ORCID Profile
0000-0002-6314-8753
Current Organisations
Australian National University Medical School
,
UK FCDO Better Health Programme
,
World Health Organization
,
The University of Newcastle
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Public Library of Science (PLoS)
Date: 10-02-2009
Publisher: Wiley
Date: 18-08-2014
DOI: 10.1002/AJHB.22603
Abstract: Changes in sleep patterns often occur in older adults. Previous studies have documented associations between sleep duration, sleep quality, and obesity risk in older in iduals, yet few studies have examined these trends in lower-income countries. The present cross-sectional study uses nationally representative datasets from six countries to examine these relationships. Two hypotheses related to obesity risk and sleep patterns were tested using data from the first wave of the World Health Organization's Study on global AGEing and adult health (SAGE). This longitudinal study draws on s les of older adults (>50 years old) in six middle-income countries (China, Ghana, India, Mexico, Russian Federation, and South Africa). Self-report data were used to measure sleep duration, sleep quality, lifestyle and sociodemographic information, while anthropometric measurements were collected to assess body mass index (BMI) and waist circumference (WC). Multiple linear regressions were used to examine the relationship between sleep patterns and obesity risk while controlling for lifestyle factors. Shorter sleep durations in both men and women were significantly associated with higher BMI and WC measures (P < 0.05). Low sleep quality did not significantly contribute to increased obesity risk. Surprisingly, high sleep quality was significantly associated with increased male BMI and WC in China and India (P < 0.01). This study documented an association between short sleep duration and increased obesity risk, which is important given the global increase of obesity-related diseases.
Publisher: Springer Science and Business Media LLC
Date: 08-09-2012
Abstract: Women represent a growing proportion of older people and experience increasing disability in their longer lives. Using a universally agreed definition of disability based on the International Classification of Functioning, Disability and Health, this paper examines how, apart from age, social and economic factors contribute to disability differences between older men and women. World Health Survey data were analyzed from 57 countries drawn from all income groups defined by the World Bank. The final s le comprises 63638 respondents aged 50 and older (28568 males and 35070 females). Item Response Theory was applied to derive a measure of disability which ensured cross country comparability. In iduals with scores at or above a threshold score were those who experienced significant difficulty in their everyday lives, irrespective of the underlying etiology. The population was then ided into “disabled” vs. “not disabled”. We firstly computed disability prevalence for males and females by socio-demographic factors, secondly used multiple logistic regression to estimate the adjusted effects of each social determinant on disability for males and females, and thirdly used a variant of the Blinder-Oaxaca decomposition technique to partition the measured inequality in disability between males and females into the “explained” part that arises because of differences between males and females in terms of age and social and economic characteristics, and an “unexplained” part attributed to the differential effects of these characteristics. Prevalence of disability among women compared with men aged 50+ years was 40.1% vs. 23.8%. Lower levels of education and economic status are associated with disability in women and men. Approximately 45% of the sex inequality in disability can be attributed to differences in the distribution of socio-demographic factors. Approximately 55% of the inequality results from differences in the effects of the determinants. There is an urgent need for data and methodologies that can identify how social, biological and other factors separately contribute to the health decrements facing men and women as they age. This study highlights the need for action to address social structures and institutional practices that impact unfairly on the health of older men and women.
Publisher: Wiley
Date: 28-03-2020
DOI: 10.1002/AJHB.23413
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.IJCARD.2019.02.068
Abstract: Global commitments to reduce cardiovascular disease (CVD) burden by 2025 will require data on CVDs from lower income countries. This study aimed to estimate the prevalence of angina, and its association with hypertension, diabetes, and depression, in six low- and middle-income countries (LMICs). Data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 from China, Ghana, India, Mexico, Russia and South Africa were utilized. Multivariable logistic regression methods were used to examine the factors associated with angina. A total of 31,443 respondents aged 50 years and over were included in these analyses. The prevalence of angina was highest in Russia (39%), lowest in China (8%), and consistently higher in women than men. Angina was comorbid with chronic conditions and depression but patterns varied across countries. Depression was negatively associated with angina among older adults in Ghana but was positively associated with angina in all other countries. Hypertension was associated with increased odds of angina among older adults in China (OR 1.9 95% CI 1.59-2.25), India (OR 1.4 95% CI 1.14-1.78) and Russia (OR 3.7 95% CI 2.33-6.00). Diabetes was associated with higher odds of angina in China (OR 1.6 95% CI 1.15-2.15), Russia (OR 2.5 95% CI 1.57-3.87), and South Africa (OR 4.1 95% CI 2.49-6.88). CVD is a significant contributor to disease burden in LMICs. Angina was often co-morbid with other conditions, therefore compelling health systems to develop longer-term integrated care systems to address co- and multi-morbidity.
Publisher: Health Affairs (Project Hope)
Date: 07-2008
Publisher: National Inquiry Services Center (NISC)
Date: 03-04-2015
DOI: 10.2989/16085906.2015.1040805
Abstract: The objective of this study was to examine gender roles in the provision and receipt of care among older Ugandans. Survey data on care work were collected in 2009-2010 from 510 older people infected or affected by HIV/AIDS, at one rural and one semi-urban site. The questionnaire was adapted from the WHO Study on global AGEing and adult health survey. The type of care work done by older men and women for children in their households differs, yet, both men and women are taking on various types of care work. Women were more likely to report taking part in health ersonal and physical care, whereas men were more likely to report providing financial assistance. Some older people, particularly women, were providing care at the same time as needing care. The finding on reciprocity of care suggests the need for further studies focused on how the reciprocity of care may affect health and well-being in older age.
Publisher: Wiley
Date: 15-01-2011
Publisher: Elsevier BV
Date: 09-2017
Publisher: Elsevier BV
Date: 2015
Publisher: BMJ
Date: 11-2016
Publisher: Elsevier BV
Date: 02-2015
Publisher: Elsevier BV
Date: 11-2018
Publisher: Springer Science and Business Media LLC
Date: 31-10-2019
Publisher: Public Library of Science (PLoS)
Date: 13-08-2015
Publisher: Informa UK Limited
Date: 08-11-2015
DOI: 10.3109/03014460.2015.1103901
Abstract: Physical activity impacts the ageing process yet, few studies have examined relationships among physical activity, functional abilities and health among older adults in non-Western settings. This study tests for associations among measures of physical activity, function and self-report health conditions among 200 older adults (49--50 years old) in Jodhpur, Rajasthan, India. Seven consecutive days of accelerometry data were used in measures of physical activity (Total Daily Energy Expenditure [TDEE], Physical Activity Level [PAL], Daily Average Activity Count [AC] and Activity Energy Expenditure [AEE]). Measures of physical function included grip strength, timed walk and daily average sit time. Participants reported if they had been diagnosed with diabetes, hypertension, arthritis and/or depression. All four measures of physical activity were positively associated with grip strength (p ≤ 0.05). AC was negatively associated with timed walk (p ≤ 0.05), and both AC and AEE were negatively associated with daily average sit time (p ≤ 0.05). Women who reported diagnosis of hypertension had lower PAL and AC (p ≤ 0.05). This study provides further evidence for a positive relationship between physical activity and functional ability among older adults and between physical activity and cardiovascular health among women in India.
Publisher: Informa UK Limited
Date: 03-05-2016
Publisher: Oxford University Press (OUP)
Date: 10-2016
DOI: 10.1093/IJE/DYW181
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.JAD.2018.08.011
Abstract: The aim of current study is to assess the cross-sectional association of chronic non-communicable diseases (diabetes mellitus, arthritis, asthma, chronic lung disease, angina, and stroke) with both diagnosed and undiagnosed depression in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1, a study of adults in six low- and middle-income countries. A total of 41,810 participants, aged ≥ 18 years, were included. Depression status was assessed by standard methods derived from the World Mental Health Survey (WHH-CIDI). Undiagnosed depression was defined as a depressed person who did not report history of diagnosis/treatment for depression. Associations between depression/undiagnosed depression and chronic diseases, adjusting for country of residence, demographics and chronic diseases risk factors were assessed. Depression was detected in 2508 (6.0%) cases, from whom 2098 (87%) were undiagnosed. Diabetes (Odds ratio:1.47[95%CI:1.24,1.75]), arthritis (2.14[1.82,2.52]), asthma (3.36[2.73,4.14]), chronic lung disease (3.74[3.10,4.51]), angina (3.20[2.66,3.85]), and stroke (3.14[2.55,3.86]) were associated with depression (p-values < 0.001). Being older, female, underweight, and having lower education, and lower income were positively associated with depression. The estimated odds ratios were similar for undiagnosed depression. Cross-sectional design of study prevent us to determine whether depression followed exposures in time. About 12% of the participant did not have data for depression status and were excluded from the study. Most depression cases were undiagnosed. Depression/undiagnosed depression were strongly associated with chronic diseases stronger than what has been reported in developed countries.
