Isometric handgrip as an adjunct for blood pressure control: a primer for clinicians

Considered a global health crisis by the World Health Organization, hypertension (HTN) is the leading risk factor for death and disability. The majority of treated patients do not attain evidence-based clinical targets, which increases the risk of potentially fatal complications. HTN is the most common chronic condition seen in primary care; thus, implementing therapies that lower and maintain BP to within-target ranges is of tremendous public health importance. Isometric handgrip (IHG) training is a simple intervention endorsed by the American Heart Association as a potential adjuvant BP-lowering treatment. With larger reductions noted in HTN patients, IHG training may be especially beneficial for those who (a) have difficulties continuing or increasing drug-based treatment; (b) are unable to attain BP control despite optimal treatment; (c) have pre-HTN or low-risk stage I mild HTN; and (d) wish to avoid medications or have less pill burden. IHG training is not routinely prescribed in clinical practice. To shift this paradigm, we focus on (1) the challenges of current HTN management strategies; (2) the effect of IHG training; (3) IHG prescription; (4) characterizing the population for whom it works best; (5) clinical relevance; and (6) important next steps to foster broader implementation by clinical practitioners

Older People’s Adherence to Community-Based Group Exercise Programmes: A Multiple-Case Study

Physical inactivity is a global phenomenon, with estimates of one in four adults not being active enough to achieve health benefits, thus heightening the risk of developing non-communicable diseases. In order to realise the health and wellbeing gains associated with physical activity the behaviour must be sustained. Community-based group exercise programmes (CBGEP) utilising social support have been shown to be one means of not only increasing activity levels for older people, but sustaining physical activity. A mixed-methods systematic review revealed a gap in the literature around older people’s long-term adherence to real-life CBGEP within a UK context. This study therefore sought to address this gap by understanding older people’s ongoing adherence to CBGEP with a view to gaining further insight about which factors contribute to enabling people to sustain their physical activity levels. A multiple case study research design was employed to understand older people’s (≥ 60 years, n=27) adherence (≥ 69%, for ≥ 1 year) to three current CBGEP in the South- West of England. Qualitative data (participant observation, focus groups, documents, and interviews) were collected and analysed using inductive thematic analysis followed by the analytic technique of explanation building. In order to gain deeper insights into adherence, the humanisation framework was utilised in an a priori manner to further understand adherence from a humanising perspective. Quantitative data were analysed using descriptive statistics and used to set the context of the study. This study found that older people’s adherence to CBGEP was mediated through six factors: factors relating to the individual, the instructor, programme design, social features, participant perceived benefits, and a humanised exercise environment. These all served to explain older people’s adherence to CBGEP. The humanising qualities of these CBGEP must be considered if we wish to support older people in sustaining a physically active lifestyle as they age. These findings are of interest to practitioners and policy makers in how CBGEP serve to aid older people in maintaining a physically active lifestyle with a view to preventing non-communicable diseases and in maintaining social connectivity

A SYSTEMS ENGINEERING ANALYSIS OF THE PESTONI PILLARS AS THEY APPLY TO USN SURFACE WARSHIPS

This project develops a tool to better understand the impact of resource allocation on fleet readiness for the future guided-missile frigate, FFG(X). This project assesses the FFG(X) in terms of the PESTONI pillars (Personnel, Equipment, Supply, Training, Ordnance, Network, and Infrastructure). To use the PESTONI framework as a way to increase FFG(X) readiness, both a qualitative and a quantitative solution were developed. The qualitative solution is a series of failure propagation chain diagrams that represent how funding changes within one pillar affect the other pillars. The quantitative solution is the readiness model itself. The readiness model decomposes each pillar in a way that is relatable to the way the FFG(X) will operate when fielded. Once each pillar was independently constructed and tested, the pillars were interconnected in the same way they are presented in the failure propagation chain diagrams. The designed operation of the readiness model is to load the model with pertinent FFG(X) data that is then used in conjunction with both current and future funding allocations to estimate FFG(X) readiness. The readiness model is verified using multiple use case scenarios that demonstrate funding shifts cannot simply be equal across the PESTONI pillars, but they must be optimized to maximize FFG(X) readiness. The FFG(X) readiness model aims to present the user with objective information that will aid in producing the highest possible ship readiness.Civilian, NAVAIRCivilian, Department of the NavyCivilian, Department of the NavyCivilian, Department of the NavyApproved for public release. distribution is unlimite

Early childhood growth in Daasanach pastoralists of Northern Kenya: Distinct patterns of faltering in linear growth and weight gain (advance online)

Abstract Objectives Investigations of early childhood growth among small-scale populations are essential for understanding human life history variation and enhancing the ability to serve such communities through global public health initiatives. This study characterizes early childhood growth trajectories and identifies differences in growth patterns relative to international references among Daasanach semi-nomadic pastoralist children living in a hot, arid region of northern Kenya. Methods A large sample of height and weight measures were collected from children (N = 1756; total observations = 4508; age = 0?5?years) between 2018 and 2020. Daasanach growth was compared to international reference standards and Daasanach-specific centile growth curves and pseudo-velocity models were generated using generalized additive models for location scale and size. Results Compared to World Health Organization (WHO) reference, relatively few Daasanach children were stunted (14.3%), while a large proportion were underweight (38.5%) and wasted (53.6%). Additionally, Daasanach children had a distinctive pattern of growth, marked by an increase in linear growth velocity after 24?months of age and relatively high linear growth velocity throughout the rest of early childhood. Conclusions These results identify a unique pattern of early childhood growth faltering among children in a small-scale population and may reflect a thermoregulatory adaptation to their hot, arid environment. As linear growth and weight gain remain important indicators of health, the results of this study provide insight into growth velocity variations. This study has important implications for global public health efforts to identify and address sources of early growth faltering and undernutrition in small-scale populations