A conceptual framework for managing modifiable risk factors for cardiovascular diseases in Fiji.

AIMS: The current review will look at modifiable lifestyle (physical inactivity, poor nutrition, risky alcohol behavior and cigarette smoking) and cardio-metabolic (obesity, diabetes mellitus, high cholesterol and high blood pressure) cardiovascular disease (CVD) risk factors among Indigenous-Fijian and Indo-Fijian subgroups. A framework for monitoring and managing these risk factors will be presented. METHODS: National health surveys were identified where available. Electronic databases identified sources for filling missing data. The most relevant data were identified, organized and synthesized. RESULTS: Compared to Indo-Fijians, Indigenous-Fijians have higher rates of obesity (17% vs 11%) and hypertension (21% vs 16%), but lower rates of diabetes mellitus (12% vs 21%) and high cholesterol (33% vs 39%). Indigenous-Fijians report higher rates of prescribed physical activity (25% vs 21%), but poorer recommended vegetable intake (48% vs 56%), greater risky alcohol behavior (17% vs 15%) and a much greater prevalence of cigarette smoking (45% vs 24%). Both Indigenous-Fijians and Indo-Fijians report a low prevalence of recommended fruit intake (17% vs 15%). CONCLUSIONS: Fiji is progressing through demographic and epidemiological transitions, including a decline in infectious diseases and improved life expectancy. However, in concert with other developing nations, 'modernization' is accompanied by increased mortality from non-communicable diseases, with CVD being the most prevalent. This transition has been associated with changes to socio-cultural aspects of Fiji, including poor lifestyle choices that may contribute to a cluster of cardio-metabolic conditions which precede CVD.

Global citizenship is key to securing global health: the role of higher education.

Despite growing public awareness, health systems are struggling under the escalating burden of non-communicable diseases. While personal responsibility is crucial, alone it is insufficient. We argue that one must place themselves within the broader/global context to begin to truly understand the health implications of personal choices. Global citizenship competency has become an integral part of the higher education discourse; this discourse can and should be extended to include global health. A global citizen is someone who is (1) aware of global issues, (2) socially responsible, and (3) civically engaged. From this perspective, personal health is not solely an individual, self-serving act; rather, the consequences of our lifestyle choices and behaviors have far-reaching implications. This paper will argue that, through consciously identifying global health within the constructs of global citizenship, institutions of higher education can play an instrumental role in fostering civically engaged students capable of driving social change.

Modifiable cardiovascular disease risk factors among indigenous populations.

Objective. To identify modifiable cardio-metabolic and lifestyle risk factors among indigenous populations from Australia (Aboriginal Australians/Torres Strait Islanders), New Zealand (Maori), and the United States (American Indians and Alaska Natives) that contribute to cardiovascular disease (CVD). Methods. National health surveys were identified where available. Electronic databases identified sources for filling missing data. The most relevant data were identified, organized, and synthesized. Results. Compared to their non-indigenous counterparts, indigenous populations exhibit lower life expectancies and a greater prevalence of CVD. All indigenous populations have higher rates of obesity and diabetes, hypertension is greater for Maori and Aboriginal Australians, and high cholesterol is greater only among American Indians/Alaska Natives. In turn, all indigenous groups exhibit higher rates of smoking and dangerous alcohol behaviour as well as consuming less fruits and vegetables. Aboriginal Australians and American Indians/Alaska Natives also exhibit greater rates of sedentary behaviour. Conclusion. Indigenous groups from Australia, New Zealand, and the United States have a lower life expectancy then their respective non-indigenous counterparts. A higher prevalence of CVD is a major driving force behind this discrepancy. A cluster of modifiable cardio-metabolic risk factors precede CVD, which, in turn, is linked to modifiable lifestyle risk factors.

How should flow-mediated dilation be normalized to its stimulus?

The brachial artery flow-mediated dilation test (FMD) is the non-invasive gold-standard used to assess endothelial function. Reduced FMD is an early event in the development of atherosclerosis and provides a marker for predicting future cardiovascular disease events. Despite its widespread popularity and proven validity, the FMD test is limited by poor reliability. There are three major limitations associated with the standard FMD methodology: (i) inappropriate expression of FMD, (ii) measurement variance associated with a short-lived FMD response and (iii) most studies fail to account for the FMD stimulus. A series of relatively simple statistical practices can be adopted to account for these limitations. In particular, we suggest that endothelial function be estimated using shear rate-diameter dose-response curves, which can be statistically analysed using hierarchical linear modelling. The use of dose-response curves could potentially improve measurement reliability and validity.

The importance of differentiating urban and rural phenomena in examining the unequal distribution of locally desirable land.

Previous research addressing the unequal distribution of locally desirable land (LDL) has mainly ignored their associated environments (i.e., rural or urban). However, this study proposed a new framework that treats rural and urban regions separately. In rural areas, the LDLs included all public lands. In urbanized areas, the LDLs were defined as green open spaces. Potential inequities in the distribution of LDL were assessed with respect to socioeconomic characteristics of residents in the State of Georgia. Using US Census Bureau Data (2000), Census Block Groups (CBGs) adjacent to LDLs were compared to CBGs outside of LDLs on four socioeconomic variables (per capita income, occupation, education, and race) in urban, suburban and rural environments. Results showed that CBGs adjacent to LDLs were composed of statistically significant upper-class communities containing fewer blue-collar workers, more whites, and higher income and higher educated people in rural, suburban and urban areas.