Publisher: Springer Science and Business Media LLC
Date: 10-09-2019
DOI: 10.1007/S00223-019-00609-X
Abstract: Identification of sarcopenia in lower- and middle-income countries (LMICs) is limited by access to technologies that assess muscle mass. We investigated associations between two functional measures of sarcopenia, grip strength and gait speed (GS), with functional disability in adults from six LMICs. Data were extracted from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007-2010) for adults (≥ 65 years) from China, Mexico, Ghana, India, Russia and South Africa (n = 10,892, 52.8% women). We calculated country-specific prevalence of low grip strength, slow GS (≤ 0.8 m/s), and both measures combined. Using multivariable negative binomial regression, we separately assessed associations between low grip strength, slow GS, and both measures combined, with the WHO Disability Assessment Schedule 2.0, accounting for selected socioeconomic factors. In women, low grip strength ranged from 7 in South Africa to 51% in India in men, it ranged from 17 in Russia to 51% in Mexico. Country-specific proportions of slow GS ranged from 77 in Russia, to 33% in China. The concomitant presence of both was the lowest in South Africa and the highest in India (12.3% vs. 33%). Independent of age, those with both low grip strength and slow GS had between 1.2- and 1.5-fold worse functional disability scores, independent of comorbidities, low education, and low wealth (all country-dependent). Low grip strength, slow GS, and the combination of both, were all associated with higher levels of functional disability, thus indicating these objective measures offer a reasonably robust estimate for potential poor health outcomes.
Publisher: MDPI AG
Date: 28-08-2017
DOI: 10.3390/NU9090939
Publisher: Oxford University Press (OUP)
Date: 12-2018
DOI: 10.1093/IJE/DYY227
Publisher: Public Library of Science (PLoS)
Date: 09-01-2019
Publisher: Instituto Nacional de Salud Publica
Date: 23-10-2019
DOI: 10.21149/10062
Abstract: To examine the longitudinal association between the social determinants of health (SDH) and frailty status with all-cause mortality in older Mexican adults. Longitudinal study with a s le of adults aged 60 and over of Study on Global AGEing and Adult Health (SAGE) in Mexico. A Cox proportional hazard model was used to estimate the SDH and frailty-related hazard ratios (HR) for mortality over the study period. Overall mortality rate was 16.9%. Higher education, having a higher frequency of inter-personal contacts (HR=0.96 p<0.01) reduced the risk of dying, after adjusting for potential confounders. While, not counting on someone to trust (HR= 1.59 p<0.03) and having a sense a lack of control over important decisions in life increased the mortality risk. Given that frailty and the SDH affect health using independent pathways, public health systems in Mexico could benefit from increasing the capacity of identifying frail and isolated older adults and providing a risk-stratified health care accordingly.
Publisher: Informa UK Limited
Date: 23-01-2013
Publisher: Springer Science and Business Media LLC
Date: 06-02-2015
Publisher: BMJ
Date: 03-2018
DOI: 10.1136/BMJOPEN-2017-020404
Abstract: The WHO’s global targets for non-communicable disease reduction recommend consumption of g salt/day. In 2016, South Africa was the first country to legislate maximum salt levels in processed foods. South Africa’s salt iodisation fortification programme has successfully addressed iodine deficiency but information is dated. Simultaneous monitoring of sodium reduction and iodine status is required to ensure compatibility of the two public health interventions. A nested cohort design within WHO’s 2015 Study on global AGEing and adult health (n=2887) including in iduals from households across South Africa. Randomly selected adults (n=875) provided 24-hour and spot urine s les for sodium and iodine concentration analysis (the primary and secondary outcome measures, respectively). Median 24-hour urinary iodine excretion (UIE) and spot urinary iodine concentrations (UIC) were compared by salt intakes of g/day, 5–9g/dayand g/day. Median daily sodium excretion was equivalent to 6.3 g salt/day (range 1–43 g/day) 35% had urinary sodium excretion values within the desirable range ( g salt/day), 37% had high values (5–9 g salt/day) and 28% had very high values ( g salt/day). Median UIC was 130 µg/L (IQR=58–202), indicating population iodine sufficiency (≥100 µg/L). Both UIC and UIE differed across salt intake categories (p .001) and were positively correlated with estimated salt intake (r=0.166 and 0.552, respectively both p .001). Participants with salt intakes of g/day were not meeting the Estimated Average Requirement for iodine intake (95 µg/day). In a nationally representative s le of South African adults, the association between indicators of population iodine status (UIC and UIE) and salt intake, estimated using 24-hour urinary sodium excretion, indicate that low salt intakes may compromise adequacy of iodine intakes in a country with mandatory iodisation of table salt. The iodine status of populations undergoing salt reduction strategies needs to be closely monitored to prevent re-emergence of iodine deficiency.
Publisher: Public Library of Science (PLoS)
Date: 27-08-2012
Publisher: National Academies Press
Date: 10-11-2006
DOI: 10.17226/11708
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12877-019-1342-5
Abstract: Anemia and frailty contribute to poor health outcomes in older adults however, most current research in lower income countries has concentrated on anemia or frailty alone rather than in combination. The aim of the present study was to investigate the association between anemia and frailty in community-dwelling adults aged 50 years and older in China. The study population was sourced from the 2007/10 SAGE China Wave 1. Anemia was defined as hemoglobin less than 13 g/dL for men and less than 12 g/dL for women. A Frailty Index (FI) was compiled to assess frailty. The association between anemia and frailty was evaluated using a 2-level hierarchical logistic model. The prevalence of anemia was 31.0% ( 95%CI : 28.4, 33.8%) and frailty 14.7% ( 95%CI : 13.5, 16.0%). In the univariate regression model, presence of anemia was significantly associated with frailty (OR = 1.62, 95% CI : 1.39, 1.90) and the effect remained consistent after adjusting for various potential confounding factors including age, gender, residence, education, household wealth, fruit and vegetable intake, tobacco use, alcohol comsumption and physical activity (adjusted OR = 1.31, 95% CI :1.09, 1.57). Each 1 g/dL increase in hemoglobin concentration was associated with 4% decrease in the odds of frailty after adjusting for several confounding variables (adjusted OR = 0.96, 95% CI : 0.93, 0.99). Anemia and low hemoglobin concentrations were significantly associated with frailty. Therefore, health care professionals caring for older adults should increase screening, assessment of causes and treatment of anemia as one method of avoiding, delaying or even reversing frailty.
Publisher: Informa UK Limited
Date: 03-04-2017
DOI: 10.1080/19485565.2017.1283582
Abstract: Apolipoprotein B (ApoB) is a strong predictor of cardiovascular disease, which remains the leading cause of mortality in both higher and lower income countries. Here, we adapted an enzyme-linked immunosorbent assay (ELISA) development kit for quantitative determination of ApoB levels in serum and plasma for use with dried blood spots (DBS). After confirming the dilution linearity of the assay for DBS, we measured ApoB in 208 venous DBS s les. Then, using Passing-Bablok regression analysis and Spearman rank correlation analysis, we evaluated the correspondence in ApoB values between matched plasma and finger-prick DBS s les from 40 in iduals who had ApoB values spanning the range of ApoB values observed in the 208 vDBS s les. We also evaluated assay precision and recovery, the effects of hematocrit, number of freeze-thaw cycles, and different storage temperatures on ApoB levels in DBS. There was a strong, significant correlation between plasma and DBS ApoB levels with little bias. Assay precision and recovery were within the range recommended by the U.S. government's industry guidelines for bioanalytical assay validation. The assay was not affected by the DBS matrix or physiological hematocrit levels. This DBS-based ELISA assay will facilitate population-scale assessment of cardiovascular risk in previously unexplored populations.
Publisher: Elsevier BV
Date: 10-2008
Publisher: Springer Science and Business Media LLC
Date: 16-07-2020
DOI: 10.1186/S40101-020-00228-8
Abstract: The prevalence of allergic and autoimmune conditions has been steadily increasing in wealthy nations over the past century. One hypothesis put forward to explain this is the Old Friends Hypothesis, which posits that increased hygiene, urbanization, and lifestyle changes have reduced our exposure to parasites and microbes that we co-evolved with, resulting in immune dysregulation. However, research in traditionally living populations, who are exposed to greater parasite and pathogen loads such as those encountered during our evolution, is limited, in part due to a lack of minimally invasive, field-friendly biomarkers of autoimmune disorders. We therefore developed an ELISA to assess positivity for thyroid peroxidase autoantibody (TPO-Ab), an indicator of autoimmune thyroid disease, based on dried blood spot (DBS) s les. We used the Accubind anti-thyroid peroxidase test system to screen our validation s les comprising matched fingerprick DBS, venous DBS, and plasma s les from 182 adults. After confirming that we had TPO-Ab-positive in iduals in our validation s le ( n = 12), we developed an indirect ELISA to measure TPO-Ab levels from one 3-mm DBS punch. The sensitivity and specificity of our assay for DBS s les ranged from 91.7–100% and 98.2–98.8%, respectively, using a cut-off value of ≥ 26 IU/mL. Intra-assay reliability for duplicate quality control DBS punches was 5.2%, while inter-assay reliability ranged from 11.5–24.4% for high, medium, and low DBS controls. Dilutional linearity ranged from 80 to 120%, and spike and recovery experiments indicated that the DBS matrix does not interfere with the detection of TPO-Ab. TPO-Ab levels remained stable in DBS s les stored at − 28 °C or − 80 °C, but decreased over time in DBS s les kept at 22 °C or at 37 °C. We developed an in-house, kit-independent indirect ELISA assay to determine in iduals’ TPO-Ab positivity based on dried blood spots, representing a cost-effective method with potential applications in a range of research settings.
