RESUMEN

BACKGROUND: The emerging role of vitamin D has drawn the attention of researchers around the world, including its involvement in cardiovascular complications among individuals with diabetes. AIM: This study aimed to obtain comprehensive evidence on the association between serum vitamin D level and the risk of cardiovascular disease among patients with diabetes. METHODS: Systematic search was performed on July 1st, 2023, to identify and screen published literature reporting the association between vitamin D and cardiovascular disease among diabetic patients in six databases. Each eligible study was appraised for its quality using modified Newcastle Ottawa Scale for cross-sectional and cohort studies. Meta-analysis was performed using Dersimonian-Laird random effect model or fix-effect model. The heterogeneity and publication bias were judged based on percentage of I2 and the symmetry of Begg's funnel plot, respectively. RESULTS: As many as 22 studies were found eligible for the systematic review. A meta-analysis from 13 studies comprising of 3850 and 1797 (control and exposure groups, respectively) revealed that serum vitamin D level was significantly lower in patients with diabetes and cardiovascular diseases (Z = 4.89; p-total<0.001; SMD = 0.68 [95%CI: 0.41-0.95]), yet the heterogeneity was high. Following the adjustment of removing the potential outliers, the same results were still observed (Z = 6.19; p-total<0.001; SMD = 0.35 [95%CI: 0.24-0.46]). Though decreased, high heterogeneity could not be resolved, resulting in moderate level of this evidence. Another pooled analysis of 7 studies with 4211 patients in control group and 2381 patients in exposure group revealed that lower level of serum vitamin D is a risk factor for cardiovascular disease incidence among diabetic patients (Z = 4.89; p-total<0.001; OR: 1.76 [95%CI: 1.4-2.2]). CONCLUSION: Serum vitamin D level status is a risk factor for developing cardiovascular diseases among diabetic patients, hence should be carefully monitored and maintained. PROSPERO REGISTRATION: CRD42023437698.

Asunto(s)

RESUMEN

Applicability of smartphone-based digital health in diabetes management still face challenges due tolow user retention or engagement. Thus, this systematic and meta-analysis aimed to estimate the dropout rate from the clinical trials. Search of literature was performedon 4 September 2023 through various databases (PubMed, Scilit, Scopus, Embase, and Web of Science). Those reporting clinical trials of smartphone apps for diabetic controls (either type 1 or type 2 diabetes mellitus) were screened and selected in accordance with PRISMA guideline. Of 5,429 identified records, as many as 36 studies were found eligible with a total of 3,327 patients in the intervention group. The overall dropout rate was 29.6 % (95 %CI: 25 %-34.3 %) with high heterogeneity (p-Het < 0.001;I2 = 84.84 %). Sample size, intervention duration, patients' age and gender, and cultural adaptation on the app appeared to be non-significant moderators (p > 0.05). In sub-group levels, notably high dropout rates were observed in studies performing cultural adaptation (34.6 %) and conducted in high-income countries (31.9 %). Given the high dropout rate, the engagement level toward diabetic management apps in real-world setting is expected to be low. High heterogeneity in this study, however, requires careful interpretation of the foregoing results. PROSPERO: CRD42023460365 (14 September 2023).

Asunto(s)

RESUMEN

The caregivers of people with schizophrenia might suffer from various problems. We investigated the prevalence of depression, anxiety, and stress among them, and factors associated with their quality of life. A cross-sectional study in communities of rural areas was conducted. We found that the prevalence of depression, anxiety, and stress were 14.2%, 25.5%, and 6.6%, respectively. Their quality of life was independently associated with family functioning (affective responsiveness, problem solving, communication) and the presence of depressive symptoms (p < .05). Schizophrenia caregivers need more supports from health care professionals to improve their skills in problem solving.

