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The Relationship between Hypertension and Anthropometric Indices in a Jordanian Population

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Background: High blood pressure is correlated with overweight and obesity which can be assessed by anthropometric indices (hip circumference, waist circumference, height, weight, waist-to-hip ratio, and a body shape index). Objectives: To investigate the correlation between anthropometric indices and age relating to hypertension; additionally to find which one of these variables are most strongly correlated with high blood pressure in the research Jordanian population. Methods: A quantitative approach utilizing a descriptive correlation cross-sectional design was used among students and workers of universities in Jordan Results: 622 participants were included in study; 34.7% were overweight, 15.4% were obese and hypertension was detected among 22.2% of the participants. The linear correlation was significant among all anthropometric indices and hypertension at the p<0.01 level, whereas body shape index and diastolic blood pressure were significant at the p< 0.05 level. Stepwise multiple linear regression research showed that waist circumference and age were the independent predictors of hypertension. Conclusions: Waist circumference and age were the independent predictors of hypertension. Assessing these predictors should be taken into inconsideration when screening members of the Jordanian population who are at risk of hypertension. Further research is required to understand other factors which may affect the issue of hypertension and to design interventions based on these predictors in order to prevent the condition’s occurrence or re-occurrence. Keywords: Anthropometric indices, blood pressure, cross-sectional study, hypertension, Jordan
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Advanced Studies in Biology, Vol. 7, 2015, no. 5, 233 - 243
HIKARI Ltd, www.m-hikari.com
http://dx.doi.org/10.12988/asb.2015.5214
The Relationship between Hypertension and
Anthropometric Indices in a Jordanian Population
Abdul-Monim Batiha1
٭
, Manar AlAzzam2, Mohammed ALBashtawy2,
Loai Tawalbeh2, Ahmad Tubaishat2 and Fadwa N. Alhalaiqa1
1Philadelphia University, Faculty of Nursing, Jordan
*
Corresponding author
2Al-AlBayt University, Faculty of Nursing, Jordan
Copyright © 2015 Abdul-Monim Batiha et al. This is an open access article distributed under
the Creative Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Abstract
Background: High blood pressure is correlated with overweight and obesity which
can be assessed by anthropometric indices (hip circumference, waist
circumference, height, weight, waist-to-hip ratio, and a body shape index).
Objectives: To investigate the correlation between anthropometric indices and age
relating to hypertension; additionally to find which one of these variables are most
strongly correlated with high blood pressure in the research Jordanian population.
Methods: A quantitative approach utilizing a descriptive correlation
cross-sectional design was used among students and workers of universities in
Jordan
Results: 622 participants were included in study; 34.7% were overweight, 15.4%
were obese and hypertension was detected among 22.2% of the participants. The
linear correlation was significant among all anthropometric indices and
hypertension at the p<0.01 level, whereas body shape index and diastolic blood
pressure were significant at the p< 0.05 level. Stepwise multiple linear regression
research showed that waist circumference and age were the independent predictors
of hypertension.
Conclusions: Waist circumference and age were the independent predictors of
hypertension. Assessing these predictors should be taken into inconsideration when
screening members of the Jordanian population who are at risk of hypertension.
Further research is required to understand other factors which may affect the issue
234 Abdul-Monim Batiha et al.
of hypertension and to design interventions based on these predictors in order to
prevent the condition’s occurrence or re-occurrence.
Keywords: Anthropometric indices, blood pressure, cross-sectional study,
hypertension, Jordan
1. Introduction
Hypertension is defined as systolic and/or diastolic blood pressure of 140/90 mm
Hg or more, and/or medication use for decreasing hypertension (Lebeau et al. 2014,
Alhalaiqa et al.2014). The World Health Organization (WHO) categorizes high
blood pressure (BP) as the top risk factor for death rate, accounting for 13% of
fatalities globally. Also, hypertension, or the ‘silent killer’ as it is also known, has
been recognized as an important risk factor for cardiac arrest, stroke, kidney
disease, and increased mortality rates in adults (WHO 2014).
