Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries.

IMPORTANCE: Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods. OBJECTIVE: To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of 153,996 adults (complete data for this analysis on 142,042) aged 35 to 70 years, recruited between January 2003 and December 2009. Participants were from 628 communities in 3 high-income countries (HIC), 10 upper-middle-income and low-middle-income countries (UMIC and LMIC), and 4 low-income countries (LIC). MAIN OUTCOMES AND MEASURES: Hypertension was defined as individuals with self-reported treated hypertension or with an average of 2 blood pressure measurements of at least 140/90 mm Hg using an automated digital device. Awareness was based on self-reports, treatment was based on the regular use of blood pressure-lowering medications, and control was defined as individuals with blood pressure lower than 140/90 mm Hg. RESULTS: Among the 142,042 participants, 57,840 (40.8%; 95% CI, 40.5%-41.0%) had hypertension and 26,877 (46.5%; 95% CI, 46.1%-46.9%) were aware of the diagnosis. Of those who were aware of the diagnosis, the majority (23,510 [87.5%; 95% CI, 87.1%-87.9%] of those who were aware) were receiving pharmacological treatments, but only a minority of those receiving treatment were controlled (7634 [32.5%; 95% CI, 31.9%-33.1%]). Overall, 30.8%, 95% CI, 30.2%-31.4% of treated patients were taking 2 or more types of blood pressure-lowering medications. The percentages aware (49.0% [95% CI, 47.8%-50.3%] in HICs, 52.5% [95% CI, 51.8%-53.2%] in UMICs, 43.6% [95% CI, 42.9%-44.2%] in LMICs, and 40.8% [95% CI, 39.9%-41.8%] in LICs) and treated (46.7% [95% CI, 45.5%-47.9%] in HICs, 48.3%, [95% CI, 47.6%-49.1%] in UMICs, 36.9%, [95% CI, 36.3%-37.6%] in LMICs, and 31.7% [95% CI, 30.8%-32.6%] in LICs) were lower in LICs compared with all other countries for awareness (P <.001) and treatment (P <.001). Awareness, treatment, and control of hypertension were higher in urban communities compared with rural ones in LICs (urban vs rural, P <.001) and LMICs (urban vs rural, P <.001), but similar for other countries. Low education was associated with lower rates of awareness, treatment, and control in LICs, but not in other countries. CONCLUSIONS AND RELEVANCE: Among a multinational study population, 46.5% of participants with hypertension were aware of the diagnosis, with blood pressure control among 32.5% of those being treated. These findings suggest substantial room for improvement in hypertension diagnosis and treatment

Post-discharge heart failure monitoring program in Turkey: Hit-PoinT

Objective: The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients. Methods: The Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death. Results: Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month follow up (5.6% vs. 8.9%, p=0.04). The median number of emergency room visits was one and the median number of all cause hospitalizations and heart failure hospitalizations were zero. Twenty-tree percent of the EHFP group and 35% of the RC group had more than a median number of emergency room visits (p=0.05). There was no significant difference regarding the median number of all-cause or heart failure hospitalizations. At baseline, 60% of patients in EHFP and 61% in RC were in NYHA Class III or IV, while at the 6-month follow up only 12% in EHFP and 32% in RC were in NYHA Class III or IV (p=0.001). Conclusion: These results demonstrate the potential clinical benefits of an enhanced HF education and follow up program led by a cardiologist in reducing cardiovascular deaths and number of emergency room visits with an improvement in functional capacity at 6 months in post-discharge ambulatory HF patients.Türk Kardiyoloji Derneği Kalp Yetmezliği Çalışma Grub

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Variations in risks from smoking between high-income, middle-income, and low-income countries: an analysis of data from 179 000 participants from 63 countries

Background Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons.MethodsWe analysed data from 134 909 participants from 21 countries followed up for a median of 11·3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study; 9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study; and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE.FindingsIn PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1·87, 95% CI 1·65-2·12) than in MICs (1·41, 1·34-1·49) and LICs (1·35, 1·25-1·46; interaction pInterpretationThe variations in risks from smoking between country income groups are probably related to the higher exposure of tobacco-derived toxicants among smokers in HICs and higher rates of high second-hand smoke exposure among never smokers in MICs and LICs

Attitudes of religious culture and moral knowledgeteachers on gender: Ankara province center case

