Human Immunodeficiency Virus Infection/acquired Immunodeficiency Syndrome Research Articles

Risk factors of HIV/AIDS in Sindh province, Pakistan – A Systemic Review

Background: - The Acquired Immunodeficiency Syndrome (AIDS) is one of the most challenging health problems in medicine today. Epidemiologic, virologic, serologic, and immunologic studies have strongly implicated that the human immunodeficiency virus (HIV) is the causal cause of this newly identified fatal disease. Although AIDS has been identified in all the major continents of the world. Methods: - We conducted a comprehensive literature search using PubMed and google scholar. Papers were included from January 2000 to December 2021. For the search strategy, combinations of the following keywords and medical subject heading (MeSH) terms were used: Risk factors of HIV in Sindh’, ‘Risk factors of AIDS in Sindh’, ‘risk factors of HIV/AIDS in Sindh, epidemic of HIV in Larkana’, ‘AIDS in children in Sindh’. Results: - The major risk factor for HIV in Sindh unsafe Injection Drug users, Hijra Sex workers, and male to male sex workers followed by heterosexual contact and blood transfusion. Larkana city was an epicenter of HIV outbreaks in the past two decades. HIV infection also spread via the renal dialysis machine in Larkana. Conclusion: - Government should take serious steps for the prevention of HIV infection and open AIDS control programs in every district of Sindh and available antiviral therapy for all patients as early as possible. Keywords: HIV infection, AIDS, communication, Sindh

Déjà Vu - A New Coronavirus Challenge.

Déjà Vu - A New Coronavirus Challenge.

Oral health status and treatment needs among HIV/AIDS patients attending antiretroviral therapy center in Western India: A cross-sectional study.

Aims and Objectives:Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) is a major public health problem across the globe. Among 37.9 million people are living with HIV in the world and 21.40 lakh are in India itself. The aim of this study was to assess the oral mucosal, periodontal, and dentition status of HIV/AIDS patients attending ART (antiretroviral therapy) center in Jaipur city, India.Methods and Materials:A total of 588 HIV/AIDS subjects at the ART center in Jaipur city were examined. Oral mucosal, periodontal, and dentition status was recorded using a modified WHO Oral Health Assessment form 1997. A pilot study was conducted among 50 patients. The data were analyzed using Statistical Package for the Social Sciences (SPSS) software, version 20.0. The statistical tests that were applied for the analysis included Chi-square test, Fisher exact test, and one-way analysis of variance (ANOVA).Results:Of 588 study subjects examined, 65.6% were men and 34.4% were women. Candidiasis was the most prevalent oral lesion (32.5%) followed by acute necrotizing gingivitis (26%), hyper melanotic pigmentation (15.8%), and ulcerations (8.7%), respectively. Oral hairy leukoplakia was observed in only 3.9% and not a single case of Kaposi's sarcoma was reported. Buccal mucosa (36.7%) was the most common site of the presence of oral mucosal lesions. The mean decayed, missing, and filled teeth (DMFT) score was 4.03 ± 1.54. Almost all the subjects needed one or other form of dental treatment. Only 12% of the patients had healthy periodontium.Conclusion:Candidiasis was the most prevalent oral lesion. Efforts should be made to meet the increased treatment needs in these patients.

Ocular Manifestations of HIV in Patients Attending Selected Centers in Khartoum State

Ocular Manifestations of HIV in Patients Attending Selected Centers in Khartoum State

A Qualitative Study on the Interconnected Nature of HIV, Water, and Family.

Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) and poor access to water are two primary global health issues. Poor access to water may significantly affect families infected with HIV and result in adverse social and health consequences. A qualitative study used semi-structured interviews to understand health and social outcomes of families after the implementation of water interventions in rural Kenya. One major sub-theme emerged during this research, which included the effects of water on an HIV-affected family. Prior to the water interventions, common adverse health effects from lack of nutrition, water, and poor hygiene were experienced. After receiving access to water, nutrition and hygiene were improved and additional time was gained and used to reinforce relationships and spread awareness about HIV/AIDS. This study provides need-based evidence for access to safe drinking water in order to decrease adverse health outcomes and improve the quality of life for HIV-affected individuals.