In 2014, WHO announced that 39% (two billion) of the world’s adults were
overweight and 13% (or 600 million) were obese (WHO 2014). The main
modifiable risk factors for high BP are being overweight and obese (Badaruddoza
et al. 2011). The conditions of overweight and obesity are connected to more
fatalities globally than being underweight. Also, most of the earth's population live
in places where being overweight and obese kills more people than those who are
underweight (this contains all high-income and most middle-income nations)
(WHO 2014).
Many studies have offered clear evidence that decreasing weight, via a healthy diet
and exercise, can help individuals with high blood pressure (Campbell & Meckling
2012, Fuglestad et al. 2012, Tawalbeh et al. 2013, Batiha 2014). Although there are
many anthropometric indices that have been used to measure obesity, there is a
debate about which of these anthropometric indices best defines obesity and
contributes to the highest risk for causing hypertension (Nahar et al. 2012). The
early detection of hypertension, and identifying risk factors relating to high blood
pressure, would be an important preventive measure in the population. In Jordan
there are many studies that discuss obesity and hypertension (Jaddou et al. 2000,
Shakhatreh et al. 2008, Jaddou et al. 2011, Bashayreh et al. 2013, Khader et al.
2014, ALBashtawy et al. 2014). But this study is the first to investigate the
correlation between anthropometric indices and age with hypertension. In addition
this research will attempt to find which one, anthropometric indices or age, was the
most strongly correlated with high blood pressure in Jordanian research population.
2. Methods
2.1. Design
A cross-sectional design was adopted in this study.
Relationship between hypertension and anthropometric indices 235
2.2. Study population and sampling technique:
Jordan consists of three provinces (North, Middle, and South). One university was
randomly selected from each province to provide a representative sample of
Jordanian universities (Jordan University of Science and Technology, Philadelphia
University, and the Al-Hussein Bin Talal University). The participants were
recruited by a convenience sampling technique. The inclusion criteria were: (a)
aged above 18 years, (b) agree to participate.
An appropriate sample size was identified by using G* power software (Faul,
Erdfelder, Lang, & Buchner, 2007). On the foundation of G* power, the minimal
sample size was 334. To allow for more generalization, and to compensate of
dropout, a total of 790 students and workers from selected universities were invited
to participate in the current study: finally 622 participants were included. The
acceptance rate to the invitation was 78.7% (n=622/790); the study was carried out
between September -November 2014.
2.3. Data collection measurements
2.3.1. Anthropometric measurement
Anthropometric indices were taken from all participants by trained nurses in a
private room in each college, according to standardized equipment and methods.
During data collection for the anthropometrical indices, all participants wore light
clothes. All measurements were taken two times and the mean was recorded: if
values differed by greater than 10%, a third value was taken and the average value
used for analysis (Nahar et al. 2012). Height and weight measurements were
utilized to determine BMI by using weight (kg) divided by height squared (m2)
expressed as kg/m2 (Nahar et al. 2012). Calculating bodyweight was done to the
nearby 0.5 kg; via reliable scales which were calibrated by using a 50 kg weight on
each day of data collection. The height measurement for participants was done in a
standing posture using a portable stadiometer; the participant being without shoes.
An overweight condition was recognized with BMI results ≥25-29.9 kg/m2; obesity
was evident with a body mass index ≥30kg/m2 (Cassani 2009; WHO 2014).
To measure WC, metric tape over light clothing was used at the level of umbilicus.
WC measurements were taken twice by a non-stretchable tape with no pressure on
the skin. The mean of the two sets of values was recorded. The cutoff value of WC
for men was 91.5 cm and for women was 85.5cm (Esteghamati et al. 2008). Hip
circumference was measured at maximum width of the buttocks in a standing
position with the participants feet together (Fu et al. 2014). Central obesity was also
calculated and defined on the basis of WHR. Recognition of an ABSI was based on
the formula: ABSI = WC/ (BMI2/3)*(height1/2) (Krakauer & Krakauer 2012).
