An exploration of knowledge and risk perceptions of cardiovascular disease from the perspectives of prisoners and stakeholders to guide the development of a cardiovascular risk reduction intervention

Background: Cardiovascular disease (CVD) is an important health concern in prison populations as they have an increased risk of the disease compared to the general population. However, there is a lack of interventions to reduce prisoners’ cardiovascular risk, and little is known about the knowledge and risk perceptions of the disease in prison. This study aims to explore the knowledge and risk perceptions of CVD from the perspectives of prisoners and staff to guide the development of a cardiovascular risk reduction intervention for prisoners. Methods: This was a qualitative, exploratory study. Semi-structured interviews were conducted with 16 prisoners and 11 staff, who were purposively recruited from a private prison in Scotland. Framework analysis was used to analyse the data. Findings: The prisoners and staff had limited, non-expert knowledge of CVD. Common behavioural risk factors and cardiovascular events were identified, but gaps in knowledge were evidenced. There were similarities and differences in perceptions of prisoners’ risk of the disease; risk was primarily assessed by judgements about the prisoners’ current health status rather than their risk factor status. Prisoners’ risk of CVD was attributed to negative health behaviours such as smoking and physical inactivity, and these were influenced by multiple factors that interacted across three levels of influence. Individual factors included self-efficacy and mental health problems, social factors included the prison culture and social interactions, and institutional factors included the prison regime and healthcare barriers. An ecological framework was designed to guide a cardiovascular risk reduction intervention that focuses on the multi-level influences of prisoners’ cardiovascular risk. Conclusion: Prisoners have limited knowledge and misconceptions of CVD, and engage in several risky behaviours. There are multi-level influences on prisoners’ CVD risk and cardiovascular health. An ecological approach is recommended to address these influences to reduce the prisoners’ risk of CVD

Interventions for prevention of type 2 diabetes in relatives:A systematic review

The relatives and partners of people with type 2 diabetes are at increased risk of developing type 2 diabetes. This systematic review examines randomized controlled trials, written in English that tested an intervention, which aimed to modify behaviors known to delay or prevent type 2 diabetes, among the relatives or partners of people with type 2 diabetes. Study quality was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Seven studies met the inclusion criteria. The majority of studies were at low risk of bias. Six studies tested an intervention in first-degree relatives of people with type 2 diabetes and one in partners. Intervention components and intervention intensity across studies varied, with those targeting diet and physical activity reporting the most significant changes in primary outcomes. Only one study did not observe significant changes in primary outcomes. There were three main recruitment approaches: advertising in the community, recruiting people through their relatives with diabetes, or identifying people as high risk by screening of their own health care contacts. Some evidence was found for potentially successful interventions to prevent type 2 diabetes among the relatives and partners of people with type 2 diabetes, although finding simple and effective methods to identify and recruit them remains a challenge. Future studies should explore the effect of patients’ perceptions on their family members’ behavior and capitalize on family relationships in order to increase intervention effectiveness

Evaluating emotional distress and health-related quality of life in patients with heart failure and their family caregivers:Testing dyadic dynamics using the Actor-Partner Interdependence Model

Purpose: 1) To compare levels of emotional symptoms and health-related quality of life between patients with heart failure and their family caregivers; and 2) to examine whether patients’ and caregivers’ emotional symptoms were associated with their own, as well as their partner’s health-related quality of life. Method: In this cross-sectional study, 41 patients-caregiver dyads (78% male patients, aged 68.6 years; and 83% female caregivers, aged 65.8 years) completed all nine dimensions of the Brief Symptom Inventory and the Minnesota Living with Heart failure Questionnaire. Dyadic data were analysed for 6 sub-scales of the Brief Symptom Inventory, using the Actor–Partner Interdependence Model. Results: There were no statistically significant differences in emotional symptoms and health-related quality of life between patients with heart failure and their caregivers. Patients’ and caregivers’ emotional symptoms were associated with their own health-related quality of life. Caregivers’ anxiety, phobic anxiety, obsession-compulsion, depression and hostility negatively influenced their partner’s (i.e. the patient’s) health-related quality of life. There were no partner effects of patients’ emotional symptoms on the health-related quality of life of caregivers. Conclusions: The results of this study suggest that patients may be particularly vulnerable to the emotional distress, i.e. thoughts, impulses and actions of their caregivers. It may be possible to improve patients’ health-related quality of life by targeting specific detrimental emotional symptoms of caregivers

CASE 5: A Stakeholder Analysis: Developing an Indigenous-Specific Intercultural Competency Training Module (Part A)

