Different definitions of prevalent hypertension impact: the clinical epidemiology of hypertension and attainment of Healthy People goals.
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SUBMITTER: Egan BM
PROVIDER: S-EPMC3589732 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:To reduce the cardiovascular disease burden, Healthy People 2020 established US hypertension goals for adults to (1) decrease the prevalence to 26.9% and (2) raise treatment to 69.5% and control to 61.2%, which requires controlling 88.1% on treatment.To assess the current status and progress toward these Healthy People 2020 goals, time trends in National Health and Nutrition Examination Surveys 1999 to 2012 data in 2-year blocks were assessed in adults ?18 years of age age-adjusted to US 2010. From 1999 to 2000 to 2011 to 2012, prevalent hypertension was unchanged (30.1% versus 30.8%, P=0.32). Hypertension treatment (59.8% versus 74.7%, P<0.001) and proportion of treated adults controlled (53.3%-68.9%, P=0.0015) increased. Hypertension control to <140/<90 mm Hg rose every 2 years from 1999 to 2000 to 2009 to 2010 (32.2% versus 53.8%, P<0.001) before declining to 51.2% in 2011 to 2012. Modifiable factor(s) significant in multivariable logistic regression modeling include: (1) increasing body mass index with prevalent hypertension (odds ratio [OR], 1.44); (2) lack of health insurance (OR, 1.68) and <2 healthcare visits per year (OR, 4.24) with untreated hypertension; (3) healthcare insurance (OR, 1.69), ?2 healthcare visits per year (OR, 3.23), and cholesterol treatment (OR, 1.90) with controlled hypertension.The National Health and Nutrition Examination Survey 1999 to 2012 analysis suggests that Healthy People 2020 goals for hypertension ([1] prevalence shows no progress, [2] treatment was exceeded, and [3] control) have flattened below target. Findings are consistent with evidence that (1) obesity prevention and treatment could reduce prevalent hypertension, and (2) healthcare insurance, ?2 healthcare visits per year, and guideline-based cholesterol treatment could improve hypertension control.
| S-EPMC4221549 | biostudies-literature
Project description:BackgroundAlthough cholinesterase inhibitors have produced statistically significant treatment effects, their clinical meaningfulness in Alzheimer's disease is disputed. An important aspect of clinical meaningfulness is the extent to which an intervention meets the goals of treatment.MethodsIn this randomized controlled trial, patients with mild to moderate Alzheimer's disease were treated with either galantamine or placebo for 4 months, followed by a 4-month open-label extension during which all patients received galantamine. The primary outcome measures were Goal Attainment Scaling (GAS) scores from assessments by clinicians and by patients or caregivers of treatment goals set before treatment and evaluated every 2 months. Secondary outcome measures included the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Clinician's Interview-based Impression of Change plus Caregiver Input (CIBIC-plus), the Disability Assessment for Dementia (DAD) and the Caregiving Burden Scale (CBS). To evaluate treatment effect, we calculated effect sizes (as standardized response means [SRMs]) and p values.ResultsOf 159 patients screened, 130 (mean age 77 [standard deviation (SD) 7.7]; 63% women) were enrolled in the study (64 in the galantamine group and 66 in the placebo group); 128 were included in the analysis because they had at least one post-baseline evaluation. In the intention-to-treat analysis, the clinician-rated GAS scores showed a significantly greater improvement in goal attainment among patients in the galantamine group than among those in the placebo group (change from baseline score 4.8 [SD 9.6]) v. 0.9 [SD 9.5] respectively; SRM = 0.41, p = 0.02). The patient- caregiver-rated GAS scores showed a similar improvement in the galantamine group (change from baseline score 4.2 [SD 10.6]); however, because of the improvement also seen in the placebo group (2.3 [SD 9.0]), the difference between groups was not statistically significant (SRM = 0.20, p = 0.27). Of the secondary outcome measures, the ADAS-cog scores differed significantly between groups (SRM = -0.36, p = 0.04), as did the CIBIC-plus scores (SRM = -0.40, p = 0.03); no significant differences were in either the DAD scores (SRM = 0.28, p = 0.13) or the CBS scores (SRM = -0.17, p = 0.38).InterpretationClinicians, but not patients and caregivers, observed a significantly greater improvement in goal attainment among patients with mild to moderate Alzheimer's disease who were taking galantamine than among those who were taking placebo.
