease in memory (1-2words less in each subsequent age group). According to the results of the final stage of testing, there was a tendency to decrease in the activity of long-term memory of both sexes with increasing age (more in men than in women). According to the MRI results, the respondents with the lowest cognitive function test results showed a picture of white matter lesion in the form of multiple foci of ischemia and local postischemic nodules, which might indicate the progression of dementia. Conclusion: According to the results of the study, a correlation was revealed, with increasing age, the concentration of attention, memory decreases and cognitive impairment develops due to damage to the white matter of the brain due to ischemia, which can lead to dementia and Alzheimer’s disease

COGNITIVE FUNCTION DETERMINANTS IN OLDER PERSONS IN URBAN AND RURAL POPULATION IN THE NUR-SULTAN REGION, KAZAKHSTAN: CROSS-SECTIONAL STUDY

Objective: The data on the cognitive function and its determinants in older population in Central Asia is limited. The objective of the present study was to assess the cognitive function and its determinants in the population of Nur-Sultan city and adjacent rural area in Kazakhstan. Methods: We implemented a cross-sectional study of urban and rural population samples (the state capital Nur-Sultan and Akmol village). Men and women aged 50–74 years were examined; a total of 954 adults participated in this study with response rate of 59%. One of the major components of cognitive function - verbal memory was assessed for this analysis using a word recall task consisting of 10 common nouns, administered over three consecutive 1-min trials. Total number of words correctly recalled for each trial was summed with an overall score of 30 at maximum. The examination also included the standardized protocol with a structured questionnaire, objective examination and collection of blood samples. Results: After controlling for age and sex the presence of cardiometabolic risk factors (excluding BMI), region, ethnicity, alcohol consumption, education levels and selected socioeconomic factors were all significantly associated with cognitive function. Women, less deprived and higher educated participants, and urban residents had significantly less decline in memory. Similar to other studies, higher cholesterol levels were strongly associated with cognitive decline. Conclusions: The associations of cognitive function and its determinants were as expected, and there were some specific associations with socio-demographic characteristics. The pronounced socio-demographic particularly regional differences suggest that preventive strategies may target population groups at higher risk for cognitive decline

Diabetes prevalence, awareness and treatment and their correlates in older persons in urban and rural population in the Astana region, Kazakhstan

Abstract AimsThe evidence on the prevalence and distribution of diabetes and its determinants in Central Asia is sparse. The aim of the present study was to investigate the prevalence, awareness, treatment, and control of diabetes and factors associated with these characteristics in the population of Astana (capital) city and adjacent rural area in Kazakhstan. MethodsParticipants aged 50-75 years old, residing in Astana city (the capital) and Akmol village were invited to participate in a cross-sectional study. The subjects were randomly selected from polyclinic registers. A total of 953 adults were interviewed (response rate 59%), and their fasting plasma glucose, blood pressure, height and weight were measured. Diabetes was defined as fasting plasma glucose (FPG) ≥7.0mmol/l (126mg/dl) and/or being on diabetes medication. ResultsThe overall prevalence of diabetes was 12.5%, and it was almost twice higher in the urban residents (16.3%) than in the rural population (8.6%). Diabetes prevalence was associated with age, men sex, hypertension, obesity, and Russian ethnicity. Among subjects with diabetes, 72.3% were aware of their condition; 65.6% were on treatment and 27.7% had controlled fasting plasma glucose. The awareness, treatment and control of diabetes were substantially higher in the urban population and among women. ConclusionsThe large differences in all diabetes indices between urban and rural regions, if confirmed in larger studies, may suggest an impact of westernised and urbanised lifestyle as well as access to health care

Independent role of Alzheimer's disease genetics and C-reactive protein on cognitive ability in aging

Apolipoprotein E (APOE) ε4, the strongest genetic risk factor for late onset Alzheimer's disease (LOAD), has been associated with cognitive decline independent from AD pathology, but the role for other LOAD risk genes in normal cognitive aging is less studied. We examined the effect of APOE ε4 and several different polygenic risk scores (PRS) for LOAD on cognitive level and decline in aging, using longitudinal data from the UK Biobank. While PRS-LOAD including all variants (except APOE) predicted cognitive level, APOE ε4 and PRS-LOAD based on 17 non-APOE gene variants with strong association to AD (p < 5e-8) predicted age-related decline in verbal numeric reasoning. The effect on decline were partly driven by 4 variants involved in the immune system. Those variants also predicted serum levels of the inflammatory marker C-reactive protein (CRP), but CRP did not mediate the effect on decline. Those findings suggest genetic variations in immune functions play a role in aspects of cognitive aging that may be independent of LOAD pathology as well as systemic inflammation measured by CRP