1,720,999 research outputs found
Types and Effectiveness of Community-Based Cardiovascular Disease Preventive Interventions in Reducing Alcohol Consumption: A Systematic Review and Meta-Analysis
No full textCardiovascular disease (CVD) poses a global health challenge, with modifiable risk factors, notably alcohol consumption, impacting its onset and progression. This review synthesizes evidence on the types and effectiveness of community-based interventions (CBIs) aimed at reducing alcohol consumption for CVD prevention. Electronic databases were systematically searched until October 31, 2019, with updates until February 28, 2023. Given the heterogeneity in outcome measures, we narratively synthesized the effectiveness of CBIs, adhering to the synthesis without meta-analysis (SWiM) guidelines for transparent reporting. For selected homogenous studies, a random-effects meta-analysis was utilized to estimate the effects of CBIs on alcohol consumption. Twenty-two eligible studies were included, with 16 demonstrating that CBIs reduced alcohol consumption compared to controls. Meta-analysis findings revealed reductions in above moderate-level alcohol consumption (pooled odds ratio (OR)=0.50, 95% confidence interval (CI): 0.37, 0.68), number of alcohol drinks per week (standardized mean difference=-0.08, 95% CI:-0.14,-0.03), and increased odds of low-risk drinking (pooled OR=1.99, 95% CI: 1.04, 3.81) compared to the control groups. Multi-component interventions (particularly those combining health education, awareness, and promotion activities) and those interventions with a duration of 12 months or more were notably effective. The beneficial effects of CBIs focusing on achieving a reduction in alcohol consumption showed promising outcomes. Implementing such interventions, especially multicomponent interventions, could play a significant role in mitigating the increasing burden of CVDs. Future studies should also consider employing standardized and validated tools to measure alcohol consumption outcomes to enhance the consistency and comparability of findings.We would like to thank the European Commission Horizon 2020 Research and Innovation for funding this work. We are also grateful to Deborah Jael Herrera for her valuable comments and contributions, including data visualization and proofreading of this manuscript. The first author (Neamin M. Berhe) and the second author (Hamid Y. Hassen) contributed equally to the work and should be considered co-first authors, while the last two authors (Hilde Bastiaens and Steven Abrams) should be considered co-senior authors
Cardiovascular disease risk factor prevalence and estimated 10-year cardiovascular risk scores in Indonesia: The SMARThealth Extend study
Full text linkBackground The brunt of cardiovascular disease (CVD) burden globally now resides within low- and middle-income countries, including Indonesia. However, little is known regarding cardiovascular health in Indonesia. This study aimed to estimate the prevalence of elevated CVD risk in a specific region of Indonesia. Methods We conducted full household screening for cardiovascular risk factors among adults aged 40 years and older in 8 villages in Malang District, East Java Province, Indonesia, in 2016-2017. 10-year cardiovascular risk scores were calculated based on the World Health Organization/International Society of Hypertension’s region-specific charts that use age, sex, blood pressure, diabetes status and smoking behaviour. Results Among 22,093 participants, 6,455 (29.2%) had high cardiovascular risk, defined as the presence of coronary heart disease, stroke or other atherosclerotic disease; estimated 10-year CVD risk of ≥ 30%; or estimated 10-year CVD risk between 10% to 29% combined with a systolic blood pressure of > 140 mmHg. The prevalence of high CVD risk was greater in urban (31.6%, CI 30.7-32.5%) than in semi-urban (28.7%, CI 27.3-30.1%) and rural areas (26.2%, CI 25.2-27.2%). Only 11% and 1% of all the respondents with high CVD risk were on blood pressure lowering and statins treatment, respectively. Conclusions High cardiovascular risk is common among Indonesian adults aged ≥40 years, and rates of preventive treatment are low. Population-based and clinical approaches to preventing CVD should be a priority in both urban and rural areas
Effectiveness of community-based cardiovascular disease prevention interventions to improve physical activity: A systematic review and meta-regression
