scholarly journals The effectiveness of hypertension management in China: a community-based intervention study

2019 ◽  
Vol 20 ◽  
Author(s):  
Xiaoguo Zheng ◽  
Feng Xiao ◽  
Ruili Li ◽  
Delu Yin ◽  
Qianqian Xin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Healthcare System ◽  
Primary Healthcare ◽  
Rural Areas ◽  
Urban Areas ◽  
Blood Pressure Reduction ◽  
Hypertension Management ◽  
Hypertension Control ◽  
Community Based ◽  
One Year

Abstract Aim: This study aimed to evaluate the effectiveness of hypertension management and analyse the factors associated with blood pressure reduction within China’s primary healthcare system. Background: Hypertension is one of the leading risk factors for global disease burden and is strongly associated with cardiovascular diseases. In China, hypertension is a serious public health problem, but few studies have evaluated the effectiveness of hypertension management in China’s primary healthcare system. Methods: The study sites were 24 primary healthcare institutions, selected using multistage stratified random sampling method. In each institution, hypertension patients aged at least 35 years who agreed to participate and had no disabilities or mental health problems were enrolled for hypertension management. Participants received comprehensive interventions in the primary healthcare system via a team. After a one-year intervention, data from 6575 hypertension patients were analysed to check the effectiveness of hypertension management and examined factors associated with hypertension control. Findings: There was an overall mean reduction of 4.5 mmHg in systolic blood pressure (SBP) and 1.9 mmHg in diastolic blood pressure (DBP). The blood pressure reduction after one year was greater in rural patients than in urban patients, 6.6 mmHg versus 3.4 mmHg for SBP and 2.6 mmHg versus 1.6 mmHg for DBP, respectively. The hypertension control rate also increased more in rural areas (22.1%) than in urban areas (10.6%) after the one-year intervention. Age, body mass index, region and being in an urban area had a significant negative association with the reduction of SBP (P < 0.05). Education level and baseline SBP showed a significant positive association (P < 0.05). Conclusions: Community-based hypertension management by general practitioners was feasible and effective. The effectiveness of hypertension management in rural areas was greater than in urban areas. Intervention strategies should pay more attention to patients in rural areas and western China.

scholarly journals Salt intake and blood pressure in Iranian children and adolescents: a population-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammad Hassan Emamian ◽  
Hossein Ebrahimi ◽  
Hassan Hashemi ◽  
Akbar Fotouhi
Keyword(s):  
Blood Pressure ◽  
Rural Areas ◽  
Urban Areas ◽  
Salt Intake ◽  
Daily Intake ◽  
Population Based ◽  
World Health ◽  
Second Phase ◽  
Salt Consumption ◽  
The Mean

Abstract Background Previous studies have reported a high prevalence of hypertension in Iranian students, especially in rural areas. The aim of this study was to investigate the daily intake of salt in students and its association with high blood pressure. Methods A random sub-sample was selected from the participants of the second phase of Shahroud schoolchildren eye cohort study and then a random urine sample was tested for sodium, potassium and creatinine. Urine electrolyte esexcretion and daily salt intake were calculated by Tanaka et al.’s formula. Results Among 1455 participants (including 230 participants from rural area and 472 girls), the mean age was 12.9 ± 1.7 year and the mean daily salt intake was 9.7 ± 2.6 g (95% CI 9.5–9.8). The mean salt consumption in rural areas [10.8 (95% CI 10.4–11.2)] was higher than urban areas [9.4 (95% CI 9.3–9.6)], in people with hypertension [10.8 (95% CI 10.3–11.3)] was more than people with normal blood pressure [9.4 (95% CI 9.3–9.6)], and in boys [9.8 (95% CI 9.7–10.0)] was more than girls [9.3 (95% CI 9.1–9.6)]. Higher age, BMI z-score, male sex and rural life, were associated with increased daily salt intake. Increased salt intake was associated with increased systolic and diastolic blood pressure. Conclusion Daily salt intake in Iranian adolescents was about 2 times the recommended amount of the World Health Organization, was higher in rural areas and was associated with blood pressure. Reducing salt intake should be considered as an important intervention, especially in rural areas.

