Our findings also indicated that overweight persons are more likely to be aware that they are hypertensive compared with those having normal body weight; these findings are consistent with the results from other recent studies conducted in both developing and developed countries [3,5,23,24,25]. In addition to the well-known adverse health effects of overweight and obesity on the develop- ment of HTN, evidence has shown that in developing countries, like Vietnam, body weight is positively associated with socio- economic status (SES) , and individuals with higher SES are more likely to access health care services compared to those of lower SES. In addition, data from our present study suggested that persons who have ever smoked cigarettes were more likely to be aware of their condition than those who had never smoked. This finding was similar to results of the Jordan National Surveyin 2009, which found that awarenessof HTN was positively associated with older age, smoking, and diabetes . Further- more, our study found that persons who worked were less likely to be aware that they were hypertensive compared with those who did not work. This consistent with findings from the study of multi- ethnic Asian population between 2004 and 2007 in Singapore, which indicated that reduced awarenessandtreatmentof HTN were associated with being younger, never married and working adults with a higher education level .
In a populationbasedsurveyof adults 15 years and above conducted in the districts of Mukono and Buikwe in Uganda hypertension was very common with more than one in five of the people affected. The finding is consistent with studies conducted in other parts of the country as well as in sub-Saharan Africa which show the prevalenceofhighbloodpressure ranging from 20% to 50% , , , , , , , . A comparison with these previous studies is however, best interpreted with caution as the studies used different age groups. In addition, our study revealed a highprevalenceof hypertension among individuals 15–24 years, with evidence of hypertension being higher among males compared to females. This finding reinforces evidence that hypertension is increasingly affecting young people in the low income countries . As observed elsewhere the prevalenceof hypertension increases with increasing age ,,, , , ,  and the increase is was more marked among women compared to men , , , . In our study the prevalenceof hypertension was higher among urban residents and among those who are overweight as well as the obese. These observations suggest that demographic transition and urbanization are major determinants of hypertension and as the life expectancy increases in low income countries and people migrate to urban areas, the burden of hypertension and other cardiovascular diseases will increase , , , [15,, . Overweight and obesity are attributed to changes in dietary and physical activity patterns which are often the result of urbanisation and societal changes attributed to development and lack of supportive policies in health and other related sectors , , , .
he treatmentof hypertension and achievement of target bloodpressure (BP) in type 2 diabetes is important in cardiovascular outcomes and mortality . According to the United Kingdom Prospective Diabetes Study (UKPDS), a linear relationship ex- ists between mean systolic bloodpressure (SBP) and the risk of macrovascular and microvascular complications [1,2]. Con- versely, several epidemiological studies and clinical trials have also demonstrated that controlof hypertension can signiicant- ly reduce mortality and microvascular or macrovascular com- plications in patients with type 2 diabetes [3-5]. Based on these results, the current treatment guideline and expert opinions have consistently stated the target BP levlel as <130/80 mm Hg in patients with type 2 diabetes. he Seventh Report of the Joint National Committee on the Detection, Evaluation, and Treat- ment ofHighBloodPressure (JNC-7), the American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the Korean Diabetes Association (KDA) treatment guidelines recommend that BP in type 2 diabetes should be maintained below 130/80 mm Hg [6-9]. However, several epi- demiological studies of achieved BP in hypertension trials have suggested no beneits associated with an achieved lower SBP [10-12]. One observational subgroup analysis of 6,400 patients with diabetes and 22,576 participants with coronary artery dis- ease (CAD) in the International Verapamil SR-Trandolapril Study showed that tight controlof SBP (<130 mm Hg) among patients with diabetes and CAD was not associated with im- proved cardiovascular outcomes compared with normal con- trols (achieved SBP 130 to 140 mm Hg) . Based on these results, ADA has recommended in 2013 that people with dia- betes and hypertension should be treated to achieve SBP of
The Complex Samples Procedure of SPSS 13.0 for Windows (SPSS Inc., Chicago, Illinois, USA) was used for statistical analyses, accounting for township strata and village clusters. All statistical tests were two-tailed, and statistical significance was set at P,0.05. Continuous variables were presented as mean values. Categorical variables were presented as frequencies. Since age and sex distributions in the four surveys varied, overall means of BP andprevalence, awareness, treatment, controlof HTN of each year were adjusted for age and/or sex, according to the 2000 Chinese National Census population distribution except for age- specific and/or sex-specific means and percentages. Differences between means were compared using General Linear Models. Chi-square tests were used to compare frequencies. Trends in means and the estimated percentages were assessed with General Linear Models (continuous outcomes) and Logistic Regression Models (dichotomous outcomes). General Linear Models (contin- uous outcomes) and Logistic Regression Models (dichotomous outcomes) were also used to evaluate the association between BP, prevalence, awareness, treatment, andcontrolof HTN and associated risk factors. Because there was no data on marital status, education level and family history of HTN in the 1982’s survey, the analyses for associated risk factors were conducted using data from 1998 to 2010.