Publisher: National Inquiry Services Center (NISC)
Date: 23-11-2018
DOI: 10.2989/16085906.2018.1542322
Abstract: This study examined the association between social engagement and survival in people with or without HIV aged 50 years and over in Uganda. We analysed two waves of a survey from two sites in Uganda to assess predictors of mortality between waves. The first wave was conducted between 2009 and 2010 while the second wave was conducted between 2012 and 2013. A standardised questionnaire adapted from the World Health Organization study on global AGEing and adult health (SAGE) was administered through face-to-face interviews at both survey waves. Cox proportional hazards models and Nelson-Aalen cumulative hazards functions were used to investigate associations between the strength of participants' social ties, using distance and intimacy metrics, and their social engagement with mortality between waves. Of the original 510 participants, 63 (12.3%) died between waves. Being more socially engaged and able to provide in-kind or financial contributions to family or friends were protective. After adjusting for covariates neither social tie measure was predictive of mortality. There were no significant differences in social engagement and survival by HIV status. Further research is needed in African settings on the relationship between social relationships and subsequent mortality in older adults to assess if improved social relationships could moderate mortality.
Publisher: Springer Science and Business Media LLC
Date: 20-10-2013
Publisher: Human Kinetics
Date: 04-2019
Abstract: Physical function is positively associated with subjective well-being in older adults from high-income nations. This study tests whether this association is evident in low- and middle-income countries. Data were drawn from the study on global AGEing and adult health, using nationally representative s les of in iduals over 50 years old from China, Ghana, India, Mexico, Russia, and South Africa. Participant interviews measured well-being (quality of life, mood, and happiness) and physical function (grip strength, usual and rapid gait speed). Logistic regressions tested relations between physical function and well-being variables within each country. Higher physical function measures exhibited moderate, yet significant, associations with increased odds of highly rated well-being (p < .05). However, higher gait speeds were unexpectedly associated with decreased odds of highly rated well-being (p < .05) in South Africa and Russia. These results suggest that physical function is generally positively associated with perceived well-being in older in iduals from lower income nations.
Publisher: Springer Science and Business Media LLC
Date: 26-10-2015
Publisher: Oxford University Press (OUP)
Date: 17-10-2019
Publisher: SAGE Publications
Date: 02-12-2016
Abstract: The objective of this article is to document factors associated with the recency of health-care service utilization by people aged 50 years and over living with and without HIV in Uganda. A survey was conducted with 510 Ugandans aged 50 and older, living with and without HIV. The survey included information on sociodemographic characteristics, health state, self-reported chronic conditions, and timing of most recent visit to a health-care facility (time since last visit [TSLV]). We use ordinal logistic regression to identify independent factors associated TSLV. Independent factors associated with TSLV ( months) include age, OR = 2.40 [95% CI 1.08–5.37] for those aged 80 years and above, urban respondents, OR = 0.6 [95%CI 0.38–0.94], HIV-positive respondents, OR = 0.33 [95%CI 0.18–0.59], and better health. To understand the meaning of these finding, further investigation should examine (a) how best to define and measure older persons’ health-care service needs and (b) older persons’ decision-making processes around the timing of their access to health-care facilities.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.DHJO.2019.03.004
Abstract: Empirical evidence suggests that multimorbidity and disability are each significantly associated with out-of-pocket (OOP) health expenditures however few efforts have been made to explore their joint association with OOP health expenditures. To estimate the association of multimorbidity and disability with OOP health expenditures in households with older adults in Mexico, as well as the potential interaction effects of multimorbidity and disability on OOP health expenditures. Longitudinal study based on data collected as part of the Study on global AGEing and adult health Wave 1 (2009) and Wave 2 (2014), a nationally representative study in Mexico with a s le of older adults aged 50 and older. The dependent variable was OOP health expenditures, and main exposure variables were multimorbidity and disability. Two-Part regression models were used to analyze the relation between multimorbidity, disability and OOP health expenditures. Multimorbidity was associated with the probability of incurring OOP health expenditures (OR = 1.28, CI Multimorbidity and disability appear to be important determinants of OOP health expenditures. The economic implications for the households and the health system should be highlighted, particularly in low- and middle-income countries because of the rapid growth of their aging populations.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2017
Publisher: Springer Science and Business Media LLC
Date: 24-11-2011
Publisher: Springer Science and Business Media LLC
Date: 24-11-2011
Publisher: Informa UK Limited
Date: 23-12-2019
DOI: 10.1080/09540121.2019.1707472
Abstract: The current longitudinal study consisted of baseline and follow-up surveys among older adults living with HIV (OALHIV) in Thailand. The health-related quality of life (HRQoL) was assessed using the Medical Outcomes Study HIV (MOS-HIV) questionnaire. We performed multiple linear regression analysis to document correlates of HRQoL at baseline and the predictors of the changes in HRQoL at follow-up. Of the 364 participants recruited at baseline 327 (89.9%) completed the follow-up survey. The mean (SD) Physical Health Summary (PHS) and Mental Health Summary (MHS) scores were respectively 49.8 (7.3) and 53.2 (6.4). There was a significant increase in the mean score of most of the MOS-HIV domains, ranging between 1.3 for the PHS and 26.9 for the energy/fatigue dimension. In contrast, the mean score significantly decreased by 4.1 and 10.3 points, respectively for the cognitive and social functioning. Female gender was a predictor of the decline in social (
Publisher: Elsevier BV
Date: 02-2020
Publisher: Springer Science and Business Media LLC
Date: 04-11-2016
Publisher: Elsevier BV
Date: 06-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
DOI: 10.1161/STROKEAHA.116.015739
Abstract: Short-term exposure to ambient fine particulate pollution (PM 2.5 ) has been linked to increased stroke. Few studies, however, have examined the effects of long-term exposure. A total of 45 625 participants were interviewed and included in this study, the participants came from the Study on Global Ageing and Adult Health, a prospective cohort in 6 low- and middle-income countries. Ambient PM 2.5 levels were estimated for participants’ communities using satellite data. A multilevel logistic regression model was used to examine the association between long-term PM 2.5 exposure and stroke. Potential effect modification by physical activity and consumption of fruit and vegetables was assessed. The odds of stroke were 1.13 (95% confidence interval, 1.04–1.22) for each 10 μg/m 3 increase in PM 2.5 . This effect remained after adjustment for confounding factors including age, sex, smoking, and indoor air pollution (adjusted odds ratio=1.12 95% confidence interval, 1.04–1.21). Further stratified analyses suggested that participants with higher levels of physical activity had greater odds of stroke, whereas those with higher consumption of fruit and vegetables had lower odds of stroke. These effects remained robust in sensitivity analyses. We further estimated that 6.55% (95% confidence interval, 1.97%–12.01%) of the stroke cases could be attributable to ambient PM 2.5 in the study population. This study suggests that ambient PM 2.5 may increase the risk of stroke and may be responsible for the astounding stroke burden in low- and middle-income countries. In addition, greater physical activity may enhance, whereas greater consumption of fruit and vegetables may mitigate the effect.
Publisher: Elsevier BV
Date: 08-2014
Abstract: The demographic and health aspects of ageing populations in Australia and New Zealand (NZ) are described. These data are relevant to compare impacts of policy and context in each country. Secondary analysis of international (Organization for Economic Co-operation and Development, United Nations and World Health Organization) and domestic population and health data. Both countries will experience a greater than 80% increase in the population aged 60-plus years between 2013 and 2050. The increase in the 80-plus population will be 200% or higher, resulting in 2.8 million Australians and more than 510,000 New Zealanders in this age group by 2050. The speed of ageing in both countries is higher than the average rate of increase in developed countries. Average life expectancy at birth and age 60 is higher in Australia than NZ, with the differences increasing slightly by 2050, and gaps between men and women consistently smaller in NZ than in Australia. However, a higher proportion of older Australians report living with a disability (53%) than older New Zealanders (45%). Australia and NZ are well aged in the context of a youthful Oceania region, with more similarities than differences between the countries. Both countries need to continue to monitor health trends, unravel the major population attributable risks, and identify preventative and other interventions that can stimulate and support declines in disability in older populations in the future, particularly for non-indigenous older persons.
