Does Use of a Mobile App and Telephone Support Promote Improved Self-Care of Heart Failure?

Background Heart failure is a complex disease and a growing global epidemic. Symptoms and multiple comorbidities contribute to the overwhelming burden of heart failure, and support people make an important contribution to self-care. Effective self-care maintenance behaviors along with confidence and support can help people living with heart failure to effectively self-manage the disease. Purpose This project aimed to determine if use of a mobile app with telephone support calls was an effective intervention to promote improved self-care of heart failure and caregiver contribution to self-care of heart failure compared to the standard of care where the intervention was not used. Methods This project used a quantitative quasi-experimental pretest-posttest design with a non-equivalent control group. Participants included people with heart failure and support people. The pretest and posttest were conducted to measure the effectiveness of a 90-day intervention compared to the standard of care. The evidence-based 90-day intervention, used a mobile app to track daily weight and heart failure symptoms with structured telephone support calls, aimed to improve self-care of and caregiver contribution to self-care of heart failure. This project was guided by the situation-specific theory of heart failure self-care. Results Thirty-five people completed the 90-day project period. While the small sample size and non-normally distributed variables likely contributed to a lack of significant results comparing the intervention to the standard of care, results within groups were interesting. Control group participants (n = 17) made no significant improvements from pretest to posttest in self-care maintenance, management, or confidence. However, intervention group participants (n = 18) made significant improvements from pretest to posttest in self-care management, t(10) = -2.031, p = 0.035, and confidence, t(17) = -3.766, p = 0.001. Examining the level of use of the app in intervention group households, participants in low-level use households (n = 10) made significant improvement from pretest to posttest in self-care confidence, z = -2.214, p = 0.018, while participants in high-level use households (n = 8) made significant improvements from pretest to posttest in self-care management, z = -1.826, p = 0.034, and confidence, z = -2.214, p = 0.014. Conclusions The intervention resulted in significantly improved self-care management and confidence for intervention group participants and improvement above adequate (70%) in self-care maintenance, management, and confidence for high-level users of the app. The results of this project validated the theory and the literature on evidence-based interventions to promote heart failure self-care. This intervention could be applied in practice as part of an individualized care plan to promote self-care of heart failure and caregiver contribution to self-care of heart failure

Identification of post-traumatic stress disorder following ICU

'No abstract

Risk factors for breast cancer in a population with high incidence rates.

BackgroundThis report examines generally recognized breast cancer risk factors and years of residence in Marin County, California, an area with high breast cancer incidence and mortality rates.MethodsEligible women who were residents of Marin County diagnosed with breast cancer in 1997-99 and women without breast cancer obtained through random digit dialing, frequency-matched by cases' age at diagnosis and ethnicity, participated in either full in-person or abbreviated telephone interviews.ResultsIn multivariate analyses, 285 cases were statistically significantly more likely than 286 controls to report being premenopausal, never to have used birth control pills, a lower highest lifetime body mass index, four or more mammograms in 1990-94, beginning drinking after the age of 21, on average drinking two or more drinks per day, the highest quartile of pack-years of cigarette smoking and having been raised in an organized religion. Cases and controls did not significantly differ with regard to having a first-degree relative with breast cancer, a history of benign breast biopsy, previous radiation treatment, age at menarche, parity, use of hormone replacement therapy, age of first living in Marin County, or total years lived in Marin County. Results for several factors differed for women aged under 50 years or 50 years and over.ConclusionsDespite similar distributions of several known breast cancer risk factors, case-control differences in alcohol consumption suggest that risk in this high-risk population might be modifiable. Intensive study of this or other areas of similarly high incidence might reveal other important risk factors proximate to diagnosis

The anti-apoptotic activity of XIAP is retained upon mutation of both the caspase 3– and caspase 9–interacting sites