Effect of an HIV/AIDS tailored health education program in Western China: An intervention study

This study is to explore the effect of a tailored health education program (THEP) to enhance knowledge of human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) among migrant construction workers (MCWs) in Western China. The THEP was given to 434 MCWs working at three construction sites in Xi’an city, Shaanxi province from December 2011 to May 2012. The MCWs were invited to complete identical baseline and follow-up questionnaire surveys. Before the THEP was conducted, awareness of HIV/AIDS was poor among these MCWs. Knowledge and attitudes among the MCWs significantly improved after implementation of the program. In conclusions: THEPs that educate people regarding HIV/AIDS are urgently needed in China, especially for itinerant workers. THEPs can significantly improve knowledge and attitudes regarding HIV/AIDS.

Effect of Biomolecular Conformation on Docking Simulation: A Case Study on a Potent HIV-1 Protease Inhibitor.

Human immunodeficiency virus infection/acquired immunodeficiency syndrome(HIV/AIDS) is adiseasepertained to the human immune system. Given its crucial role in viral replication, HIV-1 protease (HIV-1 PR) is a prime therapeutic target in AIDS therapy. In this regard, the dynamic aspects of ligand-enzyme interactions may indicate an important role of conformational variability in HIV-1 PR inhibitor/drug design. In the present contribution, the effect of HIV-1 PR flexibility (within multiple crystallographic structures of HIV-1 PR) on binding to the Amprenavir was elucidated via an ensemble docking approach. Molecular docking studies were performed via advanced AutoDock4.2 software. Ensemble docking of Amprenavir into the active site of various conformations of HIV-1 PR predicted different interaction modes/energies. Analysis of binding factors in terms of docking false negatives/positives revealed a determinant role of enzyme conformational variation in prediction of optimum induced fit (PDB ID: 1HPV). The outcomes of this study demonstrated that conformation of receptor may significantly affect the accuracy of docking/binding results in structure-based rational design of anti HIV-1 PR agents. Furthermore; some strategies to re-score the docking results in HIV-1 PR targeted docking studies were proposed.

Evaluation of CD4+ CD25+ FoxP3+ Regulatory T cells and FoxP3 and CTLA-4 gene Expression in Patients wwith Newly Diagnosed Tuberculosis in Northeast of Iran.

Background:Tuberculosis (TB) is the world's second most common infectious disease after Human Immunodeficiency Virus Infection/Acquired Immunodeficiency Syndrome (HIV/AID) and the most frequent cause of mortality especially in developing countries. T regulatory (Treg) cells, which have suppressive activity and express forkhead winged-helix family transcriptional repressor p3 (FoxP3), suppress the immune responses against pathogens such as Mycobacterium tuberculosis. There are controversial results regarding the role of FoxP3 expressing cells in the blood of patients with TB.Objectives:The aim of this study was to evaluate the frequency CD4+ CD25+ Treg cells, and FoxP3 and Cytotoxic T Lymphocyte Antigen 4 (CTLA-4) gene expressions in peripheral blood of patients with tuberculosis and patients with positive tuberculin skin test before and after Peripheral Blood Mononuclear Cells (PBMCs) activation with Purified Protein Derivative (PPD).Patients and Methods:In this cross-sectional study, Peripheral Mononuclear Cells (PBMCs) were isolated from peripheral blood of 29 patients with newly diagnosed pulmonary TB and 19 patients with positive tuberculin skin test. The PBMCs were activated with PPD for 72 hours. Activated cells were harvested, RNA was extracted and cDNA was synthesized. A real-time Taqman method was designed and optimized for evaluation of Foxp3 gene expression and SYBR Green method was used and optimized for evaluation of CTLA-4 gene expression. A flow cytometry analysis was used to evaluate the frequency of CD4+ CD25+ Foxp3+ regulatory T cells in both groups.Results:There was no significant difference in the frequency of CD4+ CD25+ FoxP3+ regulatory T cells between the two groups. Expression of FoxP3 and CTLA-4 in peripheral blood of patients with newly diagnosed TB was significantly lower than the control group after and before activation with PPD.Conclusions:The expression of FoxP3 and CTLA-4 in PBMCs of patients with newly diagnosed TB was low, which might suggest that Treg cells may be sequestered in the lungs.

