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Appraisal of Five Clinical Guidelines for the Management of Hypertension in Andean Countries and Europe

World Journal of Cardiovascular Diseases 2014年第5期4卷 211-216页

作者： Juan Moreira Edison Jaramillo Mariella Anselmi Roberto Sempertegui Patricia Ortiz Maria Belen Mena Gianni Tognoni Centro de Epidemiología Comunitaria y Medicina Tropical Esmeraldas Ecuador Department of Community Health Facultad de Ciencias Médicas Universidad Central del Ecuador Quito Ecuador Facultad de Medicina Pontificia Universidad Católica del Ecuador Quito Ecuador Fundación Salud Ambiente y Desarrollo Quito Ecuador

There is global concern on the methodological limitations, transferability and effectiveness of clinical practice guidelines (CPGs) for chronic non-communicable diseases, particularly for hypertension. Bolivia, Ecuador and Peru have regularly produced CPGs;however no formal assessment has been done on their contents, transferability and effectiveness. The past decade saw significant migration from Andean countries to Europe. Knowing how European CPGs compare with those produced in Andean countries is necessary to recommend future changes targeted to the migrant population. A systematic search of CPGs was done on indexed databases and non-indexed publications. Recognized and approved CPGs were identified by technical officers in the Ministries of Health of the respective countries. The guidelines of the European Society of hypertension and four selected CPGs from the Andean countries were assessed by two independent evaluators using the “Agree II instrument for assessing clinical practice guidelines, AGREE II Consortium, May 2009”. Comparison of the CPGs is based on the six domain scores provided by the Agree II instrument. The overall score of CPGs ranged from 1.85 to 2.94 of 6 maximum possible. The European CPG scored highest in 3 of 6 domains compared, most notably in rigor of development. Average domain scores for clarity of presentation (0.84) and scope and purpose (0.64) were highest scores for applicability (0.30). Stakeholder involvement (0.28) and rigor of development (0.17) were the lowest. The CPGs assessed appear to fail meeting the standards of quality and pertinence. They show a progressive worsening from domains declaring good intentions of being clear, to those which measure their hard aspects and implications.

关键词： Hypertension Clinical Practice Guidelines Andean Countries Chronic non-communicable Diseases

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Selected Trace Elements in Domestic Water Boreholes and Their Implications on Human Health, in Huruma Estate, Eldoret Municipality, Uasin-Gishu County, Kenya

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Journal of Environmental Protection 2014年第1期5卷 65-70页

作者： Taratisio Ndwiga Department of Environmental Health School of Public Health Moi University Eldoret Kenya.

Trace elements constitute less than 1% of the rocks in the crust (Stumm and Morgan, 1991). In the human body, they constitute less than 100 mg/kg (0.01%). These elements are released to the environment naturally by weathering and volcanic activities (Flint and skinner, 1997). It has been observed that trace elements are greatly absorbed and retained in the body when in liquid diet. This phenomenon also influences the risk to human health, especially of infants and children whose immature digestive system further promote absorption of toxic heavy metals. The study was based on the analysis of domestic borehole water supplies in Huruma estate of Eldoret Municipality for selected trace elements and their implications on human health. The boreholes were systematically selected for sampling points and trace elements, Cr, Cu and Se analyzed using AAS. Statistical analysis for mean, standard deviation and confidence interval limits was done using SPSS. The statistical t-test was used to test for significance differences at (p = 0.05). The graphs were drawn using the Microsoft Excel package. The resulting data obtained from analysis were compared with WHO data for drinking water. In the study, the mean values of the following parameters were as follows: Chromium 17.9 μg/L, Copper 563 μg/L and Selenium 22.7 μg/L. There was a significant difference at 5% level of significance (p = 0.000) in all the parameter values among the sampling points in Huruma estate. The above mean values were far below the WHO recommended limits for drinking water. It was concluded that the borehole water from Huruma was fit for drinking and therefore could not cause cancer and cardiovascular diseases. However, borehole water should be used if other water sources (tap water etc.) were not available. All the industries near Huruma estate should carefully analyze and regularly monitor their liquid waste effluents to ensure that no harmful discharges get into the soil.