Yüksek Lisans Tezi“Toplumsal cinsiyet” (gender) kavramı, toplumsal açıdan kadınlık ve erkeklik konularında öğrenilmiş kalıpları ifade eder. Bu konudaki çalışmalar genellikle kadın üzerinden hareket etmektedir. Bu kavram, bireylerin toplum içerisinde etkin bir rol oynaması ve toplumla uyumlu bir şekilde yaşamasıyla birlikte haklarını bilmesi ve kullanabilmesiyle yakın ilişki içerisindedir. Bu haklardan biri olan eğitim, bireyin diğer haklarını bilmesi ve kullanması açısından son derece önemlidir. Bu düşünce ve yaklaşımın temel alındığı tezimizde, “toplumsal cinsiyet” kavramının Din Kültürü ve Ahlak Bilgisi öğretmenleri arasındaki bilinilirliğinin ve öğrencilere ne şekilde aktarıldığının araştırılması yapılmıştır. Çalışmanın amacı, “toplumsal cinsiyet” olgusuna din ve ahlak gibi herkesi ilgilendiren bir konuda eğitim veren öğretmenlerin konu hakkında ne gibi bilgilere sahip olduklarının araştırılmasıdır. Söz konusu olgulardan hareketle “toplumsal cinsiyet” konusundaki bilinç ve gelişmelerin Türkiye’de kadının almış olduğu eğitimin bireysel ve toplumsal açıdan yansımalarına yönelik bir durum saptaması yapılmıştır. Bu amaçla feminizmin ve kadın haklarının toplumsal açıdan önemi üzerinde durulmuştur. Bu çerçevede araştırma dört bölümden oluşmaktadır. İlk bölümde, “cinsiyet” ve “toplumsal cinsiyet” kavramları incelenerek konuyla ilgili teorik bilgiler aktarılmış; Öğrencinin Adı Soyadı Sümeyra TEMİZHAN Numarası 128102061020 Ana Bilim / Bilim Dalı Felsefe ve Din Bilimleri Anabilim Dalı / Din Sosyolojisi Bilim Dalı Programı Tezli Yüksek Lisans X Doktora Tez Danışmanı Dr. Öğr. Üyesi Arif KORKMAZ Tezin Adı Din Kültürü ve Ahlak Bilgisi Öğretmenlerinin Toplumsal Cinsiyete İlişkin Tutumları: Ankara İl Merkezi Örneği iii Türkiye’de “toplumsal cinsiyet” konusundaki değişimi ve dönüşümleri tespit etmek amacıyla, Osmanlı’dan günümüze kadının toplumsal alandaki yeri hakkında akademik araştırmalar ve istatistiki verilerden yararlanarak inceleme yapılmıştır. İkinci bölümde, feminizm konusu araştırılarak feminist hareketlerin kadına bakışı incelenmiş, feminizmin tarihsel süreci araştırılmıştır. Üçüncü bölümde, toplumsal cinsiyet ve din konusu ele alınmıştır. Dinlerin kadına bakış açıları araştırılmıştır. Son bölümde ise Ankara’nın merkez ilçelerinde bulunan okullardaki Din Kültürü ve Ahlak Bilgisi öğretmenlerince cevaplandırılmış “toplumsal cinsiyet” konulu anketin sonuçları istatistiksel olarak analiz edilmiştir.The concept of gender, socially refers to the patterns learned in the subjects of feminity and masculinity. Gender studies generally act on women. This concept is closely related to the fact that individuals play an active role in society and live in harmony with the society and know and use the irrights. Education, which is one of these rights, is extremely important in terms of knowing and using other rights. Based on this idea and approach, in our thesis, it has been investigated how the concept of gender is a known concept among the teachers of Religious Culture and Moral Knowledge and how the subject is conveyed to the students. The aim of the study is to investigate how the teachers who teach in a subject that is relevant to everyone, such as religion and morality, have mentioned or have information about the subject. Based on these facts, a situation of gender has been determined for the individual and social reflections of education received by women in Turkey. In this respect, the social importance of feminism and female rights are emphasized. The study consists of four parts. In the first chapter, the concepts of gender and gender are discussed and a broad the oretical knowledge is obtained. In order to determine the gender perception in Turkey, taking advantage of academic research has been conducted and statistical data about the place of women in the social area of the Ottoman Empire until today. Author’s Name and Surname Sümeyra TEMİZHAN Student Number 128102061020 Department Department of Philosophy and Religious Sciences / Discipline of Sociology of Religion Study Programme Master’s Degree (M.A.) X Doctoral Degree (Ph.D.) Supervisor Dr. Lecturer Arif KORKMAZ Title of the Thesis/Dissertation Attitudes of Religious Culture and Moral Knowledge Teachers on Gender: Ankara Province Center Case v In the second part of the study, feminism and the view of feminist movements to women is examined. Then, the historical process of feminism were investigated. In third part of the study, gender and religion are discussed together. The viewpoint of the religions to women has been investigated. In the last part, the survey questions created within the gender scale scope were completed by the teachers of Religious Culture and Moral Knowledge in the schools in Ankara and the results were analyzed statistically