Asunto(s)

RESUMEN

Police officers may be at a higher risk of suffering from mental disorders (MDs) compared with other occupations. This study aimed to examine the physiological predictors of MDs among police officers in Indonesia. The mental health status of each participant was examined using a standardized Minnesota Multiphasic Personality Inventory (MMPI) tool and underwent several laboratory examinations including hematology, urine, serology, and electrocardiogram tests. A logistic regression was performed to calculate the odds ratio. Of the 4590 participants, 2.14% were diagnosed with MDs. The study found 19 physiological variables are potential predictors of MDs. In multivariate analysis adjusted for body mass index, sex, and age, the concentration of ketones, protein, and specific gravity in urine and the amount of lymphocyte in the blood are among important predictors of MDs. This suggests that carefully examining the results of urinalysis and hematology tests can help us detect early cases of MDs among police officers.

Asunto(s)

RESUMEN

OBJECTIVE: To compare a simple measure - age of onset of obesity - to an obese-years construct (a product of duration and magnitude of obesity) as risk factors for type 2 diabetes. METHOD: Participants from the Framingham Heart Study who were not obese and did not have diabetes at baseline were included (n=4,320). The Akaike Information Criterion (AIC) was computed to compare four Cox proportional hazards models with incident diabetes as the outcome and: (i) obese-years; (ii) age of onset of obesity; (iii) body mass index (BMI); and (iv) age of onset of obesity plus magnitude of BMI combined, as exposures. RESULTS: AIC indicated that the model with obese-years provided a more effective explanation of incidence of type 2 diabetes compared to the remaining three models. Models including age of onset of obesity plus BMI were not appreciably different from the model with BMI alone, except in those aged ≥60. CONCLUSIONS: While obese-years was the optimal obesity construct to explain risk of type 2 diabetes, age of onset may be a useful, practical addition to current BMI in the elderly. IMPLICATIONS: Where computation of obese-years is not possible or impractical, age of onset of obesity combined with BMI may provide a useful alternative.

Asunto(s)

RESUMEN

BACKGROUND: We have recently demonstrated that an obese-years construct is a better predictor of the risk of diabetes than the severity of body weight alone. However, these risk estimates were derived from a population cohort study initiated in 1948 that might not apply to the current population. OBJECTIVE: To validate an obese-years construct in estimating the risk of type-2 diabetes in a more contemporary cohort study. DESIGN: A total of 5,132 participants of the Framingham Offspring Study, initiated in 1972, were followed up for 45 years. Body mass index (BMI) above 29 kg/m(2) was multiplied by the number of years lived with obesity at that BMI to define the number of obese-years. Time-dependent Cox regression was used to explore the association. RESULTS: The risk of type-2 diabetes increased significantly with increase in obese-years. Adjusted hazard ratios increased by 6% (95% CI: 5-7%) per additional 10 points of obese-years. This ratio was observed to be similar in both men and women, but was 4% higher in current smokers than in never/ex-smokers. The Akaike Information Criterion confirmed that the Cox regression model with the obese-years construct was a stronger predictor of the risk of diabetes than a model including either BMI or the duration of obesity alone. CONCLUSIONS: In a contemporary cohort population, it was confirmed that the obese-years construct is strongly associated with an increased risk of type-2 diabetes. This suggests that both severity and the duration of obesity should be considered in future estimations of the burden of disease associated with obesity.

RESUMEN

BACKGROUND: Similar to global trends, neonatal mortality has fallen only slightly in Indonesia over the period 1990-2010, with a high proportion of deaths in the first week of life. OBJECTIVE: This study aimed to identify risk factors associated with neonatal deaths of low and normal birthweight infants that were amenable to health service intervention at a community level in a relatively poor province of Indonesia. DESIGN: A matched case-control study of neonatal deaths reported from selected community health centres (puskesmas) was conducted over 10 months in 2013. Cases were singleton births, born by vaginal delivery, at home or in a health facility, matched with two controls satisfying the same criteria. Potential variables related to maternal and neonatal risk factors were collected from puskesmas medical records and through home visit interviews. A conditional logistic regression was performed to calculate odds ratios using the clogit procedure in Stata 11. RESULTS: Combining all significant variables related to maternal, neonatal, and delivery factors into a single multivariate model, six factors were found to be significantly associated with a higher risk of neonatal death. The factors identified were as follows: neonatal complications during birth; mother noting a health problem during the first 28 days; maternal lack of knowledge of danger signs for neonates; low Apgar score; delivery at home; and history of complications during pregnancy. Three risk factors (neonatal complication at delivery; neonatal health problem noted by mother; and low Apgar score) were significantly associated with early neonatal death at age 0-7 days. For normal birthweight neonates, three factors (complications during delivery; lack of early initiation of breastfeeding; and lack of maternal knowledge of neonatal danger signs) were found to be associated with a higher risk of neonatal death. CONCLUSION: The study identified a number of factors amenable to health service intervention associated with neonatal deaths in normal and low birthweight infants. These factors include maternal knowledge of danger signs, response to health problems noted by parents in the first month, early initiation of breastfeeding, and delivery at home. Addressing these factors could reduce neonatal deaths in low resource settings.