236 Abdul-Monim Batiha et al.
2.3.2. Blood pressure measurement
BP was measured on the right arm by the use of a standardized and validated digital
monitor machine (Model HEM-711). Before measuring BP, each individual was
asked to rest comfortably for at least five minutes, while sitting with the
sphygmomanometer at the level of the participant’s heart (Ozturk et al. 2014). For
more accuracy each participant received another measurement, using a different BP
monitor and then the average reading was recorded. When the differences between
measurements exceeded five mmHg, another senior staff would measure it using a
validating mercury sphygmomanometer. The sphygmomanometer’s cuff size was
chosen according to arm circumference. Participants with BPs above 140/ 90
mmHg, or who were being treated for hypertension, were classified as having an
elevated BP.
2.3.3. Interview questionnaire
The interview questionnaire was developed by the researchers, and was informed
by other studies (Deshmukh et al. 2006; Nahar et al. 2012).To improve the face and
content validity of the interview questionnaire, three educational specialists in
nursing research examined the format of the questions and equipment to be
employed for data collection.
A pilot study was conducted with 25 students and workers to try out and assess the
framework, content, reliability, and time allowance needed for the questionnaire.
No changes were required with the equipment. However, based on the feedback
from the pilot study’s population some questions were adjusted, and others
removed. Item homogeneity (internal stability reliability) was calculated using
Cronbach's alpha coefficient. The complete stability for all items within each
subscale was good (0.83) (table 1).
The designed set of questions consisted of the following:
1. History of chronic illnesses (diabetic mellitus, hypertension, endocrine, renal,
etc.)
2. Family medical history (hypertension; diabetic mellitus, obesity….etc.).
3. Drug history, especially antihypertensive medication.
4. Smoking history.
5. Life style history including: eating habit, salt intake, fat intake and exercise.
2.4. Data analysis
Data analysis was performed by using Statistical Package for the Social Sciences
(SPSS) (Version 17). Significance was set at p<.05. In this analysis, descriptive
data for anthropometric features, systolic and diastolic BP were expressed as mean
± SD. A partial correlation coefficient was used to evaluate the connection between
independent variables (BMI, WC, HC, WHR, ABSI) and dependent variables
(systolic and diastolic BP). A logistic regression model was used to assess different
anthropometric indices with high BP, including age.
Relationship between hypertension and anthropometric indices 237
2.5. Ethical considerations
Approval of the research protocol was taken from the ethical committee of the three
universities involved in the study. Before data collection, each participant was
informed that this interview and anthropometric measurements would be totally
voluntary, there was no need for identification, and there was no risk from
participation in this study.
3. Results
Data was collected from 622 participants; the mean of their age was 30.3 years. The
majority of the participants were nonsmoker (67.8%). Regarding anthropometric
indices: the mean of height was 1.7m and weight was 73.9kg. Their BMI mean was
25.4. Nearly half of the participant are overweight (34.7%) or obese (15.4%). Their
waist circumference mean was 89.5 cm, with a hip circumference mean 102.7cm.
Meanwhile the mean of waist-to-hip ratio was 0.87cm and the BSI was 7.9. The
means of systolic and diastolic BP reflect normality (124 mmHg, 77.5 mmHg
respectively) with around half (54%) actually having normal BP. Therefore, the
majority of participants (93.6%) did not take any antihypertensive drugs. However,
around one third (37.7%) were categorized as pre-hypertensive patients (see Table
1).
Table 1: | Characteristics of participants
Characteristics
Number of
participants
Per cent
Mean ± SD
Participants
622
100%
Age (years)
30±12.4
Height (cm)
1.7±.09
Weight (kg)
74.7±26.5
Body mass index (kg/m2)
25.4±4.9
Body mass index group
Underweight (<18.5)
43
6.9%
Normal (18.524.9)
269
43.2%
Overweight (25.029.9)
216
34.7%
Obese class I (30- 34.9)
72
11.6%
Obese class II (35- 39.9)
18
2.9%
Obese class III (≥ 40.0)
4
0.6%
Waist circumference (cm)
89.5 ± 14.9
Hip circumference (cm)
102.7 ± 11.3
Waist-to-hip ratio
0.87 ± 0.11
Body shape index
7.9 ± 0.86
Systolic blood pressure (mmHg)
124 ± 17.5
Diastolic blood pressure (mmHg)
77.5 ± 10.5
238 Abdul-Monim Batiha et al.
Table 1: (Continued): | Characteristics of participants
% Hypertension category
Normal
54%
Prehypertension
27.7%
Stage 1 hypertension*
13.7%
Stage 2 hypertension
4.7%
Smokers’ category
Never
67.8 %
Former
4.8 %
Current
27.3%
*Systolic BP ≥140 mmHg and/or diastolic blood pressure (mmHg) BP ≥120 or if the
participant was on antihypertensive medication.
