How Can Consuming a Plant-Based Diet Reduce the Risk of Cardiovascular Disease in Postmenopausal Women?

Despite the fact that women suffer higher rates of cardiovascular events after menopause, there exists a significant underrepresentation of women—especially postmenopausal women—in cardiovascular clinical trials to date. Fortunately, current evidence reveals that cardiovascular events in the general population are largely preventable through modifiable lifestyle factors, with dietary intervention being one of the most important (Amiri et al., 2022). As the impact of whole-diet interventions on cardiovascular risk factors is further explored, it has been determined that a plant-based dietary pattern may favorably influence the prevention of cardiovascular events in postmenopausal women (Barańska et al., 2021). Evidence also reveals that certain phytochemicals which are provided in bulk by a plant-based diet, such as phytoestrogens, may be particularly beneficial to the health of the postmenopausal population (Barańska et al., 2021). This comprehensive literature review will attempt to evaluate exactly how a plant-based diet can reduce the risk of cardiovascular disease in postmenopausal women by examining relevant clinical trials, identifying and explaining the beneficial effects of various cardioprotective phytochemicals, and by considering how popular plant-based diets like the Mediterranean Diet are conducive to heart health. As early as 2006, Chin-Hua Fu et al. established that a plant-based diet may be a natural and effective approach to reduce the risk of cardiovascular disease in postmenopausal women (Fu et al., 2006). This review concludes that more well-designed controlled clinical trials should be conducted with this population to achieve more conclusive results regarding the most effective diet for cardiovascular risk reduction in postmenopausal women

Examining Relationship Between Food Deserts and Health

The purpose of this research is to examine the relationships that exist between food deserts, fruit and vegetable consumption and health on individuals. Using quantitative data collected through surveys that were distributed to students attending an urban higher education setting in Chicago, data was analyzed to determine relationships between the communities they live in, the amount of fresh produce they consume and their current health. The survey looked at factors such as race, income, community of residence, daily fruit and vegetable consumption, current health, diagnosis of diet-related illness for respondent and family along with the distance travelled to purchase fresh produce. The findings support the idea that the further one must travel to purchase fresh produce the more likely they are to consume less. The findings also show that those who consume less fruits and vegetables are more likely to report poorer health. The implications are to address communities who lack access to fresh fruits and vegetables in order to increase the over all health outcomes for individuals. Creating policies that encourage current storeowners or new stores that will sell fresh fruits and vegetables is one way to address the lack of access in these communities. This study shows those who must travel far to purchase fresh fruits and vegetables are less likely to consume the daily recommended amounts and also have poorer health

Calculation of extraocular muscle volume in patients with Graves' Ophthalmopathy and the correlation with disease severity and clinical activity of the Graves' disease

INTRODUCTION Graves’ disease (GD) is an autoimmune disease affecting the thyroid gland, orbital soft tissues and subcutaneous tissues of the extremities. Ophthalmic signs are clinically evident in 25-50% of patients with GD and 3-10% of cases develop severe disease. This study discusses the current understanding of the pathophysiology of GD and the associated ophthalmopathy. It summarises the clinical features of the condition and examines the numerous scoring systems used to measure and monitor the ophthalmic features of the disease. The three main radiological techniques used to image the orbit, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) are discussed. Although CT is regarded as the radiological investigation of choice for imaging orbit details subtle changes related to Graves’ ophthalmopathy (GO) can be missed. To accurately calculate extraocular muscle volume we have developed a computer software package, the Volume Estimation Tool. This software allows outlining of structures from a CT image and then calculates the volume of the structure. The aim of this study is to determine if extraocular muscle volume and orbital volume estimates from CT imaging correlate with clinical signs and scores of disease activity or severity. METHODS Study Design This is a retrospective study comparing the orbital CT scan findings in patients with GD with their clinical activity, as close as possible to the time of the scan, and their disease severity. The initial hope had been to use high definition 3 dimensional ultrasound to calculate muscle volume. This proved inaccurate and non-reproducible for calculating muscle volumes. We therefore, worked in conjunction with the Christchurch Hospital Medical Physics department to develop a computer programme to estimate muscle volume from coronal slices of CT scans. This volume estimation tool was used to calculate the volume of muscles and soft tissue orbits in a series of patients with clinical evidence of GO. The same muscle and orbital volumes were calculated for a set of matched controls without GO. In addition, methods of measuring disease state in patients with GO were compared. Disease activity and severity were calculated from the clinical records of the patients with GD as close as possible to time of the CT scan. The activity of the GO and the severity of the disease were then correlated with the muscle and orbital volumes to see what relationships there are. The clinical symptoms and signs of GO were then related to muscle volume to determine which have the greatest impact on clinical activity and disease severity. Participants A record of all patients with thyroid eye disease was compiled by correlating records of patients seen in both the thyroid clinic, Nuclear Medicine Department and the ophthalmology clinic at Christchurch Hospital. From this cohort, we used radiology department records to obtain a subset of patients for whom head/neck CT scans had been ordered. A control group of patients with no history of GD and CT scans with normal radiology reports from the same period were selected. Outcome Measures Clinical activity and disease severity were calculated by different methods and compared. The activity and severity were also compared to the estimated muscle and orbital volumes to determine any possible relationships. RESULTS In patients with GO muscle volume may be a more sensitive indicator of muscle enlargement than subjective viewing of the CT images looking for enlargement of muscle bellies. Muscle volume for patients with GO was significantly higher than for patients with no GO (p<0.0001). Patients with GO also have larger orbital volumes than patients without GO (p=0.003). Muscle volume in patients with GO also correlates positively with clinical activity (p<0.0001) and disease severity (p<0.0001). When individual clinical features are examined there is a weak correlation between muscle volume and proptosis (p=0.05), but no association with lid retraction and muscle volume (p=0.12). Neither is there a correlation between horizontal or vertical muscle restriction and muscle volume (p=0.56 and p=0.44 respectively). CONCLUSIONS The results show that accurate calculation of extraocular muscle volume using this software package is possible. We confirm that calculating extraocular muscle volume in patients with GO gives additional useful information for assessing and managing patients with GO. Muscle volume correlates positively with clinical activity and disease severity. Patients with more active and more severe disease have greater changes in muscle volume than those without. For 2 patients with optic nerve compromise there was a high percentage of orbital volume taken up by muscle. This suggests this ratio, rather than muscle volume alone, may predict risk of optic nerve damage. However, patients with very active disease or severe residual disease do not have an increased risk of restrictive eye movements despite having larger total muscle volumes