There are some limitations to our study that should be noted. First, it is unlikely that our relatively small convenience sample is representative of all persons engaged in bat-related activities in Thailand. Our findings may have also been subject to reporting bias, since guano miners and bat hunters may have been less willing than others to answer questions truthfully due to the illegal nature of their work. This potential bias may have led participants to understate their years of experience, which could explain why this variable was not found to be associated with a history of transdermal bat exposures. Estimated participation rates for these two groups were also much lower than the other two groups (participation rates were hard to definitively ascertain because parti- cipation was ultimately premised on self-identification). Addition- ally, we classified individuals based on their self-reported primary bat- associated activity; however, a few participants indicated involve- ment with other activities (e.g,. guano miners that also hunt bats) either presently or in the past. Having such a history was not accounted for this study, although it potentially could be associated with an increased lifetime risk of transdermal bat exposures. The desired sample size of 200 persons was somewhat arbitrarily determined given the lack of reliable estimates for the study population size. Failure to meet this number was largely due to the difficulty in finding willing participants who engaged in bat hunting and guano mining, and the limited availability of personnel and funds that could be used to extend the study period. As a con- sequence of our small sample size and low statistical power, truly
Socio-demographic data were gathered by interviewers who administered questionnaires to a household head or any adult representative. The WHO STEPwise Approach to Surveil- lance questionnaire was used to collect cardiovascular risk data from individuals. Bio- physical measurements (bloodpressure, weight, height, waist and hip circumferences) and biochemical analysis (HbA1c, TC, HDL-C, and triglycerides (TG)) were performed using standardised procedures described elsewhere.  Bloodpressure was measured on the right arm using appropriate cuff sizes (regular arm cuff size if arm circumference was 24-32cm, large arm cuff if arm circumference was 33-41cm, thigh cuff if over 41cm and if under 24cm paediatric cuff size was used) in a sitting position, three times within resting intervals of 5 minutes, using a digital sphygmomanometer (the Omron M4-I). The mean of the second and third reading was taken for analysis. Body weight was measured using the Seca 761 me- chanical scales and body height was measured using a portable Leicester stadiometer to the nearest 1 kg and 0.1 cm respectively, with participants wearing light clothing and no shoes. Waist and hip circumferences were measured twice over one layer of light clothing using a non-stretchable Seca 201 Ergonomic Circumference Measuring Tape to the nearest 0.1 cm. A third measurement was taken if the first two measurements differed by more than 3cm. Waist and hip circumferences were taken as the mean of two (or three where applicable) measurements. The weight scales were calibrated using standard weights and the height scale and measuring tape were calibrated using a standard one metre metallic rod every week. LDL-C was estimated by modified Friedwald formula:  LDL-C = TC-(HDL-C +- TGX0.16) mmol/L.
Probably, there is a significant portion of the population that does not seek or does not have access to services provided by PHCUs, which prevents the diagnosis of hypertension. Another portion already diagnosed may have been excluded from the system. The high percentage of comorbidities suggests a late diagnosis and inadequate treatmentof hypertension. Among hypertensive patients, many were not included in the study because of inadequate monitoring. In the group studied, there was a significant reduction in mean pressure levels. However, most patients continue to have no controlof the disease, and there is evidence of significant therapeutic inertia. The patients’ medical records have forms that are appropriate for recording the patients’ information in a well structured way. However, they are not used by the professionals. This is a fact that limits the quality of the records andof our study. There may be more hypertensive patients that have received an additional drug or non-drug treatment, without the proper registration. The lack of adherence to treatment may have been discovered, but maybe it was not recorded, and the previous therapy may have been maintained. Just as the therapeutic inertia may be overestimated, the comorbidities may be underestimated. As a result of the inclusion criteria, the sample does not represent the totality of hypertensive individuals being monitored in PHCUs.