Table 2 shows that the linear correlation was significant among all anthropometric
indices and systolic and diastolic blood pressure for (p<0.01), except for ABSI and
diastolic BP, whose readings were significant at p< 0.05. This means that increased
BP is associated with an increase of all anthropometric measurements.
Table 2:| Correlation between anthropometric indices and blood pressure
Anthropometric
measurement
Systolic
blood pressure
Diastolic
blood pressure
Body mass index
.387**
.212**
Hip circumference (cm)
.351**
.197**
Waist-to-hip ratio
.271**
.177**
A body shape index (ABSI)
.159**
.101*
Waist circumference (WC) (cm)
.452**
.268**
**Correlation is significant at the 0.01 level (2-tailed).
*Correlation is significant at the 0.05 level (2-tailed)
Hypertension was detected among 138 (22.2%) of the participants. Table 3
summarizes the independent sample t-test that compares the age and
anthropometric indices for hypertensive and normotensive contributors. A
significant difference in age and anthropometric measurements for hypertensive
and normotensive participants was detected.
Relationship between hypertension and anthropometric indices 239
Table 3: | Variances in the mean of age, normotensive, hypertensive and
anthropometric indices among participants according to the presence of
hypertension
Normotensive
(n = 484)
Hypertensive
(n = 138)
P
Age (years)
28.7 ±10.8
36±15.46
0.000
Body mass index
24.68±4.8
27.9±4.2
0.000
Waist circumference (WC) (cm)
86.66±14.5
99.3±11.9
0.000
Hip circumference (cm)
101±11.5
108±8.4
0.000
Waist-to-hip ratio
.86±.12
.91±.066
0.000
A body shape index (ABSI)
7.9±.9
8±.46
0.000
Stepwise multiple linear regression analysis was conducted to assess the effect of
age and anthropometric measurements; the only independent predictors of
hypertension were WC and age (see Table 4).
Table 4: |Stepwise multiple linear regression
Odds ratio
95% CI
P
Age (years)
1.02
(1.021.03)
<0.01
Body mass index
1.04
(0.911.19)
0.21
Waist circumference
1.08
(1.051.13)
<0.001
Hip circumference
1.03
(0.961.03)
0.31
Waist-to-hip ratio
1.01
(0.941.00)
0.62
A body shape index
1.03
(0.931.01)
.012
4. Discussion
The major findings of this study were that WC and age were the independent
predictors of hypertension. Also, all the anthropometric indices confirmed a
positive relationship with high BP. Our results are comparable to those revealed by
others (Rahimi et al. 2012; Carba et al. 2013)
An important discovery of this research was that nearly half of the participants were
overweight (34.7%) and obese (15.4%); a situation likely to be due to the intake of
carbohydrates and fats by Jordanians. This intake can be explained by the increased
adoption by the population of a westernized diet containing oily, hot, high sodium
and low fibers material. Low physical activity, due to a lack of sufficient exercising,
and limited walking, together with environmental factors (presence of housemaids,
private cars, television, and advanced household appliances, change in employment
structure, travel systems and enjoyment recreation and activities). The findings of
this research agree with previous studies that had been conducted in different
countries, in terms of a significant relation between anthropometric measures and
increased systolic and diastolic BP (Peymani et al 2012, Moser et al. 2013). These
results should motivate the health care providers in Jordan to carry out appropriate
anthropometric assessment for hypertensive patients in order to control BP.
240 Abdul-Monim Batiha et al.
Our study results found that there was a difference between normotensive and
hypertensive patients in terms of age and anthropometric measures, data which
supported other studies conducted in this field (Batiha et al. 2013, Lie and Kim
2014; Wang et al 2015). However, these studies used rib circumference and body
shape scores in addition to WC, BMI, HC and WHR data.
The findings of this study can be considered as both valuable and relevant.
