Perceived family support and its effect on cardiovascular disease risk among hypertensive patients presenting at a family medicine practice in south west nigeria

Background: Lifestyle modification and health care behaviour are influenced by the support of family members. Family support is asocioeconomic factor that affects many chronic medical illnesses' outcome. It influences medication adherence, blood pressure control and could affect the risk of developing cardiovascular disease.The aim of this study is to assess the level of family support and determine the relationship between family support and cardiovasculardisease risk in patients with hypertension.Methods: This was a descriptive cross-sectional study of 345 hypertensive patients ages 30 years and above using simple randomtechnique. Data were collected with an interviewer-administered questionnaire, physical examination and blood investigation.Perceived family support and cardiovascular disease risk were assessed with Perceived Social Support Family Scale and FraminghamGeneral cardiovascular risk score respectively. Level of significance was set at p < 0.05.Results: Majority (75.5%) of the respondents was females, 40.3% were elderly and 71.7% were married. Most of the respondents (93.3%) had strong perceived family support while 1.7% and 4.7% had no and weak perceived family support respectively. Blood pressure was controlled in 58.6% of the respondents and 30.7% had low cardiovascular disease risk. Strong perceived family supportwas associated with being currently married. There was no association found between blood pressure control, cardiovascular diseaserisk and perceived family support.Conclusions: The proportion of hypertensive patients with strong perceived family support is high in this practice setting. However,there was no association found between perceived family support and cardiovascular disease risk. Keywords: Hypertension, perceived family support, blood pressure control, cardiovascular disease risk, family medicine practic

Relationship between Knowledge of Hypertension and 10-Year Cardiovascular Risk among Patients with Hypertension at a Primary Care Clinic in Nigeria.

Background:Good knowledge of the risk factors, course and consequences of high blood pressure by patients with hypertension can influence their lifestyle, drug adherence and the risk of subsequent development of cardiovascular disease. We aimed at determining the relationship between the knowledge of hypertension and 10-year cardiovascular risk among patients with hypertension. Materials and Methods: It was a cross-sectional survey of 345 hypertensive patients attending the general outpatient clinic of the University College Hospital. Knowledge of hypertension and 10-year cardiovascular risk were estimated using hypertension fact questionnaire and Framingham General cardiovascular risk score respectively. Chi-square and t-test statistics were used for bivariate analysis with a p-value set at 0.05. Results: The age range of the respondents was 35-82 years. Coexistence of other cardiovascular risk factors such as physical inactivity, diabetes mellitus and obesity were found in 66.1%, 35.4 % and 71.3% participants respectively. Less than half (44.3%) of the participants had adequate knowledge about hypertension. There was a significant association between hypertension knowledge and 10-year cardiovascular risk (χ2= 14.70, p=.001). Also, a significant difference was found in the mean of systolic and diastolic blood pressure, hypertension knowledge score, total cardiovascular risk and physical activity between respondents with adequate and inadequate hypertension knowledge. Conclusion: Given the high inadequate hypertension knowledge and its significant association with 10-year cardiovascular risk. Comprehensive health education on hypertension and its complications should be given to patients to promote their cardiovascular health

Relationship between Perceived Spousal Social Support and Blood Pressure Control among Hypertensive Patients Attending General Outpatient Clinic in Federal Teaching Hospital, IdoEkiti, Nigeria

