Enhancing adherence and management in patients with hypertension: Impact of form and frequency of knowledge intervention

BackgroundThe alarming rise in prevalence of hypertension warrants psychosocial methods supplementing pharmacotherapy for better management and prevention of cardiac emergencies. The objective of the study was to assess the differential impact of the form and frequency of knowledge intervention on management of primary hypertension.Materials and methodThe study was conducted on 256 hypertensive patients recruited through purposive sampling at health centers in Hyderabad, India. Pretest post-test control group quasi-experimental design was adopted for the study. There were two forms of the knowledge intervention, namely ‘Direct Interaction’ and ‘Audio-Visual’. Each form was presented in two frequencies namely ‘single exposure’ and ‘double exposure’. The four groups were labelled as Direct Intervention Single (DIS), Direct Intervention Double (DID), Audio-Visual Single (AVS) and Audio-Visual Double (AVD). Adherence and management of hypertension were assessed at baseline and six weeks post experiment. Analysis of Covariance (ANCOVA) was applied using IBM SPSS Statistics version 20.ResultsANCOVA followed by Bonferroni Multiple Group Comparison Test revealed significant differences between the four intervention groups and control group on adherence (p< .001). In case of hypertension management significant differences were observed between Control group and DIS, DID (p < .001), Control and AVS (p < .01). Control group did not differ from AVD.ConclusionThere was a positive impact of Knowledge Intervention on adherence and management of hypertension. Double exposure in audio visual form was counterproductive in hypertension management.     

Changes in (poly)phenols intake and metabolic syndrome risk over ten years from adolescence to adulthood

Background and aims(Poly)phenols might contribute to prevent cardiovascular disease, but limited prospective studies exist among adolescents. This study aimed to evaluate within-subject longitudinal changes in (poly)phenols intakes and food group contributors while also exploring the association with metabolic syndrome risk (MetS) during 10 years of follow up in European adolescents becoming young adults.Methods and resultsIn 164 participants (58% girls, 13-18 y at baseline) from Ghent, Zaragoza and Lille, longitudinal data (2006–2016) on (poly)phenol intake was retrieved via 2 or 3 24 h recalls. Linear and logistic longitudinal regression tested the association of (poly)phenols intake (total and classes) with Mets risk or its components (waist-height-ratio, HDL cholesterol, LDL cholesterol, triglycerides, blood pressure and insulin resistance index), adjusted for age, sex, country and other nutrient intakes. The total (poly)phenols intake was 421 ± 107 mg/day (192 mg/1000 kcal/day) at baseline, while 610 ± 101 mg/day (311 mg/1000 kcal/day) at follow-up. The three major food sources for (poly)phenols were ‘chocolate’, ‘fruit and vegetable juices’, ‘cakes and biscuits’ during adolescence and ‘coffee’, ‘tea’ and ‘chocolate’ during adulthood. Phenolic acid intake was associated with less LDL increase over time, while stilbene intake with a steeper increase in triglycerides over time.ConclusionsDifferences in major (poly)phenols contributors over time were partially explained by age-specific dietary changes like increased coffee and tea during adulthood. Some significant (poly)phenols-MetS associations might argue for nutrition-based disease prevention during adolescence, especially since adolescents had low (poly)phenols intake.     

Efficacy and safety of cold snare polypectomy for sessile serrated polyps ≥ 10 mm: A systematic review and meta-analysis

BackgroundCold snare polypectomy (CSP) is a promising technique for the removal of sessile serrated polyps (SSPs) ≥ 10 mm. However, the efficacy and safety of this technique remain undetermined.AimsWe aimed to comprehensively evaluate the efficacy and safety of CSP for SSPs ≥ 10 mm.MethodsPubMed, EMBASE, Web of Science and Cochrane Library were searched up to January 2021.ResultsA total of 10 studies consisting of 1727 SSPs (range, 10–40 mm) from 1021 patients were included. The overall rates of technical success, adverse events (AEs) and residual SSPs were 100%, 0.7% and 2.9%, respectively. Subgroup analysis showed that the rates of technical success and AEs were comparable between CSP and cold endoscopic mucosal resection (EMR) (99.9% vs. 100% and 1.3% vs. 0.5%, respectively), between the proximal and distal colon (100% vs. 99.9% and 0.3% vs. 0, respectively), and between polyps of 10–19 mm and ≥20 mm (99.8% vs. 100% and 0.9% vs. 0, respectively). However, subgroup analysis showed that the rate of residual SSPs was slightly lower in CSP compared with cold EMR (1.3% vs. 3.9%), as well as in polyps of 10–19 mm compared with those ≥20 mm (3.1% vs. 4.7%).ConclusionCSP was an effective and safe technique for removing SSPs ≥ 10 mm.     