However, there were some limiting issues in inferring changes over time, between
the variables included and the conclusions reached when using a cross-sectional
research design (Polit & Beck 2010). Second, only Jordanian universities’ students
and workers are included in the present study. One of the strong points of this study
is that the data collection was done by well trained nurses, and the sample was
representative of all Jordanian universities.
4.1. Conclusions and recommendations
The WC and age were the independent anthropometric predictors of hypertension,
showing that this easy statistic may be an important indicator of hypertension in the
Jordanian population. Assessing these predictors should be considered when
screening people at risk for hypertension in the Jordanian population. Regular BP
measurements are essential for health monitoring purposes and for informing the
choice of a treatment plan. It is recommended that a healthy way of life, such as
maintaining a healthy diet and exercising, should be implemented to reduce
obesity. It is thus vital to use life style changes to achieve weight-loss (keeping BMI
from between 18.5 to 24.9 kg/m2), such as reducing the intake of dietary salt and
increasing exercise.
The high prevalence of overweight people in the population of this study is a
warning sign; strong evidence (from previous studies in addition to our study)
showing a close relationship between obesity and serious chronic diseases (e.g.
hypertension, coronary artery disease, diabetes mellitus). Therefore, the health
policy makers should plan practical solutions to increase the public’s
understanding and awareness of these important health issues by designing
appropriate and effective programs to encourage people to modify their life style
to decrease the negative consequences.
Further research is required to understand other factors which may affect the
hypertension and to facilitate the design of intervention based on these predictors,
in order to prevent the occurrence of hypertension, by using a larger and more
representative sample.
Acknowledgements. We would like to acknowledge all the members who
participated in this study, and to all our colleagues who participated in data
collection.
Funding
This study was financial supported by Philadelphia University, Jordan.
Relationship between hypertension and anthropometric indices 241
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Received: March 13, 2015; Published: May 11, 2015
... Our results found that there was a difference between normotension and hypertension according to the age and anthropometric measurements of the participants, which supports other studies conducted in this field. 22,23 Age is a known risk factor for high blood pressure. 24 However, these studies used WC, BMI, HC and WHR data. ...
... Our results are comparable with previous studies from different countries, in terms of a significant relationship between anthropometric measurements and increased SBP and DBP. 21,22 Likewise a study of urban black South African adults reported an association between various adiposity indices and blood pressure and hypertension, where all body composition parameters studied, including WC, BMI, and body fat %, were positively associated with SBP and DBP in both sexes. 25 These results should motivate healthcare providers in Palestine to conduct anthropometric evaluations to determine the risk of hypertension in patients. ...
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Obesity can be a major problem due to its potential to cause a number of health issues, including high blood pressure and diabetes. Many reports have come out of Palestine on overweight and obesity and their direct link to non-communicable diseases, although there is only limited evidence available on the connection between obesity and hypertension in Palestinian adults. We aimed to look at the associations between anthropometric and body composition variables and blood pressure in a large population of Palestinian adults (1337 subjects) and determine which anthropometric indices most strongly correlate with high blood pressure. Anthropometric measurements including height, waist circumference (WC), hip circumference (HC), body mass index (BMI), and total body fat (TBF) were assessed. A body composition analyzer was used to measure body weight, fat mass and fat-free mass. Systolic (SBP) and diastolic (DBP) blood pressure were measured using a Dinamap vital signs monitor. In both males and females, all the anthropometric measurements showed significant strong positive correlations with mean SBP and mean DBP (p < 0.01). SBP correlated the most strongly with waist circumference in all subjects (r = 0.444 in females, r = 0.422 in males), while DBP correlated the most strongly with WC in males (r = 0.386), but with TBF in females (r = 0.256). By controlling fat percentage, WC, HC, and BMI, which are affected by extra weight and lack of exercise, blood pressure levels can be regulated.
... Nosocomial infection not only affects the general health of patient [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], but they have also a huge financially burden. At any time, over 1.4 million people worldwide suffer from infection complication acquired in hospital [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. ...
... Nosocomial infection not only affects the general health of patient [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], but they have also a huge financially burden. At any time, over 1.4 million people worldwide suffer from infection complication acquired in hospital [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Nosocomial infection increases the According to figures, the risk of death is 2.48 times higher in patients with hospital infections than in other patients. ...
