Indian Poverty and Cardiovascular Disease††Conflict of interest: Dr. Alpert has been a consultant for Sanofi-Aventis, Paris France; Novartis International AG, Basel, Switzerland; Exeter CME, Inc., New York, New York; and King Pharmaceuticals, Inc., Bristol, Tennessee.

Ramaraj, Radhakrishnan; Alpert, Joseph S.

doi:10.1016/j.amjcard.2008.02.104

Cited by 19 publications

(6 citation statements)

References 15 publications

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“…57 Instead of the nutritional status curve moving to the right, it has widened, which has particular resonance for urban populations in low-income countries, where the shift from ancestral and early-life undernutrition to relative overnutrition 58,59 is implicated in the increasingly heavy burden of cardiovascular disease and diabetes. 60,61…”

Section: The Health Advantages Of Citiesmentioning

confidence: 99%

Shaping cities for health: complexity and the planning of urban environments in the 21st century

Rydin¹,

Bleahu²,

Davies³

et al. 2012

The Lancet

664

461

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Section: The Health Advantages Of Citiesmentioning

confidence: 99%

Shaping cities for health: complexity and the planning of urban environments in the 21st century

Rydin¹,

Bleahu²,

Davies³

et al. 2012

The Lancet

664

461

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“…Except for smoking and low vegetable and fruit diet, most of the risk factors for CVD are more prevalent in high socioeconomic groups [ 5 ]. However considering large proportion of population in lower socioeconomic group, it has been suggested that most of the burden of risk factors is contributed by poor and underprivileged [ 6 ], which puts higher onus on public health delivery system for NCD care in India.…”

Section: Introductionmentioning

confidence: 99%

Assessment of primary care facilities for cardiovascular disease preparedness in Madhya Pradesh, India

Pakhare

Kumar

Goyal

et al. 2015

BMC Health Serv Res

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BackgroundGovernment of India has launched National Program for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) to address high prevalence of non-communicable diseases (NCDs) in India. Cardiovascular diseases (CVDs) constitute a significant portion of NCD burden. While this program is yet to be launched in all districts of Madhya Pradesh state of India, we performed this study to understand facility-level gaps that need to be addressed to improve CVD services in primary care provided by the public sector.MethodsThis is a cross-sectional questionnaire based study. A standardized questionnaire was self-administered to 85 medical officers from as many primary care facilities from 24 districts of the state. These medical officers were working in two types of primary care facilities – primary health center (PHC) and community health centers (CHC). Facilities were assessed for 36 items in 5 domains (human-resource, equipment, drug supplies, point-of-care tests and laboratory services) with a focus on management of hypertension and diabetes mellitus in primary-care. Each item was to be answered as either present or absent at the facility where medical officer was working. We compared availability of an item across two levels of primary care facilities. All statistical analysis were done using Microsoft Excel.ResultsAvailability of facilities was least in laboratory services, and human resource domains followed by drugs, and better in equipment and point-of-care supply domains. Across these domains, availability of items in CHCs was (37.1, 49.0, 56.1, 67.9 and 80.9 % respectively) and in PHCs (11.8, 18.2, 44.2, 55.1, and 55.3 % respectively).DiscussionCurrent facility assessment study shows critical gaps in key items required for management of NCDs at primary care level. Human resource and laboratory services need to be strengthened the most, followed by sustained availability of all required drug classes, equipment and related supplies, and upgrading point-of-care testing. There are larger gaps in PHCs, which are level 1 facilities, as compared to CHCs, which are level 2 facilities in primary-care.ConclusionsIncreasing burden of NCDs like hypertension and diabetes mellitus necessitates public health response through health systems. Therefore health system preparedness in form of trained human resources, functional laboratories and well stocked pharmacies are essential in primary care facilities.

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“…This assessment was made at the two time points (2001 as baseline and 2007 as the follow-up point). Education categorized based on training system in Iran as, illiterate, primary,[ 1 2 3 4 5 ] high school,[ 6 7 8 9 10 11 12 ] and university training (>12). Global dietary index (GDI) was calculated representing the general dietary behavior.…”

Section: Methodsmentioning

confidence: 99%

“…Some studies have indicated that education is inversely associated with the occurrence of CVD and the level of CVD risk factors,[ 2 ] whereas there are studies revealing an opposite trend. Iran as a developing country undergoes behavioral changes due to some improvement in level of education and is the largest developing country in the world; CVD has become the major cause of death, especially in urban areas.…”

Section: Introductionmentioning

confidence: 99%

Are there any differences in education levels and changes of cardiovascular risk factors among urban and rural population: Isfahan Healthy Heart Program

Gharipour

Bahonar

Sarrafzadegan

et al. 2015

J Edu Health Promot

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Background:This study aimed to find the influence of education level on the trends of changes of these risk factors among a great sample of Iranian population.Materials and Methods:This cross-sectional study is a secondary analysis of Isfahan Healthy Heart Program (IHHP). Blood samples were taken to determine the lipid levels including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), low levels of high-density lipoprotein cholesterol (HDL-C), and triglycerides. Education categorized based on training system in Iran as 1-5, 6-12, and more than 12 years training.Results:The prevalence of diabetes was higher among illiterate participants in both areas. Hypertension was more prevalent in illiterate subjects (2001; 44.0% and 2007; 46.3%) in intervention area (P < 0.001). Dyslipidemia was more prevalent among illiterate people (P < 0.001). In the intervention, illiterates have higher BMI in both 2001 and 2007 (P < 0.001). The prevalence of current smoking was the highest in education level range 6 to 12 years and was steadily decreased in higher education levels (P < 0.001). Subjects with 6-12 years of education have more unhealthy nutritional habits in both areas. In 2001, subjects with 12 years of education or more had more physical activity than other groups (P < 0.001), whereas, in 2007, subjects with 6-12 years of education were more active (P < 0.001).Conclusion:Although the prevalence of diabetes, hypertension obesity, and dyslipidemia are more in illiterate subjects and prevalence of diabetes and hyperlipidemia was sharply decreased with education level, it seems that well educated participants have higher daily physically activity compared with those who have lower education without considering the place or residency.

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Indian Poverty and Cardiovascular Disease††Conflict of interest: Dr. Alpert has been a consultant for Sanofi-Aventis, Paris France; Novartis International AG, Basel, Switzerland; Exeter CME, Inc., New York, New York; and King Pharmaceuticals, Inc., Bristol, Tennessee.

Cited by 19 publications

References 15 publications

Shaping cities for health: complexity and the planning of urban environments in the 21st century

Shaping cities for health: complexity and the planning of urban environments in the 21st century

Assessment of primary care facilities for cardiovascular disease preparedness in Madhya Pradesh, India

Are there any differences in education levels and changes of cardiovascular risk factors among urban and rural population: Isfahan Healthy Heart Program

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