Dietary N-3 polyunsaturated fatty acids decrease biliary cholesterol saturation in gallstone disease

Because fatty acid composition of biliary phospholipids influences cholesterol secretion into bile, we investigated whether replacement of n-1 monounsaturated or n-6 polyunsaturated fatty acids with n-3 polyunsaturated fatty acids in biliary phosphatidylcholines reduces supersaturation with cholesterol and prevents precipitation of cholesterol crystals in bile of gallstone patients. Seven patients with radiolucent gallstones in functioning gallbladders were studied before (control) and after 5 wk of dietary supplementation with marine fish oil (11.3 gm/day = 3.75 gm n-3 polyunsaturated fatty acids/day). Duodenal bile was collected for analysis during intravenous infusion of cholecystokinin. Gallbladder emptying in response to cholecystokinin was comparable before and during intake of n-3 polyunsaturated fatty acids. Intake of n-3 polyunsaturated fatty acids increased (p < 0.001) the fractions of eicosapentaenoic and docosahexaenoic acids and decreased the fractions of linoleic (p < 0.001) and arachidonic acids (p < 0.02) in biliary phospholipids. Concomitantly, the molar ratio of cholesterol to phospholipids decreased (-19%; p < 0.05). As a consequence, the cholesterol saturation index was reduced by -25% (p = 0.01), from 1.60 ± 0.44 to 1.24 ± 0.38. However, in vitro nucleation time of duodenal bile was not prolonged. The decrease in cholesterol saturation was not sufficient to prevent nucleation of cholesterol crystals in bile of gallstone patients. In conclusion, our data suggest that cholesterol saturation can be influenced by the fatty acid composition of the phosphatidylcholines secreted in bile

From the rhetoric to the real: a critical review of how the concepts of recovery and social inclusion may inform mental health nurse advanced level curricula – the eMenthe project

Objectives This critical review addresses the question of how the concepts of recovery and social inclusion may inform mental health nurse education curricula at Master’s level in order to bring about significant and positive change to practice. Design This is a literature-based critical review incorporating a modified rapid review method. It has been said that if done well, this approach can be highly relevant to health care studies and social interventions, and has substantial claims to be as rigorous and enlightening as other, more conventional approaches to literature (Rolfe, 2008). Data sources In this review, we have accessed contemporary literature directly related to the concepts of recovery and social inclusion in mental health. Review methods We have firstly surveyed the international literature directly related to the concepts of recovery and social inclusion in mental health and used the concept of emotional intelligence to help consider educational outcomes in terms of the required knowledge, skills and attitudes needed to promote these values-based approaches in practice. Results A number of themes have been identified that lend themselves to educational application. International frameworks exist that provide some basis for the developments of recovery and social inclusion approaches in mental health practice, however the review identifies specific areas for future development. Conclusions This is the first article that attempts to scope the knowledge, attitudes and skills required to deliver education for Master’s level mental health nurses based upon the principles of recovery and social inclusion. Emotional intelligence theory may help to identify desired outcomes especially in terms of attitudinal development to promote the philosophy of recovery and social inclusive approaches in advanced practice. Whilst recovery is becoming enshrined in policy, there is a need in higher education to ensure that mental health nurse leaders are able to discern the difference between the rhetoric and the reality

Irbesartan in Marfan syndrome (AIMS): a double-blind, placebo-controlled randomised trial

BACKGROUND: Irbesartan, a long acting selective angiotensin-1 receptor inhibitor, in Marfan syndrome might reduce aortic dilatation, which is associated with dissection and rupture. We aimed to determine the effects of irbesartan on the rate of aortic dilatation in children and adults with Marfan syndrome. METHODS: We did a placebo-controlled, double-blind randomised trial at 22 centres in the UK. Individuals aged 6-40 years with clinically confirmed Marfan syndrome were eligible for inclusion. Study participants were all given 75 mg open label irbesartan once daily, then randomly assigned to 150 mg of irbesartan (increased to 300 mg as tolerated) or matching placebo. Aortic diameter was measured by echocardiography at baseline and then annually. All images were analysed by a core laboratory blinded to treatment allocation. The primary endpoint was the rate of aortic root dilatation. This trial is registered with ISRCTN, number ISRCTN90011794. FINDINGS: Between March 14, 2012, and May 1, 2015, 192 participants were recruited and randomly assigned to irbesartan (n=104) or placebo (n=88), and all were followed for up to 5 years. Median age at recruitment was 18 years (IQR 12-28), 99 (52%) were female, mean blood pressure was 110/65 mm Hg (SDs 16 and 12), and 108 (56%) were taking β blockers. Mean baseline aortic root diameter was 34·4 mm in the irbesartan group (SD 5·8) and placebo group (5·5). The mean rate of aortic root dilatation was 0·53 mm per year (95% CI 0·39 to 0·67) in the irbesartan group compared with 0·74 mm per year (0·60 to 0·89) in the placebo group, with a difference in means of -0·22 mm per year (-0·41 to -0·02, p=0·030). The rate of change in aortic Z score was also reduced by irbesartan (difference in means -0·10 per year, 95% CI -0·19 to -0·01, p=0·035). Irbesartan was well tolerated with no observed differences in rates of serious adverse events. INTERPRETATION: Irbesartan is associated with a reduction in the rate of aortic dilatation in children and young adults with Marfan syndrome and could reduce the incidence of aortic complications

Markers of physiological stress during exercise under conditions of normoxia, normobaric hypoxia, hypobaric hypoxia and genuine high altitude.