No full textCardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality globally. Despite preventive community-based interventions (CBIs) seem efficacious in reducing CVD risks, a comprehensive up-to-date synthesis on the effectiveness of such interventions in improving physical activity (PA) is lacking. We performed a systematic review and meta-analysis of community-based CVD preventive interventions aimed at improving PA level. MEDLINE, EMBASE, CINAHL, Cochrane register and PSYCINFO databases were searched in October 2019 for studies reported between January 2000 and June 2019. We assessed the methodological quality of included studies using the Cochrane risk of bias tools. We performed a random-effects meta-analysis and meta-regression to pool estimates of various effect measures. Results are reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guideline. Our study protocol was registered in the PROSPERO database (CRD42019119885). A total of 44 randomized and 20 non-randomized controlled studies involving 98,919 participants were included. Meta-analyses found that CBIs improved the odds of attaining the recommended PA level (at least 150 min of moderate and vigorous PA (MVPA)/week) at 12 month (OR: 1.62; 95%CI: 1.25-2.11) and 18 to 24 months of follow-up (OR: 1.46; 95%CI: 1.12-1.91). Furthermore, interventions were effective in improving metabolic equivalents of task at 12 month (standardized mean difference (SMD): 0.28; 95% CI: 0.03-0.53), MVPA time at 12 to 18 months (SMD: 0.34; 95%CI: 0.05-0.64), steps per day (SMD: 0.32; 95%CI: 0.08-0.55), and sitting time (SMD: -0.25; 95%CI: -0.34 to -0.17). Subgroup analyses found that interventions in low- and middle-income countries showed a greater positive effect on attainment of recommended PA level (OR: 1.40; 95%CI: 1.02-1.92) than those in high-income countries (OR: 1.31; 95%CI: 0.96-1.78). Moreover, interventions targeting high-risk groups showed greater effectiveness than those targeting the general population (OR: 1.76; 95%CI: 1.30-2.39 vs. 1.17; 95%CI: 0.89-1.55). In conclusion, community-based CVD preventive interventions have a positive impact on improving the PA level, albeit that relevant studies in lower-middle and low-income countries are limited. With the rising burden of CVDs, rolling out CBIs targeting the general population and high-risk groups are needed to control the growing CVD-burden.This work is supported by the SPICES project in Belgium which received funding from the European Commission through the Horizon 2020 research and innovation action grant agreement No 733356. The funder had no role in the design, decision to publish, or preparation of the manuscript
Type and effectiveness of community-based interventions in improving knowledge related to cardiovascular diseases and risk factors: A systematic review
No full textBackground: Despite an improvement in the healthcare system, cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. Improving knowledge is a key for behavioral change towards prevention of CVDs. However, up-to-date evidence is limited on the effect of interventions on CVD knowledge. Thus this study aimed to synthesize comprehensive evidence on the type and effectiveness of community-based interventions (CBIs) to improve knowledge related to CVDs. Methods: We performed a systematic review of studies that tested the effectiveness of CBIs in improving CVD knowledge. International databases including MEDLINE, EMBASE, CINAHL, PSYCINFO and Cochrane register of controlled studies were searched for studies published between January 2000 and December 2019. The Cochrane risk of bias tools were used to assess the methodological quality of included studies. Since CVD knowledge was measured using various tools, results were synthesized narratively and reported in line with the reporting guideline for Synthesis Without Meta-analysis (SWiM). The review protocol is registered in the PROSPERO database (CRD42019119885). Results: 7 randomized and 9 non-randomized controlled trials involving 34,845 participants were included. Most of the interventions targeted the general population and majorities delivered the intervention to groups of individuals. Likewise, most of the interventions employed various intervention components including health education using different strategies. Overall, most studies showed that CBIs significantly improved knowledge related to CVDs. Conclusion: Community-based CVD preventive interventions are effective in improving knowledge related to CVD and risk factors. Measures to scale up CBIs are recommended to improve an individual's level of CVD knowledge, which potentially helps to counter the growing burden of CVDs.The SPICES project in Belgium supports this study, which received funding from the European Commission through the Horizon 2020 research and innovation action grant agreement No 733356. The funder had no role in the design, decision to publish, or preparation of the manuscript
We would like to thank the European Commission Horizon 2020 research and innovation, for funding this wor
Cardiovascular disease prevention in Mukono and Buikwe districts in Uganda : evidence to implementation