scholarly journals The Differences in the Prevalence of Cardiovascular Disease, Its Risk Factors, and Achievement of Therapeutic Goals among Urban and Rural Primary Care Patients in Poland: Results from the LIPIDOGRAM 2015 Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5656
Author(s):  
Krzysztof Studziński ◽  
Tomasz Tomasik ◽  
Adam Windak ◽  
Maciej Banach ◽  
Ewa Wójtowicz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Primary Care Physicians ◽  
Primary Care Patient ◽  
Care Patient ◽  
Cross Sectional ◽  
Therapeutic Goals ◽  
Rural Primary Care

A nationwide cross-sectional study, LIPIDOGRAM2015, was carried out in Poland in the years 2015 and 2016. A total of 438 primary care physicians enrolled 13,724 adult patients that sought medical care in primary health care practices. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CVD were similar in urban and rural areas (49.5 vs. 49.4%; 13.7 vs. 13.1%; 84.2 vs. 85.2%; 14.4 vs. 14.2%, respectively). The prevalence of obesity (32.3 vs. 37.5%, p < 0.01) and excessive waist circumference (77.5 vs. 80.7%, p < 0.01), as well as abdominal obesity (p = 43.2 vs. 46.4%, p < 0.01), were higher in rural areas in both genders. Mean levels of LDL-C (128 vs. 130 mg/dL, p = 0.04) and non-HDL-C (147 vs. 148 mg/dL, p = 0.03) were slightly higher in rural populations. Altogether, 14.3% of patients with CVD from urban areas and 11.3% from rural areas reached LDL <70 mg/dL (p = 0.04). There were no important differences in the prevalence of hypertension, diabetes, dyslipidaemia, and CVD, or in mean levels of blood pressure, cholesterol fractions, glucose, and HbA1c between Polish urban and rural primary care patient populations. A high proportion of patients in cities and an even-higher proportion in rural areas did not reach the recommended targets for blood pressure, LDL-C, and HbA1c, indicating the need for novel CVD-prevention programs.

scholarly journals URBAN-RURAL DISPARITY: THE UTILIZATION OF PRIMARY HEALTHCARE CENTERS AMONG ELDERLY IN EAST JAVA, INDONESIA

2019 ◽  
Vol 7 (2) ◽  
pp. 147 ◽  
Author(s):  
Ratna Dwi Wulandari ◽  
Agung Dwi Laksono
Keyword(s):  
Primary Healthcare ◽  
Rural Areas ◽  
Health Research ◽  
Urban Areas ◽  
The Elderly ◽  
Utilization Of Health Services ◽  
Healthcare Center ◽  
Urban Rural ◽  
Primary Healthcare Centers ◽  
Primary Healthcare Center

Background: Urban always attracts investors to invest. Health facilities in urban areas are growing rapidly compared to villages. This condition is estimated to contribute to the disparity of urban-rural areas in the utilization of health services. Studying the utilization of health services is a way to evaluate the performance of the health care system through its output.Aim: This study analyzed the urban-rural disparity in the utilization of primary healthcare center by the elderly.Method: This study used in the 2013 Basic Health Research raw data. The 2013 Basic Health Research was designed as a cross-sectional survey. With the multi-stage cluster random sampling method, 25,813 elderly people in East Java Province participated. Data were analyzed using Multinomial Logistic Regression tests.Results: Elderly people in urban areas have a better probability of outpatient use of 1.208 than those living in rural areas (OR 1.208; 95% CI 1.057-1.380). The elderly who have a primary school and under education have the possibility of 1.558 times more utilizing outpatients in primary healthcare centers than the elderly who have college education levels (OR 1.558; 95% CI 1.001-2.424).Conclusion: There was a disparity between urban and rural areas in the utilization of outpatient primary healthcare centers in East Java by the elderly. Policymakers in East Java are recommended to improve facilities and infrastructure of the primary healthcare centers in rural areas by paying attention to the results of this study.Keywords: elderly, urban-rural disparities, primary healthcare center, healthcare utilization, inpatient-outpatient. 