关键词： Trace Elements Human Health Chronic Exposure Borehole non-communicable Disease

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Esophageal squamous cell cancer in a highly endemic region

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World Journal of Gastroenterology 2016年第9期22卷 2811-2817页

作者： Akwi W Asombang Violet Kayamba Mpala M Lisulo Kathryn Trinkaus Victor Mudenda Edford Sinkala Stayner Mwanamakondo Themba Banda Rose Soko Paul Kelly Division of Gastroenterology and Hepatology University of Missouri School of Medicine Department of Internal Medicine University of Zambia School of Medicine University Teaching Hospital Tropical Gastroenterology and Nutrition Group University of Zambia School of Medicine University Teaching Hospital Washington University School of Medicine Biostatistics Shared Resource Siteman Cancer Center Department of Pathology University of Zambia School of Medicine Blizard Institute Barts and The London School of Medicine Queen Mary University of London

AIM: To identify risk factors associated with esophageal cancer in Zambia and association between dietary intake and urinary 8-iso prostaglandin F2α(8-iso PGF2α).METHODS: We conducted a prospective, case control study at the University Teaching Hospital. Subjects included both individuals admitted to the hospital and those presenting for an outpatient upper endoscopy. Esophageal cancer cases were compared to age and sex-matched controls. Cases were defined as patients with biopsy proven esophageal cancer; controls were defined as subjects without endoscopic evidence ofesophageal cancer. Clinical and dietary data were collected using a standard questionnaire, developed a priori. Blood was collected for human immunodeficiency virus(HIV) serology. Urine was collected, and 8-iso PGF2α was measured primarily by enzyme-linked immunosorbent assay and expressed as a ratio to ***: Forty five controls(mean age 54.2 ± 15.3, 31 male) and 27 cases(mean age 54.6 ± 16.4, 17 males) were studied. Body mass index was lower in cases(median 16.8) than controls(median 23.2), P = 0.01. Histopathologically, 25/27(93%) were squamous cell carcinoma and 2/27(7%) adenocarcinoma. More cases smoked cigarettes(OR = 11.24, 95%CI: 1.37-92.4, P = 0.02) but alcohol consumption and HIV seropositivity did not differ significantly(P = 0.14 for both). Fruit, vegetables and fish consumption did not differ significantly between groups(P = 0.11, 0.12, and 0.10, respectively). Mean isoprostane level was significantly higher in cases(0.03 ng/mg creatinine) than controls(0.01 ng/mg creatinine)(OR = 2.35, 95%CI: 1.19-4.65, P = 0.014).CONCLUSION: Smoking and isoprostane levels were significantly associated with esophageal cancer in Zambians, but diet, HIV status, and alcohol consumption were not.

关键词： Gastrointestinal cancer non-communicable diseases Zambia

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Influenza prevention can help meet wider public health objectives

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Health 2012年第10期4卷 963-967页

作者： Abraham Palache International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Influenza Vaccine Supply International Task Force (IVS ITF) Geneva Switzerland

Influenza burden: Influenza imposes a major burden on people and public health systems, causing millions of severe cases and up to one million deaths annually. Much of this burden is borne by those aged 65 or over, children under 2 years of age and people with non-communicable chronic diseases, such as heart and lung conditions and diabetes. In the elderly, influenza can have longer-term effects beyond acute infection, with some facing increased disability and care requirements. Prevention: Taking into account the growing elderly population worldwide and their susceptibility to non-communicable conditions as well as rising healthcare costs, public health policies are increasingly focusing on disease prevention strategies and promotion of healthy ageing initiatives. Influenza vaccination has an important role to play in these approaches. Immunization of high-risk groups is recommended by public health organizations, both internationally and locally within many countries. However, although vaccines are considered the most effective method for preventing influenza, many high-risk people remain unvaccinated. Improving vaccination rates: In recent years, research has focused on increasing vaccine coverage. The results demonstrate the key role healthcare professionals play in encouraging immunization, alongside factors such as communication, education and financial support for vaccination. Paradoxically, although vaccination recommendations often include healthcare professionals and studies demonstrate the potential protection offered to workers and patients, many remain unvaccinated. As a result, a growing number of organizations, particularly in North America, are implementing policies requiring vaccination of healthcare pro fessionals as a patient safety measure. In summary: Influenza vaccination has a key role to play in helping to protect the health of the growing elderly population, reduce the burden associated with non-communicable diseases and decrease the annual