Publisher: Wiley
Date: 06-10-2014
DOI: 10.1111/JPHD.12075
Abstract: Edentulism has important health implications for aging in iduals and is used as an indicator of the oral health of a population. Its distribution is unequal within populations, with the greatest burden on disadvantaged and socially marginalized populations. With an increasing older adult population in Ghana, its burden may increase however, there is no nationwide information on edentulism in Ghana. Focusing on adults 50 years and older, this study assessed the prevalence of edentulism among older Ghanaians and its distribution across the country. Secondary analysis of WHO's Study on global AGEing and adult health (SAGE) Wave 1 in Ghana was conducted using self-reported edentulism as the dependent variable. The overall prevalence was 2.8%, varying by sex (men had lower rates OR = 0.67, 95% CI = 0.47-0.97) by location, being more prevalent in urban areas (3.6%) and the Western Region (4.7%) by education levels (rates were higher among those with no formal education OR = 1.626, 95% CI = 1.111-2.380) and by marital status (those living without a partner had higher rates OR = 1.980, 95% CI =1.366-2.870). On multivariate logistic regression, the variables positively associated with edentulism were older age (OR = 0.945) and urban residence (OR = 0.582). Living in the Brong Ahafo (OR = 3.138), Central (OR = 2.172), Eastern (OR = 2.257), or Volta regions (OR = 3.333) was negatively associated with edentulism. Edentulism is unequally distributed across Ghana. Future aged cohorts are likely to follow the same patterns of geographic and social disadvantage if needed interventions are not carried out. This study provides nationwide data to assist service planning.
Publisher: Informa UK Limited
Date: 11-06-2013
Publisher: Public Library of Science (PLoS)
Date: 04-06-2015
Publisher: National Inquiry Services Center (NISC)
Date: 03-07-2022
Publisher: Informa UK Limited
Date: 27-04-2018
Publisher: Public Library of Science (PLoS)
Date: 14-09-2015
Publisher: Wiley
Date: 21-03-2019
DOI: 10.1002/AJHB.23240
Abstract: A number of basic questions about bone biology have not been answered, including population differences in bone turnover. In part, this stems from the lack of validated minimally invasive biomarker techniques to measure bone formation and resorption in field‐based population‐level research. The present study addresses this gap by validating a fingerprick dried blood spot (fDBS) assay for tartrate‐resistant acid phosphatase 5b (TRACP‐5b), a well‐defined biomarker of bone resorption and osteoclast number. We adapted a commercially available enzyme‐linked immunosorbent assay (ELISA) kit from MyBiosource for the quantitative determination of TRACP‐5b levels in serum and plasma for use with DBS. We used a rigorous process of assay modification and validation, including the use of a matched set of 189 adult plasma, fDBS, and venous DBS (vDBS) s les parameters evaluated included precision, reliability, and analyte stability. Plasma and DBS TRACP‐5b concentrations showed a linear relationship. There were no systematic differences in TRACP‐5b levels in fDBS and vDBS, indicating no significant differences in TRACP‐5b distribution between capillary and venous blood. Parallelism and spike‐and‐recovery results indicated that matrix factors in DBS do not interfere with measurement of TRACP‐5b levels from DBS using the validated kit. Intra‐ and interassay CVs were 5.0% and 12.1%, respectively. DBS s les should preferably be stored frozen but controlled room temperature storage for up to a month may be acceptable. This DBS‐based ELISA assay adds to the methodological toolkit available to human biologists and will facilitate research on bone turnover in population studies.
Publisher: SAGE Publications
Date: 27-08-2018
Abstract: Objectives: The study compared the proportion of older adults identified as drinking hazardously based on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) with the older adult-specific Comorbidity Alcohol Risk Evaluation Tool (CARET) and investigated whether sociodemographics, comorbidities, health, medication use, and alcohol-related risk behaviors explained discrepancies between the screens in classification of hazardousness. Method: The AUDIT-C and the CARET were administered to 3,673 adults aged 55 to 89 years. Classification agreement between the screens was evaluated using Cohen’s kappa. Hazardous drinking groups were compared using logistic regression. Results: Analysis indicated moderate agreement between the screens. Drinkers classified as “hazardous on the CARET only” consumed less alcohol, but were more likely to drink-drive. Introducing a drink-driving criterion into the calculation of hazardousness on the AUDIT-C substantially decreased the classification discrepancy between the measures. Discussion: Standard screening can be improved by investigating comorbidities, medication use, and alcohol-related risk behaviors in those initially identified as nonhazardous drinkers.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-07-2014
Publisher: Informa UK Limited
Date: 11-2013
DOI: 10.1080/09540121.2013.765936
Abstract: Older caregivers have major caregiving responsibilities in countries severely affected by the HIV epidemic, but little is known about their own health and well-being. We conducted this study to assess the association of caregiving responsibilities and self-perceived burden with caregivers' health, HIV status, background characteristics and care-receiving among older people in South Western Uganda. Men and women aged 50 years and older were recruited from existing cohort studies and clinic registers and interviewed at home. Health was measured through a composite score of health in eight domains, anthropometry and handgrip strength. Summary measures of caregiving responsibilities and self-reported burden were used to analyse the main associations. There were 510 participants, including 198 living with HIV. Four fifths of women and 66% of men were caregivers. Older respondents with no care responsibility had poorer scores on all health indicators (self-reported health score, body mass index and grip strength). Having a caregiving responsibility was not associated with poorer health status or quality of life. Notably, HIV-infected people, whether on antiretroviral treatment (ART) or not, had similar caregiving responsibilities and health status as others. The self-reported burden associated with caregiving was significantly associated with a poorer health score. One third of female caregivers were the single adult in the household with larger caregiving responsibilities. Many of these women are in the poorest wealth quartile of the households in the study and are therefore more likely to need assistance. Physical and financial supports were received by 70% and 63%, respectively. Those with larger caregiving responsibilities more frequently received support. Caregiving responsibilities were associated with better health status, greater satisfaction and quality of life. Older HIV-infected people, whether on ART or not, had similar caregiving responsibilities and self-reported health status as other older people.
Publisher: Springer Science and Business Media LLC
Date: 13-08-2015
Publisher: Wiley
Date: 11-2006
Abstract: The effects of conjugated equine estrogens (CEE) 0.625 mg daily on cytochrome P450 (CYP) were quantified in 12 middle-aged and 13 elderly postmenopausal women at baseline and 6 months later. CYP phenotype was characterized by caffeine (CYP1A2), chlorzoxazone (CYP2E1), dapsone (CYP, N-acetyltransferase 2), dextromethorphan (CYP2D6), and mephenytoin (CYP2C19) metabolism. CEE significantly decreased CYP1A2 (caffeine metabolic ratio: 0.57 +/- 0.20 before, 0.40 +/- 0.20 after, P = .001) and significantly increased CYP2D6 (dextromethorphan/dextrorphan ratio: 0.0116 +/- 0.0143 before, 0.0084 +/- 0.0135 after, P = .022) metabolism. CEE had no overall effect on CYP2C19, CYP2E1, CYP-mediated dapsone metabolism, and N-acetyltransferase 2. The dextromethorphan metabolic ratio decreased only in the seniors. The dapsone recovery ratio decreased in the middle-aged group and increased in the seniors. CEE significantly influenced CYP1A2, CYP2D6, and CYP-mediated dapsone oxidative metabolism but not CYP2C19, CYP2E1, or N-acetyltransferase 2 metabolism in postmenopausal women. Age influenced CYP2D6 metabolism and dapsone hydroxylation.
Publisher: Springer Science and Business Media LLC
Date: 25-04-2009
DOI: 10.1007/S10198-008-0106-5
Abstract: This study assessed the quality of life (QoL) of Palestinians living in conditions of chronic conflict and examined its determinants. An adapted World Health Organization quality of life (WHOQoL-Bref) instrument was used in a representative s le of 1,008 adults. Factor analysis and multiple regression were conducted to determine associations between demographic and socioeconomic characteristics and scores of extracted principal determinants, and estimated overall and domain-specific QoL scores. Men, older persons and those less educated reported lower QoL than their counterparts. Negative associations were also found with higher distress and fear levels, and lower financial and freedom status. The chronic and entrenched conflict over generations resulted in lower QoL for the population of the Occupied Palestinian Territory.
Publisher: Springer Science and Business Media LLC
Date: 12-09-2014
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-06-2014
DOI: 10.5664/JCSM.3782
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.EJIM.2016.03.007
Abstract: One of the leading causes of morbidity and premature mortality in older people is frailty. Frailty occurs when multiple physiological systems decline, to the extent that an in idual's cellular repair mechanisms cannot maintain system homeostasis. This review gives an overview of the definitions and measurement of frailty in research and clinical practice, including: Fried's frailty phenotype Rockwood and Mitnitski's Frailty Index (FI) the Study of Osteoporotic Fractures (SOF) Index Edmonton Frailty Scale (EFS) the Fatigue, Resistance, Ambulation, Illness and Loss of weight (FRAIL) Index Clinical Frailty Scale (CFS) the Multidimensional Prognostic Index (MPI) Tilburg Frailty Indicator (TFI) PRISMA-7 Groningen Frailty Indicator (GFI), Sherbrooke Postal Questionnaire (SPQ) the Gérontopôle Frailty Screening Tool (GFST) and the Kihon Checklist (KCL), among others. We summarise the main strengths and limitations of existing frailty measurements, and examine how well these measurements operationalise frailty according to Clegg's guidelines for frailty classification - that is: their accuracy in identifying frailty their basis on biological causative theory and their ability to reliably predict patient outcomes and response to potential therapies.
