Community-Based Participatory Research Approaches for Hypertension Control and Prevention in Churches

Hypertension (HTN) is a highly prevalent risk factor for cardiovascular (CV), cerebrovascular, and renal diseases and disproportionately affects African Americans (AAs). It has been shown that promoting the adoption of healthy lifestyles, ones that involve best practices of diet and exercise and abundant expert support, can, in a healthcare setting, reduce the incidence of hypertension in those who are at high risk. In this paper, we will examine whether similar programs are effective in the AA church-community-based participatory research settings, outside of the healthcare arena. If successful, these church-based approaches may be applied successfully to reduce the incidence and consequences of hypertension in large communities with potentially huge impact on public health

Carotid intima media thickness and low high-density lipoprotein (HDL) in South Asian immigrants: could dysfunctional HDL be the missing link?

IntroductionSouth Asian immigrants (SAIs) in the US exhibit higher prevalence of coronary artery disease (CAD) and its risk factors compared with other ethnic populations. Conventional CAD risk factors do not explain the excess CAD risk; therefore there is a need to identify other markers that can predict future risk of CAD in high-risk SAIs. The objective of the current study is to assess the presence of sub-clinical CAD using common carotid artery intima-media thickness (CCA-IMT), and its association with metabolic syndrome (MS) and pro-inflammatory/dysfunctional HDL (Dys-HDL).Material and methodsA community-based study was conducted on 130 first generation SAIs aged 35-65 years. Dys-HDL was determined using the HDL inflammatory index. Analysis was completed using logistic regression and Fisher's exact test.ResultsSub-clinical CAD using CCA-IMT ≥ 0.8 mm (as a surrogate marker) was seen in 31.46%. Age and gender adjusted CCA-IMT was significantly associated with type 2 diabetes (p = 0.008), hypertension (p = 0.012), high-sensitivity C-reactive protein (p < 0.001) and homocysteine (p = 0.051). Both the presence of MS and Dys-HDL was significantly correlated with CCA-IMT, even after age and gender adjustment. The odds of having Dys-HDL with CCA-IMT were 5 times (95% CI: 1.68, 10.78).ConclusionsThere is a need to explore and understand non-traditional CAD risk factors with a special focus on Dys-HDL, knowing that SAIs have low HDL levels. This information will not only help to stratify high-risk asymptomatic SAI groups, but will also be useful from a disease management point of view

Center-based prevalence of anxiety and depression in women of the northern areas of Pakistan

Objective: To estimate the prevalence of anxiety and depression in women of the Northern areas. Methods: A cross-sectional center-based study was conducted at Singal Medical Center (SNIC), Gilgit, in the Northern Areas of Pakistan, using the Hospital Anxiety and Depression Scale (HADS). Results: One hundred and twenty women, between the ages of 16 and 60, attended the SMC over a two month period and were included in the study. Using HADS, it was found that 50% of the women had anxiety and/or depression; 25% suffered only from anxiety, 8% from depression and 17% had features of both. Conclusion: This study supports the previous studies of stress in remote areas and also contradicts the belief that people who live in the remote rural areas lead stress-free lives or have low rates of psvchiatric morbidit

Risk factors and behaviours for coronary artery disease (CAD) among ambulatory Pakistanis

Objective: To determine the frequency and distribution of various risk factors and behaviours for coronary artery disease (CAD) among ambulatory Pakistanis.Methods: It is a cross-sectional descriptive study carried out at the Aga Khan University Hospital, a teaching hospital in Karachi. All the subjects were adults (18-60 years) presenting at the general checkup clinic with no history or evidence of CAD by convenient sampling method. Demographic variables included risk factors and behaviors including diabetes, hypertension, dyslipidemia, family history of heart disease, obesity, smoking and sedentary lifestyle.Results: Among 370 ambulatory Pakistanis, the proportions of major risk factors for CAD were: sedentary life style 72%, family history 42%, dyslipidemia 31%, obesity 24%, hypertension 19% and diabetes mellitus 15%. Diabetes, hypertension and dyslipidemia were poorly controlled in the study population. Proportions of the three major risk factors (smoking, hypertension and dyslipidemia) occurring singly, doubly and all three together in the study population were found to be 39%, 11% and 1%, respectively. Data were also analyzed for risk factors by comparing those with and without family history of CAD to eliminate any bias. The results were not statistically significant except for the sedentary life style (P=0.016).Conclusion: There is a high prevalence of CAD risk factors in this study population. Modifiable risk factors like diabetes, hypertension and high cholesterol need better control. Preventive screening programs and healthy lifestyle behaviours need to be emphasized upon in the community

Syndrome X and family practitioners

Background: Increased incidence of hypertension, non-insulin dependent diabetes (NIDDM) and coronary heart disease often cluster in the same individuals and there have been speculations that a common mechanism may be responsible for all of these pathological conditions. This risk factor constellation, which is associated with an enhanced risk for cardiovascular disease, is sometimes referred to as the Insulin Resistance Syndrome , Syndrome X , or the Metabolic Syndrome .AIM: To find out the prevalence of Syndrome X in the population of patients coming to a preventive health check clinic at a tertiary care teaching hospital in a megacity of the developing world.Methods: A total of 270 patients, above the age of 40 years, who attended preventive health check clinics of 2 Family Physicians at the Aga Khan University from January 1996 to July 1997 were selected. Patients below 40 years were excluded from the study.Results: The prevalence of Syndrome X, defined as association of obesity, NIDDM, hypertension, raised LDL and raised triglycerides is 2.6% in patients above 40 years, who were screened in this study.CONCLUSION: The significant prevalence of Syndrome X is alarming and we need to strengthen our existing educational programs for prevention of obesity, increased physical activity and better control of hypertension. When drugs are selected for pharmacological treatment, priority should be given to those, which improve the insulin sensitivity index or are at least neutral in this respect