the last two or three decades, irst in close relation with obesity and later on, also in the non-obese populations. Frequently, insulin resistance appears in the non diabetic population together with a cluster of risk factors including highbloodpressure, chronic low grade inlammation and hyperlipidemia, which characterize the metabolic syndrome 2 . The most common and typical disorders of
Differences in burden due to stroke also exist within countries where the incidence and mortality rates vary across socioeconomic groups. A substantial number of studies in western countries have demonstrated a significant positive association between socioeco- nomic disadvantage and the incidence and mortality due to stroke [10,11]. By contrast, the few studies available in developing countries show various patterns as the social gradient for risk factors leading to stroke may change over time. Recent studies investigating such patterns in transitioning economies have supported the fact that risky behaviors associated with stroke and other cardio-vascular diseases are initially higher within the highest socioeconomic classes (early adopters), but the socioeco- nomic gradient is gradually inversed and with time the burden increasingly supported by the poor [12–15]. The same inversion of the social gradient was observed for HICs throughout their past evolution . This social transition occurs because those ofhigh socioeconomic status (SES), who were early adopters of poor health behaviors (such as smoking and diets rich in processed foods with more fat, sugar, and salt), are also the first to respond to health messages and recognize more rapidly that their lifestyles are not conducive to a healthy life. Those of higher SES also have the resources to change their behaviors and environment to decrease their risk .
cover the defecation site adequately when they defecate into the ground. Four feces samples presented eggs that were morphologically similar to those of Toxocara sp., which is a parasite of dogs and cats, and there were two feces samples with eggs of T. vulpis, which is a common parasite among dogs. Closer analysis of the results from the tests on those samples made it possible to dismiss the irst possibility and accept the second hypothesis, given that in addition to the animal parasites, human parasites were found in greater proportion in all of the six samples. The possibility that the subjects might hand in lasks containing domestic animal feces as if they were human was minimized by the relationship of conidence that the indigenous community maintained with the group of investigators. The investigators included an anthropologist with great experience among indigenous people in Paraná. Occurrences of cross-infection by eggs of Capillaria sp. (a common parasite of rodents) and Balantidium coli (a parasite of pigs) are possible, as seen among Brazilian indigenous populations. 2,3 Findings of eggs from animal parasites
The weight was measured in kilograms, with a precision scale of 100 grams. The height was measured in centimeters, with precision of 1 millimeter, using portable stadiometer fixed to the wall smooth and without skirting. The BMI was calculated according to the new curves proposed by the World Health Organization. The child that presented a BMI > 5 percentile and < 85 percentile for sex and age, overweight that presented a BMI ≥ 85 percentile for sex was considered eutrophic and age, and obesity who presented BMI ≥ 95 percentile for sex and age. 20
between means. The paired Student’s t-test was used for comparisons between means coming from the same individuals at different times. The analyses were perfor- med using the SPSS 10.0.1 software. All the analyses took into consideration the study sample design. The study had been approved by the Research Ethics Committee of the Universidade Federal de Mato Grosso, and the Departments of Education and Health of the State of Mato Grosso and the municipality were made aware that the study was being conducted. The parents were all informed about their children’s bloodpressure levels. Children who were considered to be hypertensive were referred for outpatient follow-up with the aim of conﬁ rming the diagnosis.
their purchasing behavior. The work on CSR and consumer choice could be a new growth opportunity for marketing. CSR initiatives with well-designed targets andhigh consumer awareness through communication could play an important role in successful marketing. Becker- Olsen et al. (2006) suspected the assumption that consumers will always reward firms for their socially responsible initiatives unselectively. They designed two studies to explore how consumers react to different CSR activities. In addition, they investigated the impact of the motivations and time choice of CSR initiatives. CSR activities that do not fit with a fir m‘s expertise have negative impact on consumers‘ attitudes toward a firm and the firm‘s credibility. Firms can be perceived as ―doing good‖ only by addressing selected CSR initiatives. CSR activities with low fitness with a firm are perceived as ―doing CSR business‖ by consumers, and lead to non-positive consumer evaluations. Perceived motivations of consumers have effect on consumers‘ evaluation of a firm and a firm‘s CSR initiatives. If consumers believe CSR initiatives are profit- driven rather than social-driven, then they will assess a firm and its credibility negatively. This leads to a low likelihood of consumers‘ purchase intention. The time of practicing CSR activities matters to consumers‘ assessments. Proactive CSR activities help firms get positive evaluations from consumers. In contrast, consumers regard reactive CSR activities as doing ―CSR business‖. Reactive CSR has non-positive contribution to a firm‘s image (Becker-Olsen et al., 2006).