Publisher: Springer Science and Business Media LLC
Date: 20-02-2016
DOI: 10.1007/S10823-016-9283-3
Abstract: This paper describes overall socioeconomic gradients and the age patterns of socioeconomic gradients of health of Indian adults for multiple health indicators encompassing the multiple aspects of health. Cross-sectional data on 11,230 Indians aged 18 years and older from the WHO-SAGE India Wave 1, 2007 were analyzed. Multivariate logit models were estimated to examine effects of socioeconomic status (education and household wealth) and age on four health domains: self-rated health, self-reported functioning, chronic diseases, and biological health measures. Results show that socioeconomic status (SES) was negatively associated with prevalence of each health measure but with considerable heterogeneity across age groups. Results for hypertension and COPD were inconclusive. SES effects are significant while adjusting for background characteristics and health risk factors. The age patterns of SES gradient of health depict ergence with age, however, no conclusive age pattern emerged for biological markers. Overall, results in this paper dispelled the conclusion of negative SES-health association found in some previous Indian studies and reinforced the hypothesis of positive association of SES with health for Indian adults. Higher prevalence of negative health outcomes and SES disparities of health outcomes among older age-groups highlight need for inclusive and focused health care interventions for older adults across socioeconomic spectrum.
Publisher: Informa UK Limited
Date: 2018
Publisher: Oxford University Press (OUP)
Date: 16-11-2019
Abstract: Perceived income adequacy is positively associated with self-rated health (SRH) and quality of life (QOL) among adults in higher-income countries. Additionally, older in iduals often report higher levels of income adequacy. However, it is unclear if these associations, documented primarily in high-income countries, are also evident across economically and culturally distinctive low- and middle-income countries. Data were drawn from the World Health Organization’s Study on global AGEing and adult health (SAGE), a study of adults aged 50 years or older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. Smaller s les of younger adults (18–49 years) were included for comparison purposes. Participants reported income adequacy, SRH, and QOL. Associations between age and income adequacy and between income adequacy and SRH/QOL were examined using country-specific logistic regression analysis. Older adults in China and Russia were more likely to report better income adequacy than their 18- to 49-year-old counterparts however, the opposite was observed in Ghana and India. SRH and QOL improved as income adequacy increased in all countries. As expected, income adequacy was correlated with SRH and QOL. However, the relationship between age and income adequacy varied cross-culturally, potentially due to differences in familial and governmental financial support.
Publisher: Oxford University Press (OUP)
Date: 12-2012
DOI: 10.1093/IJE/DYS210
Publisher: Wiley
Date: 14-11-2015
DOI: 10.1002/AJHB.22803
Abstract: Accelerometry provides researchers with a powerful tool to measure physical activity in population-based studies, yet this technology has been underutilized in cross-cultural studies of older adults. The present study was conducted among older adults in an urban setting in India with the following three objectives: (1) to compare average activity levels obtained through different durations of monitoring (1, 3, and 7 days) (2) to document differences in physical activity patterns by sex and age and (3) to evaluate links between measures of physical activity and anthropometrics, as well as between activity parameters and measures of household size, work status, and social cohesion. The present study uses data from a physical activity substudy of the World Health Organization's Study on global AGEing and adult health (SAGE-PA). This study of 200 older adults (49-90 years old 72 males, 128 females) in urban India combines 7 continuous days of ActiGraph GT3X accelerometry with anthropometric and sociodemographic data. Results reveal overall low activity levels, with significantly lower activity energy expenditure (AEE) among females (P < 0.05). No significant differences were documented in activity level by monitoring duration. Age was negatively correlated with AEE in men (P < 0.01) and women (P < 0.001). AEE was positively correlated with BMI in men (P < 0.01) and women (P < 0.05). Finally, women who were more socially integrated had greater AEE (P < 0.01). This study illustrates the utility of accelerometry for quantifying activity levels in aging populations in non-Western nations. Am. J. Hum. Biol. 28:412-420, 2016. © 2015 Wiley Periodicals, Inc.
Publisher: Informa UK Limited
Date: 30-03-2016
DOI: 10.3402/GHA.V9.30747
Abstract: As populations age, cognitive decline and dementia pose significant burdens for societies and health care systems, including low- and middle-income countries such as Mexico. Minor age-related declines in cognitive function appear to represent a stable but heterogeneous phase in the continuum between normal cognitive ageing and dementia. Loss of cognitive function has impacts at societal and in idual levels and understanding the risk factors can help provide a framework for health policies and interventions to target at-risk groups. A cohort of older Mexican adults (50+) from the World Health Organization's Study on global AGEing and adult health (WHO SAGE) was used to examine cognitive function, including a total of 2315 respondents, with 325 respondents aged 80 years and older. Cognition was objectively evaluated using verbal recall, verbal fluency, forward digit span and backward digit span, with differences in an overall cognitive score assessed against sociodemographic variables, and associated factors using linear regression. The most significant predictors of poorer cognitive function were found to be older age (β=-13.88), rural living (β=-2.25), low income (β=-8.28), self-reported severe or extreme memory difficulties (β=-6.62), and difficulty with two or more activities of daily living (β=-2.02). These findings can inform public health initiatives to address cognitive impairment in ageing populations in Mexico and other middle-income countries.
Publisher: Springer Science and Business Media LLC
Date: 20-03-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-07-2012
Publisher: Public Library of Science (PLoS)
Date: 17-09-2013
Publisher: Springer Science and Business Media LLC
Date: 05-04-2014
Publisher: Wiley
Date: 09-2016
DOI: 10.1016/J.IJGO.2016.03.011
Abstract: Screening reduces cervical cancer incidence and mortality. To describe cervical cancer epidemiology and screening guidelines in six low- and middle-income countries (LMICs) participating in the Study on global AGEing and adult health (SAGE). Incidence, mortality, and screening-rate data were obtained for six LMICs and three higher-income comparator countries (Australia, USA, and UK). SCOPUS and PubMed were used to identify literature published after 2000 in English, using several screening-linked terms. Literature describing the use of cervical cancer screening guidelines in China, Ghana, India, Mexico, Russia, and South Africa were included. Incidence, mortality trends, and screening rates were graphed and screening recommendations were summarized. Higher rates of cervical cancer incidence, mortality, and 5-year prevalence were found in LMICs compared with the comparator countries. LMICs with absent or newly implemented screening guidelines had the lowest rates of crude and effective cervical cancer screening, with high cancer incidence and mortality. Countries with established guidelines had higher screening rates and lower disease burden. Cost, inadequate knowledge, geographical location, and cultural views were common barriers to effective screening coverage. Work must continue to improve the implementation of affordable, relevant, and achievable methods to improve screening coverage in LMICs.
Publisher: Informa UK Limited
Date: 30-04-2016
DOI: 10.1080/17441692.2016.1173717
Abstract: The burden of HIV is increasing among adults aged over 50, who generally experience increased risk of cormorbid illnesses and poorer financial protection. We compared patterns of health utilisation and expenditure among HIV-positive and HIV-negative adults over 50. Data were drawn from the Study on global AGEing and adult health in South Africa with analysis focusing on in idual and household-level data of 147 HIV-positive and 2725 HIV-negative respondents. HIV-positive respondents reported lower utilisation of private health-care facilities (11.8%) than HIV-negative respondents (25.0%) (p = .03) and generally had more negative attitudes towards health system responsiveness than HIV-negative counterparts. Less than 10% of HIV-positive and HIV-negative respondents experienced catastrophic health expenditure (CHE). Women (OR 1.8 p < .001) and respondents from rural settings (OR 2.9 p < .01) had higher odds of CHE than men or respondents in urban settings. Over half the respondents in both groups indicated that they had received free health care. These findings suggest that although HIV-positive and HIV-negative older adults in South Africa are protected to some extent from CHE, inequalities still exist in access to and quality of care available at health-care services - which can inform South Africa's development of a national health insurance scheme.
Publisher: MDPI AG
Date: 17-06-2014
DOI: 10.3390/NU6062305
Publisher: Springer Science and Business Media LLC
Date: 15-09-2023
Publisher: Wiley
Date: 04-06-2009
DOI: 10.1111/J.1360-0443.2009.02559.X
Abstract: ABSTRACT Aims This paper describes drinking patterns in 20 African countries, exploring the extent of abstention, heavy occasional drinking and daily light drinking and how these aspects of drinking are inter-related. Design and participants Data were collected as part of the World Health Survey in 2002-04 and comprise national representative data sets from 20 African countries. A cross-sectional survey of 77 165 adults aged 18 years and older were undertaken by face-to-face interviews in respondent households. Measures Drinking behaviour was assessed in terms of life-time abstention and the following measures over the 7 days immediately preceding interview: high consumption (15 or more drinks) heavy drinking occasions (five or more standard units at at least one session) and daily light drinking (one or two drinks daily). Findings In four countries (Comoros, Mali, Mauritania and Senegal), virtually all respondents were life-time abstainers. The prevalence of current drinkers (previous week) did not exceed one-third in any country. Among current drinkers the prevalence of heavy drinking varied between 7% and 77% and the prevalence of daily light drinkers varied between 0% and 21%. Overall drinking patterns varied significantly between and within the examined African countries. Conclusions African drinking patterns are erse, and although life-time abstinence dominates in African countries, a single typical pattern of drinking for the African continent, such as the alleged 'all-or-none' pattern, was not observed.
