The microbiome role in cardiovascular diseases: A systematic review

Introdução: As Doenças Cardiovasculares são a maior causa de morbilidade e de mortalidade mundialmente. Apesar de cada vez mais estudadas, a sua complexidade tem justificado a relevância de procurar novos mecanismos fisiopatológicos associados de forma a promover estratégias terapêuticas mais eficazes. Recentemente, o papel desempenhado pela microbiota intestinal nas vias inflamatórias e metabólicas tem sido explorado e considerado relevante na progressão das doenças cardiovasculares, embora em termos mecanísticos o conhecimento seja insípido. Objetivo(s): O objetivo deste estudo é sistematizar e avaliar a relação entre o microbioma intestinal e as doenças Cardiovasculares, em estudos baseados apenas na população Humana. Métodos: A pesquisa literária foi feita através da MEDLINE e da Web of Science. De acordo com as orientações PRISMA, foram incluídos apenas estudos observacionais e experimentais, realizados em humanos, que avaliassem o microbioma intestinal em doentes com Fibrilhação Auricular (FA), Insuficiência Cardíaca (IC) e Acidente Cerebrovascular (AVC). Resultados: Globalmente, e considerando a classe de metabolitos, verificam-se níveis elevados de TMAO (N-óxido de trimetilamina) nas patologias Cardiovasculares quando doentes são comparados a controlos. Relativamente à microbiota intestinal, os filos predominantes foram as Actinobacteria, Bacteroidetes, Firmicutes e as Proteobacteria. Na FA, as amostras estavam enriquecidas com os géneros: Bacteroides, Parabacteroides, Enterococcus, Dorea, Ruminococcus, e Streptococcus. Na IC, comprovou-se um aumento de Streptococcus e Veillonella. Nos estudos relativos ao AVC, constatou-se um aumento da família Enterobacteriaceae e do seu género Enterobacter. Conclusão: Apesar da falta de informação quantitativa dos metabolitos e da microbiota intestinal por parte dos trabalhos incluídos, este estudo suporta a existência de uma relação entre os mecanismos fisiopatológicos das Doenças Cardiovasculares e o microbioma intestinal. Este trabalho demonstra também, que há um vasto conjunto de trabalhos muito heterógenos, sem poder amostral, que afetam a construção de um edifício de evidência forte entre a microbiota e algumas doenças cardiovasculares.Background: Cardiovascular Diseases (CVD) are a set of heterogeneous diseases affecting the heart and blood vessels whose underlying cause of the development is most often atherosclerosis. The basic mechanisms of atherosclerosis involve a complex interaction of vasculature, the immune system, and lipid metabolism. The gut microbiome plays a role in these mechanisms, with most of the contributions related to microbial metabolites. Therefore, it is crucial to clarify the link between the gut microbiome and cardiovascular diseases in humans to find new possible therapeutic pathways for the foreseeable future. Objectives: The purpose of this study is to systematize and evaluate the relationship between the gut microbiome and CVD, in human-based studies. Methods: The literary research was carried out at MEDLINE and Web of Science. Based on PRISMA Guidelines, were included human-based observational and experimental studies assessing gut microbiome and CVD, namely Atrial Fibrillation (AF), Heart Failure (HF) and stroke. Results: Overall, when compared with controls, higher TMAO levels were associated with CV diseases' patients. Relatively to the gut microbiota, the predominant phyla were Actinobacteria, Bacteroidetes, Firmicutes, and Proteobacteria. In AF, patients' samples were enriched with the genera Bacteroides, Parabacteroides, Enterococcus, Dorea, Ruminococcus, and Streptococcus. In HF patients, there was an increase in the genera Streptococcus and Veillonella. Studies with stroke patients reported the family Enterobacteriaceae and its genus Enterobacter enrichment. Conclusions: Despite the lack of quantitative data regarding metabolites and microbiota, this study supports a relationship between the pathophysiology of CVD and the gut microbiome. However, this work also demonstrates that there is a vast set of very heterogeneous studies, without sample power, that affect the construction of a strong evidence between the gut microbiome and CVD

Partners in learning : proceedings of the 12th annual Teaching and Learning Forum, Edith Cowan University, 11-12 February 2003