Risk Factors Predictive of Endogenous Endophthalmitis Among Hospitalized Patients With Hematogenous Infections in the United States

To identify potential risk factors associated with endogenous endophthalmitis among hospitalized patients with hematogenous infections. Retrospective cross-sectional study. MarketScan Commercial Claims and Encounters, and Medicare Supplemental and Coordination of Benefit inpatient databases from the years 2007-2011 were obtained. Utilizing ICD-9 codes, logistic regression was used to identify potential predictors/comorbidities for developing endophthalmitis in patients with hematogenous infections. Among inpatients with hematogenous infections, the overall incidence rate of presumed endogenous endophthalmitis was 0.05%-0.4% among patients with fungemia and 0.04% among patients with bacteremia. Comorbid human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) (OR = 4.27; CI, 1.55-11.8; P = .005), tuberculosis (OR = 8.5; CI, 1.2-61.5; P = .03), endocarditis (OR = 8.3; CI, 4.9-13.9; P < .0001), bacterial meningitis (OR = 3.8; CI, 1.2-12.0; P = .023), fungal meningitis (OR = 59.1; CI, 14.1-247.8; P < .0001), internal organ abscess (OR = 2.9; CI, 1.2-6.4; P = .02), lymphoma/leukemia (OR = 2.9; CI, 1.6-5.3; P < .0001), skin abscess/cellulitis (OR = 1.75; CI, 1.1-2.8; P = .02), pyogenic arthritis (OR = 4.2; CI, 1.8-9.6; P = .001), diabetes with ophthalmic manifestations (OR = 7.0; CI, 1.7-28.3; P = .006), and urinary tract infection (OR = 0.04; CI, 0.3-0.9; P = .023) were each significantly associated with a diagnosis of endogenous endophthalmitis. Patients aged 0-17 years (OR = 2.61; CI, 1.2-5.7; P = .02), 45-54 years (OR = 3.4; CI, 2.0-5.4; P < .0001), and 55-64 years (OR = 2.9; CI, 1.8-4.8; P < .0001); those having length of stay of 3-10 days (OR = 1.9; CI, 1.1-3.3; P = .01), 11-30 days (OR = 3.1; CI, 1.8-5.5; P < .0001), and 31+ days (OR = 5.3; CI, 2.7-10.4; P < .0001); and those with intensive care unit/neonatal intensive care unit (ICU/NICU) admissions (OR = 1.5; CI, 1.4-1.6; P < .0001) were all more likely to be diagnosed with endogenous endophthalmitis. Endogenous endophthalmitis is rare among hospitalized patients in the United States. Among patients with hematogenous infections, odds of endogenous endophthalmitis were higher for children and middle-aged patients, and for patients with endocarditis, bacterial meningitis, lymphoma/leukemia, HIV/AIDS, internal organ abscess, diabetes with ophthalmic manifestations, skin cellulitis/abscess, pyogenic arthritis, tuberculosis, longer hospital stays, and/or ICU/NICU admission.

Depression and social functioning among HIV-infected and uninfected persons in South Africa

Depression and other health problems are common co-morbidities among persons living with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS). The aim of this study was to investigate depression, health status, and substance use in relation to HIV-infected and uninfected individuals in South Africa. Using a cross-sectional case-control design, we compared depression, physical health, mental health, problem alcohol use, and tobacco use in a sample of HIV-infected (N = 143) and HIV-uninfected (N = 199) respondents who had known their HIV status for two months. We found that depression was higher, and physical health and mental health were lower in HIV-positive than HIV-negative individuals. Poor physical health also moderated the effect of HIV infection on depression; HIV-positive individuals were significantly more depressed than HIV-negative controls, but only when general physical health was also poor. We did not find an association between alcohol or tobacco use and HIV status. These results suggest the importance of incorporating the management of psychological health in the treatment of HIV.

