OBJECTIVES: Medical students experience worse psychological well-being than the general population. Social determinants of health (SDOH) relate to conditions in which people live, work, and age and significantly influence mental health. This study examines the association between depressive symptoms and SDOH in medical students from four countries: Czechia, Iran, Kenya, and Venezuela. METHODS: An online cross-sectional survey was conducted in the spring of 2022. The questionnaire focused on depressive symptoms (using a validated psychiatric scale DASS-21 to assess mental health) and various SDOHs. RESULTS: A total of 2,033 medical students participated in the survey, with a median age of 23.0 years; 64.8% were females; 60.8% of respondents had some degree of depressive symptoms (mild-to-moderate 32.5%, severe-to-extremely severe 28.3%). Several SDOHs, such as low engagement in social life, low personal funds, and low social class, were strongly associated with severe-to-extremely severe depressive symptoms (p < 0.001), and the associations differed among countries. The prevalence of severe-to-extremely severe depressive symptoms varied significantly across the four countries, with Iran having the highest prevalence (OR = 2.1 compared to Czechia), followed by Czechia (OR = 1, reference value), Kenya (OR = 0.9), and Venezuela (OR = 0.6). CONCLUSION: The study demonstrates the high prevalence of depressive symptoms among medical students from four global regions and the significant association with specific SDOH. Notably, the variation in prevalence across countries and differential relationships with SDOH underscore the importance of considering transcultural factors in research and management to improve mental health among medical students.
- MeSH
- deprese * epidemiologie MeSH
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- prevalence MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- sociální determinanty zdraví * statistika a číselné údaje MeSH
- studenti lékařství * psychologie statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- Írán MeSH
- Keňa MeSH
- Venezuela MeSH
BACKGROUND: Preventing type 2 diabetes during humanitarian crises is under-researched. In Venezuela, a third of adults have prediabetes amid a prolonged crisis. AIM: This study assessed the effectiveness of an intensive weight reduction strategy aimed at achieving a 7% weight loss in Venezuelan individuals with elevated risk of type 2 diabetes. METHODS: A six-month pilot randomized clinical trial was conducted at a Community Health Center. Participants were assigned to the Diabetes Prevention Program (DPP) or a low-calorie liquid diet followed by DPP (LD-DPP). The LD-DPP group underwent a two-month liquid diet, followed by food reintroduction and DPP content. The DPP group received a transculturally adapted Group Lifestyle Balance curriculum through 16 group sessions. Both Intention to Treat and Per-Protocol analyses with Inverse Probability Weighting were conducted. RESULTS: Of 127 adults (64 LD-DPP, 63 DPP), 70 (55.1%) completed the intervention. In the ITT analysis, 32.9% achieved the 7% weight loss goal, significantly higher in the LD-DPP arm (54.8%) compared to DPP (15.4%). CONCLUSION: Initiating the DPP with intensive low-calorie restriction led to greater weight loss and improved chances of meeting weight loss goals during a humanitarian crisis.
- MeSH
- diabetes mellitus 2. typu * prevence a kontrola dietoterapie epidemiologie MeSH
- dospělí MeSH
- hmotnostní úbytek * fyziologie MeSH
- kalorická restrikce * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- obezita prevence a kontrola dietoterapie MeSH
- pilotní projekty MeSH
- prediabetes dietoterapie terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pragmatická klinická studie MeSH
- randomizované kontrolované studie MeSH
- Geografické názvy
- Venezuela MeSH
BACKGROUND: Ethno-racial disparities in cardiometabolic diseases are driven by socioeconomic, behavioral, and environmental factors. Bayesian networks offer an approach to analyze the complex interaction of the multi-tiered modifiable factors and non-modifiable demographics that influence the incidence and progression of cardiometabolic disease. METHODS: In this study, we learn the structure and parameters of a Bayesian network based on 20 years of data from the US National Health and Nutrition Examination Survey to explore the pathways mediating associations between ethno-racial group and cardiometabolic outcomes. The impact of different factors on cardiometabolic outcomes by ethno-racial group is analyzed using conditional probability queries. RESULTS: Multiple pathways mediate the indirect association from ethno-racial group to cardiometabolic outcomes: (1) ethno-racial group to education and to behavioral factors (diet); (2) education to behavioral factors (smoking, physical activity, and-via income-to alcohol); (3) and behavioral factors to adiposity-based chronic disease (ABCD) and then other cardiometabolic drivers. Improved diet and physical activity are associated with a larger decrease in probability of ABCD stage 4 among non-Hispanic White (NHW) individuals compared to non-Hispanic Black (NHB) and Hispanic (HI) individuals. CONCLUSION: Education, income, and behavioral factors mediate ethno-racial disparities in cardiometabolic outcomes, but traditional behavioral factors (diet and physical activity) are less influential among NHB or HI individuals compared to NHW individuals. This suggests the greater contribution of unmeasured individual- and/or neighborhood-level structural determinants of health that impact cardiometabolic drivers among NHB and HI individuals. Further study is needed to discover the nature of these unmeasured determinants to guide cardiometabolic care in diverse populations.