| S-EPMC1421447 | biostudies-literature
Project description:Wastewater-based epidemiology (WBE) emerged as a powerful, actionable health management tool during the COVID-19 pandemic. Hypothesizing future uses, we explored its potential for real-time, tracking of progress in attaining United Nations Sustainable Development Goals (SDGs) globally as a non-expensive method using existing infrastructure. We inventoried (i) literature-documented sewerage infrastructure, (ii) demographics of populations served, and (iii) WBE markers informative of 9 SDGs. Among the 17 different sustainable development goals listed by the UN 2030 agenda, more than half of these may be monitored by using WBE monitoring at centralized treatment infrastructure as tabulated in this study. Driven mainly by COVID-19, WBE currently is practiced in at least 55 countries, reaching about 300 million people. Expansion of WBE to 109,000 + treatment plants inventoried in 129 countries would increase global coverage 9-fold to 34.7% or 2.7 billion, leaving out 5 billion people not served by centralized sewerage systems. Associations between population demographics and present-day infrastructure are explored, and geospatial regions particularly vulnerable to infectious disease outbreaks are identified. The results suggest that difference in the differential outcomes in well-being is an outcome of the sanitation infrastructure inequalities and lack of sanitation infrastructure creates doubly disadvantaged populations at risk of poor hygiene and cut off from the early-warning benefits of conventional WBE. This is the first study to explore the feasibility and potential barriers to the use of WBE for tracking the attainment of SDGs globally with at least 9 out of 17 SDGs.
| S-EPMC9815123 | biostudies-literature
Project description:CONTEXT:Epidemiology is a discipline which has evolved with the changes taking place in society and the emergence of new diseases and new discipline related to epidemiology. With these evolutions, it is important to understand epidemiology and to analyse the evolution of content of definitions of epidemiology. OBJECTIVES:The main objective of this paper was to identify new definitions of epidemiology available since 1978. Secondary objectives were to analyse the content of these definitions, to compare them with those used by Lilienfeld and to determine whether changes have taken place over the last forty years. METHODS:A review of grey literature and published literature was conducted to find the definitions of epidemiology written between 1978 and 2017. RESULTS:102 definitions of epidemiology were retained. They helped to highlight 20 terms and concepts related to epidemiology. Most of them were already used in the definitions used by Lilienfeld. Five terms were present in more than 50% of definitions from the period 1978 to 2017: "population", "study", "disease", "health" and "distribution". Several developments have occurred: strengthening of the terms "control" and "health" already used, the concept of "disease" was less frequently encountered whereas the concepts "infectious diseases", "mass phenomenon" are no longer used in definitions from 1978 to 2017. CONCLUSION:This evolution of content of definition of epidemiology is absent from books on epidemiology. A thematic analysis of definitions of epidemiology could be conducted in order to improve our understanding of changes observed.
| S-EPMC6287859 | biostudies-other
Project description:BackgroundHypertension is common in hemodialysis patients. A subset of patients experience systolic blood pressure increases from prehemodialysis to posthemodialysis (intradialytic hypertension), which are associated with adverse outcomes. However, little consensus exists on an evidence-based definition.MethodsIn 3198 hemodialysis patients, Cox models were fit to examine the association of various definitions of intradialytic hypertension (≥30% of baseline sessions with an increase in prehemodialysis to posthemodialysis systolic blood pressure of (1) ≥0 mm Hg [Hyper0]; (2) ≥10 mm Hg [Hyper10], or (3) ≥20 mm Hg increase [Hyper20]) with all-cause mortality. Effect modification was assessed using interaction terms according to prespecified variables.ResultsAt baseline, mean age was 62±15 years, 57% were male, and 14% of patients were Black. During the baseline period, 47% of individuals met the Hyper0 definition and experienced 32% (hazard ratio, 1.32 [95% CI, 1.05-1.66]) higher adjusted risk of death, compared with no systolic blood pressure increase. Hyper10 was present in 21.2% and associated with 18% higher adjusted risk of death (hazard ratio, 1.18 [95% CI, 0.94-1.48]). Hyper20 was present in 6.8% and associated with 3% higher adjusted risk of death (hazard ratio 1.03 [95% CI, 0.74-1.44]). Effect modification by age and peripheral vascular disease was observed (P interaction=0.04 for age and 0.02 for peripheral vascular disease), with higher associated risk of death for those aged 45 to 70 years and those without peripheral vascular disease.ConclusionsIndividuals with any systolic blood pressure increase from prehemodialysis to posthemodialysis had the highest adjusted risk of mortality, compared with other threshold-based definitions.