English

The Academy for Educational Development (AED) held a long-term, multi-country, multi-continent program funded by the United States Department of Labor (USDOL). It aimed to help both employees and employers deal with the impacts of the increase in the spread of human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) in the various parts of the world.&nbsp; The focus of this program was to work in the private sector to ameliorate the negative impacts of HIV/AIDS in the workplace. Measuring employees&rsquo; and employers&rsquo; attitudes towards people working with HIV/AIDS as part of early interventions was the key to the project success. AED has subsequently been acquired by Family Health International, to create FHI 360, which also does a significant amount of work with people living with HIV/AIDS. The project has ended but the survey results, while analyzed in 2006, continue to be relevant for practitioners planning to implement similar activities through corporate- and donor-funded health in the workplace initiatives.&nbsp; Both co-authors now work at Creative Associates International. &nbsp; Key words: HIV/AIDS, health in the workplace, absenteeism, labor turnover, workplace discrimination, workplace stigmatization, behavior change communication.

Some Case Studies of AIDS/HIV Patients in India

The present study deals with the mental health of AIDS patients. Therefore it is essential that we should have some clear ideas about the scientific nature of AIDS and mental health. Human Immunodeficiency Virus Infection / Acquired Immunodeficiency Syndrome (HIV/AIDS) is a disease of the human immune system caused by infection with human immunodeficiency virus (HIV). During the initial infection, a person may experience a brief period of influenza-like illness. This is typically followed by a prolonged period without symptoms. As the illness progresses, it interferes more and more with the immune system, making the person much more likely to get infections, including opportunistic infections and tumors that do not usually affect people who have working immune systems. HIV is transmitted primarily via unprotected sexual intercourse (including anal and even oral sex), contaminated blood transfusions, hypodermic needles, and from mother to child during pregnancy, delivery, or breastfeeding. Some bodily fluids, such as saliva and tears, do not transmit HIV. Prevention of HIV infection, primarily through safe sex and needle-exchange programs, is a key strategy to control the spread of the disease. There is no cure or vaccine; however, antiretroviral treatment can slow the course of the disease and may lead to a near-normal life expectancy. While antiretroviral treatment reduces the risk of death and complications from the disease, these medications are expensive and may be associated with side effects.

New Insights into the Diagnosis and Chemotheraphy for Visceral Leishmaniasis

Visceral leishmaniasis (VL) is a severe form of leishmaniasis - a disease caused by protozoan parasites and transmitted by the bite of certain species of sand fly. In VL, parasites migrate to the vital organs and bone marrow, destroying white and red blood cells. VL has been called the parasitic version of HIV/AIDs (Human immunodeficiency virus infection / acquired immunodeficiency syndrome), as it attacks the immune system. The most common form of the disease is cutaneous leishmaniasis, which causes skin lesions and often leaves the infected individual permanently disfigured. Even though the disease is treatable, current treatments are difficult to administer, too expensive, or toxic for extensive use in developing nations. Furthermore, resistance to treatment is an increasing problem, particularly in India. 90% of people with VL die if the infection is left untreated, and death can come within 2 years, significantly faster than AIDS. The search for new drugs continues, with new chemical and natural compounds. Many potential drug targets have been identified in biochemical and molecular studies, and some have been validated. Attempts to exploit these targets are in progress. This article reviews the epidemiology, clinical features, control Strategies, diagnosis and current treatment about visceral leishmaniasis.

Commonization of HIV/AIDS services in Nigeria: the need, the processes and the prospects.

IntroductionWith the first case of Human Immunodeficiency Virus infection/Acquired Immunodeficiency Syndrome (HIV/AIDS) identified in 1986, the management of HIV/AIDS in Nigeria has evolved through the years. The emergency phase of the HIV/AIDS program, aimed at containing the HIV/AIDS epidemic within a short time frame, was carried out by international agencies that built structures separate from hospitals’ programs. It is imperative that Nigeria shifts from the previous paradigm to the concept of Commonization of HIV to achieve sustainability. Commonization ensures that HIV/AIDS is seen as a health condition like others. It involves making HIV services available at all levels of healthcare.MethodsExcellence & Friends Management Consult (EFMC) undertook this process by conducting HIV tests in people's homes and work places, referring infected persons for treatment and follow up, establishing multiple HIV testing points and HIV services in private and public primary healthcare facilities. EFMC integrated HIV services within existing hospital care structures and trained all healthcare workers at all supported sites on HIV/AIDS prevention, care and treatment modalities.ResultsCommonization has improved the uptake of HIV testing and counseling and enrolment into HIV care as more people are aware that HIV services are available. It has integrated HIV services into general hospital services and minimized the cost of HIV programming as the existing structures and personnel in healthcare facilities are utilized for HIV services.ConclusionCommonization of HIV services i.e. integrating HIV care into the existing fabric of the healthcare system, is highly recommended for a sustainable and efficient healthcare system as it makes HIV services acceptable by all.