... An examination of the literature also suggests that other factors may influence people's perceptions toward FWR are education, training, and experience [53][54][55][56][57][58][59][60]. ...
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... 39,40 Conversely, in a study evaluating 622 Jordanian people, WC was introduced as an independent predictor of hypertension. 41 It is likely that such differences could occur as a result of differences in ethnicity/race and other sociodemographic factors. ...
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... Significant risk factors linked with HAIs are the invasive therapeutic devices use (e.g. central lines, mechanical ventilators and urinary catheters), and poor adherence of staff to prevention practices of infection through insertion and care for the procedures in place, nevertheless, in general, the break of aseptic technique through insertion and care for the device, as well as the device use duration, were significant influences for the occurrence of these severe infections [6][7][8][9][10][11][12][13][14][15][16]. ...
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... Finally, there are many reasons that may cause psychological and social problems among health care providers such as long working hours, dealing with patients directly and fear of acquiring infection and transmitting it to their families [30][31][32][33][34][35][36][37][38][39]. In addition to their absence from their families for a long time [40]. ...
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The health care providers are similarly susceptible to COVID-19 infections as the rest of the people, particularly, the frontline providers. The current paper aimed to examine the main literature on the subject of the psychological and social effects of COVID-19 on health care providers. The electronic examination was including EBSCO, CINHAL and PubMed databases. Symptoms of anxiety, fear, depression, insomnia were found within the health care providers. This review highlights the significance of considering the psychological and social effects of COVID-19 pandemic on Jordanian health care providers.
... Quality affirmation framework persuades health care providers, especially nurses, to endeavor for fabulousness in conveying quality care and to be more open and adaptable in testing new inventive ways to alter outdated frameworks[50][51][52][53][54][55][56][57][58][59][60]. In different populations, different settings and age groups[61][62][63][64][65][66][67][68][69][70][71][72][73][74]. ...
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... The nurse is the closest to the patient, as well patient education is one of the most important roles for nurse, and the nurse should be aware regarding all information that will be given to patient [3][4][5][6][7][8][9][10][11][12][13]. Improving nurses' knowledge regarding care of angina and cardiac artery disease may enhance the life style for patient [15], and increase the quality of care [16]. ...
... The factors affecting the knowledge [26][27][28][29][30] and practice level regarding the ETS were: the professional training that they received, the level of experience, type of ICU, support, and the level of education [24,31,33,[36][37][38][39]. ...
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Endotracheal tube suction (ETS) is an invasive procedure which done by intensive care unit (ICU) nurses to keep airway clear from lung secretion, many complications may occur if these procedures done without sufficient knowledge and good practice accord-ing to evidence-based practice among ICU nurses. This review aimed to evaluate the level of the knowledge and practice regarding endotracheal tube suction among ICU nurses and explore the factors that affect the knowledge and practice. In most studies, ICU nurses have a good level of knowledge and fair level of practice regarding ETS and practices not in line with current recommenda-tions of ETS the professional training that they received, the level of experience, type of ICU, support, and the level of education are factors affecting the knowledge and practice level regarding the ETS. Further studies are recommended with larger sample size, in different setting, and include developing countries.Keywords: Endotracheal Tube Suctioning; Nursing Knowledge; Nursing Practice
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Looking at school nurses' roles in tackling overweight and obesity Obesity is a global issue and school nurses across the world can play an important role in preventing and reducing overweight and obesity in school-aged children and young people. This article provides an overview of their multi-faceted role.