| S-EPMC8916991 | biostudies-literature
Project description:Although the etiology of essential hypertension is not clearly understood, endothelial dysfunction from chronic infection and/or impaired glucose metabolism may be involved. We hypothesized that salivary lysozyme, a marker for oral infection and hyperglycemia, might display a significant relationship with hypertension, an early stage of cardiovascular disease. Logistic regression analyses of the Kuopio Oral Health and Heart Study demonstrated that persons with higher lysozyme levels were more likely to have hypertension, after adjustment for age, gender, smoking, BMI, diabetes, the ratio of total cholesterol to HDL cholesterol, and C-reactive protein. The exposure to increasing quartiles of lysozyme was associated with adjusted Odds Ratios for the outcome, hypertension, 1.00 (referent), 1.25, 1.42, and 2.56 (linear trend p < 0.003). When we restricted the sample to the individuals without heart disease (N = 250), we observed a non-significant trend for increasing odds. Our hypothesis--"high salivary lysozyme levels are associated with the odds of hypertension"--was confirmed.
| S-EPMC2895412 | biostudies-other
Project description:BackgroundPrior research has inconsistently operationalized Science, Technology, Engineering, and Math (STEM) fields, presenting an interpretation challenge. A content analysis of 51 quantitative, gender-focused, higher education-oriented, STEM-related studies in the ERIC database published between January 2010 and July 2018 revealed that only 13 articles used an existing STEM definition. In 15, STEM was not explicitly defined, and others defined STEM independently. This wide range of definitions may lead to confusion or misrepresentation of findings for interventions and practices to support women in STEM. To illustrate the issue and prompt recommendations for future research, this study uses data from the United States National Center for Education Statistics' Education Longitudinal Study (ELS:2002/12) to investigate the connection between STEM definition and the outcome of college degree completion, comparing results by gender for five ways of operationalizing STEM fields.ResultsWe found the size, direction, and significance of the gender gap depended on STEM operationalization. When STEM was defined as high paradigm fields, the odds of women attaining a non-STEM degree were higher than otherwise. When social science fields were included in STEM, there was no statistically significant difference by gender. When looking specifically at fields considered related to science and engineering, the direction of the relationship was reversed.ConclusionWhile our findings follow expectations about social science fields and gender, it is noteworthy that results regarding STEM degree completion by gender for science and engineering-related fields were opposite those of high paradigm STEM fields. This result highlights that the definition of STEM matters, and inconsistent operationalization in the literature presents an interpretation challenge. We argue the field should strive to find common categorizations of STEM that retain the legitimate variation in how STEM can and should be defined, while providing a basis for consistent comparison. We recommend researchers and practitioners developing research-based practices: 1) interpret research findings understanding potential inconsistency from different STEM operationalizations, 2) explicitly describe STEM operational definitions to enable comparing findings, 3) routinely analyze sensitivity to alternate STEM definitions, and 4) find common STEM categorizations that retain legitimate variation while providing a basis for consistent comparison.
| S-EPMC6310425 | biostudies-literature
Project description:ObjectiveThe aim of this study is to find the most suitable heat wave definition among 15 different ones and to evaluate its impact on total, age-, and gender-specific mortality for Bandafassi, Senegal.MethodsDaily weather station data were obtained from Kedougou situated at 17 km from Bandafassi from 1973 to 2012. Poisson generalized additive model (GAM) and distributed lag non-linear model (DLNM) are used to investigate the effect of heat wave on mortality and to evaluate the nonlinear association of heat wave definitions at different lag days, respectively.ResultsHeat wave definitions, based on three or more consecutive days with both daily minimum and maximum temperatures greater than the 90th percentile, provided the best model fit. A statistically significant increase in the relative risk (RRs 1.4 (95% Confidence Interval (CI): 1.2-1.6), 1.7 (95% CI: 1.5-1.9), 1.21 (95% CI: 1.08-1.3), 1.2 (95% CI: 1.04-1.5), 1.5 (95% CI: 1.3-1.8), 1.4 (95% CI: 1.2-1.5), 1.5 (95% CI: 1.07-1.6), and 1.5 (95% CI: 1.3-1.8)) of total mortality was observed for eight definitions. By using the definition based on the 90th percentile of minimum and maximum temperature with a 3-day duration, we also found that females and people aged ≥ 55 years old were at higher risks than males and other different age groups to heat wave related mortality.ConclusionThe impact of heat waves was associated with total-, age-, gender-mortality. These results are expected to be useful for decision makers who conceive of public health policies in Senegal and elsewhere. Climate parameters, including temperatures and humidity, could be used to forecast heat wave risks as an early warning system in the area where we conduct this research. More broadly, our findings should be highly beneficial to climate services, researchers, clinicians, end-users and decision-makers.