关键词： Influenza non-communicable Disease Vaccination Public Health Policy Healthy Ageing Healthcare Professional Patient Safety

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Blood pressure,prevalence of hypertension and hypertension related complications in Nigerian Africans:A review

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World Journal of Cardiology 2012年第12期4卷 327-340页

作者： Okechukwu S Ogah Ikechi Okpechi Innocent I Chukwuonye Joshua O Akinyemi Basden JC Onwubere Ayodele O Falase Simon Stewart Karen Sliwa Ministry of Health Nnamdi Azikiwe SecretariatUmuahia 440233Abia StateNigeria Division of Cardiovascular Medicine Department of MedicineUniversity College HospitalPMB 5116Dugbe GPOIbadan 200211Oyo StateNigeria Division of of Nephrology and Hypertension Department of MedicineE13Renal UnitGrootes Schuur HospitalObservatory 7925Cape TownSouth Africa Division of Renal Medicine(Nephrology) Department of MedicineFederal Medical CentreUmuahia 440233Abia StateNigeria Department of Epidemiology and Medical Statistics College of MedicineUniversity of IbadanIbadan 200211Oyo StateNigeria Division of Cardiology Department of MedicineUniversity of Nigeria Teaching HospitalEnugu 400001Nigeria NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease Baker IDI Heart and Diabetes Institute 75 Commercial RoadMelbourneVIC 3004Australia Hatter Cardiovascular Research Institute Faculty of Health SciencesUniversity of Cape TownCape TownPrivate Bag X3Observatory 7935South Africa

To review studies on hypertension in Nigeria over the past five decades in terms of prevalence,awareness and treatment and *** our search on Pubmed,African Journals Online and the World Health Organization Global cardiovascular infobase,1060 related references were identified out of which 43 were found to be relevant for this *** overall prevalence of hypertension in Nigeria ranges from 8%-46.4% depending on the study target population,type of measurement and cut-off value used for defining *** prevalence is similar in men and women(7.9%-50.2% vs 3.5%-68.8%,respectively) and in the urban(8.1%-42.0%) and rural setting(13.5%-46.4%).The pooled prevalence increased from 8.6% from the only study during the period from 1970-1979 to 22.5%(2000-2011).Awareness,treatment and control of hypertension were generally low with attendant high burden of hypertension related *** order to improve outcomes of cardiovascular disease in Africans,public health education to improve awareness of hypertension is *** epidemiological studies on hypertension are required to adequately understand and characterize the impact of hypertension in society.

关键词： Blood pressure Hypertension Prevalence non-communicable disease Nigeria

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Obesity and Protein Metabolism

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Journal of Pharmacy and Pharmacology 2018年第11期6卷 956-964页

作者： Emil Mukhamejanov Sara Erjanova JSC National Medical University named after S.Asfendiarov Almaty 050000Kazakhstan

A conceptual model of the interdependence between the metabolism of proteins,fats and carbohydrates taking into account the transport of the carbon skeleton and the stages of the relationship between the processes of formation and utilization of ATP(Adenosine Triphosphate)energy,which demonstrates the key role of protein metabolism and the maintenance of glucose homeostasis with different organism availability in energy was *** supporting the processes of vital activity of the body,two periods should be *** first one is absorptive period,which is for providing rehabilitation processes,the expression of which is the“food pyramid”and the second one is postabsorptive period,which is for the energetic provision of physical and mental work,the expression of which is the“energy pyramid”.These pyramids differ in the ratio of macronutrients,and in their composition,which must be taken into account when developing the principles of human *** obesity is seen as a simple discrepancy between the amount of intake of food calories and their utilization for physical activity,however,do not take into account the large energy expenditure on volatile processes,in particular,the process of protein *** process of protein synthesis depends on the availability in the substrate(amino acids),the intensity of mRNA expression(transcription)and the speed of reproduction(translation),so the violation at each of these stages will affect the energy balance and promote the development of *** of the protein mass is muscle,so it largely determines the homeostasis of glucose and the development of energy balance,which is presented in the form of an interdisciplinary model for the development of diabetes,obesity and cardiovascular *** conclusion,technologies were proposed to support the process of protein synthesis and ways of preventing and treating obesity.

关键词： Obesity protein metabolism food model energy homeostasis non-communicable disease

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