Despite the important achievements worldwide in the polio eradication initiative, particularly the recent eradication of wild Poliovirus in the Western Pacific region and the apparent global interruption of wild Poliovirus type 2 transmission [10, 11], wild Poliovirus transmission is still a severe public health threat in various regions of the world, particularly in Africa and South-east Asia [10, 12-14]. The continued circulation of wild Poliovirus types 1 and 3 poses a reintroduction risk for any polio-free region . Thus, it is fundamental that all countries keep up with polio eradication andcontrol strategies, even in regions considered free of wild poliovirus transmission. Furthermore, various areas with low OPV coverage have documented the circulation of OPV-derived and recombinant Poliovirus, including alarming recent outbreaks in the Dominican Republic and Haiti [16, 23- 25]. It is known that the key factor for controlling circulating OPV-derived viruses as well as wild polioviruses is achieving and maintaining high vaccination coverage, as recently reemphasized during the certification of poliomyelitis eradication in the Western Pacific Region [10, 16]. As a result, it is of decisive importance to follow adequate control measures through high vaccination coverage and adequate surveillance in order to achieve the ultimate goals of the worldwide polio eradication program [2, 3, 15].
Thus, this study highlighted the strong influence of demographic and social economical factors on bloodpressure increase, revealing the impor- tance of hypertension among employ- ees of the Brazilian health care area and reinforcing the need for hyperten- sion prevention andcontrol. Since it is a distinct population that is involved with a hospital environment and, con- sequently, can have access to informa- tion, prevention methods, early dis- ease diagnosis andtreatment, a lower hypertension prevalence was expected to be found. However, the results show the need for special programs at the workplace for higher-risk groups, such as those whose job fell in the “others” category, as well as males, the elderly, non-white, those whose family income and educational levels are low, and those who are obese. These special
A visit to the doctor’s office by a patient to be informed of or receive a confirmation of a hypertension diagnosis is the opportune time to establish what will hopefully be a lasting relationship, since this is the basis for quality care and a good doctor-patient relationship 1,2 .
Objective: To analyze the association between different biological/behavioral risk factors andbloodpressurein a sample of type 2 diabetes mellitus patients with poor glycemic control. Methods: A sample of 121 type 2 diabetic patients was selected in the Public Healthcare System in a middle size Brazilian city. Bloodpressure was measured using an aneroid device, previously calibrated. Six determinants ofbloodpressure were taken into count: age, hypoglycemic agents, general obesity, abdominal obesity, eating behaviors and physical activity level. Results: The type 2 diabetic patients presented mean age of 60.1±8.9 years-old and, at least, one risk factor. Eating behaviors (OR adj = 0.31 [0.12-0.75]) and sports practice (OR adj = 0.12 [0.02-0.75]) constituted protective factors associated with lower systolic blood pres- sure. On the other hand, age was positively associated with high systolic bloodpressure (OR adj = 3.81 [1.39-10.38]). Patients with 5-6 risk factors, presented higher values of systolic and (F= 3.857; p= 0.011 [post hoc with p= 0.039]), diastolic bloodpressure (F= 4.158; p= 0.008 [post hoc with p= 0.036]) and increased occurrence of hypertension (p= 0.010). Conclusion: Our findings indicate that, behavioral variables were important determinants ofbloodpressurein type 2 diabetic patients with poor glycemic controland clustering of behavioral and biological risk factors increase the hypertension occurrence.
Inclusion criteria were adults of both genders (age 18 and less than 70 years) with arterial hypertension under drug treatment, and at regular follow-up appointments (the criterion was regular attendance at all visits in the previous year). Exclusion criteria were: inability or refusal to sign the consent form, participation in other research protocols, patients with chronic diseases in terminal stages, patients with hypertension stage III 8 or resistant
34. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004;79(3):379-84. 35. National Institutes of Health. (NIH). National Heart, Lung, andBlood Institute. Your guided to Lowering your bloodpressure with DASH. Bethesda (MD); 2006. 36. Hardy LL, Dobbins TA, Denney-Wilson EA, Okely AD, Booth ML. Sedentariness, small-screen recreation, and fitness in youth. Am J Prev Med. 2009;36(2):120-5.