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Background: Uncontrolled pain in intensive care units triggers physical and emotional stress responses, inhibits healing, increases the risk of other complications, and increases the length of ICU stay. Aim: To explore pain management barriers as identified by Jordanian critical care units. Method: This study employed qualitative content analysis with 37 participant nurses from Jordanian critical care units. Data were ob-tained through semi-structured serial interviews. Purpose nonprobability sampling was used for the initial interviews. Results: Several themes emerged to describe barriers to managing pain identified by the critical care nurses. These were grouped into three main themes: (1) Barriers related to patients with subgroups such as patient did not want to bother nurses, patients’ difficulty with completing pain scales, patients’ reluctance to take pain medications because of side-effects, patients reporting their pain to the doctor, but not to the nurse, and fatalistic beliefs. (2) Barriers related to nurses that included patient sedation, frequent complaints from patients, inconsistent practices around administering if necessary medications, time limitations, limited communication, the fear of side effects of pain drugs, physicians' lack of trust in the nursing assessment of pain in critically ill patients, inadequate staff knowledge of pain man-agement, and fear of causing delirium or confusion. and (3) Barriers related to hospital policies includes: policies and rules of hospital, lack proper pain assessment tool, nursing shortages, powerlessness ,interruptions of activities relating to pain, lack of psychosocial sup-port services, lack of alternatives non-pharmacologic therapy , and lack of pain management drugs. Conclusion: The results identify potential pain management barriers which can be considered when developing and disseminating poli-cies and procedures in managing the pain in Jordanian critical care settings.
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Objective In six United Nations Relief and Works Agency (UNRWA) primary health care clinics in Jordan serving Palestine refugees diagnosed with hypertension, to determine the number, characteristics, programme outcomes and measures of disease control for those registered up to 30 June, 2013, and in those who attended clinic in the second quarter of 2013, the prevalence of disease-related complications between those with hypertension only and hypertension combined with diabetes mellitus.Method Retrospective cohort study with programme and outcome data collected and analysed using E-Health.ResultsThere were 18 881 patients registered with hypertension with females (64%) and persons aged ≥40 years (87%) predominating. At baseline, cigarette smoking was recorded in 17%, physical inactivity in 48% and obesity in 71% of patients. 77% of all registered patients attended clinic in the second quarter of 2013; of these, 50% had hypertension and diabetes and 50% had hypertension alone; 9% did not attend the clinics and 10% were lost to follow-up. Amongst those attending clinic, 92% had their blood pressure measured, of whom 83% had blood pressure <140/90 mm Hg. There were significantly more patients with hypertension and diabetes (N = 966, 13%) who had disease-related complications than patients who had hypertension alone (N = 472, 6%) [OR 2.2, 95% CI 2.0–2.5], and these differences were found for both males [18% vs. 10%, OR 1.9, 95% CI 1.6–2.2] and females [11% vs. 5%, OR 2.4, 95% CI 2.1–2.9].Conclusion Large numbers of Palestine refugees are being registered and treated for hypertension in UNRWA primary health care clinics in Jordan. Cohort analysis and E-Health can be used to regularly assess caseload, programme outcomes, clinic performance, blood pressure control and cumulative prevalence of disease-related complications. Current challenges include the need to increase clinic attendance and attain better control of blood pressure.
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Background Therapeutic inertia has been defined as the failure of health-care provider to initiate or intensify therapy when therapeutic goals are not reached. It is regarded as a major cause of uncontrolled hypertension. The exploration of its causes and the interventions to reduce it are plagued by unclear conceptualizations and hypothesized mechanisms. We therefore systematically searched the literature for definitions and discussions on the concept of therapeutic inertia in hypertension in primary care, to try and form an operational definition. Methods A systematic review of all types of publications related to clinical inertia in hypertension was performed. Medline, EMbase, PsycInfo, the Cochrane library and databases, BDSP, CRD and NGC were searched from the start of their databases to June 2013. Articles were selected independently by two authors on the basis of their conceptual content, without other eligibility criteria or formal quality appraisal. Qualitative data were extracted independently by two teams of authors. Data were analyzed using a constant comparative qualitative method. Results The final selection included 89 articles. 112 codes were grouped in 4 categories: terms and definitions (semantics), “who” (physician, patient or system), “how and why” (mechanisms and reasons), and “appropriateness”. Regarding each of these categories, a number of contradictory assertions were found, most of them relying on little or no empirical data. Overall, the limits of what should be considered as inertia were not clear. A number of authors insisted that what was considered deleterious inertia might in fact be appropriate care, depending on the situation. Conclusions Our data analysis revealed a major lack of conceptualization of therapeutic inertia in hypertension and important discrepancies regarding its possible causes, mechanisms and outcomes. The concept should be split in two parts: appropriate inaction and inappropriate inertia. The development of consensual and operational definitions relying on empirical data and the exploration of the intimate mechanisms that underlie these behaviors are now needed.