| S-EPMC8021182 | biostudies-literature
Project description:BackgroundThere is no objective test that can unequivocally confirm the diagnosis of atopic dermatitis (AD), and no uniform clinical definition.ObjectivesTo investigate to what extent operational definitions of AD cause fluctuation in the prevalence estimates and the associated risk factors.MethodsWe first reviewed the operational definitions of AD used in the literature. We then tested the impact of the choice of the most common definitions of 'cases' and 'controls' on AD prevalence estimates and associated risk factors (including filaggrin mutations) among children aged 5 years in two population-based birth cohorts: the Manchester Asthma and Allergy Study (MAAS) and Asthma in Ashford. Model performance was measured by the percentage of children within an area of clinical indecision (defined as having a posterior probability of AD between 25% and 60%).ResultsWe identified 59 different definitions of AD across 45 reviewed studies. Of those, we chose four common 'case' definitions and two definitions of 'controls'. The prevalence estimates using different case definitions ranged between 22% and 33% in MAAS, and between 12% and 22% in Ashford. The area of clinical indecision ranged from 32% to 44% in MAAS and from 9% to 29% in Ashford. Depending on the case definition used, the associations with filaggrin mutations varied, with odds ratios (95% confidence intervals) ranging from 1·8 (1·1-2·9) to 2·2 (1·3-3·7) in MAAS and 1·7 (0·8-3·7) to 2·3 (1·2-4·5) in Ashford. Associations with filaggrin mutations also differed when using the same 'case' definition but different definitions of 'controls'.ConclusionsUse of different definitions of AD results in substantial differences in prevalence estimates, the performance of prediction models and association with risk factors. What's already known about this topic? There is no objective test that can unequivocally confirm the diagnosis of atopic dermatitis (AD) and no uniform clinical definition. This results in different definitions utilized in AD studies, raising concerns on the generalizability of the results and comparability across different studies. What does this study add? This study has shown that different definitions of 'cases' and 'controls' have major impacts upon prevalence estimates and associations with risk factors, including genetics, in two population-based birth cohorts. These findings suggest the importance of developing a consensus on AD definitions of both 'controls' and 'cases' to minimize biases in studies.
| S-EPMC6916614 | biostudies-literature
Project description:BackgroundThe purpose of this study was to evaluate the daily feeding practice of enterally fed patients in an intensive care unit (ICU) and to study the impact of preset factors in reaching predefined optimal nutritional goals.MethodsThe feeding practice of all ICU patients receiving enteral nutrition for at least 48 hours was recorded during a 1-year period. Actual intake was expressed as the percentage of the prescribed volume of formula (a success is defined as 90% or more). Prescribed volume (optimal intake) was guided by protocol but adjusted to individual patient conditions by the intensivist. The potential barriers to the success of feeding were assessed by multivariate analysis.ResultsFour-hundred-and-three eligible patients had a total of 3,526 records of feeding days. The desired intake was successful in 52% (1,842 of 3,526) of feeding days. The percentage of successful feeding days increased from 39% (124 of 316) on day 1 to 51% (112 of 218) on day 5. Average ideal protein intake was 54% (95% confidence interval (CI) 52 to 55), energy intake was 66% (95% CI 65 to 68) and volume 75% (95% CI 74 to 76). Factors impeding successful nutrition were the use of the feeding tube to deliver contrast, the need for prokinetic drugs, a high Therapeutic Intervention Score System category and elective admissions.ConclusionThe records revealed an unsatisfactory feeding process. A better use of relative successful volume intake, namely increasing the energy and protein density, could enhance the nutritional yield. Factors such as an improper use of tubes and feeding intolerance were related to failure. Meticulous recording of intake and interfering factors helps to uncover inadequacies in ICU feeding practice.
| S-EPMC1175883 | biostudies-literature