This publication of selected papers addressing the 12th Annual Teaching and Learning Forum theme of Partners in Learning provides an overview of the issues facing staff in higher education in Australia. The articles chosen for this post-forum publication provide innovative ideas that bring the opportunity to share and learn about teaching and learning into focus as lecturers consider ways to improve students’ learning and experiences in higher education through partnerships with them and with others. With the advent of Higher Education at the Crossroads by Federal Minister Brendan Nelson, it is evident that staff will face new challenges

The Effects of Education on Cardiovascular Disease Knowledge

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality for adults in the United States. The three main risk factors for the development of CVD include hypertension, high cholesterol, and tobacco use; these factors are largely prevented or reduced through lifestyle modifications. Researchers indicate that knowledge of CVD mortality has been linked with individual action to reduce one’s CVD risk. Researchers have also indicated that segments of our underserved society, particularly those with the highest CVD mortality rates, are also the least knowledgeable about CVD and their own personal risk. These risk factors were a concern within the targeted population for this EBP project: adult patients at a rural Midwest outpatient health center. Using the Stetler Model and Kotter’s Eight Stages of Change as guides, this EBP project was implemented with the objective of evaluating the effectiveness of video plus written education materials on CVD knowledge levels among adults with one or more risk factors for the development of CVD. Over an 8-week period, a total of 100 adult patients were asked to watch a 3-minute NHLBI video and provided a CDC written handout on CVD risk factors before their regularly scheduled appointments. Pre- and post-test knowledge tests were collected on 57 adults who completed the entire project. A paired sample t-test demonstrated that the educational intervention significantly increased patient’s CVD knowledge (p \u3c .001). Sixty-eight percent of patients reported they would change their lifestyle habits to reduce their CVD risk factors as a result of this education. The findings suggest this educational strategy resulted in overall favorable effects on patients with CVD risk factors

Teleconsultation perspective for cardiovascular patients in Saudi Arabia

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This research of teleconsultation services aims to improve the quality of diagnosis and treatment for rural cardiovascular patients through utilizing distant medical expertise. Equitable access to expert healthcare as well as improved medical management for these patients can assist in modifying cardiovascular disease (CVD) risk and reduce morbidity and mortality in Saudi Arabia. The objectives were to design and develop a new care pathway for cardiovascular disease patients by utilizing teleconsultation technology, investigate factors and issues that might act as barriers to its adoption, and then evaluate the impact of this model on the stakeholders. A small scale pilot project was used to determine the issues of technology, processes and human resources required to deliver an effective service with the context of the research setting. Four primary healthcare centres, two regional hospitals, fifteen patients and sixty other participant stakeholders were included in this study. An approach using (PCP) patient care pathways was used to introduce the teleconsultation technology and integrate it within the healthcare delivery system. Compared to the traditional PCP, the modified PCP utilising teleconsultation technology improved the quality of healthcare through: Improved access to medical care and quality of diagnosis by obtaining the expertise of a distant specialist. More efficient medical evaluation and management. Enhanced role of primary healthcare centres and participating hospitals by providing all levels of health services for patients. Evidence-based referral (reduced waiting time, reduced burden on outpatient clinics). The telconsultation adoption barriers included: Inadequacy of finance Limited infrastructure Legal and regularity difficulties. Organization issues. Literacy on technology. This study recommends the following for telemedicine implementation in the country: Promote perception and readiness for ICT services with the healthcare community. Enhance structural readiness including appropriate infrastructure and adequate funding, human resources and equipment. Proactive policies to encourage growth of the telecommunication sector and to address concerns regarding privacy and security

Columbia Chronicle (10/31/2005)

Student newspaper from October 31, 2005 entitled The Columbia Chronicle. This issue is 36 pages and is listed as Volume 40, Number 9. Cover story: Chronicle Special Report: A serious new threat to independent media Editor-in-Chief: Jeffrey Dannahttps://digitalcommons.colum.edu/cadc_chronicle/1656/thumbnail.jp

Vitamin K and metabolic syndrome: is there a link?