- MeSH
- Bayesova věta * MeSH
- běloch MeSH
- černoši nebo Afroameričané MeSH
- chronická nemoc MeSH
- disparity zdravotního stavu * MeSH
- dospělí MeSH
- etnicita MeSH
- Hispánci a Latinoameričané MeSH
- kardiovaskulární nemoci MeSH
- lidé středního věku MeSH
- lidé MeSH
- rasové skupiny MeSH
- senioři MeSH
- socioekonomické faktory MeSH
- výživa - přehledy * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Spojené státy americké MeSH
The impact of the humanitarian crisis in Venezuela on care for noncommunicable diseases (NCDs) such as diabetes is unknown. This study aims to document health system performance for diabetes management in Venezuela during the humanitarian crisis. This longitudinal study on NCDs is nationally representative at baseline (2014-2017) and has follow-up (2018-2020) data on 35% of participants. Separate analyses of the baseline population with diabetes (n = 585) and the longitudinal population with diabetes (n = 210) were conducted. Baseline analyses constructed a weighted care continuum: all diabetes; diagnosed; treated; achieved glycaemic control; achieved blood pressure, cholesterol, and glycaemic control; and achieved aforementioned control plus non-smoking. Weighted multinomial regression models controlling for region were used to estimate the association between socio-demographic characteristics and care continuum stage. Longitudinal analyses constructed an unweighted care continuum: all diabetes; diagnosed; treated; and achieved glycaemic control. Unweighted multinomial regression models controlling for region were used to estimate the association between socio-demographic characteristics and changes in care continuum stage. Among 585 participants with diabetes at baseline, 71% were diagnosed, 51% were on treatment, and 32% had achieved glycaemic control. Among 210 participants with diabetes in the longitudinal population, 50 (24%) participants' diabetes management worsened, while 40 (19%) participants improved. Specifically, the proportion of those treated decreased (60% in 2014-2017 to 51% in 2018-2020), while the proportion of participants achieving glycaemic control did not change. Although treatment rates have declined substantially among people with diabetes in Venezuela, management changed less than expected during the crisis.
