Blood pressure vs altitude in hypertensive and non-hypertensive himalayan trekkers

Introduction: Determine blood pressure (BP) response to changes in altitude in Himalayan trekkers with and without hypertension (HTN). Methods: BP was measured in Lukla (2800m), Namche (3400m), and either Pheriche or Dingboche (4400m) on ascent and descent. Hypertensive subjects were defined by self-reported diagnosis of HTN. Results: Trekkers had HTN (H, n=60) or no HTN (NH, n=604). Of those with HTN, 50 (83%) took one or more BP medications including ACEIs/ARBs (n=35, 48%), Ca++ channel blockers (n=15, 22%), beta-blockers (n=9, 13%), thiazide diuretics (n=7, 10%), and others (n=5, 7%). At 2800m, systolic BP (SBP) and diastolic BP (DBP) were greater in the H group than in the NH group [mean SBP= 151mmHg (95% CI 145.4-155.7) vs 127mmHg (95% CI 125.5 128.0); mean DBP=88mmHg (95% CI 85.1-91.7) vs 80mmHg (95% CI 79.3-80.8)] and remained higher at both 3400m [mean SBP=150mmHg (95% CI 143.7-156.9) vs 127mmHg (95% CI 125.8-128.5); mean DBP=88mmHg (95% CI 84.3-90.8) vs 82mmHg (95% CI 80.7-82.5)] and 4400m [mean SBP=144mmHg (95% CI 136.7-151.7) vs 128mmHg (95% CI 126.4-129.5); mean DBP=87mmHg (95% CI 83.2-91.7) vs 82mmHg (95% CI 81.3-83.2)]. Between 2800m and 3400m, BP increased in 37% of trekkers, decreased in 25%, and did not change in 38%; from 3400m to 4400m, BP increased in 35% of trekkers, decreased in 26%, and did not change in 40%. Prevalence of severe hypertension (BP\u3e180/120mmHg) was similar across altitudes but higher in the H group (9%; 10%; 8% vs 0.7%; 0.6%, 0.3%) at 2800m, 3400m, and 4400m, respectively. No subjects reported symptoms of hypertensive emergency (chest pain, stroke, etc.). Conclusion: Blood pressure response to altitude is variable. High prevalence of severe hypertension in hypertensive trekkers warrants further study regarding BP control at high altitude

'Reaching the hard to reach' - lessons learned from the VCS (voluntary and community Sector). A qualitative study.

Background The notion 'hard to reach' is a contested and ambiguous term that is commonly used within the spheres of social care and health, especially in discourse around health and social inequalities. There is a need to address health inequalities and to engage in services the marginalized and socially excluded sectors of society. Methods This paper describes a pilot study involving interviews with representatives from eight Voluntary and Community Sector (VCS) organisations . The purpose of the study was to explore the notion of 'hard to reach' and perceptions of the barriers and facilitators to accessing services for 'hard to reach' groups from a voluntary and community sector perspective. Results The 'hard to reach' may include drug users, people living with HIV, people from sexual minority communities, asylum seekers, refugees, people from black and ethnic minority communities, and homeless people although defining the notion of the 'hard to reach' is not straight forward. It may be that certain groups resist engaging in treatment services and are deemed hard to reach by a particular service or from a societal stance. There are a number of potential barriers for people who may try and access services, including people having bad experiences in the past; location and opening times of services and how services are funded and managed. A number of areas of commonality are found in terms of how access to services for 'hard to reach' individuals and groups could be improved including: respectful treatment of service users, establishing trust with service users, offering service flexibility, partnership working with other organisations and harnessing service user involvement. Conclusions: If health services are to engage with groups that are deemed 'hard to reach' and marginalised from mainstream health services, the experiences and practices for engagement from within the VCS may serve as useful lessons for service improvement for statutory health services

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Worker: The iteration game or coming out of the eternal return

info:eu-repo/semantics/publishe