BACKGROUND: More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown.
METHODS: We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries) and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing (with higher scores indicating greater risk-factor burden). Participants were followed for incident cardiovascular disease and death for a mean of 4.1 years.
RESULTS: The mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P<0.001). However, the rates of major cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, or heart failure) were lower in high-income countries than in middle- and low-income countries (3.99 events per 1000 person-years vs. 5.38 and 6.43 events per 1000 person-years, respectively; P<0.001). Case fatality rates were also lowest in high-income countries (6.5%, 15.9%, and 17.3% in high-, middle-, and low-income countries, respectively; P=0.01). Urban communities had a higher risk-factor burden than rural communities but lower rates of cardiovascular events (4.83 vs. 6.25 events per 1000 person-years, P<0.001) and case fatality rates (13.52% vs. 17.25%, P<0.001). The use of preventive medications and revascularization procedures was significantly more common in high-income countries than in middle- or low-income countries (P<0.001).
CONCLUSIONS: Although the risk-factor burden was lowest in low-income countries, the rates of major cardiovascular disease and death were substantially higher in low-income countries than in high-income countries. The high burden of risk factors in high-income countries may have been mitigated by better control of risk factors and more frequent use of proven pharmacologic therapies and revascularization. (Funded by the Population Health Research Institute and others.).
Note: Malaysia is a study site (Author: Yusoff K)
OBJECTIVE: To investigate factors associated with self-reported pregnancy termination in Ghana and thereby appreciate the correlates of abortion-seeking in order to understand safe abortion care provision.
METHODS: In a retrospective study, data from the Ghana 2008 Demographic and Health Survey were used to investigate factors associated with self-reported pregnancy termination. Variables on an individual and household level were examined by both bivariate analyses and multivariate logistic regression. A five-point autonomy scale was created to explore the role of female autonomy in reported abortion-seeking behavior.
RESULTS: Among 4916 women included in the survey, 791 (16.1%) reported having an abortion. Factors associated with abortion-seeking included being older, having attended school, and living in an urban versus a rural area. When entered into a logistic regression model with demographic control variables, every step up the autonomy scale (i.e. increasing autonomy) was associated with a 14.0% increased likelihood of reporting the termination of a pregnancy (P < 0.05).
CONCLUSION: Although health system barriers might play a role in preventing women from seeking safe abortion services, autonomy on an individual level is also important and needs to be addressed if women are to be empowered to seek safe abortion services.
KEYWORDS: Abortion; Autonomy; Empowerment; Low-resource countries; Maternal health; Reproductive health
Objectives: The objectives are to assess the prevalence and determinants of cardiovascular disease (CVD) risk factors among the residents of Community Housing Projects in metropolitan Kuala Lumpur, Malaysia.
Method: By using simple random sampling, we selected and surveyed 833 households which comprised of 3,722 individuals. Out of the 2,360 adults, 50.5% participated in blood sampling and anthropometric measurement sessions. Uni and bivariate data analysis and multivariate binary logistic regression were applied to identify demographic and socioeconomic determinants of the existence of having at least one CVD risk factor.
Results: As a Result, while obesity (54.8%), hypercholesterolemia (51.5%), and hypertension (39.3%) were the most common CVD risk factors among the low-income respondents, smoking (16.3%), diabetes mellitus (7.8%) and alcohol consumption (1.4%) were the least prevalent. Finally, the results from the multivariate binary logistic model illustrated that compared to the Malays, the Indians were 41% less likely to have at least one of the CVD risk factors (OR = 0.59; 95% CI: 0.37 - 0.93).
Conclusion: In Conclusion, the low-income individuals were at higher risk of developing CVDs. Prospective policies addressing preventive actions and increased awareness focusing on low-income communities are highly recommended and to consider age, gender, ethnic backgrounds, and occupation classes.
The urban low income has often been assumed to have the greatest dental treatment needs compared to the general population. However, no studies have been carried out to verify these assumptions. This study was conducted to assess whether there was any difference between the treatment needs of an urban poor population as compared to the general population in order to design an intervention programme for this community.
To investigate the role of geography (place of residence) as a moderator in the relationship between dental caries disease and treatment experience and dental fear in 16-year-olds living in Malaysia.
Matched MeSH terms: Urban Health/statistics & numerical data
The Malaysian Cohort study was initiated in 2005 by the Malaysian government. The top-down approach to this population-based cohort study ensured the allocation of sufficient funding for the project which aimed to recruit 100,000 individuals aged 35-70 years. Participants were recruited from rural and urban areas as well as from various socioeconomic groups. The main objectives of the study were to identify risk factors, to study gene-environment interaction and to discover biomarkers for the early detection of cancers and other diseases. At recruitment, a questionnaire-based interview was conducted, biophysical measurements were performed and biospecimens were collected, processed and stored. Baseline investigations included fasting blood sugar, fasting lipid profile, renal profile and full blood count. From April 2006 to the end of September 2012 we recruited a total of 106,527 participants. The baseline prevalence data showed 16.6% participants with diabetes, 46.5% with hypertension, 44.9% with hypercholesterolaemia and 17.7% with obesity. The follow-up phase commenced in June 2013. This is the most comprehensive and biggest cohort study in Malaysia, and has become a valuable resource for epidemiological and biological research. For information on collaboration and also data access, investigators can contact the project leader at (rahmanj@ppukm.ukm.edu.my).