Asunto(s)

RESUMEN

Many developing countries have achieved a remarkable improvement in nutrition status in the past decades. However, the prevalence of undernutrition remains a serious problem. At the same time, the prevalence of obesity is increasing substantially, and in some countries, it has approached that of developed countries. This article provides an update on this double burden of malnutrition (DBMN) in developing nations. One hundred countries (lower, middle-lower, and upper-middle income countries) were selected and analysed, and to support the analysis, a systematic review of current published studies was performed. The results show that DBMN already exists in almost all developing countries and that the DBMN ratio (i.e., overweight/underweight) has increased as income per capita has increased. DBMN may manifest within the community, household, or individual. In addition to common factors, poor nutrition in early childhood is suggested as another important driving factor behind the rising obesity rate in most developing countries. A life-course approach has been proposed to prevent undernutrition and overnutrition and should be integrated into the development of health systems to control double burden in developing countries.

Asunto(s)

RESUMEN

At BMC Obesity, the Policies, Socio-economic Aspects, and Health Systems Research Section provides an opportunity to submit research focussed on what we need to know to support implementation of obesity policies most likely to achieve substantial, sustainable and equitable reductions in the prevalence of obesity globally. Here, we present the aims and objectives of this section, hearing from each of the Associate Editors in turn. The ambition of the Policies, Socio-economic Aspects, and Health Systems Research Section is to foster innovative research combining scientific quality with real world experience. We envisage this will include research addressing the structural drivers of obesity, solution oriented research, research addressing socio-economic inequalities in obesity and obesity prevention in low and middle income countries. We look forward to stimulating research to advance both the methods and substance required to drive uptake of effective and equitable obesity reduction policies globally.

RESUMEN

OBJECTIVE: To relate measured obesity duration in mid-life with subsequent incidence of physical disability over and above body mass index (BMI) attained. METHODS: Framingham Offspring Study is a longitudinal study that began in 1971. Examination 5 (1991-1995; "baseline") and disability onset ascertained from examinations 6-8 (2008) were used. About 2,095 disability-free participants aged 45-65 years at baseline were included. Obesity (BMI ≥ 30 kg/m(2) ) duration was calculated between examination 1 and examination 5. Cox regression was used to analyze time to disability. RESULTS: 204 participants developed disability (incidence rate=7.9 per 1,000 person-years). Obesity duration ranged from 0 to 22 years (mean of 2.0 years overall, 8.3 years for those with baseline obesity). Obesity duration increased risk of new disability (hazard ratio [HR] 1.07 per year of obesity; 95% confidence interval [CI] 1.05-1.09). This association was attenuated on further adjustment for baseline BMI (HR 1.03; 95% CI 1.00-1.06). CONCLUSIONS: Being obese for longer during mid-life increases the risk of later-life disability over and above attained BMI. These results support the need for prevention of weight gain in young adults to avoid an increasing burden of physical disability in later life.

Asunto(s)

RESUMEN

BACKGROUND: Previous studies exploring the association between obesity and hypertension generally used a single baseline measurement of obesity. The effect of accumulating excess adiposity over time on the risk of hypertension is uncertain. This study aimed to examine the relationship between duration of obesity and incident hypertension using the Framingham Heart Study. METHODS: Two thousand, nine hundred and fifty-three participants aged 30-62 years without baseline hypertension were included. Blood pressure, height and weight were measured biennially. Duration of obesity was calculated. Time to incident hypertension was analysed using time-varying Cox proportional hazards regression with age as the time scale and censoring at time of death or end of follow-up. RESULTS: Eighty percent of participants developed hypertension (median follow-up 15.9 years). A positive association between obesity duration and incident hypertension was observed in women. There was no longer an association when time-varying BMI was adjusted for (hazard ratio 0.95; (95% confidence interval 0.85-1.05)). CONCLUSION: These findings suggest that the mechanism by which excess adiposity may increase blood pressure is primarily immediate and that long-term exposure to obesity does not further increase the risk of developing hypertension beyond the level of BMI attained.

