Prevalence, awareness, treatment, control and correlates of prevalence and control of hypertension among older adults in Kerala: A mixed methods study

Introduction: We conducted this study among older adults with the following objectives: (1) To find out the prevalence, awareness, treatment and control of hypertension, (2) To understand the factors associated with hypertension prevalence and control. Methods: A mixed-methods study employing a sequential explanatory design was conducted with a survey of 300 participants aged _x0001_60 years, and 15 in-depth interviews. Blood Pressure (BP) and waist circumference were measured using standard protocol. Survey data were analysed using univariate and multivariate procedures. In-depth interviews were analysed employing thematic analysis. Results: Hypertension prevalence was 72.3% (95% CI ¼ 67.1e77.2), 68.2% (CI ¼ 61.8e74.2) were aware, 65.4% (CI ¼ 59.0e71.6) were treated and 24% (CI ¼ 18.6e29.9) achieved adequate control. Inadequate physical activity [(adjusted odds ratio (AOR)] ¼ 2.34; CI ¼ 1.19e4.59), current alcohol use (AOR ¼ 2.28; CI ¼ 1.06e4.91) and self-reported diabetes (AOR ¼ 2.02; CI ¼ 1.15e3.52) were associated with hypertension prevalence. Those who reported diabetes (AOR ¼ 2.72, CI ¼ 1.34e5.55), with education level up to high school (AOR ¼ 2.58, CI ¼ 1.11e6.00) and who were in the age group 60e70 years (AOR ¼ 2.14, CI ¼ 1.09e4.20) were more likely to have controlled hypertension compared to their counterparts. From the in-depth interviews it was found that availability and accessibility of services, family support, financial wellbeing, habits and beliefs and conducive environment played a role in hypertension diagnosis and management. Discussion: Prevalence of hypertension was high in this population along with poor control. Efforts are required to improve hypertension control focussing on older adults with low education and those who are aged 70 years and above

Factors associated with uncontrolled asthma in Porto Alegre, Brazil

The prevalence of uncontrolled and controlled asthma, and the factors associated with uncontrolled asthma were investigated in a cross-sectional study. Patients aged 11 years with confirmed asthma diagnosis were recruited from the outpatient asthma clinic of Hospital de Clínicas de Porto Alegre, Brazil. Patients were excluded if they had other chronic pulmonary disease. They underwent an evaluation by a general questionnaire, an asthma control questionnaire (based on the 2006 Global Initiative for Asthma guidelines), assessment of inhaled device technique and pulmonary function tests. Asthma was controlled in 48 of 275 patients (17.5 percent), partly controlled in 74 (26.9 percent) and uncontrolled in 153 (55.6 percent). In the univariate analysis, asthma severity was associated with asthma control (P < 0.001). Availability of asthma medications was associated with asthma control (P = 0.01), so that most patients who could purchase medications had controlled asthma, while patients who depend on the public health system for access to medications had lower rates of controlled asthma. The use of inhaled corticosteroid was lower in the uncontrolled group (P < 0.001). Logistic regression analysis identified three factors associated with uncontrolled asthma: severity of asthma (OR = 5.33, P < 0.0001), access to medications (OR = 1.97, P = 0.025) and use of inhaled corticosteroids (OR = 0.17, P = 0.030). This study showed a high rate of uncontrolled asthma in patients who attended an outpatient asthma clinic. Severity of asthma, access to medications and adequate use of inhaled corticosteroids were associated with the degree of asthma control.

Um século de experiência no controle da ancilostomíase / One century of experience with the control of ancylostomiasis

In the beginning of the XX century, ancylostomiasis was considered a serious public health problem and governments started the first systematic planning for the control of an endemic disease, in large scale. Thereafter, ancylostomiasis was considered a less important subject, because efficient anti-helminthic drugs were introduced, this in combination with the economic development in rich countries, reduced undernourishment and improved housing and sanitary conditions. Consequently, the residual cases of the infection became in general asymptomatic. However, in the third world the problem is still present, and must be considered with realism and managed accordingly. Various suggestions for controling the disease are presented in this paper.

A ancilostomíase despertou a atenção do mundo, no começo do século XX, como grave problema de saúde pública e deu origem aos primeiros planos sistemáticos de controle de uma endemia em larga escala. Passou depois a ser vista como questão de menor importância quando surgiram medicamentos anti-helmínticos eficazes e o desenvolvimento econômico dos países mais ricos reduziu neles a subnutrição, melhorando ao mesmo tempo as condições habitacionais e sanitárias que tornaram as infecções residuais clinicamente assintomáticas. O problema persiste; entretanto, no terceiro mundo que deve encará-lo com realismo e agir em conseqüência. Sugestões são feitas nesse sentido.