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Differing views regarding family-witnessed resuscitation (FWR) have been debated. There is a growing body of research that clearly highlights the benefits of allowing FWR. However, the process of active medical resuscitation in the presence of family members remains an ethical, moral, and legal dilemma to healthcare professionals. An emotional debate has arisen among healthcare providers concerning the topic of FWR. The purpose of this study is to deepen understanding of the experience of health professionals regarding the phenomenon of family-witnessed resuscitation in adult critical care settings. 31 semi-structured interviews with critical care professionals were arranged. The critical care professionals included nurses, doctors, anaesthetists, theatre technicians and respiratory therapists. The thematic analysis was utilised to interpret the professionals’ accounts. Two main themes were raised from the health professionals’ views. The first theme “should family members be given the opportunity to enter the resuscitation room?” discusses the willingness of healthcare professionals to allow FWR. The second theme “suggestions and interventions” provides realistic steps to facilitate FWR and to improve professionals’ attitudes. Most of the health professionals opposed FWR. In conclusion, a few professionals, however, expressed their favour for this new trend. The findings of this study uniquely suggest some interventions to organise FWR such as health education and increasing awareness about this subject, preparing family members to witness CPR and the importance of preparing the resuscitation room and increasing the staff number.
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Problem statement: We have examined the prevalence and association of cardiovascular diseases with respect to obesity and metabolic risk factors clustering among urban and rural Punjabi males aged 20-55 years. Obesity has been defined by increased Waist Circumference (WC), Body Mass Index (BMI) and Waist Hip Ratio (WHR). Metabolic traits such as increased total cholesterol, triglycerides and lipoproteins have also detrimental effect on the development of cardiovascular disease. Approach: This cross-sectional study was carried out on a total of 400 urban and rural origin Punjabi males (200 each from urban and rural). The anthropometric, physiometric and metabolic assessments were through standard procedures. Statistical analysis includes descriptive statistics, correlation, multivariate regression analysis and odds ratios. Results: It observed that males of rural population were at a higher risk to develop cardiovascular diseases compared to their urban counterparts. Rural males had significantly (p<0.001) higher mean values of cardiovascular risk factors with respect to BMI, weight, waist circumference, WHR, fasting glucose, total cholesterol, triglyceride, HDL and CHO-HDL ratio. SBP and DBP have positive association with waist-to-hip ratio, body mass index; waist circumference, skinfolds, pulse pressure, alcohol consumptions, food habit, HDL and triglyceride. Conclusion: Cardiovascular disease risk is found more in rural male Punjabi population due to consumption of more dietary products and leading of more sedentary lifestyle due to the overuse of mechanized substances for agriculture and personal use.
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Problem statement: We have examined the prevalence and association of cardiovascular diseases with respect to obesity and metabolic risk factors clustering among urban and rural Punjabi males aged 20-55 years. Obesity has been defined by increased Waist Circumference (WC), Body Mass Index (BMI) and Waist Hip Ratio (WHR). Metabolic traits such as increased total cholesterol, triglycerides and lipoproteins have also detrimental effect on the development of cardiovascular disease. Approach: This cross-sectional study was carried out on a total of 400 urban and rural origin Punjabi males (200 each from urban and rural). The anthropometric, physiometric and metabolic assessments were through standard procedures. Statistical analysis includes descriptive statistics, correlation, multivariate regression analysis and odds ratios. Results: It observed that males of rural population were at a higher risk to develop cardiovascular diseases compared to their urban counterparts. Rural males had significantly (p<0.001) higher mean values of cardiovascular risk factors with respect to BMI, weight, waist circumference, WHR, fasting glucose, total cholesterol, triglyceride, HDL and CHO-HDL ratio. SBP and DBP have positive association with waist-to-hip ratio, body mass index; waist circumference, skinfolds, pulse pressure, alcohol consumptions, food habit, HDL and triglyceride. Conclusion: Cardiovascular disease risk is found more in rural male Punjabi population due to consumption of more dietary products and leading of more sedentary lifestyle due to the overuse of mechanized substances for agriculture and personal use.