Changes in marital quality over 6 years and its association with cardiovascular disease risk factors in men: findings from the ALSPAC prospective cohort study

Background: Marital relationship quality has been suggested to have independent effects on cardiovascular health outcomes. This study investigates the association between changes in marital relationship quality and cardiovascular disease (CVD) risk factors in men. Methods: We used data from The Avon Longitudinal Study of Parents and Children, a prospective birth cohort study (Bristol, UK). Our baseline sample was restricted to married study fathers with baseline relationship and covariate data (n=2496). We restricted final analysis (n=620) to those with complete outcome, exposure and covariate data, who were married and confirmed the study child’s father at 6.4 years and 18.8 years after baseline. Relationship quality was measured at baseline and 6.4 years and operationalised as consistently good, improving, deteriorating or consistently poor relationship. We measured CVD risk factors of blood pressure, resting heart rate, body mass index, lipid profile and fasting glucose at 18.8 years after baseline. Results: Improving relationships were associated with lower levels of low-density lipoprotein (−0.25 mmol/L, 95% CI −0.46 to −0.03) and relative reduction of body mass index (−1.07 kg/m2, 95% CI −1.73 to −0.42) compared with consistently good relationships, adjusting for confounders. Weaker associations were found between improving relationships and total cholesterol (−0.24 mmol/L, 95% CI −0.48 to 0.00) and diastolic blood pressure (−2.24 mm Hg, 95% CI −4.59 to +0.11). Deteriorating relationships were associated with worsening diastolic blood pressure (+2.74 mm Hg, 95% CI 0.50 to 4.98). Conclusions: Improvement and deterioration of longitudinal relationship quality appears associated with respectively positive and negative associations with a range of CVD risk factors

Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis

The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context. The aim of this systematic review and meta-analysis is to assess the efficacy of the nurse-led self-management support versus usual care evaluating patient outcomes in chronic care community programs. Systematic review was carried out in MEDLINE, CINAHL, Scopus and Web of Science including RCTs of nurse-led self-management support interventions performed to improve observer reported outcomes (OROs) and patients reported outcomes (PROs), with any method of communication exchange or education in a community setting on patients >18 years of age with a diagnosis of chronic diseases or multi-morbidity. Of the 7,279 papers initially retrieved, 29 met the inclusion criteria. Meta-analyses on systolic (SBP) and diastolic (DBP) blood pressure reduction (10 studies-3,881 patients) and HbA1c reduction (7 studies-2,669 patients) were carried-out. The pooled MD were: SBP -3.04 (95% CI -5.01--1.06), DBP -1.42 (95% CI -1.42--0.49) and HbA1c -0.15 (95% CI -0.32-0.01) in favor of the experimental groups. Meta-analyses of subgroups showed, among others, a statistically significant effect if the interventions were delivered to patients with diabetes (SBP) or CVD (DBP), if the nurses were specifically trained, if the studies had a sample size higher than 200 patients and if the allocation concealment was not clearly defined. Effects on other OROs and PROs as well as quality of life remain inconclusive

Shared Medical Appointments: An Innovative Model to Reduce Health Disparities Among Latinxs With Type-2 Diabetes.

In the United States, diabetes is epidemic. A study of Latinxs with diabetes evaluated a behavioral shared medical appointment (SMA) intervention. This quasi-experimental study included nonrandomized matched control group participants receiving usual care. The nonprobability convenience sample consisted of 90 participants (SMA = 30; control = 60) receiving primary care at an FQHC (Federally Qualified Health Center) clinic. At 6 months, the percentage of participants achieving target A1C goals was greater in the intervention group (59%) than in the control group (31%; χ2 = 4.462, p ≤ .05). In a multiple regression model, the SMA intervention group, compared to the control group had an A1C decline at 3 months of 0.55% (b = - 0.55, t = - 1.48, p=.14) and an A1C decline at 6 months of 0.83% (b= - 0.83, t= - 2.25, p = .03). Therefore, the results showed 3- and 6-month declines that were greater in the SMA group than in the control group. Underserved, underinsured Latinxs in the ALDEA program achieved significant A1C reductions; the program succeeded in empowering Latino patients and improving glycemic control

Berberine for prevention of dementia associated with diabetes and its comorbidities: A systematic review