Asunto(s)

RESUMEN

Addressing the growing burden of noncommunicable diseases (NCDs) in countries of the Asia-Pacific region requires well-functioning health systems. In low- and middle-income countries (LMICs), however, health systems are generally characterized by inadequate financial and human resources, unsuitable service delivery models, and weak information systems. The aims of this review were to identify (a) health systems interventions being implemented to deliver NCD programs and services and their outcomes and (b) the health systems bottlenecks impeding access to or delivery of these programs and services in LMICs of the Asia-Pacific region. A search of 4 databases for literature published between 1990 and 2010 retrieved 36 relevant studies. For each study, information on basic characteristics, type of health systems bottleneck/intervention, and outcome was extracted, and methodological quality appraised. Health systems interventions and bottlenecks were classified as per the World Health Organization health systems building blocks framework. The review identified interventions and bottlenecks in the building blocks of service delivery, health workforce, financing, health information systems, and medical products, vaccines, and technologies. Studies, however, were heterogeneous in methodologies used, and the overall quality was generally low. There are several gaps in the evidence base around NCDs in the Asia-Pacific region that require further investigation.

Asunto(s)

RESUMEN

OBJECTIVE: To examine the association between obese-years and the risk of cardiovascular disease (CVD). STUDY DESIGN: Prospective cohort study. SETTING: Boston, USA. PARTICIPANTS: 5036 participants of the Framingham Heart Study were examined. METHODS: Obese-years was calculated by multiplying for each participant the number of body mass index (BMI) units above 29 kg/m(2) by the number of years lived at that BMI during approximately 50 years of follow-up. The association between obese-years and CVD was analysed using time-dependent Cox regression adjusted for potential confounders and compared with other models using the Akaike information criterion (AIC). The lowest AIC indicated better fit. PRIMARY OUTCOME CVD RESULTS: The median cumulative obese-years was 24 (range 2-556 obese-years). During 138,918 person-years of follow-up, 2753 (55%) participants were diagnosed with CVD. The incidence rates and adjusted HR (AHR) for CVD increased with an increase in the number of obese-years. AHR for the categories 1-24.9, 25-49.9, 50-74.9 and ≥75 obese-years were, respectively, 1.31 (95% CI 1.15 to 1.48), 1.37 (95% CI 1.14 to 1.65), 1.62 (95% CI 1.32 to 1.99) and 1.80 (95% CI 1.54 to 2.10) compared with those who were never obese (ie, had zero obese-years). The effect of obese-years was stronger in males than females. For every 10 unit increase in obese-years, the AHR of CVD increased by 6% (95% CI 4% to 8%) for males and 3% (95% CI 2% to 4%) for females. The AIC was lowest for the model containing obese-years compared with models containing either the level of BMI or the duration of obesity alone. CONCLUSIONS: This study demonstrates that obese-years metric conceptually captures the cumulative damage of obesity on body systems, and is found to provide slightly more precise estimation of the risk of CVD than the level or duration of obesity alone.

Asunto(s)

RESUMEN

Despite significant investment in improving service infrastructure and training of staff, public primary healthcare services in low-income and middle-income countries tend to perform poorly in reaching coverage targets. One of the factors identified in Aceh, Indonesia was the lack of operational funds for service provision. The objective of this study was to develop a simple and transparent costing tool that enables health planners to calculate the unit costs of providing basic health services to estimate additional budgets required to deliver services in accordance with national targets. The tool was developed using a standard economic approach that linked the input activities to achieving six national priority programs at primary healthcare level: health promotion, sanitation and environment health, maternal and child health and family planning, nutrition, immunization and communicable diseases control, and treatment of common illness. Costing was focused on costs of delivery of the programs that need to be funded by local government budgets. The costing tool consisting of 16 linked Microsoft Excel worksheets was developed and tested in several districts enabled the calculation of the unit costs of delivering of the six national priority programs per coverage target of each program (such as unit costs of delivering of maternal and child health program per pregnant mother). This costing tool can be used by health planners to estimate additional money required to achieve a certain level of coverage of programs, and it can be adjusted for different costs and program delivery parameters in different settings.