No full textAbstract: Summary Introduction Cardiovascular disease (CVD), the number one cause of death globally, disproportionately affects low- and middle- income countries (LMICs) creating a new burden for their unprepared health systems amidst resource constraints. Community-wide interventions targeting CVD risk factors can support CVD prevention and control efforts in LMICs. However, there is need for more evidence on the effectiveness of community-based interventions for CVD prevention and an exploration of their implementation processes in real-world settings. This evidence will inform implementation and scale-up of community level CVD prevention programmes in LMIC contexts. Objectives The objectives of this research were to: synthesize evidence on the effectiveness of community-based interventions for CVD prevention among adults in LMICs (Paper I); determine community knowledge and describe the distribution of lifestyle practices for CVD prevention (Paper II & III); explore the acceptability of a community programme to increase knowledge and improve lifestyle practices for CVD prevention (Paper IV); document barriers and facilitators in implementation of the community programme (Paper V); and examine the factors influencing uptake of lifestyle practices for CVD prevention following implementation of the CVD prevention programme (Paper VI). Methods This thesis employed an embedded mixed methods study within a quasi-experimental design to answer the research questions. Besides a systematic review that was conducted to synthesise evidence on effectiveness of community-based interventions for CVD prevention among adults in LMICs, the remaining objectives were answered using primary data collected in Mukono and Buikwe districts in Uganda. Quantitative data were collected at baseline among 4372 respondents from 3689 randomly selected households providing information on the level of knowledge and distribution of CVD risk factors within the community. For analysis, descriptive statistics and generalized linear modelling controlling for clustering were conducted with the aid of Stata 13.0 or 15.0. The community intervention that involved community health workers (CHWs) to educate community members, screen for their CVD risk and counsel or refer them to health facilities was implemented in five parishes within 20 selected villages. Qualitative data were collected from community members and community health workers to inform exploration of the acceptability of the intervention, barriers and facilitators of implementation and factors influencing uptake of healthy lifestyle practices. Thematic analysis following semantic or latent approaches were employed in analysing qualitative data with the aid of either Atlas ti 6.0.15 or NVIVO 12.6. Results Results from the systematic review revealed that community-based interventions successfully improved population knowledge on CVD and its risk factors and influenced physical activity and dietary practices for CVD prevention. However, evidence was inconsistent for smoking cessation and reduced alcohol consumption. The most effective interventions involved health education, community mobilisation and lifestyle counselling (Paper I). To inform the community CVD prevention programme, we collected baseline data from 4372 respondents and found that only 776 (17.7%) were knowledgeable on CVD prevention. The factors associated with CVD knowledge were post-primary education [adjusted prevalence ratio (APR) = 1.55 (95% CI: 1.18 - 2.02), p = 0.002]; formal employment [APR = 1.69 (95% CI: 1.40 - 2.06), p <0.001]; and high socio-economic index [APR = 1.35 (95% CI: 1.09 - 1.67), p = 0.004]. Households that owned a mobile phone [APR = 1.35 (95% CI: 1.07 - 1.70), p = 0.012] and respondents who had ever received advice on healthy lifestyles [APR = 1.38 (95% CI: 1.15 - 1.67), p = 0.001] had significantly high knowledge (Paper II). Mapping of the prevalence of selected CVD risk factors using the baseline data indicated substantial gender and small area geographic heterogeneity which was masked on aggregate analysis. Patterns and clustering were observed for hypertension, physical inactivity, smoking, alcohol consumption and risk factor combination (Paper III). Evidence on effective interventions together with gaps identified in knowledge and CVD risk practices informed the design of our intervention which was acceptable to both CHWs and community members. CHWs had implemented similar community programmes and were eager to participate in the intervention while community members looked forward to health services being brought nearer to them. CHWs anticipated challenges in mobilising the community but anticipated to be trained, supported, and supervised while the community