Dado que cerca de um quarto da população adulta mundial apresenta síndrome metabólica, encontrar estratégias para atrasar, ou até prevenir, o aparecimento de patologias associadas a esta condição, como doenças cardiovasculares (DCV), a diabetes tipo 2 (DT2) e a obesidade, revela-se fundamental. A síndrome metabólica encontra-se relacionada com a malnutrição e os micronutrientes têm vindo a ganhar relevância como ferramentas terapêuticas nesta condição. Níveis reduzidos das vitaminas lipossolúveis A, D e E parecem estar associados ao desenvolvimento de síndrome metabólica e, nos últimos anos, foi descoberto que a vitamina K não é, apenas, uma vitamina anti-hemorrágica. A vitamina K tem propriedades anti-inflamatórias e antioxidantes e, para além do seu papel na síntese de várias proteínas Gla, parece estar envolvida na regulação de vias moleculares associadas ao metabolismo. A vitamina K pode proteger de diversas patologias, incluindo DCV, osteoporose, obesidade e DT2. Neste trabalho, serão revistas as fontes de vitamina K, o seu metabolismo e biomarcadores, bem como as evidências atuais do efeito das vitaminas K1 e K2 na inflamação, resistência à insulina, obesidade, dislipidemias e hipertensão arterial, e os seus mecanismos subjacentes.With approximately a quarter of the adult population in the world suffering from metabolic syndrome, finding strategies to delay, or even prevent, the development of diseases associated with this condition, such as cardiovascular diseases (CVD), type 2 diabetes (T2D) and obesity, is paramount. Metabolic syndrome is linked to malnutrition and micronutrients have been gaining acceptance as therapeutic tools for this condition. Low levels of the fat-soluble vitamins A, D and E seem to be associated with metabolic syndrome and, in recent years, it was discovered that vitamin K is more than just an antihaemorrhagic vitamin. It has anti-inflammatory and antioxidant properties and, in addition to its role in the synthesis of several Gla proteins, it seems to be involved in the regulation of metabolic pathways associated with metabolism. Vitamin K may protect from several diseases, including CVD, osteoporosis, obesity and T2D. Within this work, we present an overview of vitamin K sources, metabolism and biomarkers, as well as the current available evidence of the effect of vitamins K1 and K2 on inflammation, insulin resistance, obesity, dyslipidemia and high blood pressure, and their underlying mechanisms

Applications of Personal Computer Presentations For Corporate Video Users

This thesis is a study of desktop video as an application to the traditional postproduction process utilized by corporate video producers. Desktop video involves the personal computer in the editing process; this definition includes the personal computer as an editing and special effects tool. The purpose of this study is to measure the feelings and attitudes of professionals in the field of video postproduction about desktop video and its application to traditional methods of editing. The introduction of new technology inevitably leads to a period which the new technology is opposed by those who understand and are comfortable with the traditional modes of operation. The goal is to find out whether the desktop video technology is a threat to tradition, whether it is being accepted in everyday use by businesses who utilize industrial videos, or if the application of desktop video will lead to the opening of new markets. The promise of desktop video production is that it is cheaper than traditional processes, enabling industrial users to expand their usage and the markets they can afford to approach. This qualitative focus group study was conducted with members of the International Television Association (ITVA) chapter located in Knoxville, Tennessee. The study involved the presentation of a 10 minute video, prepared by one person, which showed what the desktop presentation technology could do and its application to the corporate user. A group discussion followed the showing of the video, using a set of questions designed to elicit responses to the presentation and the field of desktop video in general. Next, a demographic questionnaire and a Likert Scale questionnaire were distributed with questions about desktop video and its application to the corporate video user. Responses from strongly agree to strongly disagree were used to create a quantitative means of comparison for this study. The results of this focus group study showed a variety of feelings and attitudes concerning the use of personal computers in the postproduction process. The majority of the professionals were familiar with the new technology, but felt that it only applied to those high-end professionals who knew how to use the present equipment. The group agreed that applications for the individual user were limited, that the learning curve for personal computers was a deterrent for anyone to simply pick up a personal computer and instantly become an expert in postproduction editing. The general feeling of this group was that personal computers were an asset to the professional, but that the postproduction process was still one where trained personnel could best handle the job, with or without a computer. The findings of this study point out an inherent weakness of the application of the personal computer to the traditional postproduction process. Working within the constraints of magnetic tape, an analog method of storing information, limits the computer to working within a system which it cannot simply optimize by becoming a part of it. For the desktop video use to create a difference, a change will have to come in the method of storing and recording video information. This study includes brief glimpses at the future of video, moving from magnetic tape to the compact disc and other digitally oriented modes of video production. In order for desktop video to make a difference, the postproduction reliance on magnetic tape must be changed, for then a computer may enhance the process by working with digital devices instead of analog tape

