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BackgroundCardiovascular diseases are among the leading causes of mortality and morbidity in sub-Saharan Africa, including Zambia, where cardiovascular diseases account for 8% of the mortality rates. Despite an increasing number of cardiovascular disease-related studies in Zambia, qualitative studies exploring how cardiovascular diseases and their risk factors are understood in the socioeconomic and cultural contexts are still few. This study, therefore, aimed to analyze the beliefs, perceptions, and behaviors related to cardiovascular diseases and their risk factors among the local residents of Zambia.MethodsThis qualitative study was conducted from August to September 2014 among healthy residents aged 40 years and above in a rural community in Mumbwa District. We investigated the beliefs, perceptions, and behaviors related to cardiovascular diseases and their potential risk factors in the sociocultural context of Zambia by conducting in-depth interviews and focus group interviews. Audio-recorded interviews were transcribed and analyzed using thematic analysis with investigator triangulation.ResultsWe conducted 34 in-depth interviews and 6 focus group interviews with 27 males and 40 females. Most participants were aware of the prevalence of cardiovascular diseases around them and correctly identified hypertension, excessive salt, sugar, and cooking oil intakes, poor quality cooking oil, consumption of meat or vegetables contaminated with chemicals, obesity, stress ["thinking too much"], lack of physical exercise, and heredity as potential risk factors of cardiovascular diseases, while smoking and alcohol were mentioned by only a few participants. However, they claimed that many of these risk factors were difficult to avoid due to ingrained taste preferences for high salt and sugar, increasingly busy lives that force them to use cooking oil to reduce preparation time, cultural preference for big body size or fatness, especially for women, stigmatized body image attached to HIV, stressful life or life events related to poverty, and financial barriers to affording quality foods and healthcare services. Limited health screening opportunities and the negative impact of HIV-related stigma on health-seeking behavior also emerged as important risk factors for cardiovascular diseases.ConclusionsThis study revealed that participants are relatively well aware of cardiovascular diseases and their risk factors. However, they engage in high-risk health behaviors, due to ingrained taste preferences, limited knowledge, and unavoidable socioeconomic and cultural circumstances. Results suggest that prevention interventions addressing cardiovascular diseases in rural Zambia should target gaps in knowledge and socioeconomic and cultural barriers.

BackgroundThere has been a global increase in HIV infection in persons 50 years of age and older. This group is at risk for development of chronic illness that may be exacerbated by socio-behavioral risk factors such as smoking, unhealthy alcohol use, and sedentary lifestyle. However, socio-behavioral risk factors in this older HIV infected population are not well described. The current study aims to describe and document factors related to alcohol use, tobacco smoking, and physical exercise in older adults living with HIV (OALHIV).MethodsThis cross-sectional quantitative study was conducted between August and September 2015, and enrolled HIV-infected participants aged 50 years and older from 12 community hospitals in Chiang Mai Province, Northern Thailand.ResultsOf the 364 participants recruited in the study, 57.1% were female, and 67.3% were between 50-59 years of age. Respectively, 15.1%, 59.1%, and 18.7% were current smokers, currently engaged in physical exercises, and reported ever drank alcohol in the past year. 22.1% of those who drank alcohol reported experience of heavy episodic drinking. Male gender was one of the strongest predictors of ever drank alcohol in the past year (AOR, 4.66; CI, 2.28-9.49; P 20,000 Baht: AOR, 5.34; CI, 1.28-22.25; P = 0.021). Lower educational level was associated with decreased odds of physical exercises (no education versus secondary and higher: AOR, 0.22; CI, 0.08-0.55; P = 0.001).ConclusionSmoking and alcohol use is common among OALHIV, with a substantial proportion not engaging in physical exercises. Interventions for OALHIV should particularly target males and those of lower socio-economic status to deter smoking and alcohol use and to promote physical exercises.

This study explores the experiences and unmet needs related to post-discharge long-term rehabilitation from triadic perspective of male patients with stroke, caregivers, and rehabilitation professionals. This is an exploratory qualitative study using in-depth interviews conducted in two outpatient rehabilitation facilities in Japan. Nine male patients with stroke, ten caregivers, and five rehabilitation professionals participated in this study. The data were coded, followed by thematic analysis. Patients who did not achieve further physical recovery regardless of their efforts experienced a loss of motivation and lost sight of their goals. Moreover, caregivers regarded such patients as lazy and reported feeling frustrated with them. Furthermore, patients and caregivers had unmet needs regarding communication with professionals and psychological and emotional care. In contrast, professionals perceived time constraints on outpatient rehabilitation service provision and sometimes narrowed the scope of the care approach to physical function aspects for providing services efficiently. They also expressed difficulties in identifying patients' needs, values, and meaningful goals. These findings suggest that in Japanese post-stroke outpatient rehabilitation, there is a need to adopt a comprehensive care approach, enhance the quality of communication, and involve caregivers in the rehabilitation process in limited-resource situations. In long-term outpatient rehabilitation services in the community, stroke patients and their caregivers often face a physical recovery plateau. A comprehensive approach such as enhancing the quality of communication and providing psychological and emotional care —other than physical rehabilitation— is needed, particularly once the patient physical recovery stagnates. Involving caregivers in the rehabilitation process may be helpful for rehabilitation professionals to understand a potential problem that the patient cannot express but the caregiver can. It can be crucial to develop strategies that enable the rehabilitation professionals to provide a comprehensive care approach and prevent too much reliance on physical rehabilitation under the time-constraint situation in outpatient rehabilitation services. [ABSTRACT FROM AUTHOR]

This study explored the association of disagreement in the perception of patient disability between patients and family caregivers with physical and psychological quality of life (QOL) in both parties. A cross-sectional analysis of data collected from male stroke patients and family caregivers was conducted. Physical and psychological QOL in patients and caregivers were measured using the WHOQOL BREF. Perceptions of patient disability were measured using the 12-item WHO Disability Assessment Schedule 2.0 (DAS). Using DAS scores reported independently by patients and caregivers, dyads were categorized into one of four groups representing agreement or disagreement about patient disability. Generalized estimating equations were used to examine the associations between WHOQOL scores in patients and caregivers and these four groups. Among 56 dyads enrolled, approximately 52% were categorized into 'agreement' groups and 48% were categorized into 'disagreement' groups. The disagreement in perception about patient disability were significantly associated with poor patient physical QOL. However, the disagreement in perception were not significantly associated with caregiver QOL. Findings suggest the association of disagreement with QOL differs between patients and caregivers. Further research is needed to carefully appraise the relationship and interaction between patient and caregiver. [ABSTRACT FROM AUTHOR]

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 (β = −11.37; P = 0.031) and cognitive (β = −8.05; P = 0.002) functioning at follow-up, while being married was related to an increase of in the score of energy/fatigue (vitality) (β = 5.98; P = 0.011) at follow-up. Physical exercise was associated with an increase in social functioning (β = 9.38; p = 0.042). Overall the HRQoL of OALHIV improved or was maintained over time. [ABSTRACT FROM AUTHOR]