Building Research Capacity in Pakistan: Effectiveness of an Epidemiology Training Workshop Taught By Traditional Class-Room and Video Teleconferencing Methods

Building research capacity in health services has been recognized internationally as an important pillar for the production of a sound evidence base for decision-making in policy and practice. The developing countries are currently facing an increasing epidemic of non-communicable diseases in addition to non-resolving problems of infections, malnutrition and health problems of reproductive health. Clinical research is the link between advances in research and innovations in medical practice. Physician-scientists, trained in patient care and epidemiological research, are crucial in developing and performing cutting-edge clinical research in developing countries. Due to lack of local research capacity, these challenges have not been matched by the ability and capability of developing countries to carry out appropriate studies, the results of which will enable them deal with the health problems in their national contexts. An effort was made to build and strengthen local research capacity in Pakistan and conducted a 9-day workshop on epidemiology research methods to train the trainers. Study objectives: (a) To assess the short and long-term effectiveness in terms of knowledge gain from the epidemiologic research training workshop offered to participants by face-to-face (F2F) and Video-teleconferencing (VTC) methods in Pakistan. (b) to assess the impact of the workshop on students' future career goals in both F2F and VTC groups and (C) to assess the cost-effectiveness of VTC relative to F2F instruction of training.Methods: This was a prospective study on 40 F2F and 18 VTC health care professional with post-graduate degrees. A 9- day epidemiological research training workshop was conducted by 5 research faculty from University of Pittsburgh who developed course contents. Pretest and post-test1 were on 1st and last day of the workshop respectively. Post-test 2 was conducted after one year of the workshop. Cost of both teaching methods were obtained using ingredient method and cost -effective ratios were calculatedResults: The total study sample included 56 and 49 for the short-term and long-term workshop assessment. Within each group, paired sample t-test showed significant improvement in scores after the completion of workshop (P<0.001 for F2F and VTC). In F2F, mean scores increased from 11.13 (pre-test) to 15.08 (post-test1) and in VTC scores increased from 10.67 (pre-test) to 13.22(post-test1). After one year, post-test2 scores remained higher than pretest scores in both the groups (2-sample T-test P=0.11) and were not statistically significant. On 2-way repeated measure ANOVA, both groups showed significant changes in mean scores over time (P<0.001), and no interaction was seen between time and groups (P=0.31). The between subject-effect of groups was found significant (P=0.013). The total incremental cost per score gained was higher for VTC group for both short-term ($166 incremental cost /score gained) and long-term ($458 incremental cost / score gained).Conclusion: The epidemiology research training workshop was found to be effective in terms of knowledge gain in both the groups. This study has public health significance and has presented a model for training doctors and other health care professional in research methods by providing in-house training to reduce increasing problems of brain drain

Customizable Intraoperative Neural Stimulator and Recording System for Deep Brain Stimulation Research and Surgery.

Intraoperative targeting systems provide neurosurgeons with raw electrophysiological data through microelectrodes used for determining location in the brain. There are significant deficits to the available targeting systems, limiting the use in both clinical and research applications. The work presented in this dissertation is of the development and validation of an intraoperative neural stimulator and recording system for use in deep brain stimulation (DBS) surgeries. This intraoperative data acquisition system (IODA) was validated in three applications to ensure efficacy and improvements in research and clinical studies. The first application investigated was a clinical study illustrating the improvement IODA had on the targeting accuracy of DBS leads in the subthalamic nucleus (STN) over current targeting methods. It was demonstrated that the novel navigation algorithm developed for use with IODA targeted microelectrode probe locations significantly closer to final DBS lead positions compared to preoperatively planned trajectory positions. The second study investigated a clinical science application. There are considerable differences in recently published studies for the optimal chronic stimulation site in the STN region. It was shown, using beta oscillations of local field potentials (LFP) recorded by IODA, that optimal stimulation sites were significantly correlated with locations of peak beta activity when DBS leads were medial to the STN midpoint. While DBS lead trajectories lateral of the STN midpoint were significantly correlated with the dorsal border of the STN. The third study explored a basic science application involving the role of the STN in movement inhibition. Through wideband recordings made with IODA, it was shown that the STN is significantly activated during movement and movement inhibition cues as seen in the theta, alpha, and beta bands and single unit activity. Overall the results indicate the utility and adaptability of this system for use within DBS surgeries. There are many applications of IODA for use in research for other neurodegenerative disease including Essential Tremor and Depression. The use of this system has enables neurosurgeons to reduce surgical time, risk, and error for DBS procedures and made entry for those less experienced in this procedure easier.PHDBiomedical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/99771/1/dodani_1.pd