The X-linked mammalian inhibitor of apoptosis protein (XIAP) has been shown to bind several partners. These partners include caspase 3, caspase 9, DIABLO/Smac, HtrA2/Omi, TAB1, the bone morphogenetic protein receptor, and a presumptive E2 ubiquitin-conjugating enzyme. In addition, we show here that XIAP can bind to itself. To determine which of these interactions are required for it to inhibit apoptosis, we generated point mutant XIAP proteins and correlated their ability to bind other proteins with their ability to inhibit apoptosis. ∂RING point mutants of XIAP were as competent as their full-length counterparts in inhibiting apoptosis, although impaired in their ability to oligomerize with full-length XIAP. Triple point mutants, unable to bind caspase 9, caspase 3, and DIABLO/HtrA2/Omi, were completely ineffectual in inhibiting apoptosis. However, point mutants that had lost the ability to inhibit caspase 9 and caspase 3 but retained the ability to inhibit DIABLO were still able to inhibit apoptosis, demonstrating that IAP antagonism is required for apoptosis to proceed following UV irradiation

Radiative pion capture by a nucleon

The differential cross sections for $\pi^- p \to \gamma n$ and $\pi^+ n \to \gamma p$ are computed up to $O(p^3)$ in heavy baryon chiral perturbation theory (HBChPT). The expressions at $O(p)$ and $O(p^2)$ have no free parameters. There are three unknown parameters at $O(p^3)$, low energy constants of the HBChPT Lagrangian, which are determined by fitting to experimental data. Two acceptable fits are obtained, which can be separated by comparing with earlier dispersion relation calculations of the inverse process. Expressions for the multipoles, with emphasis on the p-wave multipoles, are obtained and evaluated at threshold. Generally the results obtained from the best of the two fits are in good agreement with the dispersion relation predictions.Comment: 24 pages, Latex, using RevTe

Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care

<p>Abstract</p> <p>Background</p> <p>The risk of depression is increased in people with long term conditions (LTCs) and is associated with poorer patient outcomes for both the depressive illness and the LTC, but often remains undetected and poorly managed. The aim of this study was to identify and explore barriers to detecting and managing depression in primary care in people with two exemplar LTCs: diabetes and coronary heart disease (CHD).</p> <p>Methods</p> <p>Qualitative in-depth interviews were conducted with 19 healthcare professionals drawn predominately from primary care, along with 7 service users and 3 carers (n = 29). One focus group was then held with a set of 6 healthcare professionals and a set of 7 service users and 1 carer (n = 14). Interviews and the focus group were digitally recorded, transcribed verbatim, and analysed independently. The two data sets were then inspected for commonalities using a constant comparative method, leading to a final thematic framework used in this paper.</p> <p>Results</p> <p>Barriers to detecting and managing depression in people with LTCs in primary care exist: i) when practitioners in partnership with patients conceptualise depression as a common and understandable response to the losses associated with LTCs - depression in the presence of LTCs is normalised, militating against its recognition and treatment; ii) where highly performanced managed consultations under the terms of the Quality and Outcomes Framework encourage reductionist approaches to case-finding in people with CHD and diabetes, and iii) where there is uncertainty among practitioners about how to negotiate labels for depression in people with LTCs in ways that might facilitate shared understanding and future management.</p> <p>Conclusion</p> <p>Depression was often normalised in the presence of LTCs, obviating rather than facilitating further assessment and management. Furthermore, structural constraints imposed by the QOF encouraged reductionist approaches to case-finding for depression in consultations for CHD and diabetes. Future work might focus on how interventions that draw on the principles of the chronic care model, such as collaborative care, could support primary care practitioners to better recognise and manage depression in patients with LTCs.</p

CRYPTOCHROMES promote daily protein homeostasis.