Study name: The Malaysian Cohort (TMC) project
Matched MeSH terms: Urban Health/statistics & numerical data
Reduced muscular strength, as measured by grip strength, has been associated with an increased risk of all-cause and cardiovascular mortality. Grip strength is appealing as a simple, quick, and inexpensive means of stratifying an individual's risk of cardiovascular death. However, the prognostic value of grip strength with respect to the number and range of populations and confounders is unknown. The aim of this study was to assess the independent prognostic importance of grip strength measurement in socioculturally and economically diverse countries.
The term "co-benefits" refers to positive outcomes accruing from a policy beyond the intended outcome, often or usually in other sectors. In the urban context, policies implemented in particular sectors (such as transport, energy or waste) often generate multiple co-benefits in other areas. Such benefits may be related to the reduction of local or global environmental impacts and also extend into the area of public health. A key to identifying and realising co-benefits is the adoption of systems approaches to understand inter-sectoral linkages and, in particular, the translation of this understanding to improved sector-specific and city governance. This paper reviews a range of policies which can yield health and climate co-benefits across different urban sectors and illustrates, through a series of cases, how taking a systems approach can lead to innovations in urban governance which aid the development of healthy and sustainable cities.
The ability of older people to function independently is crucial as physical disability and functional limitation have profound impacts on health. Interventions that either delay the onset of frailty or attenuate its severity potentially have cascading benefits for older people, their families and society. This study aims to develop and evaluate the effectiveness of a multiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention program targeted at improving physical performance and maintaining independent living as compared to general health education among older people in an urban poor setting in Malaysia.
Prehypertension is one of the most common conditions affecting human beings worldwide. It is associated with several complications including hypertension. The blood pressure between normal and hypertension is prehypertension as per the Seventh Report Joint National Committee (JNC-7) classification. The current study was done to measure the magnitude of prehypertension and to study their sociodemographic correlates in the urban field practice area of Kasturba Medical College, Mangalore, India, among 624 people aged ≥20 years. The measurements of blood pressure were done (JNC 7 criteria) with the anthropometric measurements and lifestyle factors. Data analysis was done using Statistical Package for Social Sciences version 16. Adjusted odds ratios were calculated. Overall, 55% subjects had prehypertension and 30% had hypertension. Prehypertension was higher among males. Those from the higher age groups, those from upper socioeconomic status, obese individuals, and those with lesser physical activity had significantly higher association with prehypertension, and it was least among those who never used tobacco and alcohol.
OBJECTIVE: Shared decision-making has been advocated as a useful model for patient management. In developing Asian countries such as Malaysia, there is a common belief that patients prefer a passive role in clinical consultation. As such, the objective of this study was to determine Malaysian patients' role preference in decision-making and the associated factors.
DESIGN: A cross-sectional study.
SETTING: Study was conducted at an urban primary care clinic in Malaysia in 2012.
PARTICIPANTS: Patients aged >21 years were chosen using systematic random sampling.
METHODS: Consenting patients answered a self-administered questionnaire, which included demographic data and their preferred and actual role before and after consultation. Doctors were asked to determine patients' role preference. The Control Preference Scale was used to assess patients' role preference.
PRIMARY OUTCOME: Prevalence of patients' preferred role in decision-making.
SECONDARY OUTCOMES: (1) Actual role played by the patient in decision-making. (2) Sociodemographic factors associated with patients' preferred role in decision-making. (3) Doctors' perception of patients' involvement in decision-making.
RESULTS: The response rate was 95.1% (470/494). Shared decision-making was preferred by 51.9% of patients, followed by passive (26.3%) and active (21.8%) roles in decision-making. Higher household income was significantly associated with autonomous role preference (p=0.018). Doctors' perception did not concur with patients' preferred role. Among patients whom doctors perceived to prefer a passive role, 73.5% preferred an autonomous role (p=0.900, κ=0.006).
CONCLUSIONS: The majority of patients attending the primary care clinic preferred and played an autonomous role in decision-making. Doctors underestimated patients' preference to play an autonomous role.
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Extreme events, both natural and anthropogenic, increasingly affect cities in terms of economic losses and impacts on health and well-being. Most people now live in cities, and Asian cities, in particular, are experiencing growth on unprecedented scales. Meanwhile, the economic and health consequences of climate-related events are worsening, a trend projected to continue. Urbanization, climate change and other geophysical and social forces interact with urban systems in ways that give rise to complex and in many cases synergistic relationships. Such effects may be mediated by location, scale, density, or connectivity, and also involve feedbacks and cascading outcomes. In this context, traditional, siloed, reductionist approaches to understanding and dealing with extreme events are unlikely to be adequate. Systems approaches to mitigation, management and response for extreme events offer a more effective way forward. Well-managed urban systems can decrease risk and increase resilience in the face of such events.