Abstract 13706: Differences in the Distribution of Systolic Blood Pressure by Rural and Urban Residence

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Brittain Heindl ◽  
George Howard ◽  
Elizabeth A Jackson
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Racial Differences ◽  
Rural Areas ◽  
Urban Areas ◽  
Census Bureau ◽  
Urban Group ◽  
Rural And Urban ◽  
Urban Rural ◽  
The Difference

Introduction: The incidence of stroke is higher in rural areas. Hypertension is the leading risk factor for stroke, but the difference in systolic blood pressure (SBP) for those living in rural and urban areas is unknown. Hypothesis: We hypothesized that rural residence is associated with higher SBP levels, and this difference is modified by race, sex, and United States (US) division. Methods: We analyzed 26,113 participants enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, recruited between 2003 and 2007. Participants were grouped based on the Rural-Urban Commuting Area (RUCA) scheme into urban, large-rural, and small-isolated rural groups. Resting SBP was measured during the initial home visit. Differences in percentiles of SBP distribution were compared using multivariate models with adjustment for age, race, sex, and US Census Bureau division. Results: Of the participants, 20,976 (80.3%) were classified as urban, 3,020 (11.6%) as large-rural, and 2,137 (8.2%) as small-isolated rural, reflecting the distribution of the population. The large-rural group had a 0.09 mmHg higher mean SBP compared to the urban group (95% CI, 0.33 to 1.52 mmHg, p = 0.0023), but the difference in SBP at the 95th percentile between these groups was 3.23 mmHg (95% CI, 1.43 to 4.73 mmHg, p = 0.0006). A similar difference was present between the small-isolated rural and urban groups at the highest percentiles. No urban-rural interaction was observed by race, sex, or US division. However, large SBP differences were present between US divisions, especially at the highest percentiles. To illustrate, SBP at the 95th percentile was 9.51 mmHg higher in the East North Central division than in the Pacific (95% CI, 6.41 to 12.61 mmHg, p < 0.0001). Conclusions: Residence in a rural area is associated with higher SBP, with larger differences at the highest percentiles of distribution. SBP differences are present between US divisions, independent of urban-rural status.

Survival Disparities in Patients with Lymphoma According to Place of Residence and Treatment Provider: A Population-Based Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 874-874
Author(s):  
Fausto R Loberiza ◽  
Anthony J Cannon ◽  
Dennis D Weisenburger ◽  
Julie M. Vose ◽  
Matt J. Moehr ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Rural Areas ◽  
Urban Areas ◽  
Population Based ◽  
Place Of Residence ◽  
Community Based ◽  
Risk Levels ◽  
Risk Of Death ◽  
Risk Patients