The Attitudes about Complex Therapy Scale (ACTS) in Type 2 Diabetes and Cardiovascular Disease: Development, Validity and Reliability

Background: Type 2 diabetes is associated with cardiovascular disease, and patients with both conditions are prescribed complex medication regimens. Aim: The aim was to develop a reliable and valid measure of attitudes associated with the prescription and management of multiple medicines in patients with Type 2 diabetes and cardiovascular disease. Methods: Principal component analysis (PCA) and Cronbach alpha assessed the reliability of the Attitudes about Complex Therapy Scale (ACTS). Examinations of relationships with related measures inform concurrent validity. Questionnaires were sent to a cross-sectional sample of 480 people prescribed multiple medicines for co-morbid Type 2 diabetes. Results: Cronbach alpha was 0.76, indicating the scale had good internal reliability. PCA rotated a four factor model accounting for 37% of the variance. Four subscales identified; 1. Concerns about multiple medicines and increasing numbers of medicines; 2.Anxiety over missed medicines; 3. Desires to substitute medicines and reduce the number of medicines prescribed and; 4. Perceptions related to organising and managing complex therapy. The ACTS showed significant relationships with measures of anxiety, depression, general beliefs about medicines and self-efficacy. Also, the ACTS significantly correlated with adherence to medicines, showing good predictive validity. Conclusion: The ACTS was designed to assess negative attitudes towards complex therapy and multiple medication management. This tool could aid prescribing decisions and may identify people who are intentionally non-adherent to all or some of their medicines

Healthcare professionals’ perceptions of interacting with patients of South Asian origin attending early inflammatory arthritis clinics

ObjectiveTo explore rheumatology healthcare professionals’ (HCPs) perceptions of interacting with patients of South Asian origin attending early inflammatory arthritis (EIA) clinics.MethodsWe used face to face semi structured interviews, designed in partnership with clinician partner to interview ten HCPs involved in running of EIA clinics across seven centres in the UK. Data were recorded, transcribed by an independent company and were analysed using inductive thematic analysis.ResultsThree emerging themes were identified that characterised consulting experiences of HCPs. [1] Varied approaches were used in early inflammatory arthritis clinic, [2] Rheumatology HCP’s challenges in managing and delivering information to patients of South Asian origin in early inflammatory arthritis clinic [3] Moving towards good practice: views on managing future patients of South Asian origin in early inflammatory arthritis clinics. Overall, HCPs found that they required additional skills to support the engagement and management for patients of South Asian origin living with inflammatory arthritis. HCPs felt that they were less effective in addressing self-management issues for this patient group and they found it difficult to determine adherence to medication. In such consultations, HCPs perceived their own limitation of inadequate training contributed towards poor consultations.ConclusionFor the first time, our data demonstrates that the management of patients of South Asian origin in EIA clinics is under served. To address this, HCPs have identified training needs to improve knowledge and skills in engaging with and supporting patients of South Asian origin. These findings provide a good direction for future research