The impact of antiviral therapy for HCV on kidney disease: a systematic review and meta-analysis

BackgroundControversy persists about the role of hepatitis C as a risk factor for developing kidney disease in the general population. Some authors have evaluated the effect of antiviral therapy for HCV on the risk of kidney disease.Study Aims and DesignA systematic review of the published medical literature was performed to assess whether antiviral therapy for HCV has an independent impact on kidney survival in the adult general population. A random effects model was used to generate an overall estimate of the risk of kidney disease after anti-HCV therapy across the published studies. Meta-regression and stratified analysis were also carried out.ResultsFifteen studies were eligible (n = 356, 285 patients) and separate meta-analyses were conducted according to the outcome. Pooling studies based on viral responses (n = 7; 34,763 individual patients) demonstrated a relationship between sustained viral response and lower frequency of kidney disease; the overall estimate for adjusted risk of kidney disease was 2.50 (95% CI, 1.41; 4.41) (p = 0.0016) and between-study heterogeneity was found (p-value by Q test = 0.004). Aggregation of studies comparing treated vs untreated cohorts (n = 8, n = 333,312 patients) revealed an association between anti-HCV therapy and lower risk of kidney disease. The overall estimate for adjusted risk of kidney disease across the eight studies was 0.39 (95% CI, 0.25; 0.612) (p = 0.0001). Meta-regression showed that the effectiveness of antiviral therapy in reducing the frequency of kidney disease diminishes as cirrhosis (p = 0.02) and HBV infection (p = 0.0001) increase among HCV-infected individuals.ConclusionsAntiviral therapy for HCV lowers the risk of kidney disease among HCV-infected individuals. Studies to understand the mechanisms underlying this association are ongoing.     

Can the Bispectral Index Monitor Quantify Altered Level of Consciousness in Emergency Department Patients?

OBJECTIVES: A daily part of emergency medicine practice includes assessing patients with altered levels of consciousness (ALOC). The authors hypothesized that a bispectral index monitor (BIS), a processed electroencephalographic monitor traditionally used to monitor patients under anesthesia, would represent an objective quantification of impairment of consciousness. They compared the BIS score with the Glasgow Coma Scale score (GCS) in emergency department (ED) patients with ALOC. METHODS: The authors performed a convenience sampling of ED adults presenting with ALOC (GCS 相似文献   

THRIVE量表、mSOAR量表和简易量表对 急性缺血性卒中患者1年预后预测价值

目的:探讨THRIVE量表、m SOAR量表和简易量表对急性缺血性卒中(AIS)患者1年不良预后的预测价值。方法:纳入AIS患者772例,收集患者临床基线资料,同时应用THRIVE量表、mSOAR量表和简易量表进行评分。随访1年,以患者1年时出现死亡或改良Rankin评分(mRS)≥3分为不良预后,应用ROC曲线下面积(AUC)比较3个量表对患者预后的预测价值。结果:本组772例患者根据随访结果,纳入预后良好组576例(74.6%),不良预后组196例(25.4%),其中死亡68例(34.7%)。THRIVE、mSOAR和简易量表预测患者1年不良预后的AUC值分别为0.777[95%CI,(0.738, 0.815)]、0.820[95%CI,(0.706, 0.770)]和0.854[95%CI,(0.827,0.878)](均P0.001);THRIVE和mSOAR量表的AUC值均低于简易量表(P0.05)。THRIVE、mSOAR和简易量表预测死亡结局的AUC值分别为0.775[95%CI,(0.721, 0.828)]、0.748[95%CI,(0.716, 0.778)]和0.807[95%CI,(0.778, 0.835)](均P0.05);且mSOAR量表的AUC值低于简易量表(P0.05)。结论:THRIVE、mSOAR和简易量表对AIS患者1年不良预后有较好的预测效能;简易量表的预测能力更优。     