The daily organisation of most mammalian cellular functions is attributed to circadian regulation of clock-controlled protein expression, driven by daily cycles of CRYPTOCHROME-dependent transcriptional feedback repression. To test this, we used quantitative mass spectrometry to compare wild-type and CRY-deficient fibroblasts under constant conditions. In CRY-deficient cells, we found that temporal variation in protein, phosphopeptide, and K+ abundance was at least as great as wild-type controls. Most strikingly, the extent of temporal variation within either genotype was much smaller than overall differences in proteome composition between WT and CRY-deficient cells. This proteome imbalance in CRY-deficient cells and tissues was associated with increased susceptibility to proteotoxic stress, which impairs circadian robustness, and may contribute to the wide-ranging phenotypes of CRY-deficient mice. Rather than generating large-scale daily variation in proteome composition, we suggest it is plausible that the various transcriptional and post-translational functions of CRY proteins ultimately act to maintain protein and osmotic homeostasis against daily perturbation

The emotional context of self-management in chronic illness: A qualitative study of the role of health professional support in the self-management of type 2 diabetes

Background: Support for patient self-management is an accepted role for health professionals. Little evidence exists on the appropriate basis for the role of health professionals in achieving optimum self-management outcomes. This study explores the perceptions of people with type 2 diabetes about their self-management strategies and how relationships with health professionals may support this.Methods: Four focus groups were conducted with people with type 2 diabetes:&nbsp; two with English speaking and one each with Turkish and Arabic-speaking. Transcripts from the groups were analysed drawing on grounded hermeneutics and interpretive description.Results: We describe three conceptually linked categories of text from the focus groups based on emotional context of self management, dominant approaches to self management and support from health professionals for self management. All groups described important emotional contexts to living with and self-managing diabetes and these linked closely with how they approached their diabetes management and what they looked for from health professionals. Culture seemed an important influence in shaping these linkages.Conclusion: Our findings suggest people construct their own individual self-management and self-care program, springing from an important emotional base. This is shaped in part by culture and in turn determines the aims each&nbsp; person has in pursuing self-management strategies and the role they make available to health professionals to support them. While health professionals\u27&nbsp; support for self-care strategies will be more congruent with patients\u27 expectations if they explore each person\u27s social, emotional and cultural circumstances, pursuit of improved health outcomes may involve a careful balance between supporting as well as helping shift the emotional constructs surrounding a patient life with diabetes.<br /

KRBAVICA (Fragments from the Historio-sociologic Study of Lika\u27s Village)

sis of its socio-economic conditions throughout the history, from the beginning of XVIII century to the present days. The village is situated at the karst field in Lika (province of Croatia), 647 m above the sea level, in the mountmous climate conditions; its arrable land is very small and covers only 13% of the total agricultural soil surface. Tillage, livestock-breeding and work in the forest are the main peasants\u27 activities. In the past this region was first under the Turkish rule, and after that it was a part of the Austrian military frontier. During the last world war its economy was completely destroyed. With the pentration of the commodity production and inovations family cooperatives and old traditions started to diminish. Up to 1914. about 300 people migrated, mostly to USA. They were all men in the age of 18 to 40 years. There were two organized colonizations to Vojvodina (1920—1925) and Slavonija (1945). The maximum number of population living in the village during the last 83 years amounted to 1,448. During the last 23 years the number of the population decreased for 72,5%. Out of that 14% were killed during the World War II., 37% changed their accupation and do not live in the village any more, 13,5% migrated to other regions of Yugoslavia, 8,0% went to schools and did not return to the village. Now only 27,5% of the prewar population live in the village. According to author\u27s, estimate, the main reasons for such intensive out migration tendencies in the past were; 1) unfavourable agricultural conditions änd. agrarian overpopulation 2) opposition to the house-cooperative s discipline, 3) strong inclination of getting rid of the military frontier obligations and 4) striving for better living standard. Birth rate decreases. In 1960 only 6 children were born, 1961 — 3 and in 1962 only one. Taking into account all mentioned tendencies, the author comes to the conclusion that this village in the near future will die out. At the same time he suggests some measures which would be necessary to be undertaken in order to stop the process of dying out not only of this village but also of many similar ones in mountinous regions