Publisher: Springer Science and Business Media LLC
Date: 14-02-2023
DOI: 10.1186/S12889-023-14986-4
Abstract: Despite the public health system’s critical role in non-communicable disease (NCD) surveillance in Vietnam, limited evidence exists on the implementation of NCD surveillance activities within these systems and the need for capacity building across different system levels to meet expected NCD surveillance goals. This study aimed to evaluate the status of and describe factors affecting the implementation of NCD surveillance activities and to identify the NCD surveillance capacity building needs of the public health system in Vietnam. We used a mixed-methods approach in four provinces, conducting self-completed surveys of staff from six Preventive Medicine Institutes (PHI), 53 Centres for Disease Control (CDC) and 148 commune health stations (CHS), as well as 14 in-depth interviews and 22 focus group discussions at four PHI, four CDC, and eight district health centres and CHS. Study findings highlighted that although Vietnam has a well-functioning NCD surveillance system, a number of quality issues related to NCD surveillance data were salient. Multifactorial reasons were identified for incomplete, unconfirmed, and inaccurate mortality data and current disease surveillance data. Data on NCD management and treatment were reported to be of better quality than data for screening, targeted treatment, and counselling communication. Main factors affected the effective implementation of NCD surveillance, namely lack of complete and specific guidelines for NCD surveillance, limitations in human resource capacity within NCD departments, and shortage of funding for NCD surveillance activities. Study findings provide practical strategies for strengthening health system capacity for NCD surveillance through developing policies, guidelines, and standardised tools to guide NCD surveillance and a road map for integrated NCD surveillance, developing training packages and manuals for all levels of the health system, and conducting utilisation-focused surveillance training programs.
Publisher: MDPI AG
Date: 30-10-2014
Publisher: Springer Science and Business Media LLC
Date: 04-10-2018
Publisher: BMJ
Date: 02-08-2011
DOI: 10.1136/BMJ.D4885
Publisher: Elsevier BV
Date: 04-2016
Publisher: Oxford University Press (OUP)
Date: 04-12-2019
Abstract: Obesity is a major risk factor for many chronic diseases and disabilities, with severe implications on morbidity and mortality among older adults. With an increasing prevalence of obesity among older adults in Ghana, it has become necessary to develop cost-effective strategies for its management and prevention. However, developing such strategies is challenging as body mass index (BMI)-specific utilization and costs required for cost-effectiveness analysis are not available in this population. Therefore, this study examines the associations between health services utilization as well as direct healthcare costs and overweight (BMI ≥25.00 and & .00 kg/m2) and obesity (BMI ≥30.00 kg/m2) among older adults in Ghana. Data were used from a nationally representative, multistage s le of 3350 people aged 50+ years from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE 2014/15). Health service utilization was measured by the number of health facility visits over a 12-month period. Direct costs (2017 US dollars) included out-of-pocket payments and the National Health Insurance Scheme (NHIS) claims. Associations between utilization and BMI were examined using multivariable zero-inflated negative binomial regressions and between costs and BMI using multivariable two-part regressions. Twenty-three percent were overweight and 13% were obese. Compared with normal-weight participants, overweight and obesity were associated with 75% and 159% more inpatient admissions, respectively. Obesity was also associated with 53% additional outpatient visits. One in five of the overweight and obese population had at least one chronic disease, and having chronic disease was associated with increased outpatient utilization. The average per person total costs for overweight was $78 and obesity was $132 compared with $35 for normal weight. The NHIS bore approximately 60% of the average total costs per person expended in 2014/15. Overweight and obese groups had significantly higher total direct healthcare costs burden of $121 million compared with $64 million for normal weight in the entire older adult Ghanaian population. Compared with normal weight, the total costs per person associated with overweight increased by 73% and more than doubled for obesity. Even though the total prevalence of overweight and obesity was about half of that of normal weight, the sum of their cost burden was almost doubled. Implementing weight reduction measures could reduce health service utilization and costs in this population.
Publisher: Elsevier BV
Date: 02-2019
Publisher: MDPI AG
Date: 07-06-2018
DOI: 10.3390/NU10060736
Publisher: Springer Science and Business Media LLC
Date: 20-06-2018
Publisher: Informa UK Limited
Date: 15-04-2014
DOI: 10.3402/GHA.V7.21292
Publisher: Springer Science and Business Media LLC
Date: 10-05-2019
DOI: 10.1038/S41371-019-0210-2
Abstract: Repeated 24-hour urine collection is considered to be the gold standard for assessing salt intake. This is often impractical in large-population studies, especially in low–middle-income countries. Equations to estimate 24-hour urinary salt excretion from a spot urine s le have been developed, but have not been widely validated in African populations. This study aimed to systematically assess the validity of four existing equations to predict 24-hour urinary sodium excretion (24UNa) from spot urine s les in a nationally representative s le of South Africans. Spot and 24-hour urine s les were collected in a subs le ( n = 438) of participants from the World Health Organisation Study on global AGEing and adult health (SAGE) Wave 2 in South Africa in 2015. Measured 24UNa values were compared with predicted 24UNa values from the Kawasaki, Tanaka, INTERSALT and Mage equations using Bland–Altman plots. In this subs le (mean age 52.8 ± 16.4 years body mass index 30.2 ± 8.2 kg/m 2 76% female 73% black African 42% hypertensive), all four equations produced a significantly different population estimate compared with the measured median value of 6.7 g salt/day (IQR 4.4–10.5). Although INTERSALT underestimated salt intake (−3.77 g/d −1.64 to −7.09), the other equations overestimated by 1.28 g/d (−3.52 1.97), 6.24 g/d (2.22 9.45), and 17.18 g/d (8.42 31.96) for Tanaka, Kawasaki, and Mage, respectively. Bland–Altman curves indicated unacceptably wide levels of agreement. Use of these equations to estimate population level salt intake from spot urine s les in South Africans is not recommended.
Publisher: Springer Science and Business Media LLC
Date: 03-08-2015
Publisher: Public Library of Science (PLoS)
Date: 23-04-2013
Publisher: Springer Science and Business Media LLC
Date: 02-04-2012
Publisher: Springer Science and Business Media LLC
Date: 14-05-2020
Publisher: Informa UK Limited
Date: 2017
Publisher: Informa UK Limited
Date: 24-05-2016
DOI: 10.3402/GHA.V9.31098
Abstract: Data on the prevalence of chronic conditions, their risk factors, and their associations with disability in older people living with and without HIV are scarce in sub-Saharan Africa. In older people living with and without HIV in sub-Saharan Africa: 1) to describe the prevalence of chronic conditions and their risk factors and 2) to draw attention to associations between chronic conditions and disability. Cross-sectional in idual-level survey data from people aged 50 years and over living with and without HIV were analyzed from three study sites in Uganda. Diagnoses of chronic conditions were made through self-report, and disability was determined using the WHO Disability Assessment Schedule (WHODAS). We used ordered logistic regression and calculated predicted probabilities to show differences in the prevalence of multiple chronic conditions across HIV status, age groups, and locality. We used linear regression to determine associations between chronic conditions and the WHODAS. In total, 471 participants were surveyed about half the respondents were living with HIV. The prevalence of chronic obstructive pulmonary disease and eye problems (except for those aged 60-69 years) was higher in the HIV-positive participants and increased with age. The prevalence of diabetes and angina was higher in HIV-negative participants. The odds of having one or more compared with no chronic conditions were higher in women (OR 1.6, 95% CI 1.1-2.3) and in those aged 70 years and above (OR 2.1, 95% CI 1.2-3.6). Sleep problems (coefficient 14.2, 95% CI 7.3-21.0) and depression (coefficient 9.4, 95% CI 1.2-17.0) were strongly associated with higher disability scores. Chronic conditions are common in older adults and affect their functioning. Many of these conditions are not currently addressed by health services in Uganda. There is a need to revise health care policy and practice in Uganda to consider the health needs of older people, particularly as the numbers of people living into older age with HIV and other chronic conditions are increasing.
Publisher: Wiley
Date: 05-07-2017
DOI: 10.1002/AJHB.23033
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.JAD.2019.01.054
Abstract: Data from the World Health Organization Study on global AGEing and adult health (SAGE) were used to estimate the prevalence of depression in older adults in six low- and middle-income countries (LMICs), namely China, Ghana, India, Mexico, the Russian Federation, and South Africa, and to examine the relationship between demographic and lifestyle characteristics and depression. A total of 33,421 participants aged ≥ 50 years were included. A set of diagnostic questions from the World Mental Health Survey was used within SAGE to define depression. The crude population prevalence of depression was 7.4% [95%CI: 6.5%-8.3%] ranging from 1.5% in China to 15.2% in India. It was higher in females 8.6% [7.6%-9.6%] compared to males 6.1% [5.0%-7.2%]. The age-standardized prevalence of depression was 7.8% [6.3%-9.6%] in pooled data, 8.9% [6.9%-11.1%] in females and 6.6% [4.6%-9.0%] in males. Greater fruit (0.89[0.84-0.93]) and vegetable intake (0.94 [0.89-1.00]) was associated with a lower prevalence of depression. Furthermore, those who were older, female, underweight, and with lower education and lower wealth, had higher prevalence of depression. The cross-sectional design of this study precluded conclusions on causality. In nationally-representative s les of older adults in six LMICs, an average of one in every 13 participants suffered from depression. The prevalence of depression varied considerably between countries, sexes, and with wealth and educational disadvantage. Increased fruit and vegetable intake appeared to co-occur with significantly lower rates of depression, suggesting diet as a modifiable factor for addressing depression burden.