Abstract Objectives: We evaluated the association of the primary area of residence (urban vs. rural) and treatment (trt) provider (university-based vs. community-based) with overall survival in patients with lymphoma, and determined if there are patient subgroups that could benefit from better coordination of care. Methods: We performed a population-based study in 2,330 patients with centrally confirmed lymphoma from Nebraska and surrounding states reported to the Nebraska Lymphoma Study Group between 1982 and 2006. Patient residential ZIP codes at the time to trt were used to determine rural/urban designation, household income and distance to trt center; while trt providers were categorized into university-based or community based. Multivariate analyses were used to group patients into risk levels based on 8 factors found to be associated with survival at the time of trt (age, performance score, Ann Arbor stage, presence of B symptoms, LDH levels, tumor bulk, nodal and extranodal involvement). The following categories were identified: low-risk (1–3 factors), intermediate risk (4–5 factors), and high-risk (≥6 factors). Cox proportional regression analyses, stratified by type of lymphoma (low-grade NHL, high-grade NHL and Hodgkin) were used to evaluate the association between place of residence and trt provider with overall survival. Results: Among urban residents, 321 (14%) were treated by university-based providers (UUB) and 816 (35%) were treated by community-based providers (UCB). Among rural residents, 332 (14%) were treated by university-based providers (RUB) and 861 (37%) were treated by community-based providers (RCB). Patients from rural areas were more likely to be older and Caucasian, with a lower median household income, greater travel distance to seek trt, and more likely to have high-risk disease when compared to patients from urban areas. In multivariate analysis, using all patients regardless of risk level, the relative risk of death (RR) among UUB, UCB and RUB was not statistically different. However, RCB had a higher risk of death RR 1.37, 95% CI 1.14–1.65, p=0.01; RR 1.18, 95% CI 1.04–1.33, p<0.01; and RR 1.26, 95% CI 1.06–1.49, p=0.01 when compared with UUB, UCB and RUB, respectively. This association remained true in both low- and intermediate-risk patients. Among high-risk patients, both RUB and RCB were at higher risk of death when compared with UUB or UCB, while UCB were not different from UUB. We found no differences in progression-free survival according to place of residence and trt provider. The use of stem cell transplantation was significantly higher in patients coming from urban and rural areas treated by university-based providers (UUB 19%, RUB 16%) compared to urban and rural patients treated by community-based providers (UCB 11%, RCB 10%, p < 0.01). Patients from rural areas (RUB and RCB) were slightly less likely to die from lymphoma-related causes than patients from urban areas (75% versus 80%, p=0.04). Conclusion: Overall survival in patients with lymphoma is inferior in patients coming from rural areas. This relationship varies according to treatment provider and pretreatment risk levels. Further studies in patients from rural areas are needed to understand how coordination of care is carried to design appropriate interventions that may improve the disparity noted.

scholarly journals Parents´ Knowledge about the Effects of Oral Hygiene, Proper Nutrition and Fluoride Prophylaxis on Oral Health in Early Childhood

2018 ◽  
Vol 22 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Aleksandrija Djordjevic
Keyword(s):  
Early Childhood ◽  
Oral Health ◽  
Oral Hygiene ◽  
Rural Areas ◽  
Urban Areas ◽  
Education Institution ◽  
Preventive Dentistry ◽  
One Year ◽  
The One ◽  
The Impact

SummaryBackground/Aim: Health education, as one of the important aspects of preventive dentistry, plays an important role in promoting and achieving good oral health. The aim of this study was to determine the influence of parents´ knowledge about the effects of oral hygiene, proper nutrition and fluoride prophylaxis on oral heath in early childhood. Material andMethods: Parents were asked to fill a questionnaire which consisted of three sections, oral hygiene, fluoride prophylaxis and nutrition. The study included 136 parents of children, aged between 3-6 years. The survey was conducted in pedagogical-education institution - PE “Our happiness” - Leposavic, Kosovo and Metohia, Serbia. Results: More than 58% parents from urban areas and 63% parents from rural areas were informed that the teeth should be brushed at least twice a day (p=0.007). Only 31.11% of parents from urban and 15.22% of parents from rural areas were informed that a child should visit dentists for the first time, at the one year of age (p=0.083). The analysis of the questionnaire section regarding the nutrition and oral health, showed that parents from rural areas were better informed than parents from urban areas. Awareness about fluoride and their role in preventive dentistry was poor, as only 3% of children from urban and 1% of children from rural areas were using tablets based on fluoride while only 1% of children from urban and none from rural areas were using fluoride mouth rinses. Conclusions: The study showed that parents have the knowledge about the impact of oral hygiene, food and fluoride prophylaxis on the oral health but unfortunately they do not apply their knowledge in practice.

scholarly journals Sociodemographic inequalities in cardiovascular risk factors among adolescents from indigenous areas of Chiapas, Mexico

2020 ◽  
Author(s):  
Elena Flores-Guillen ◽  
Itandehui Castro-Quezada ◽  
Hector Ochoa ◽  
Rosario Garcia-Miranda ◽  
Miguel Cruz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Rural Areas ◽  
Urban Areas ◽  
Descriptive Analysis ◽  
Geographic Area ◽  
Secondary Outcome ◽  
Cross Sectional

