Effect of hypertension duration on relationship between blood pressure and signs and symptoms in hypertensive patients:a cross sectional survey

Background: Hypertension is defined as a systolic blood pressure of 140 mmHg or more, or a diastolic blood pressure of 90 mmHg or more or taking anti-hypertensive medication. The clinical presentation of high blood pressure may depend upon several factors such as age, gender, severity and duration of hypertension. There is a paucity of data exploring the role hypertension duration may play in shaping the relationship between blood pressure and signs and symptoms of hypertension. To evaluate the effect of hypertension duration on relationship between blood pressure and signs and symptoms in hypertensive patients.Methods: A cross-sectional study was carried out among 250 patients, aged 18 or above, with self-reported history of hypertension and on anti-hypertensive medication. Data were collected by means of a structured questionnaire whereas the blood pressure level was measured with the help of sphygmomanometer using stethoscope. Inferential analysis was performed by applying chi-square test whereas the significance level was set at 0.05.Results: The study results revealed that among patients with ≥5 years duration of hypertension headache history (P=0.021), edema (P=0.034), increased urinary frequency (P=0.031), sleep apnoea (P=0.016), palpitation (P=0.005) and confusion (p=0.021) were significantly associated with systolic whereas only increased urinary frequency (P=0.009) was significantly associated with diastolic blood pressure. Moreover, among patients with <5 years duration of hypertension vision problems (P=0.03), sleep apnoea (P=0.015) and palpitation (P=0.035) were significantly associated with systolic whereas sleep apnoea (P=0.048) and palpitation (P=0.028) were significantly associated with diastolic blood pressure.Conclusions: The study results showed that patients with higher blood pressure were more likely to have the signs and symptoms of hypertension. Also, patients with longer duration of hypertension had greater number of signs and symptoms associated with systolic hypertension

Behaviour change interventions to reduce second-hand smoke (SHS) exposure at home in pregnant women - A systematic review and intervention appraisal

Abstract Background Second-hand smoke (SHS) exposure during pregnancy is associated with poor pregnancy and foetal outcomes. Theory-based behaviour change interventions (BCI) have been used successfully to change smoking related behaviours and offer the potential to reduce exposure of SHS in pregnant women. Systematic reviews conducted so far do not evaluate the generalisability and scalability of interventions. The objectives of this review were to (1) report the BCIs for reduction in home exposure to SHS for pregnant women; and (2) critically appraise intervention-reporting, generalisability, feasibility and scalability of the BCIs employed. Methods Standard methods following PRISMA guidelines were employed. Eight databases were searched from 2000 to 2015 in English. The studies included used BCIs on pregnant women to reduce their home SHS exposure by targeting husbands/partners. The Workgroup for Intervention Development and Evaluation Research (WIDER) guidelines were used to assess intervention reporting. Generalisability, feasibility and scalability were assessed against criteria described by Bonell and Milat. Results Of 3479 papers identified, six studies met the inclusion criteria. These studies found that BCIs led to increased knowledge about SHS harms, reduction or husbands quitting smoking, and increased susceptibility and change in level of actions to reduce SHS at home. Two studies reported objective exposure measures, and one reported objective health outcomes. The studies partially followed WIDER guidelines for reporting, and none met all generalisability, feasibility and scalability criteria. Conclusions There is a dearth of literature in this area and the quality of studies reviewed was moderate to low. The BCIs appear effective in reducing SHS, however, weak study methodology (self-reported exposure, lack of objective outcome assessment, short follow-up, absence of control group) preclude firm conclusion. Some components of the WIDER checklist were followed for BCI reporting, scalability and feasibility of the studies were not described. More rigorous studies using biochemical and clinical measures for exposures and health outcomes in varied study settings are required. Studies should report interventions in detail using WIDER checklist and assess them for generalisability, feasibility and scalability. Trial registration CRD40125026666

The long‐term impact of loneliness and social isolation on depression and anxiety in memory clinic attendees and their care partners: A longitudinal actor–partner interdependence model

Abstract Introduction This study examined the long‐term influence of loneliness and social isolation on mental health outcomes in memory assessment service (MAS) attendees and their care partners, with a focus on interdependence and bidirectionality. Methods Longitudinal data from 95 clinic attendees with cognitive impairment, and their care partners (dyads), from four MAS in the North of England were analyzed. We applied the actor–partner interdependence model, seeking associations within the dyad. At baseline and 12‐month follow‐up, clinic attendees and care partners completed measures of loneliness and social isolation, depression, and anxiety. Results Social isolation at baseline was more prevalent in care partners compared to MAS attendees. Social isolation in MAS attendees was associated with higher anxiety symptoms (β = 0.28, 95% confidence intervals [CIs] = 0.11 to 0.45) in themselves at 12 months. We found significant positive actor and partner effects of loneliness on depression (actor effect: β = 0.36, 95% CIs = 0.19 to 0.53; partner effect: β = 0.23, 95% CIs = 0.06 to 0.40) and anxiety (actor effect: β = 0.39, 95% CIs = 0.23 to 0.55; partner effect: β = 0.22, 95% CIs = 0.05 to 0.39) among MAS attendees 1 year later. Loneliness scores of the care partners have a significant and positive association with depressive (β = 0.36, 95% CIs = 0.19 to 0.53) and anxiety symptoms (β = 0.32, 95% CIs = 0.22 to 0.55) in themselves at 12 months. Discussion Loneliness and social isolation in MAS clinic attendees had a downstream effect on their own and their care partners’ mental health. This highlights the importance of including care partners in assessments of mental health and social connectedness and expanding the remit of social prescribing in the MAS context