中国公众公共卫生安全素养量表的开发研究

目的开发公共卫生安全素养量表, 为我国公众的公共卫生安全素养测评提供适宜工具。方法通过理论构想、指标池构建、现场验证、题项缩减等步骤编制中国公共卫生安全素养初始量表, 转为"问卷星"电子问卷, 随机抽取4个省份共2 809名居民进行现场测试。利用经典测试理论(CTT)和项目反应理论(IRT)进行题项缩减。使用SPSS 23.0软件进行探索性因子分析(EFA)和单维性检验。使用R 4.1.1软件ltm和mirt包进行题项的心理测量学指标分析, 并绘制项目特征曲线(ICC)和信息函数曲线(IIC和TIF)。结果选用专家一致性系数最优的初始量表3, 共30个题项(B1～B30), 测试对象完成1个题项平均需9.8 s。根据CTT分析, 删除校正题项-总相关系数(CITC)<0.3及题项-维度相关系数(IDCC)<0.4的B2题项;删除CITC<0.3、IDCC<0.4及难度指数<0.2的B23题项;删除CITC<0.3及难度指数<0.2的B30题项。删除后量表总内部一致性信度(Cronbach’’sα)值为0.923。EFA提示删除14个因子载荷较小...     

昏迷恢复量表与ICU病房DOC患者预后关系

目的 探讨行为量表与ICU病房意识障碍(Disorders of consiousness,DOC)患者预后的关系。方法 选择2018年1～12月在我院ICU治疗的意识障碍患者为研究对象,根据随访GOS评分分为预后良好组39例与预后不良组29例。比较两组一般资料及临床资料、CRS-R评分以及EEG结果。多因素分析影响患者预后的相关因素。分析GRS-R评分与GOS评分的相关性。结果 (1)随访3个月,其中39例恢复良好,占57.35%,29例恢复不良,占42.65%。(2)预后良好组患者CRS-R评分显著高于预后不良组的患者,EEGⅠ～Ⅱ的比例显著高于预后不良组的患者,差异有统计学意义(P0.05)。(3)多因素分析结果显示,CRS-R评分、EEG是ICU病房DOC患者预后的相关影响因素(OR=8.712、5.709,P0.05)。(4)CRS-R评分与GOS评分呈显著正相关关系(r=0.903)。结论 ICU病房DOC患者的预后与入院时CRS-R评分以及EEG检查结果有密切的关系,临床上患者入院时通过CRS-R评分以及EEG检查可对患者病情以及预后进行初步判断。     

Clinical, biochemical and pathological features of low-renin ("primary") hyperaldosteronism

The clinical and biochemical findings in 136 patients with low-renin (“primary”) hyperaldosteronism are described. A pathological diagnosis was made in 82 cases and a unilateral adrenocortical adenoma was found in 62. However, a tumor was not identified in 17, the adrenal glands then usually showing hyperplasia of the zona glomerulosa, often with nodular changes. The adrenal lesion in a further three cases proved fifficult to classify.Patients with an adrenocortical adenoma were significantly younger than those in whom a tumor was not found. The female/male ratio was greater than 2:1 in the adenoma group, but no sex difference was observed in the group without tumor. Vascular complications of hypertension occurred in 23 per cent and there was histologic evidence of malignant-phase hypertension in four. It is concluded that this condition is not a benign form of hypertension.Biochemical abnormalities were more marked among patients with an adrenocortical adenoma, compared with those in whom a tumor was not found. Mean plasma concentrations of aldosterone, sodium and tCO₂, and mean exchangeable sodium were significantly higher, while plasma potassium and renin concentrations and mean exchangeable potassium were significantly lower. Although plasma aldosterone was above normal at least once in all, levels were often only intermittently raised. Hypokalemia occurred in all patients with a proved adenoma and was usually persistent. Among patients in whom a tumor was not found, hypokalemia was less severe and usually intermittent, while plasma potassium was persistently normal in three of 17 patients in this group.In addition to the aldosterone excess, plasma deoxycorticosterone was raised in 13 of 26 patients, plasma corticosterone was marginally raised in two and plasma 18-OH-DOC in four of 15. There was a significant inverse correlation between plasma renin concentration and age in the non-adenoma group but not among patients with an aldosterone-producing adenoma. Weak positive correlations were observed in the adenoma group between total exchangeable sodium and both systolic and diastolic blood pressure and between exchangeable sodium and plasma aldosterone concentrations. Such correlations were not seen in the non-tumor group. The hypertension may have a different basis in these two groups.