Objectives: The objective of this study was to determine the prevalence of cardiovascular risk factors among different sociodemographic and geographic areas of adolescents from indigenous areas of Chiapas, Mexico. Design: A cross-sectional study. Setting: Communities in the Totzil - Tseltal and Selva region of Chiapas, Mexico, were studied. Urban and rural areas of high marginalization according to the Human Development Index. Participants: 253 adolescents were studied, of which 48.2% were girls and 51.8% were boys. Primary and secondary outcome measures: a descriptive analysis of the quantitative variables was performed through central tendency and dispersion measures. Prevalence of cardiovascular risk factors and 95% confidence intervals (95% CI), stratified by sex, geographic area (rural/urban), schooling and ethnicity of mothers were estimated. Results: the predominant risk factor in the study population was low HDL-c (51%). Higher prevalences of abdominal obesity and high triglycerides in girls were found and abnormal diastolic blood pressure in boys was identified. In urban areas were found greater prevalences of overweight/obesity and of insulin resistance while abnormal blood pressure levels were more prevalent in rural areas. Differences were found in the educational levels and ethnicity of the adolescents' mothers. Prevalence of metabolic syndrome was 10% according to NCEP-ATPIII. Conclusions: In this study, sociodemographic and geographical disparities were found in cardiovascular risk factors. Prevalence of risk factors was high, affecting mostly girls and urban population. Thus, there is a great need to promote healthy lifestyles and health, social and economic interventions to prevent chronic diseases in adulthood.

scholarly journals Difficulties and Barriers of Primary Health Care Physicians in Rural Areas of Aseer Region, Saudi Arabia

2021 ◽  
Vol 19 (2) ◽  
Author(s):  
Mastor A.M. Alshahrani ◽  
Mohammed A. Alsaleem ◽  
Safar A. Alsaleem ◽  
Mohammed A. Alfaya ◽  
Muhammed A.Y. Alkhairi ◽  
...  
Keyword(s):  
Health Care ◽  
Saudi Arabia ◽  
Primary Health Care ◽  
Primary Healthcare ◽  
Rural Areas ◽  
Urban Areas ◽  
Social Life ◽  
Well Being ◽  
Primary Health ◽  
Primary Health Care Physicians

Aim of Study: To identify difficulties and barriers facing primary health care physicians in rural areas of Aseer Region, Saudi Arabia. Methods: This cross-sectional study was conducted at primary healthcare centers (PHCCs) belonging to the Saudi Ministry of Health, in rural areas of Aseer Region. A total of 134 physicians participated in the study. A validated study questionnaire was adapted and used for data collection. Results: Female physicians constituted 43.3% of respondents, age of 58.2% was 30-35 years, (Mean±SD: 32.8 ± 7.0 years), 54.5% were married, the salary of 76.1% was <10,000 SR, and the place of residence of 43.3% was in urban areas. Only 34.3% had opportunities for on-the-job continuing medical education, 33.6% were satisfied with medical equipment and resources, and 50% were dissatisfied with their salary. Internet service was present for 83.6% of participants. The social life of 83.6% was negatively affected, and 16.4% were exposed to violence at the workplace. Most participants had a favorable attitude toward working in rural areas, mainly in the form of professional satisfaction, pursuing postgraduate academic studies, building confidence as a clinician and provision of opportunities to upgrade knowledge and skills. Participants were less satisfied regarding several social factors, such as internet connectivity, isolation from family and relatives; received support from rural people, difficult schooling for children, but were not satisfied regarding PHCC infrastructure, their residential facilities, or earning more money. Conclusion: Serving within the rural healthcare system provides young physicians with an opportunity to build up their experience and to increase their confidence as physicians. However, important difficulties that they face are mainly social and financial. Hence, creating a health policy to safeguard the serving physicians’ career and providing facilities to promote personal and social well-being needs to be considered. Key words: Primary healthcare, rural health, difficulties, barriers, Saudi Arabia

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