Publisher: SAGE Publications
Date: 2015
DOI: 10.4137/SART.S23549
Abstract: Alcohol use is a well-known risk factor for injury. However, information is needed about alcohol drinking patterns and the risk of injury among older adults in low- and middle-income countries as this population grows. We aimed to examine the influence of drinking patterns on the burden of injury and investigate factors associated with different types of injury in older populations in six emerging economies. Data from more than 37,0 adults aged 50 years and older were included from the Study on Global AGEing and Adult Health (SAGE) Wave 1 conducted in six emerging economies, namely, China, Ghana, India, Mexico, Russia, and South Africa. We investigated past-year reported injuries from falls, traffic accidents, and being hit or stabbed. Alcohol drinking patterns were measured as lifetime abstinence, ever but not past- week use, and gender-specific past-week low-risk and high-risk use. We stratified by gender and used logistic regression models to observe the association between alcohol drinking pattern and risk of injury by controlling for other factors. During the year prior to interview, 627 (2.2%) subjects reported bodily injury resulting from a car accident, 1,156 (4.2%) from a fall, and 339 (.9%) from being hit or stabbed during the past year. For women, only being a high-risk drinker increased the risk of being hit or stabbed, whereas for men, all levels of drinking were associated with an increased risk of being hit or stabbed. We observed a higher risk of being hit or stabbed from past-week high-risk drinking among women (odds ratio [OR] = 6.09, P 0.01) than among men (OR = 3.57, P 0.01). We observed no association between alcohol drinking pattern and injury due to car accidents for either women or men. The risk of experiencing injury due to violence increased with level of alcohol exposure of the victim. The increase in alcohol use in emerging economies calls for further study into the consequences of alcohol use and for public health initiatives to reduce the risk of violence in older adult populations, with special attention to the experience of older adult women.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.JVAL.2019.04.1925
Abstract: Obesity is a major public health challenge and its prevalence has increased across the age spectrum from 1980 to date in most parts of the world including sub-Saharan Africa. Studies that derive health state utilities (HSUs) stratified by weight status to support the conduct of economic evaluations and prioritization of cost-effective weight management interventions are lacking in sub-Saharan Africa. To estimate age- and sex-specific HSUs for Ghana, along with HSUs by weight status. Associations between HSUs and overweight and obesity will be examined. Cross-sectional survey of the Ghanaian population. Data were sourced from the World Health Organization Study of Global AGEing and Adult Health (WHO SAGE), 2014 to 2015. Using a "judgment-based mapping" method, responses to items from the World Health Organization Quality-of-Life (WHOQOL-100) used in the WHO SAGE were mapped to EQ-5D-5L profiles, and the Zimbabwe value set was applied to calculate HSUs. Poststratified s ling weights were applied to estimate mean HSUs, and a multivariable linear regression model was used to examine associations between HSUs and overweight or obesity. Responses from 3966 adults aged 18 to 110 years were analyzed. The mean (95% confidence interval) HSU was 0.856 (95% CI: 0.850, 0.863) for the population, 0.866 (95% CI: 0.857, 0.875) for men, and 0.849 (95% CI: 0.841, 0.856) for women. Lower mean HSUs were observed for obese in iduals and with older ages. Multivariable regression analysis showed that HSUs were negatively associated with obesity (-0.024 95% CI: -0.037, -0.011), female sex (-0.011 95% CI: -0.020, -0.003), and older age groups in the population. The study provides HSUs by sex, age, and body mass index (BMI) categories for the Ghanaian population and examines associations between HSU and high BMI. Obesity was negatively associated with health state utility in the population. These data can be used in future economic evaluations for Ghana and sub-Saharan African populations.
Publisher: The Haworth Press
Date: 1994
Publisher: Oxford University Press (OUP)
Date: 18-02-2017
DOI: 10.1093/AJE/KWW125
Publisher: Oxford University Press (OUP)
Date: 30-09-2019
Abstract: We examined the development of disease and disability in a large cohort of older women, the extent to which these conditions exempt them from being classified as successful agers and different trajectories of disease, disability and longevity across women’s later life. We used survey data from 12,432 participants of the 1921–26 birth cohort of the Australian Longitudinal Study of Women’s Health from 1996 (age 70–75) to 2016 (age 90–95). Repeated measures latent class analysis (RMLCA) identified trajectories of the development of disease with or without disability and according to longevity. Bivariate analyses and multivariable multinomial logistic regression models were used to examine the association between participants’ baseline characteristics and membership of the latent classes. Over one-third of women could be considered to be successful agers when in their early 70s, few women could still be classified in this category throughout their later life or by the end of the study when they were in their 90s (~1%). RMLCA identified six trajectory groups including managed agers long survivors (9.0%) with disease but little disability, usual agers long survivors (14.9%) with disease and disability, usual agers (26.6%) and early mortality (25.7%). A small group of women having no major disease or disability well into their 80s were identified as successful agers (5.5%). A final group, missing surveys (18.3%), had a high rate of non-death attrition. Groups were differentiated by a number of social and health factors including marital status, education, smoking, body mass index, exercise and social support. The study shows different trajectories of disease and disability in a cohort of ageing women, over time and through to very old ages. While some women continue into very old age with no disease or disability, many more women live long with disease but little disability, remaining independent beyond their capacity to be classified as successful agers.
Publisher: National Inquiry Services Center (NISC)
Date: 02-07-2020
Publisher: BMJ
Date: 12-2017
Publisher: Elsevier BV
Date: 07-2019
Publisher: MDPI AG
Date: 14-04-2019
Abstract: The low- and middle-income countries (LMICs) are experiencing rapid population ageing, yet knowledge about disability among older populations in these countries is scarce. This study aims to identify the prevalence and factors associated with disability among people aged 50 years and over in six LMICs. Cross-sectional data from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007–2010) in China, Ghana, India, Mexico, the Russian Federation, and South Africa was used. Multivariable logistic regression analyses were undertaken to examine the association between sociodemographic factors, health behaviours, chronic conditions, and activities of daily living (ADL) disability. The prevalence of disability among older adults ranged from 16.2% in China to 55.7% in India. Older age, multimorbidity, and depression were the most common factors related to disability in all six countries. Gender was significant in China (OR = 1.14, 95% CI: 1.01–1.29), Ghana (OR = 1.22, 95% CI: 1.01–1.48) and India (OR = 1.65, 95% CI: 1.37–1.99). Having no access to social capital was significantly associated with ADL disability in China (OR = 2.57, 95% CI: 1.54–4.31) and South Africa (OR = 4.11, 95% CI: 1.79–9.43). Prevalence data is valuable in these six ageing countries, with important evidence on mitigating factors for each. Identifying determinants associated with ADL disability among older people in LMICs can inform how to best implement health prevention programmes considering different country-specific factors.
Publisher: Public Library of Science (PLoS)
Date: 18-11-2016
Publisher: MDPI AG
Date: 05-05-2020
Abstract: Background: Health effects of air pollution on anaemia have been scarcely studied worldwide. We aimed to explore the associations of long-term exposure to ambient air pollutants with anaemia prevalence and haemoglobin levels in Chinese older adults. Methods: We used two-level linear regression models and modified Poisson regression with robust error variance to examine the associations of particulate matter (PM) and nitrogen dioxide (NO2) on haemoglobin concentrations and the prevalence of anaemia, respectively, among 10,611 older Chinese adults enrolled in World Health Organization (WHO) Study on global AGEing and adult health (SAGE) China. The average community exposure to ambient air pollutants (PM with an aerodynamic diameter of 10 μm or less (PM10), 2.5 μm or less (PM2.5), 1 μm or less (PM1) and nitrogen dioxide (NO2)) for each participant was estimated using a satellite-based spatial statistical model. Haemoglobin levels were measured for participants from dried blood spots. The models were controlled for confounders. Results: All the studied pollutants were significantly associated with increased anaemia prevalence in single pollutant model (e.g., the prevalence ratios associated with an increase in inter quartile range in three years moving average PM10 (1.05 95% CI: 1.02–1.09), PM2.5 (1.11 95% CI: 1.06–1.16), PM1 (1.13 95% CI: 1.06–1.20) and NO2 (1.42 95% CI: 1.34–1.49), respectively. These air pollutants were also associated with lower concentrations of haemoglobin: PM10 (−0.53 95% CI: −0.67, −0.38) PM2.5 (−0.52 95% CI: −0.71, −0.33) PM1 (−0.55 95% CI: −0.69, −0.41) NO2 (−1.71 95% CI: −1.85, −1.57) respectively. Conclusions: Air pollution exposure was significantly associated with increased prevalence of anaemia and decreased haemoglobin levels in a cohort of older Chinese adults.
