Cardiovascular disease risk factor clustering among African American adults.

OBJECTIVES: Although the co-occurrence of multiple risk factors increases the risk of cardiovascular disease (CVD) morbidity/mortality, few studies have examined the prevalence of risk factor clustering among African Americans in community-based faith settings. This study examined the prevalence and clustering of CVD risk factors in a sample of church members from South Carolina. DESIGN: Cross-sectional analysis of baseline data from a faith-based intervention, Faith, Activity, and Nutrition (FAN). SETTING: African Methodist Episcopal churches in four geographically-defined districts in South Carolina. PARTICIPANTS: 1119 church members. MAIN OUTCOME MEASURES: Self-reported presence or absence of healthcare provider diagnosed diabetes, high cholesterol, and hypertension. Objectively measured blood pressure, height, and weight (body mass index) were also taken. The prevalence of single, multiple, and clustering of risk factors was computed. RESULTS: 62% of participants were obese, 64% had hypertension, 23% had diabetes, and 39% had high cholesterol; 15% had no risk factors, 24% had 1 risk factor, 30% had 2 risk factors, 22% had 3 risk factors, and 10% had 4 risk factors. The most common clusters of risk factors were: obese and hypertensive (18%), obese, hypertensive and hypercholesterolemic (13%), and obese, hypertensive, hypercholesterolemic, and diabetic (10%). CONCLUSIONS: The prevalence of risk factors and risk factor clustering in church members in South Carolina is exceedingly high. Culturally-relevant behavioral interventions targeting risk factor reduction in this population should be a public health goal

Teleconsent: A novel approach to obtain informed consent for research

Lack of recruitment of qualified research participants continues to be a significant bottleneck in clinical trials, often resulting in costly time extensions, underpowered results, and in some cases early termination. Some of the reasons for suboptimal recruitment include laborious consent processes and access to participants at remote locations. While new electronic consents technologies (eConsent) help overcome challenges related to readability and consent management, they do not adequately address challenges related to remote access. To address this, we have developed an innovative solution called “teleconsent”, which embeds the informed consent process into a telemedicine session. Teleconsent allows a researcher to remotely video conference with a prospective research participant, display and interactively guide participants in real-time through a consent form. When finished, the researcher and participant can electronically sign the consent form and print or download the signed document for archiving. This process can eliminate challenges related to travel and management of personnel at remote sites. Teleconsent has been successfully implemented in several clinical trials. Teleconsent can improve research recruitment by reducing the barriers related to informed consent, while preserving human interaction

Changes in urine microalbumin-to-creatinine ratio in children with sickle cell disease over time

Background: Approximately 20% of children with sickle cell disease (SCD) have microalbuminuria (MA). Very little is known about the progression of MA in children and young adults with SCD. Methods: In this study, we analyzed 5 year EMR data of 373 children (with ≥2 Microalbumin to creatinine (MA/Cr) ratio measurements) followed at the Medical University of South Carolina to determine the rate, direction, magnitude and predictors of MA/Cr change over time. Results: Age range was 1 – 22 years; mean 10.2 ± 5.2 years, 49.5% were male. Median follow up duration was 3.12 ±1.16 years. At baseline, 328 children had normal (<20 mg/L) MA level. Forty-five (12.1%) of children had MA (≥ 20 mg/L), of which 91% were ≥ 8 years and 21 (47%) continued to have MA at the end of the study period. On the other hand, during the study period, 24 new patients developed MA and 24 normalized their MA to levels <20 mg/L. In multivariate logistic regression model, age and bilirubin levels were predictive of MA/Cr increase in patients who received at least one blood transfusion during the study period. Baseline MA level was not predictive of the change in MA/Cr. Conclusions: In children and young adults, microalbuminuria is considered a marker of early renal injury. Over time, MA/Cr levels may increase or decrease. Further studies are needed to confirm our findings, assess the reliability of MA as marker of long-term renal injury and identify high risk patients likely to have worsening of MA over time