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: The relevance of lifestyle medicine in diabetes treatment is now incorporated in clinical practice guidelines but finding an exemplar for the creation of a Lifestyle Medicine Program (LMP) is a difficult task. AIM: To use Lifedoc Health (LDH) as a LMP exemplar by describing their multidisciplinary team (MDT) approach to diabetes care along with tactics to address sustainability challenges. RESULTS: The LDH model facilitates early activation of patients with diabetes and other cardiometabolic risk factors, MDT approaches, and protocols/policies that are able to overcome barriers to equitable healthcare in the community. Specific programmatic targets are clinical outcomes, effective dissemination, economic viability, and sustainability. Infrastructure centers on patient-driven problem-based visits, shared medical appointments, telemedicine, and patient tracking. Further discussions on program conceptualization and operationalization are provided. CONCLUSION: Even though strategic plans for LMPs that specialize in diabetes care are well represented in the literature, implementation protocols, and performance metrics are lacking. The LDH experience provides a starting point for those healthcare professionals interested in translating ideas into action.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVE: Guidelines recommend case finding for dysglycemia (prediabetes and type 2 diabetes [T2D]) in adults or youth older than 10 years with overweight/obesity, but increased adiposity has not been associated with dysglycemia in some Hispanic populations. This study aims to determine the prevalence of dysglycemia in this population using simplified criteria independent of body mass index and age to request an oral glucose tolerance test (OGTT). METHODS: Cross-sectional retrospective analysis of medical records from a clinical center in Chile (2000-2007). OGTT was obtained from any patient with 1 cardiometabolic risk factor (CMRF) independent of age and body mass index. RESULTS: In total, 4969 adults (mean age ± SD) 45.7 ± 15.9 years and 509 youths 16.6 ± 3.0 years were included. The prevalence (%, 95% CI) of prediabetes doubled that of T2D in youths (14.1%, 1.4-17.4 vs 6.3%, 4.5-8.7) and tripled it in adults (36.0%, 34.7-37.4 vs 10.7%, 9.8-11.5). In underweight and normal-weight adults, 22% (12.0-36.7) and 29.2% (26.4-32.1) had prediabetes, whereas 4.9% (1.3-16.1) and 8.8% (7.2-10.7) had T2D, respectively. In normal weight youths, 10.5% (6.7-15.9) and 2.9% (1.2-6.6) had prediabetes and T2D, respectively. In adults, but not in youths, most dysglycemia categories were related to overweight/obesity. CONCLUSION: This study supports a public health policy to identify more people at risk for cardiovascular disease by implementing a revised case finding protocol for dysglycemia using OGTT in even normal weight patients over 6 years of age when there is at least 1 CMRF. Reanalysis of case finding protocols for cardiometabolic risk in other populations is warranted.
- MeSH
- diabetes mellitus 2. typu * komplikace MeSH
- dospělí MeSH
- krevní glukóza MeSH
- lidé MeSH
- mladiství MeSH
- nadváha epidemiologie MeSH
- obezita epidemiologie komplikace MeSH
- prediabetes * epidemiologie MeSH
- průřezové studie MeSH
- retrospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Chile MeSH
OBJECTIVES: This study compared the relationships of social determinants with cardiometabolic risk in different socioeconomic contexts: sociopolitically unstable Venezuela (VE) and stable Czechia (CZ). DESIGN: cross-sectional analysis involving two population-based studies. SETTING: Brno, Czechia and 23 cities of Venezuela. PARTICIPANTS: 25-64 years old subjects from CZ (2013-2014, n=1579, 56% females) and VE (2014-2017, n=1652, 70% females). MAIN OUTCOME MEASURES: The composite cardiometabolic risk score (CMRS) (scaled 0-8) was calculated using eight biomarkers (body mass index, waist circumference, blood glucose, systolic and diastolic blood pressure, total and high-density lipoprotein-cholesterol, triglycerides). Social characteristics included education in both countries, income in CZ and a composite measure of social position (SP) in VE. Sex stratified ordinal regression examined the social gradient in having less favourable CMRS. RESULTS: In CZ, men and women with low education and women with low income had higher odds of higher CMRS compared with those with high education and income with OR 1.45 (95% CI 1.01 to 2.21), 2.29 (95% CI 1.62 to 3.24) and 1.69 (95% CI 1.23 to 2.35). In VE, women with low education and low SP had higher odds to have higher CMRS OR 1.47 (95% CI 1.09 to 1.97) and 1.51 (95% CI 1.16 to 1.97), while men with low education and low SP had lower odds to have higher CMRS OR 0.64 (95% CI 0.41 to 1.00) and 0.61 (95% CI 0.40 to 0.97), compared with those with high education and high SP. Independently of age, sex and socioeconomic characteristics, Venezuelans had higher odds to have higher CMRS than Czechs (OR 2.70; 95% CI 2.37 to 3.08). CONCLUSIONS: The results suggest that the associations of socioeconomic status indices and cardiometabolic risk differed between CZ and VE, likely reflecting differences in the social environment among countries. Further research is needed to confirm and quantify these differences.
