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: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: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
Project description:BackgroundUnderstanding the processes across childhood and adolescence that affect later life inequalities depends on many variables for a large number of individuals measured over substantial time periods. Linkable administrative data were used to generate birth cohorts and to study pathways of inequity in childhood and early adolescence leading to differences in educational attainment. Advantages and disadvantages of using large administrative data bases for such research were highlighted.MethodsChildren born in Manitoba, Canada between 1982 and 1995 were followed until age 19 (N = 89,763), with many time-invariant measures serving as controls. Five time-varying predictors of high school graduation-three social and two health-were modelled using logistic regression and a framework for examining predictors across the life course. For each time-varying predictor, six temporal patterns were tested: full, accumulation of risk, sensitive period, and three critical period models.ResultsPredictors measured in early adolescence generated the highest odds ratios, suggesting the importance of adolescence. Full models provided the best fit for the three time-varying social measures. Residence in a low-income neighborhood was a particularly influential predictor of not graduating from high school. The transmission of risk across developmental periods was also highlighted; exposure in one period had significant implications for subsequent life stages.ConclusionThis study advances life course epidemiology, using administrative data to clarify the relationships among several measures of social behavior, cognitive development, and health. Analyses of temporal patterns can be useful in studying such other outcomes as educational achievement, teen pregnancy, and workforce participation.
| S-EPMC5744927 | biostudies-literature
Project description:ObjectiveTo describe functional goals and factors associated with goal attainment among low-income older adults with disabilities living in the community.DesignSecondary analysis.SettingParticipants' homes.ParticipantsOlder adults (N=226) with disability who participated in the Community Aging in Place, Advancing Better Living for Elders trial.InterventionsA 5-month, home-based, person-directed, structured program delivered by an interprofessional team: occupational therapist, registered nurse, and handyman.Main outcome measuresProcess of occupational therapist goal setting and attainment at the final occupational therapist visit.ResultsParticipants identified 728 functional goals (mean of 3.2 goals per participant), most commonly related to transferring (22.0%; n=160 goals), changing or maintaining body position (21.4%; n=156 goals), and stair climbing (13.0%; n=95 goals). Participants attained 73.5% (n=535) of goals. Goal attainment was highest for stair climbing (86.3%), transferring (85.6%), and self-care (84.6%); walking goals were less likely attained (54.0%). Goal attainment was not associated with age, sex, education, depressive symptoms, function, or health-related quality of life but was less likely among participants who had severe pain compared with those without pain (adjusted odds ratio, 0.38; 95% confidence interval, 0.17-0.86). When participant readiness to change score increases by 1 point on the 4-point scale, goal attainment was 62% more likely (adjusted odds ratio, 1.62; 95% confidence interval, 1.14-2.29).ConclusionsHome-based collaborative goal setting between older adults and occupational therapists is feasible and particularly effective when individuals are ready or willing to adopt new strategies to achieve identified goals.
| S-EPMC5403585 | biostudies-literature