Background: Despite many approaches to control hypertension, a lot of people still experience challenges keeping their Blood Pressure (BP) under control, and because the condition requires life - long treatment, many patients will need additional effort from their spouses. The spouse shares intimacy with patient and is the chief source of social support that provides fi nancial assistance, reminds and encourages medication use, shows concern and interest by discussing issues related to the disease. Therefore, exploring the relationship between Perceived Spousal Social Support (PSSS) and BP control will help the physician and other stakeholders harness the gains of this association to achieving BP control, prevent complications and death associated with hypertension. Objective: To identify the relationship between perceived spousal social support and blood pressure control among hypertensive patients attending General Outpatient Clinic (GOPC) in Federal Teaching Hospital, Ido-Ekiti, Nigeria. Materials and methods: This was a hospital - based cross - sectional study carried out between June and August 2016 among 298 hypertensive patients aged 18 and 65 years attending GOPC of the Federal Teaching Hospital, Ido Ekiti. Collection of data was done using pre-tested, semi-structured questionnaire on sociodemographic characteristics, blood pressure measurement and 4-point Likert Social Support questionnaire to measure the perceived spousal social support. Data was analysed using SPSS IBM version 17.0. Results: Mean age of respondents was 56.0 ± 8.5 years and seventy percent were females with male to female ratio of 1:2.3. Less than half of the respondents, 47.7% and about half of the respondents, 50.3% achieved BP control and demonstrated strong PSSS respectively. There was statistically signifi cant relationship between PSSS and BP control (χ2 = 27.05, p < 0.001). Conclusion: Social support perceived by participants positively infl uenced their BP control. Family Physicians and other health care providers should therefore determine and enhance the level of this support and encourage spouses to provide this support for their partners who have hypertension or those having diffi culty controlling their BP despite the appropriate use their medications

Resolved versus confirmed ARDS after 24&#160;h: insights from the LUNG SAFE study

Purpose: To evaluate patients with resolved versus confirmed ARDS, identify subgroups with substantial mortality risk, and to determine the utility of day 2 ARDS reclassification. Methods: Our primary objective, in this secondary LUNG SAFE analysis, was to compare outcome in patients with resolved versus confirmed ARDS after 24\ua0h. Secondary objectives included identifying factors associated with ARDS persistence and mortality, and the utility of day 2 ARDS reclassification. Results: Of 2377 patients fulfilling the ARDS definition on the first day of ARDS (day 1) and receiving invasive mechanical ventilation, 503 (24%) no longer fulfilled the ARDS definition the next day, 52% of whom initially had moderate or severe ARDS. Higher tidal volume on day 1 of ARDS was associated with confirmed ARDS [OR 1.07 (CI 1.01\u20131.13), P = 0.035]. Hospital mortality was 38% overall, ranging from 31% in resolved ARDS to 41% in confirmed ARDS, and 57% in confirmed severe ARDS at day 2. In both\ua0resolved and confirmed\ua0ARDS, age, non-respiratory SOFA score, lower PEEP and P/F ratio, higher peak pressure and respiratory rate were each\ua0associated with mortality. In confirmed ARDS, pH and the presence of immunosuppression or neoplasm were also associated\ua0with mortality. The increase in area under the receiver operating curve for ARDS reclassification on day 2 was marginal. Conclusions: ARDS, whether resolved or confirmed at day 2, has a high mortality rate. ARDS reclassification at day 2 has limited predictive value for mortality. The substantial mortality risk in severe confirmed ARDS suggests that complex interventions might best be tested in this population. Trial Registration: ClinicalTrials.gov NCT02010073. \ua9 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM

Correction to: Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study

Correction to: Intensive Care Med (2016) 42:1865\u20131876 DOI 10.1007/s00134-016-4571-

Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Hospital mortality in acute respiratory distress syndrome is approximately 40%, but mortality and trajectory in "mild" acute respiratory distress syndrome (classified only since 2012) are unknown, and many cases are not detected WHAT THIS ARTICLE TELLS US THAT IS NEW: Approximately 80% of cases of mild acute respiratory distress syndrome persist or worsen in the first week; in all cases, the mortality is substantial (30%) and is higher (37%) in those in whom the acute respiratory distress syndrome progresses BACKGROUND:: Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. METHODS: This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: "worsening" if moderate or severe acute respiratory distress syndrome criteria were met, "persisting" if mild acute respiratory distress syndrome criteria were the most severe category, and "improving" if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2. RESULTS: Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening. CONCLUSIONS: Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population

Death in hospital following ICU discharge : insights from the LUNG SAFE study

Altres ajuts: Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic); Science Foundation Ireland Future Research Leaders Award; European Society of Intensive Care Medicine (ESICM), Brussels; St Michael's Hospital, Toronto; University of Milan-Bicocca, Monza, Italy.Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations. Results: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. Trial Registration: ClinicalTrials.gov NCT02010073