A consortium approach to competency-based undergraduate medical education in Uganda: process, opportunities and challenges.

Uganda, like the rest of Africa, is faced with serious health challenges including human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS), other infectious diseases and increasing non-communicable diseases, yet it has a significant shortage of health workers. Even the few health workers available may lack desired competencies required to address current and future health challenges. Reducing Uganda's disease burden and addressing health challenges requires Ugandan medical schools to produce health workers with the necessary competencies. This study describes the process which a consortium of Ugandan medical schools and the Medical Education Partnership for Equitable Services to all Ugandans (MESAU) undertook to define the required competencies of graduating doctors in Uganda and implement competency-based medical education (CBME). A retrospective qualitative study was conducted in which document analysis was used to collect data employing pre-defined checklists, in a desktop or secondary review of various documents. These included reports of MESAU meetings and workshops, reports from individual institutions as well as medical undergraduate curricula of the different institutions. Thematic analysis was used to extract patterns from the collected data. MESAU initiated the process of developing competencies for medical graduates in 2011 using a participatory approach of all stakeholders. The process involved consultative deliberations to identify priority health needs of Uganda and develop competencies to address these needs. Nine competence domain areas were collaboratively identified and agreed upon, and competencies developed in these domains. Key successes from the process include institutional collaboration, faculty development in CBME and initiating the implementation of CBME. The consortium approach strengthened institutional collaboration that led to the development of common competencies desired of all medical graduates to address priority health challenges in Uganda. It is important that the MESAU consortium continues engaging all stakeholders in medical education to support the implementation and sustainability of CBME in Uganda.

Noninvasive High-Throughput Single-Cell Analysis of HIV Protease Activity Using Ratiometric Flow Cytometry

To effectively fight against the human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) epidemic, ongoing development of novel HIV protease inhibitors is required. Inexpensive high-throughput screening assays are needed to quickly scan large sets of chemicals for potential inhibitors. We have developed a Förster resonance energy transfer (FRET)-based, HIV protease-sensitive sensor using a combination of a fluorescent protein pair, namely mCerulean and mCitrine. Through extensive in vitro characterization, we show that the FRET-HIV sensor can be used in HIV protease screening assays. Furthermore, we have used the FRET-HIV sensor for intracellular quantitative detection of HIV protease activity in living cells, which more closely resembles an actual viral infection than an in vitro assay. We have developed a high-throughput method that employs a ratiometric flow cytometry for analyzing large populations of cells that express the FRET-HIV sensor. The method enables FRET measurement of single cells with high sensitivity and speed and should be used when subpopulation-specific intracellular activity of HIV protease needs to be estimated. In addition, we have used a confocal microscopy sensitized emission FRET technique to evaluate the usefulness of the FRET-HIV sensor for spatiotemporal detection of intracellular HIV protease activity.

CD4 Cell Count of HIV-Positive Patients in Awka, South East Nigeria

CD4 cell count (CD4 count) is pivotal in determining when to initiate antiretroviral therapy and in staging of human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS). It gives information on possible treatment failure. This study was undertaken to evaluate the CD4 count of treatment naive HIV–positive patients who registered at HIV clinic of Anambra State University Teaching Hospital Awka, Anambra State. 460 case notes of all confirmed, HIV-positive patients who enrolled at the HIV clinic of Anambra State University Teaching Hospital Awka between Jan 2011-June 2013 were retrieved from the medical records. Baseline CD4 count, sex, age, ethnicity, occupation and religion were recorded and reviewed.143 patients (31.09%) were males, while 317 (68.91%) were females with male to female ratio being 1:2.2. 39.13% were between 21-30 age range, closely followed by 31-40 age range with 33.48%. Only one patient (0.22%) belonged to above 70 age group. The occupation of most patients was business/trade which had 165 patients (35.87%). 22.61% were self-employed. The least was professional with 15 patients (3.26%). Those with CD4 count of less than 350 cells/mm 3 were 240 (52.17%) while 220 (47.83%) had above 350 cells/mm 3 . 119 patients (25.9%) had CD4 count of 200 cells/mm 3 or less. Based on current guidelines, most HIV positive patients in this study