was eager to receive sufficient information on CVD prevention (Paper IV). In exploration of the barriers and facilitators during intervention implementation, the CHWs noted that the intervention was complex, they were sometimes mistrusted by their community whose awareness of CVD was low and had other competing demands. On the other hand, the availability of inputs and protective equipment, being trained, frequent support supervision and engagements and working with available community structures including leaders and groups facilitated the intervention (Paper V). Following implementation, we found variations in uptake of healthy lifestyle practices for CVD prevention with most changes reported for dietary behaviour and physical activity than alcohol consumption, smoking behaviours, and stress reduction like our review findings. The barriers to uptake of healthy lifestyle practices were related to accessibility challenges, limited resources, limited capability or skills, low risk perception and effects of COVID-19 restrictions such as lockdown. In contrast, the facilitators of practices uptake were knowledge, personal determination, competence to change, health benefits, social support, and reinforcement of messages (Paper VI). Conclusions Evidence-based, acceptable, and well-designed community-based interventions led by community health workers can support uptake of healthy lifestyles that are key for CVD prevention. These interventions hold promise for LMICs to deal with CVD. Study strengths and limitations This thesis provides evidence of effectiveness of community-based interventions for CVD prevention through a systematic review that informed the planned interventions. The thesis was informed by theories and frameworks and triangulation was used as a principle to present perspectives of CHWs and the community. The research could have been influenced by social desirability and information biases, however, the in-depth nature of the inquiry lessened the impact of these. The study was also only conducted in two districts, which although are similar to many rural and semi-urban areas in Uganda, may limit generalisability of findings
Epidemiology, awareness, health seeking behaviour and capacity of health systems to deal with hypertension in a Ugandan rural context
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Dietary outcomes of community-based CVD preventive interventions: a systematic review and meta-analysis
No full textObjective: We aimed to synthesize available evidence on the effects of community-based
interventions in improving various dietary outcome measures.
Design: Systematic review and meta-analysis
Setting: We searched databases including Medline, EMBASE, PSYCINFO, CINAHL, and the
Cochrane registry for studies reported between January 2000 and June 2022. The methodological
quality of the included studies was evaluated using the Cochrane risk of bias tools for each study
type. For some of the outcomes, we pooled the effect size using a random-effects meta-analysis.
Participants: A total of 51 studies, 33 randomized and 18 non-randomized, involving 100 746
participants were included.
Results: Overall, 37 studies found a statistically significant difference in at least one dietary
outcome measure favoring the intervention group, whereas 14 studies found no statistically
significant difference. Our meta-analyses indicated that, compared to controls, interventions
were effective in decreasing daily energy intake (MJ/day) (MD: -0.25; 95% CI: -0.37, -0.14), fat
% of energy (MD: -1.01; 95% CI: -1.76, -0.25), and saturated fat % of energy (MD: -1.54; 95%
CI: -2.01, -1.07). Furthermore, the interventions were effective in improving fiber intake (g/day)
(MD: 1.08; 95% CI: 0.39, 1.77). Effective interventions use various strategies including tailored
individual lifestyle coaching, health education, health promotion activities, community
engagement activities and/or structural changes.
Conclusion: This review shows the potential of improving dietary patterns through communitybased CVD preventive interventions. Thus, development and implementation of context-specific
preventive interventions could help to minimize dietary risk factors, which in turn decrease
morbidity and mortality due to CVDs and other non-communicable diseases.This work is supported by the SPICES project which received funding from the European Commission through the Horizon 2020 research and innovation action grant (No:
733356). The funder had no role in the design, decision to publish, or preparation of the manuscript.
Acknowledgements:
We would like to thank the European Commission Horizon 2020 research and innovation, for funding this work
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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