Asunto(s)

RESUMEN

This study aims to test the effect of combining the degree and the duration of obesity into a single variable-obese-years-and to examine whether obese-years is a better predictor of the risk of diabetes than simply body mass index (BMI) or duration of obesity. Of the original cohort of the Framingham Heart Study, 5,036 participants were followed up every 2 years for up to 48 years (from 1948). The variable, obese-years, was defined by multiplying for each participant the number of BMI units above 30 kg/m(2) by the number of years lived at that BMI. Associations with diabetes were analyzed by using time-dependent Cox proportional hazards regression models adjusted for potential confounders. The incidence of type-2 diabetes increased as the number of obese-years increased, with adjusted hazard ratios of 1.07 (95% confidence interval: 1.06, 1.09) per additional 10 obese-years. The dose-response relation between diabetes incidence and obese-years varied by sex and smoking status. The Akaike Information Criterion was lowest in the model containing obese-years compared with models containing either the degree or duration of obesity alone. A construct of obese-years is strongly associated with risk of diabetes and could be a better indicator of the health risks associated with increasing body weight than BMI or duration of obesity alone.

Asunto(s)

RESUMEN

BACKGROUND: The role of the duration of obesity as an independent risk factor for mortality has not been investigated. The aim of this study was to analyse the association between the duration of obesity and the risk of mortality. METHODS: A total of 5036 participants (aged 28-62 years) of the Framingham Cohort Study were followed up every 2 years from 1948 for up to 48 years. The association between obesity duration and all-cause and cause-specific mortality was analysed using time-dependent Cox models adjusted for body mass index. The role of biological intermediates and chronic diseases was also explored. RESULTS: The adjusted hazard ratio (HR) for mortality increased as the number of years lived with obesity increased. For those who were obese for 1-4.9, 5-14.9, 15-24.9 and ≥ 25 years of the study follow-up period, adjusted HRs for all-cause mortality were 1.51 [95% confidence interval (CI) 1.27-1.79], 1.94 (95% CI 1.71-2.20), 2.25 (95% CI 1.89-2.67) and 2.52 (95% CI 2.08-3.06), respectively, compared with those who were never obese. A dose-response relation between years of duration of obesity was also clear for all-cause, cardiovascular, cancer and other-cause mortality. For every additional 2 years of obesity, the HRs for all-cause, cardiovascular disease, cancer and other-cause mortality were 1.06 (95% CI 1.05-1.07), 1.07 (95% CI 1.05-1.08), 1.03 (95% CI 1.01-1.05) and 1.07 (95% CI 1.05-1.11), respectively. CONCLUSIONS: The number of years lived with obesity is directly associated with the risk of mortality. This needs to be taken into account when estimating its burden on mortality.

Asunto(s)

RESUMEN

OBJECTIVE: The evidence for the association between obesity and the risk of type 2 diabetes has been derived mainly from the analysis of the degree of obesity. The role of the duration of obesity as an independent risk has not been fully explored. The objective of the present study was to investigate the association between the duration of obesity and the risk of type 2 diabetes. DESIGN: Prospective cohort study. SETTING: The Framingham Heart Study (FHS), follow-up from 1948 to 1998. SUBJECTS: A total of 1256 FHS participants who were free from type 2 diabetes at baseline, but were obese on at least two consecutive of the study's twenty-four biennial examinations, were included. Type 2 diabetes status was collected throughout the 48 years of follow-up of the study. The relationship between duration of obesity and type 2 diabetes was analysed using time-dependent Cox models, adjusting for a number of covariates. RESULTS: The unadjusted hazard ratio (HR) for the risk of type 2 diabetes for men was 1.13 (95 % CI 1.09, 1.17) and for women was 1.12 (95 % CI 1.08, 1.16) per additional 2-year increase in the duration of obesity. Adjustment for sociodemographic variables, family history of diabetes, health behaviour and physical activity made little difference to these HR. For women the evidence of a dose-response relationship was less clear than for men, particularly for women with an older age at obesity onset. CONCLUSIONS: The duration of obesity is a relevant risk factor for type 2 diabetes, independent of the degree of BMI.