This review discusses how climate undergo changes and the effect of climate change on air quality as well as public health. It also covers the inter relationship between climate and air quality. The air quality discussed here are in relation to the 5 criteria pollutants; ozone (O3), carbon dioxide (CO2), nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter (PM). Urban air pollution is the main concern due to higher anthropogenic activities in urban areas. The implications on health are also discussed. Mitigating measures are presented with the final conclusion.
Insufficient physical activity and growing obesity levels among Malaysian adolescents are becoming a public health concern. Our study is to identify the trends of self-reported physical activity (PA) levels, blood lipid profiles, and body composition (BC) indices from a cohort of 820 adolescents. The self-reported PA was assessed using a validated Malay version of the PA Questionnaire for Older Children (PAQ-C). Fasting blood samples were collected to investigate their lipid profiles. Height, weight, waist and hip circumferences as well as body fat percentage were measured. The baseline and the first follow-up were conducted in 2012 and 2014, respectively. A downward trend in the PA level was seen in all categories with a significant reduction among all rural adolescents (P = 0.013) and more specifically, PA among girls residing in rural areas dropped significantly (P = 0.006). Either a significant reduction in high-density lipoprotein (HDL) or a significant increment in BC indices (i.e., body mass index [BMI], waist circumference [WC], hip circumference, and body fat percentage [BF %]) were seen in this group. Female adolescents experienced more body fat increment with the reduction of physical activity. If not intervened early, adolescents from rural areas may increase their risk of developing cardiovascular diseases earlier.
Understanding cities comprehensively as systems is a costly challenge and is typically not feasible for policy makers. Nevertheless, focusing on some key systemic characteristics of cities can give useful insights for policy to advance health and well-being outcomes. Moreover, if we take a coevolutionary systems view of cities, some conventional assumptions about the nature of urban development (e.g. the growth in private vehicle use with income) may not stand up. We illustrate this by examining the coevolution of urban transport and land use systems, and institutional change, giving examples of policy implications. At a high level, our concern derives from the need to better understand the dynamics of urban change, and its implications for health and well-being. At a practical level, we see opportunities to use stylised findings about urban systems to underpin policy experiments. While it is now not uncommon to view cities as systems, policy makers appear to have made little use so far of a systems approach to inform choice of policies with consequences for health and well-being. System insights can be applied to intelligently anticipate change - for example, as cities are subjected to increasing natural system reactions to climate change, they must find ways to mitigate and adapt to it. Secondly, systems insights around policy cobenefits are vital for better informing horizontal policy integration. Lastly, an implication of system complexity is that rather than seeking detailed, 'full' knowledge about urban issues and policies, cities would be well advised to engage in policy experimentation to address increasingly urgent health and climate change issues.
Cities are complex adaptive systems whose responses to policy initiatives emerge from feedback interactions between their parts. Urban policy makers must routinely deal with both detail and dynamic complexity, coupled with high levels of diversity, uncertainty and contingency. In such circumstances, it is difficult to generate reliable predictions of health-policy outcomes. In this paper we explore the potential for low-order system dynamics (LOSD) models to make a contribution towards meeting this challenge. By definition, LOSD models have few state variables (≤5), illustrate the non-linear effects caused by feedback and accumulation, and focus on endogenous dynamics generated within well-defined boundaries. We suggest that experience with LOSD models can help practitioners to develop an understanding of basic principles of system dynamics, giving them the ability to 'see with new eyes'. Because efforts to build a set of LOSD models can help a transdisciplinary group to develop a shared, coherent view of the problems that they seek to tackle, such models can also become the foundations of 'powerful ideas'. Powerful ideas are conceptual metaphors that provide the members of a policy-making group with the a priori shared context required for effective communication, the co-production of knowledge, and the collaborative development of effective public health policies.
Health has been the main driver for many urban environmental interventions, particularly in cases of significant health problems linked to poor urban environmental conditions. This paper examines empirically the links between climate change mitigation and health in urban areas, when health is the main driver for improvements. The paper aims to understand how systems of urban governance can enable or prevent the creation of health outcomes via continuous improvements in the environmental conditions in a city. The research draws on cases from two Indian cities where initiatives were undertaken in different sectors: Surat (waste) and Delhi (transportation). Using the literature on network effectiveness as an analytical framework, the paper compares the cases to identify the possible ways to strengthen the governance and policy making process in the urban system so that each intervention can intentionally realize multiple impacts for both local health and climate change mitigation in the long term as well as factors that may pose a threat to long-term progress and revert back to the previous situation after initial achievements.