Lysophosphatidic Acid Disrupts Junctional Integrity and Epithelial Cohesion in Ovarian Cancer Cells

Ovarian cancer metastasizes via exfoliation of free-floating cells and multicellular aggregates from the primary tumor to the peritoneal cavity. A key event in EOC metastasis is disruption of cell-cell contacts via modulation of intercellular junctional components including cadherins. Ascites is rich in lysophosphatidic acid (LPA), a bioactive lipid that may promote early events in ovarian cancer dissemination. The objective of this paper was to assess the effect of LPA on E-cadherin junctional integrity. We report a loss of junctional E-cadherin in OVCAR3, OVCA429, and OVCA433 cells exposed to LPA. LPA-induced loss of E-cadherin was concentration and time dependent. LPA increased MMP-9 expression and promoted MMP-9-catalyzed E-cadherin ectodomain shedding. Blocking LPA receptor signaling inhibited MMP-9 expression and restored junctional E-cadherin staining. LPA-treated cells demonstrated a significant decrease in epithelial cohesion. Together these data support a model wherein LPA induces MMP-9 expression and MMP-9-catalyzed E-cadherin ectodomain shedding, resulting in loss of E-cadherin junctional integrity and epithelial cohesion, facilitating metastatic dissemination of ovarian cancer cells

Predictors of the likelihood that patients with rheumatoid arthritis will communicate information about rheumatoid arthritis risk to relatives:a quantitative assessment

First-degree relatives (FDRs) of people with rheumatoid arthritis (RA) are increasingly recruited to prediction and prevention studies. Access to FDRs is usually via their proband with RA. Quantitative data on predictors of family risk communication are lacking. RA patients completed a questionnaire assessing likelihood of communicating RA risk information to their FDRs, demographic variables, disease impact, illness perceptions, autonomy preferences, interest in FDRs taking a predictive test for RA, dispositional openness, family functioning, and attitudes towards predictive testing. Ordinal regression examined associations between patients’ characteristics and their median likelihood of communicating RA risk to FDRs. Questionnaires were completed by 482 patients. The majority (75.1%) were likely/extremely likely to communicate RA risk information to FDRs, especially their children. Decision-making preferences, interest in FDRs taking a predictive test, and beliefs that risk knowledge would increase people’s empowerment over their health increased patients’ odds of being likely to communicate RA risk information to FDRs. Beliefs that risk information would cause stress to their relatives decreased odds that patients would be likely to communicate RA risk. These findings will inform the development of resources to support family communication about RA risk.<br/

Patient perceptions of treatment and illness when prescribed multiple medicines for co-morbid type 2 diabetes

Illness and treatment perceptions are vital for people self-managing co-morbid conditions with associated cardiovascular disease, such as type 2 diabetes (T2D). However, perceptions of a co-morbid condition and the use of multiple medicines have yet to be researched. This study investigated the illness and treatment perceptions of people with co-morbid T2D. The Brief Illness Perception Questionnaire (repeated for T2D, hypertension, and hyperlipidemia) and the Beliefs about Medicines Questionnaire Specific Concerns Scales (repeated for Oral hypoglycemic agents, anti-hypertensive medicines, and statins) were sent to 480 people managing co-morbid T2D. Data on the number of medicines prescribed were collected from medical records. Significantly different perceptions were found across the illnesses. The strongest effect was for personal control; the greatest control reported for T2D. Illness perceptions of T2D differed significantly from perceptions about hyperlipidemia. Furthermore, illness perceptions of T2D also differed from perceptions of hypertension with the exception of perceptions of illness severity. Hypertension and hyperlipidemia shared similar perceptions about comprehensibility, concerns, personal control, and timeline. Significant differences were found for beliefs about treatment necessity, but no difference was found for treatment concerns. When the number of medicines was taken as a between-subjects factor, only intentional non-adherence, treatment necessity beliefs, and perceptions of illness timeline were accounted for. Co-morbid illness and treatment perceptions are complex, often vary between illnesses, and can be influenced by the number of medicines prescribed. Further research should investigate relationships between co-morbid illness and treatment perception structures and self-management practices

ArtMaps: A Technology for Looking at Tate’s Collection

This article presents ArtMaps, a crowdsourcing web-based app for desktop and mobile use that allows users to locate, move and annotate artworks in the Tate collection in relation to one or more sets of locations. Here the authors show that ArtMaps extends the ‘space’ of the museum and facilitates a new, pluriperspectival, way of looking at art