Publisher: Public Library of Science (PLoS)
Date: 19-08-2019
Publisher: Public Library of Science (PLoS)
Date: 15-10-2013
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.MATURITAS.2018.06.011
Abstract: The aim of this study was to investigate socioeconomic inequalities in frailty among older adults in six low- and middle-income countries (LMICs), and to examine to what extent chronic diseases account for these inequalities. Data were used from the Study on global AGEing and adult health (SAGE) wave 1 (2007-2010). Nationally representative s les of adults aged 50+ years from China, Ghana, India, Mexico, the Russian Federation and South Africa were analyzed (n = 31,174). Educational level and wealth were used as socioeconomic indicators. Frailty was assessed with modified criteria for the frailty phenotype. Self-reported disease diagnoses were used. A relative index of inequality (RII) was calculated to compare socioeconomic inequalities in frailty between countries. People in lower socioeconomic positions had higher prevalence rates of frailty. The largest inequalities in frailty were found in Mexico (RII 3.7, 95% CI 2.1-6.4), and the smallest inequalities in Ghana (RII 1.1, 95% CI 0.7-1.8). Mediation analyses revealed that the chronic diseases considered in this study do not explain the higher prevalence of frailty seen in lower socioeconomic groups. Substantial socioeconomic inequalities in frailty were observed in LMICs, but additional research is needed to find explanations for these. Given that the population of older adults in many LMICs is expanding at a greater rate than in many high-income countries, our results indicate an urgent public health need to address frailty in these countries.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-07-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-01-2015
Publisher: Royal College of Psychiatrists
Date: 09-2017
DOI: 10.1192/BJP.BP.117.202325
Abstract: Little is known about the joint mental health effects of air pollution and tobacco smoking in low- and middle-income countries. To investigate the effects of exposure to ambient fine particulate matter pollution (PM 2.5 ) and smoking and their combined (interactive) effects on depression. Multilevel logistic regression analysis of baseline data of a prospective cohort study ( n =41785). The 3-year average concentrations of PM 2.5 were estimated using US National Aeronautics and Space Administration satellite data, and depression was diagnosed using a standardised questionnaire. Three-level logistic regression models were applied to examine the associations with depression. The odds ratio (OR) for depression was 1.09 (95% CI 1.01–1.17) per 10 μg/m 3 increase in ambient PM 2.5 , and the association remained after adjusting for potential confounding factors (adjusted OR = 1.10, 95% CI 1.02–1.19). Tobacco smoking (smoking status, frequency, duration and amount) was also significantly associated with depression. There appeared to be a synergistic interaction between ambient PM 2.5 and smoking on depression in the additive model, but the interaction was not statistically significant in the multiplicative model. Our study suggests that exposure to ambient PM 2.5 may increase the risk of depression, and smoking may enhance this effect.
Publisher: Informa UK Limited
Date: 31-10-2014
DOI: 10.3402/GHA.V7.25314
Abstract: The achievement of universal health coverage (UHC) in emerging economies is a high priority within the global community. This timely study uses standardized national population data collected from adults aged 50 and older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. The objective is to describe health care utilization and measure association between inpatient and outpatient service use and patient characteristics in these six low- and middle-income countries. Secondary analysis of data from the World Health Organization's Study on global AGEing and adult health Wave 1 was undertaken. Country s les are compared by socio-demographic characteristics, type of health care, and reasons for use. Logistic regressions describe association between socio-demographic and health factors and inpatient and outpatient service use. In the pooled multi-country s le of over 26,000 adults aged 50-plus, who reported getting health care the last time it was needed, almost 80% of men and women received inpatient or outpatient care, or both. Roughly 30% of men and women in the Russian Federation used inpatient services in the previous 3 years and 90% of men and women in India used outpatient services in the past year. In China, public hospitals were the most frequently used service type for 52% of men and 51% of women. Multivariable regression showed that, compared with men, women were less likely to use inpatient services and more likely to use outpatient services. Respondents with two or more chronic conditions were almost three times as likely to use inpatient services and twice as likely to use outpatient services compared with respondents with no reported chronic conditions. This study provides a basis for further investigation of country-specific responses to UHC.
Publisher: Springer Science and Business Media LLC
Date: 23-06-2015
Publisher: Informa UK Limited
Date: 26-09-2010
Publisher: Elsevier BV
Date: 10-2019
Publisher: American Psychological Association (APA)
Date: 12-2020
DOI: 10.1037/EMO0000637
Abstract: Little is known about how retirement and the time use redistribution that comes with it relate to experiential wellbeing, especially in low- and middle-income countries (LAMICs). This study aims to determine whether there are differences in experiential wellbeing between retired and working older adults whether time use accounts for a portion of these differences and whether these potential relationships differ across LAMICs and high-income countries. We used data from 2 multicountry studies conducted in countries at different levels of economic development: SAGE (China, Ghana, India, Mexico, and South Africa) and COURAGE in Europe (Finland, Poland, and Spain), focusing on participants aged 50+ (N = 21,000). Retirement was significantly associated with higher experiential wellbeing in both surveys, and time use accounted for more than 40% of the total effect. Retirees were higher in experiential wellbeing than working older adults, and differences in how in iduals spend their day accounted for part of this relationship. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Publisher: BMJ
Date: 09-2009
DOI: 10.1136/BMJ.B3503
Publisher: Frontiers Media SA
Date: 28-11-2018
Publisher: MDPI AG
Date: 08-07-2020
DOI: 10.3390/NU12072026
Abstract: Given a global focus on salt reduction efforts to reduce cardiovascular risk, it is important to obtain accurate measures of salt intake on a population level. This study determined firstly whether adjustment for intra-in idual variation in urinary sodium (Na) excretion using three repeated 24 h collections affects daily estimates and whether the use of repeated spot urine s les results in better prediction of 24 h Na compared to a single collection. Twenty three community-dwelling men and women from South Africa (mean age 59.7 years (SD = 15.6)) participating in the World Health Organization Study on global AGEing and adult health (WHO-SAGE) Wave 3 study collected 24 h and spot early morning urine s les over three consecutive days to assess urinary Na excretion. INTERSALT, Tanaka, and Kawasaki prediction equations, with either average or adjusted spot Na values, were used to estimate 24 h Na and compared these against measured 24 h urinary Na. Adjustment was performed by using the ratio of between-person (sb) and total (sobs) variability obtained from repeated measures analysis of variance. Sensitivity of the equations to predict daily urinary Na values below 5 g salt equivalent was calculated. The sb/sobs for urinary Na using three repeated s les for spot and 24 h s les were 0.706 and 0.798, respectively. Correction using analysis of variance for 3 × 24 h collections resulted in contraction of the upper end of the distribution curve (90th centile: 157 to 136 mmoL/day 95th centile: 220 to 178 mmoL/day). All three prediction equations grossly over-estimated 24 h urinary Na excretion, regardless of whether a single spot urine or repeated collections corrected for intra-in idual variation were used. Sensitivity of equations to detect salt intake equivalent values of ≤5 g/day was 13% for INTERSALT, while the other two equations had zero sensitivity. Correcting for intra-in idual variability in Na excretion using three 24 h urine collections contracted the distribution curve for high intakes. Repeated collection of spot s les for urinary Na analysis does not improve the accuracy of predicting 24 h Na excretion. Spot urine s les are not appropriate to detect participants with salt intakes below the recommended 5 g/day.
Publisher: MDPI AG
Date: 05-01-2021
Abstract: Recent studies have suggested the common co-occurrence of hypertension and diabetes in South Africa. Given that hypertension and diabetes are known to share common socio-demographic, anthropometric and lifestyle risk factors, the aim of this study was to jointly model the shared and disease-specific geographical variation of hypertension and diabetes. The current analysis used the Study on Global Ageing and Adult Health (SAGE) South Africa Wave 2 (2014/15) data collected from 2761 participants. Of the 2761 adults (median age = 56 years), 641 (23.2%) had high blood pressure on measurement and 338 (12.3%) reported being diagnosed with diabetes. The shared component has distinct spatial patterns with higher values of odds in the eastern districts of Kwa-Zulu Natal and central Gauteng province. The shared component may represent unmeasured health behavior characteristics or the social determinants of health in our population. Our study further showed how a shared component (latent and unmeasured health behavior characteristics or the social determinants of health) is distributed across South Africa among the older adult population. Further research using similar shared joint models may focus on extending these models for multiple diseases with ecological factors and also incorporating s ling weights in the spatial analyses.
Publisher: Springer Science and Business Media LLC
Date: 08-06-2018
Publisher: Springer Science and Business Media LLC
Date: 09-04-2015
Publisher: Public Library of Science (PLoS)
Date: 13-04-2012
Publisher: MDPI AG
Date: 16-09-2014
DOI: 10.3390/NU6093672
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2013
No related grants have been discovered for Paul Kowal.