Purpose To investigate whether there is a differential response at rest and following exercise to conditions of genuine high altitude (GHA), normobaric hypoxia (NH), hypobaric hypoxia (HH) and normobaric normoxia (NN). Method Markers of sympathoadrenal and adrenocortical function (plasma normetanephrine [PNORMET], metanephrine [PMET], cortisol), myocardial injury (highly sensitive cardiac troponin T [hscTnT]) and function (N-terminal brain natriuretic peptide [NT-proBNP]) were evaluated at rest and with exercise under NN, at 3375 m in the Alps (GHA) and at equivalent simulated altitude under NH and HH. Participants cycled for 2 hours {15 minute warm-up, 105 minutes at 55% Wmax (maximal workload)} with venous blood samples taken prior (T0), immediately following (T120) and 2 hours post-exercise (T240). Results Exercise in the three hypoxic environments produced a similar pattern of response with the only difference between environments being in relation to PNORMET. Exercise in NN only induced a rise in PNORMET and PMET. Conclusion Biochemical markers that reflect sympathoadrenal, adrenocortical and myocardial responses to physiological stress demonstrate significant differences in the response to exercise under conditions of normoxia versus hypoxia while NH and HH appear to induce broadly similar responses to GHA and may therefore be reasonable surrogates

Economía y sostenibilidad azul

Línea de InvestigaciónLa economía depende del consumo de habitantes y la producción de las empresas, no obstante, existen factores ambientales y culturales que ponen en riesgo la sostenibilidad de los proyectos y de la vida en el planeta, la economía azul presenta metodologías innovadoras capaces de generar un entorno de bienestar y propone la transformación de problemas en soluciones usando como insumos.1. Resumen 2. Palabras Clave 3. Introducción 4. Desarrollo 5. Conclusiones 6. Referencias bibliográficasEspecializaciónEspecialista en Análisis y Administración Financier

Healthy Heart Healthy Mind Dementia Risk Reduction Awareness Campaign: Final Report and Evaluation

Dementia is an umbrella term which describes a number of different diseases that cause progressive decline of brain functions such as language, memory and cognitive ability (Australian Institute of Health and Welfare, 2004). In 2009, 245,000 Australians were living with dementia, and it is projected that this will increase to around 1.13 million by 2050 (Access Economics, 2009). There is currently no cure for dementia. The uptake of early intervention and prevention strategies is therefore paramount to curb the current dementia epidemic, yet there is a lack of awareness of dementia prevention strategies among Australians (Farrow, 2008). Current research suggests that treating hypertension is the most important means of reducing dementia risk (Valenzuela and Sachdev, 2006;Woodward, 2007) and yet awareness of this, in comparison to other dementia risk reduction strategies such as mental stimulation, is extremely low (Low and Anstey, 2007)

Developing Messages to Create Community Awareness of Hypertension as a Risk Factor for Dementia

Dementia is the leading single cause of disability in older Australians. Due to the ageing of the population, the number of people living with dementia will increase significantly over the coming decades and there is pressing need for effective prevention strategies. One relatively unknown but modifiable risk factor for dementia is hypertension. ‘Healthy Heart Healthy Mind’ is a social marketing campaign that aims to create awareness of the link between hypertension and dementia, and encourage improved hypertension management in the target audience in order to prevent dementia. This paper describes the use of behaviour change theory and qualitative research undertaken with the target audience to inform the development of the campaign. Results of this research were important in devising campaign strategies, key messages and creative concepts

Implementation and Evaluation of a Community-Based Social Marketing Campaign to Create Awareness of Hypertension as a Risk Factor for Dementia

As the Australian population ages, the incidence of dementia is rising in epidemic proportions, with serious implications for sufferers, carers and health services. There is a compelling need for effective early intervention and prevention strategies as well as models to guide knowledge translation to improve dementia prevention and care. The most modifiable risk factor for dementia is hypertension and treating hypertension in midlife is the most effective means of reducing dementia risk, yet public awareness of this is extremely low. The purpose of this pilot project was to plan, implement and evaluate a social marketing campaign to raise community awareness of the link between hypertension and dementia, and how to prevent, monitor and manage hypertension