Impact of implementing a computerised quality improvement intervention in primary healthcare

Health systems worldwide experience large evidence practice gaps with underuse of proven therapies, overuse of inappropriate treatments and misuse of treatments due to medical error. Quality improvement (QI) initiatives have been shown to overcome some of these gaps. Computerised interventions, in particular, are potential enablers to improving system performance. However, implementation of these interventions into routine practice has resulted in mixed outcomes and those that have been successfully integrated into routine practice are difficult to sustain. The objective of this thesis is to understand how a multifaceted, computerised QI intervention for cardiovascular disease (CVD) prevention and management was implemented in Australian general practices and Aboriginal Community Controlled Health Services and assess the implications for scale-up of the intervention. The intervention was implemented as part of a large cluster-randomised controlled trial, the TORPEDO (Treatment of Cardiovascular Risk using Electronic Decision Support) study. The intervention was associated with improved guideline recommended cardiovascular risk factor screening rates but had mixed impact on improving medication prescribing rates. In this thesis, I designed a multimethod process and economic evaluation of the TORPEDO trial. The aims were to: i. Develop a theory-informed logic model to assist in the design of the overall evaluation to address study aims (Chapter 3). ii. Conduct a post-trial audit to quantify changes in cardiovascular risk factor screening and prescribing to high risk patients over an 18-month post-trial period and understand the impact of the intervention outside of a research trial setting (Chapter 4). vi iii. Use normalisation process theory to identify the underlying mechanisms by which the intervention did and did not have an impact on trial outcomes (Chapter 5). iv. Use video ethnography to explore how the intervention was used and cardiovascular risk communicated between patients and healthcare providers (Chapter 6). v. Conduct an economic evaluation to inform policy makers for delivering the intervention at scale through Primary Health Networks in New South Wales (Chapter 7). vi. Use a new theory to explain the factors that drove adoption and non-adoption of the intervention and assess what modifications may be needed to promote spread and scale-up (Chapter 8). I found variable outcomes during the post-trial period with a plateauing of improvements in guideline recommended screening practices but an ongoing improvement in prescribing to high risk patients. The group that continued to have the most benefit was patients at high CVD risk who were not receiving recommended medications at baseline. The delay in prescribing recommended medication suggests healthcare providers adopt a cautious approach when introducing new treatments. Six intervention primary healthcare services participated as case studies for the process evaluation. Qualitative and quantitative data sources were combined at each primary healthcare service to enable a detailed examination of intervention implementation from multiple perspectives. The process evaluation identified the complex interaction between several underlying mechanisms that influenced the implementation processes and explained the mixed trial outcomes: (1) organisational mission; (2) leadership; (3) the role of teams; (4) technical competence and dependability of the software tools. Further, there were different ‘active ingredients’ vii necessary during the initial implementation compared to those needed to sustain use of the intervention. In the video ethnography and post-consultation patient interviews, important insights were gained into how the intervention was used, and its interpretation by the doctor and patient. Through ethnographic accounts, the doctor’s communication of cardiovascular risk was not sufficient in engaging patients and having them act upon their high-risk status; effective communication required interactions be assessed, discussed and negotiated. The economic evaluation identified the cost implications of implementing the intervention as part of a Primary Health Network program in the state of New South Wales, Australia; and modelled data looked at the impact of small but statistically significant reductions in clinical risk factors based on the trial data. When scaled to a larger population the intervention has potential to prevent major CVD events at under AU$50,000 per CVD event averted largely due to the low costs of implementing the intervention. However, the clinical risk factor reductions were small and a stronger case for investment would be made if the effects sizes could be enhanced and sustained over time. The findings from chapters 4-6 provide insight into the intricacy of the barriers influencing implementation processes and adoption of the intervention. Taken together, these studies provide a detailed explanation of the processes that may be required to implement such an intervention at scale and the factors that might influence its impact and sustainability. The findings are expected to assist policy makers, administrators and health professionals in developing multiple interdependent QI strategies at the organisational, provider and consumer levels to improve primary healthcare system performance for cardiovascular disease management and prevention