Background A growing number of epidemiological studies indicate that metabolic syndrome (MetS) and its associated features play a key role in the development of certain degenerative brain disorders, including Alzheimer’s disease and vascular dementia. Produced by several different medicinal plants, berberine is a bioactive alkaloid with a wide range of pharmacological effects, including antidiabetic effects. However, it is not clear whether berberine could prevent the development of dementia in association with diabetes. Objective To give an overview of the therapeutic potential of berberine as a treatment for dementia associated with diabetes. Search strategy Database searches A and B were conducted using PubMed and ScienceDirect. In search A, studies on berberine’s antidementia activities were identified using “berberine” and “dementia” as search terms. In search B, recent studies on berberine’s effects on diabetes were surveyed using “berberine” and “diabetes” as search terms. Inclusion criteria Clinical and preclinical studies that investigated berberine’s effects associated with MetS and cognitive dysfunction were included. Data extraction and analysis Data from studies were extracted by one author, and checked by a second; quality assessments were performed independently by two authors. Results In search A, 61 articles were identified, and 22 original research articles were selected. In search B, 458 articles were identified, of which 101 were deemed relevant and selected. Three duplicates were removed, and a total of 120 articles were reviewed for this study. The results demonstrate that berberine exerts beneficial effects directly in the brain: enhancing cholinergic neurotransmission, improving cerebral blood flow, protecting neurons from inflammation, limiting hyperphosphorylation of tau and facilitating β-amyloid peptide clearance. In addition, evidence is growing that berberine is effective against diabetes and associated disorders, such as atherosclerosis, cardiomyopathy, hypertension, hepatic steatosis, diabetic nephropathy, gut dysbiosis, retinopathy and neuropathy, suggesting indirect benefits for the prevention of dementia. Conclusion Berberine could impede the development of dementia via multiple mechanisms: preventing brain damages and enhancing cognition directly in the brain, and indirectly through alleviating risk factors such as metabolic dysfunction, and cardiovascular, kidney and liver diseases. This study provided evidence to support the value of berberine in the prevention of dementia associated with MetS

Marshfield Clinic: Health Information Technology Paves the Way for Population Health Management

Highlights Fund-defined attributes of an ideal care delivery system and best practices, including an internal electronic health record, primary care teams, physician quality metrics and mentors, and standardized care processes for chronic care management

A framework for design engineering education in a global context

This paper presents a framework for teaching design engineering in a global context using innovative technologies to enable distributed teams to work together effectively across international and cultural boundaries. The DIDET Framework represents the findings of a 5-year project conducted by the University of Strathclyde, Stanford University and Olin College which enhanced student learning opportunities by enabling them to partake in global, team based design engineering projects, directly experiencing different cultural contexts and accessing a variety of digital information sources via a range of innovative technology. The use of innovative technology enabled the formalization of design knowledge within international student teams as did the methods that were developed for students to store, share and reuse information. Coaching methods were used by teaching staff to support distributed teams and evaluation work on relevant classes was carried out regularly to allow ongoing improvement of learning and teaching and show improvements in student learning. Major findings of the 5 year project include the requirement to overcome technological, pedagogical and cultural issues for successful eLearning implementations. The DIDET Framework encapsulates all the conclusions relating to design engineering in a global context. Each of the principles for effective distributed design learning is shown along with relevant findings and suggested metrics. The findings detailed in the paper were reached through a series of interventions in design engineering education at the collaborating institutions. Evaluation was carried out on an ongoing basis and fed back into project development, both on the pedagogical and the technological approaches

Motivational Interviewing Impact on Cardiovascular Disease

abstract: Harm reduction in cardiovascular disease is a significant problem worldwide. Providers, families, and healthcare agencies are feeling the burdens imparted by these diseases. Not to mention missed days of work and caregiver strain, the losses are insurmountable. Motivational interviewing (MI) is gaining momentum as a method of stimulating change through intrinsic motivation by resolving ambivalence toward change (Ma, Zhou, Zhou, & Huang, 2014). If practitioners can find methods of educating the public in a culturally-appropriate and sensitive manner, and if they can work with community stakeholders to organize our resources to make them more accessible to the people, we may find that simple lifestyle changes can lead to risk reduction of cardiovascular diseases. By working with our community leaders and identifying barriers unique to each population, we can make positive impacts on a wide range of issues that markedly impact our healthcare systems

DIDET: Digital libraries for distributed, innovative design education and teamwork. Final project report

The central goal of the DIDET Project was to enhance student learning opportunities by enabling them to partake in global, team based design engineering projects, in which they directly experience different cultural contexts and access a variety of digital information sources via a range of appropriate technology. To achieve this overall project goal, the project delivered on the following objectives: 1. Teach engineering information retrieval, manipulation, and archiving skills to students studying on engineering degree programs. 2. Measure the use of those skills in design projects in all years of an undergraduate degree program. 3. Measure the learning performance in engineering design courses affected by the provision of access to information that would have been otherwise difficult to access. 4. Measure student learning performance in different cultural contexts that influence the use of alternative sources of information and varying forms of Information and Communications Technology. 5. Develop and provide workshops for staff development. 6. Use the measurement results to annually redesign course content and the digital libraries technology. The overall DIDET Project approach was to develop, implement, use and evaluate a testbed to improve the teaching and learning of students partaking in global team based design projects. The use of digital libraries and virtual design studios was used to fundamentally change the way design engineering is taught at the collaborating institutions. This was done by implementing a digital library at the partner institutions to improve learning in the field of Design Engineering and by developing a Global Team Design Project run as part of assessed classes at Strathclyde, Stanford and Olin. Evaluation was carried out on an ongoing basis and fed back into project development, both on the class teaching model and the LauLima system developed at Strathclyde to support teaching and learning. Major findings include the requirement to overcome technological, pedagogical and cultural issues for successful elearning implementations. A need for strong leadership has been identified, particularly to exploit the benefits of cross-discipline team working. One major project output still being developed is a DIDET Project Framework for Distributed Innovative Design, Education and Teamwork to encapsulate all project findings and outputs. The project achieved its goal of embedding major change to the teaching of Design Engineering and Strathclyde's new Global Design class has been both successful and popular with students