Social Aspects of HIV/AIDS and Aging: A Thematic Review

Little research can be found describing social aspects of aging with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) in Canada specifically, despite an overall increase in an aging population and increased numbers of those aging with HIV/AIDS. A systematic literature review was conducted with a selective focus on social aspects related to older adults who are living with or at risk for contracting HIV/AIDS. The primary themes that emerged in the literature are ageism and stigma, gender, mental health, and social supports. Recommendations for future research regarding prevention and education of risks for older adults and programming suitable for a wide range of audiences are presented.

Effectiveness of Reading as a Communication Strategy on the Awareness and Attitude Related to Hiv/Aids Among School Going Adolescents in Rajasthan, India

Background: One of the major factors responsible for the spread and high prevalence for HIV/AIDS (Human immuno-deficiency virus infection/Acquired immunodeficiency syndrome) and the stigma/discrimination people with this disorder face is the lack of proper knowledge and misconceptions about this disease. Despite significant progress having been made in knowing about its causative organism(a retro-virus), the mode of transmission, the diagnostic tests that establish a person’s HIV status and the drugs that have improved survival, this disease still claims 1.8 million lives annually. As such, the role of information, education and communication in prevention and control of HIV/AIDS is being greatly emphasized. Reading is one such communication strategy that can be used to educate adolescents about HIV/AIDS. Objectives: 1. To assess the knowledge of school-going adolescents regarding HIV/AIDS and their attitude towards people living with HIV/AIDS. 2. To test the effectiveness of reading as a communication strategy on the knowledge and attitude of students towards people living with HIV/AIDS. Methodology: 245 students from three English medium elite schools, studying in class 11th and 12th, selected for the study, conducted between February 2011-April 2011, were randomly divided into experimental and control groups, where the former read an HIV-related story and the latter read an unrelated story. After this, both groups were administered a knowledge and attitude questionnaire to fill and their responses recorded. Results: The students who read the HIV-related story, Experimental group, possessed superior knowledge related to 58% questions on awareness and held a more positive attitude, (with a mean score of 7.34± 3.11 vs.6.18± 3.62) towards HIV-positive patients as compared to the respondents from the Control group, the difference in both the cases being statistically significant (p

Cardiovascular disease risk factors among HIV-infected Nigerians receiving highly active antiretroviral therapy

Background:Highly active antiretroviral therapy (HAART) has become more accessible to Human immunodeficiency virus infection/Acquired Immunodeficiency Syndrome (HIV/AIDS) patients worldwide. There is growing concern that the metabolic complications associated with HIV and HAART may increase cardiovascular risk and lead to cardiovascular diseases. We, therefore, set out to describe the cardiovascular risk profile of HIV/AIDS patients receiving HAART at a health facility in northern part of Nigeria.Materials and Methods:This cross-sectional study was conducted at the Aminu Kano Teaching Hospital, Kano, Nigeria. Consenting patients, who had been receiving HAART, were compared with age and sex matched HAART-naive subjects. Questionnaire interview, electrocardiography, anthropometric and blood pressure measurements were conducted under standard conditions. Blood samples were obtained for the determination of plasma glucose, uric acid and lipid levels.Results:Two hundred subjects were studied, 100 were on HAART (group 1) and the other 100 (group 2) were HAART-naive. Subjects’ mean age for all the participants was 32.5 (7.6) years. The prevalence of hypertension was 17% in group 1 and 2% in group 2 (P < 0.001). Similarly, 11% and 21% of group 1 subjects were obese or had metabolic syndrome compared with 2% and 9% of group 2 patients (P < 0.05 for both).Conclusion:HAART treatment was associated with significantly higher prevalences of hypertension, obesity and metabolic syndrome.