Asunto(s)

RESUMEN

The nature of excess body weight may be changing over time to one of greater central adiposity. The aim of this study is to determine whether BMI and waist circumference (WC) are increasing proportionately among population subgroups and the range of bodyweight, and to examine the public health implications of the findings. Our data are from two cross-sectional surveys (the US National Health and Nutrition Examination Studies (NHANES) in 1988-1994 (NHANES III) and 2005-2006), from which we have used samples of 15,349 and 4,176 participants aged ≥20 years. Between 1988-1994 and 2005-2006 BMI increased by an average of 1.8 kg/m² and WC by 4.7 cm (adjusted for sex, age, race-ethnicity, and education). The increase in WC was more than could be attributed simply to increases in BMI. This independent increase in WC (of on average, 0.9 cm) was consistent across the different BMI categories, sexes, education levels, and race-ethnicity groups. It occurred in younger but not older age groups. Overall in each BMI category, the prevalence of low-risk WC decreased and the prevalence of increased-risk or substantially increased-risk WC increased. These results suggest that the adverse health consequences associated with obesity may be increasingly underestimated by trends in BMI alone. Since WC is closely linked to adverse cardiovascular outcomes, it is important to know the prevailing trends in both of these parameters.

Asunto(s)

RESUMEN

The objectives of this meta-analysis were to examine the magnitude of the relative risk (RR) of developing type 2 diabetes for overweight and obese populations, compared to those with normal weight, and to determine causes of the variation in RR between various cohort studies. The magnitude of the RR was analyzed by combining 18 prospective cohort studies that matched defined criteria. The variance in RR between studies was explored. The overall RR of diabetes for obese persons compared to those with normal weight was 7.19, 95% CI: 5.74, 9.00 and for overweight was 2.99, 95% CI: 2.42, 3.72. The variation in RR among studies was explored and it was found that the effect of heterogeneity was highly related with sample size, method of assessment of body mass index (BMI) and method of ascertainment of type 2 diabetes. By combining only cohort studies with more than 400 cases of incident diabetes (>median), adjusted by at least three main confounding variables (age, family history of type 2 diabetes, physical activity), measured BMI, and diabetes determined by clinical diagnosis, the RR was 7.28, 95% CI: 6.47, 8.28 for obesity and 2.92, 95% CI: 2.57, 3.32 for overweight.

Asunto(s)

RESUMEN

Health resource allocation has been an issue of political debate in many health systems. However, the debate has tended to concentrate on vertical allocation from the national to regional level. Allocation within regions or institutions has been largely ignored. This study was conducted to contribute analysis to this gap. The objective was to investigate health resource allocation within District Health Offices (DHOs) and to compare the trends and patterns of several budget categories before and after decentralization. The study was conducted in three districts in the Province of Nanggroe Aceh Darussalam. Six fiscal year budgets, two before decentralization and four after, were studied. Data was collected from the Local Government Planning Office and DHOs. Results indicated that in the first year of implementing a decentralization policy, the local government budget rose sharply, particularly in the wealthiest district. In contrast, in relatively poor districts the budget was only boosted slightly. Increasing total local government budgets had a positive impact on increasing the health budget. The absolute amount of health budgets increased significantly, but by percentage did not change very much. Budgets for several projects and budget items increased significantly, but others, such as health promotion, monitoring and evaluation, and public-goods-related activities, decreased. This study concluded that decentralization in Indonesia had made a positive impact on district government fiscal capacity and had affected DHO budgets positively. However, an imbalanced budget allocation between projects and budget items was obvious, and this needs serious attention from policy makers. Otherwise, decentralization will not significantly improve the health system in Indonesia.

Asunto(s)