- MeSH
- dospělí MeSH
- index tělesné hmotnosti MeSH
- kardiovaskulární nemoci * epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- průřezové studie MeSH
- rizikové faktory MeSH
- společenská třída MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Venezuela MeSH
High consumption of sugar-sweetened beverages (SSBs) is associated with a higher risk of cardiovascular disease (CVD). The last report on the prevalence of SSBs consumption in Czechia was 17 years ago, an updated analysis will enable the design of appropriate public health policies. This study aimed to determine the prevalence of SSBs consumption in a Czech city during 2020 and 2022, and its association with cardiometabolic biomarkers, behavioral risk factors, and socioeconomic determinants. A total of 730 participants (33 to 73 years) were assessed from a random population-based survey. SSBs consumption was evaluated using two methods: by calorie amount, with a 24 h dietary recall, and by frequency, with a food frequency questionnaire. By calorie amount, the prevalence of SSBs consumption was none: 52.5%, low: 30.0%, and moderate-high: 17.5%; by frequency was never: 16.0%, occasionally: 64.1%, and daily: 19.9%. SSBs intake was higher in men (p < 0.001) and younger participants (p = 0.001). Men consuming daily had higher waist circumference and visceral fat area compared to both occasional and never consumers. Higher SSBs consumption was associated with low household income, middle education level, and high total energy intake. In total, 20% drank SSBs daily and 17.5% of participants consumed moderate-high calorie amounts of SSBs. These results represent an increase in the prevalence of SSBs consumption in the last two decades. Public health policies should target men of younger age and people with low education and income.
- MeSH
- cukrem slazené nápoje * škodlivé účinky MeSH
- dieta MeSH
- dospělí MeSH
- lidé MeSH
- nápoje škodlivé účinky MeSH
- rizikové faktory MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: The complex humanitarian crisis (CHC) in Venezuela is characterized by food insecurity, hyperinflation, insufficient basic services, and the collapse of the healthcare system. The evolution of the epidemiology of cardiometabolic risk factors in this context is unknown. AIM: To compile the last 20 years evidence on the prevalence of cardiometabolic risk factors in adults of Venezuela in the context of the CHC. METHODS: A comprehensive literature review of population-based studies of adults in Venezuela from 2000 to 2020. RESULTS: Seven studies (National EVESCAM 2014-2017, 3 regions VEMSOLS 2006-2010, Maracaibo city 2007-2010, Merida city 2015, Mucuchies city 2009, Barquisimeto city CARMELA 2003-2005, and Zulia state 1999-2001) with samples sizes ranging from 109 to 3414 subjects were included. Over time, apparent decrease was observed in smoking from 21.8% (2003-2005) to 11.7% (2014-2017) and for obesity from 33.3% (2007-2010) to 24.6% (2014-2017). In contrast, there was an apparent increase in diabetes from 6% (2003-2005) to 12.3% (2014-2017), prediabetes 14.6% (2006-2010) to 34.9% (2014-2017), and hypertension 24.7% (2003-2005) to 34.1% (2014-2017). The most prevalent dyslipidemia - a low HDL-cholesterol - remained between 65.3% (1999-2001) and 63.2% (2014-2017). From 2006-2010 to 2014-2017, the high total cholesterol (22.2% vs 19.8%, respectively) and high LDL-cholesterol (23.3% vs 20.5%, respectively) remained similar, but high triglycerides decreased (39.7% vs 22.7%, respectively). Using the same definition across all the studies, metabolic syndrome prevalence increased from 35.6% (2006-2010) to 47.6% (2014-2017). Insufficient physical activity remained steady from 2007-2010 (34.3%) to 2014-2017 (35.2%). CONCLUSION: Changes in the prevalence of cardiometabolic risk factors in Venezuela are heterogeneous and can be affected by various social determinants of health. Though the Venezuelan healthcare system has not successfully adapted, the dynamics and repercussions of the CHC on population-based cardiometabolic care can be instructive for other at-risk populations.
- MeSH
- cholesterol MeSH
- dospělí MeSH
- hyperlipidemie * MeSH
- kardiometabolické riziko MeSH
- lidé MeSH
- metabolický syndrom * epidemiologie MeSH
- prevalence MeSH
- rizikové faktory MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Venezuela MeSH