The case focuses on developing an Indigenous-specific intercultural competency training module and outlines the steps needed to achieve this, with particular emphasis on the importance of conducting a stakeholder analysis and developing a stakeholder engagement plan. The protagonist of the case, Nia Singh, heads up the Intercultural Education Program at the Southwestern Ontario Intercultural Education Centre. After working at the organization as an intercultural education specialist for several years, Nia is looking to expand her project portfolio by redesigning the Intercultural Education Program’s pre-existing Indigenous intercultural competency training module. Nia determines the objective of the new training module will be to educate health care workers about the importance of intercultural competency within health care organizations. Specifically, the module will focus on Indigenous populations and will aim to improve the quality of care they receive so their long-term health outcomes ultimately improve. Nia works with her colleague, Steven Miller, to complete a stakeholder analysis and engagement plan, and they use four different steps to accomplish this: 1) brainstorming all possible stakeholders who have a vested interest in the training module; 2) prioritizing and categorizing each stakeholder as a core stakeholder, involved stakeholder, supportive stakeholder, or peripheral stakeholder; 3) determining the level of engagement required for each stakeholder; and 4) determining which engagement strategies to use for each stakeholder. After completing the stakeholder analysis and engagement plan, Nia and Steven arrange to interview the key stakeholders in order to gather additional opinions, ideas, and perspectives related to developing the training module. These stakeholders include health care workers, Indigenous community members, and other relevant informants. Once the interview process is complete, Nia and Steven develop a pilot version of the training module that is ready to be implemented on a small scale. However, Nia and Steven know they still have their work cut out for them in terms of identifying an effective implementation strategy. This case is intended to be a skills practice case with the primary objective of having students learn about conducting a stakeholder analysis and then learn about stakeholder engagement. By examining this case and completing the learning team activity, students will be able to understand the importance of stakeholder analysis and stakeholder engagement as they relate to developing an Indigenous-specific intercultural competency training module. Once students have acquired this knowledge, they will be able to apply stakeholder analyses and engagement strategies to developing a variety of public health programs. However, given that the training module focuses on Indigenous populations, the case will focus on concepts related to health equity and the barriers faced by Indigenous people when they access health care services. A secondary learning objective is for students to acquire knowledge pertaining to intercultural competency, particularly in terms of its significance within the field of public health and how it can be used as a strategy for reducing health disparities for other marginalized populations

Evaluating perceptions of self-efficacy and quality of life in patients having coronary artery bypass grafting and their family caregivers

Background Self-efficacy is a critical factor for quality of life in patients who undergo coronary artery bypass grafting, as well as for their family caregivers. However, there is lack of knowledge about whether patients' self-efficacy and caregivers' perceptions of patient self-efficacy are associated with quality of life in patient and caregiver dyads. Objectives The aims of this study were to compare self-efficacy and quality of life between patients and family caregivers and to examine whether patients' and caregivers' perceptions of patient self-efficacy were associated with their own and their partner's quality of life in patient and caregiver dyads who were waiting for patients' coronary artery bypass grafting. Methods In this cross-sectional study, 84 dyads (85% male patients and 87% female caregivers) completed the Cardiac Self-efficacy Scale, which consists of self-efficacy for controlling symptoms and self-efficacy for maintaining function subscales, and the Short-Form 12 Health Survey for quality of life. Data were analyzed using the Actor-Partner Interdependence Model. Results Caregivers rated patient self-efficacy for maintaining function higher than did patients themselves and caregivers' perceptions were positively correlated with patients' physical health. Patients' self-efficacy for maintaining function exhibited an actor effect on their own mental health. There were no other actor or partner effects of self-efficacy on quality of life. Conclusions Differences between patients' and caregivers' perceptions of patient self-efficacy for maintaining function should be addressed before surgery to reduce discordance. Patients' self-efficacy for maintaining function was associated with their own quality of life. There was no partner (relationship) effect of self-efficacy on quality of life. More research is needed in this area

Peptide redesign for inhibition of the complement system: Targeting age-related macular degeneration.

PurposeTo redesign a complement-inhibiting peptide with the potential to become a therapeutic for dry and wet age-related macular degeneration (AMD).MethodsWe present a new potent peptide (Peptide 2) of the compstatin family. The peptide is developed by rational design, based on a mechanistic binding hypothesis, and structural and physicochemical properties derived from molecular dynamics (MD) simulation. The inhibitory activity, efficacy, and solubility of Peptide 2 are evaluated using a hemolytic assay, a human RPE cell-based assay, and ultraviolet (UV) absorption properties, respectively, and compared to the respective properties of its parent peptide (Peptide 1).ResultsThe sequence of Peptide 2 contains an arginine-serine N-terminal extension (a characteristic of parent Peptide 1) and a novel 8-polyethylene glycol (PEG) block C-terminal extension. Peptide 2 has significantly improved aqueous solubility compared to Peptide 1 and comparable complement inhibitory activity. In addition, Peptide 2 is more efficacious in inhibiting complement activation in a cell-based model that mimics the pathobiology of dry AMD.ConclusionsWe have designed a new peptide analog of compstatin that combines N-terminal polar amino acid extensions and C-terminal PEGylation extensions. This peptide demonstrates significantly improved aqueous solubility and complement inhibitory efficacy, compared to the parent peptide. The new peptide overcomes the aggregation limitation for clinical translation of previous compstatin analogs and is a candidate to become a therapeutic for the treatment of AMD

Minimum-Delay Service Provisioning in Opportunistic Networks

Opportunistic networks are (ad hoc) networks created dynamically by exploiting contacts between pairs of mobile devices that come within communication range. This networking paradigm overcomes main limitations of conventional MANETs, related to the fact that, due to mobility and energy conservation issues, it is often not practical to maintain connected multihop paths among nodes. While forwarding in opportunistic networking has been explored, investigations into asynchronous service provisioning are unique contributions of this paper. Mobile devices are typically heterogeneous, possess disparate physical resources, and can provide a variety of services. During opportunistic contacts, the pairing peers can cooperatively provide (avail of) its (other peer\u27s) services. This service provisioning paradigm is a key feature of the emerging opportunistic computing paradigm. We develop an analytical model to study the behaviors of service seeking nodes (seekers) and service providing nodes (providers) that spawn and execute service requests, respectively. The model considers the case in which seekers can spawn parallel executions on multiple providers for any given request, and determines: i) the delays at different stages of service provisioning; and ii) the optimal number of parallel executions that minimizes the expected execution time without saturating providers\u27 resources. The analytical model is validated through simulations, and exploited to investigate the performance of service provisioning over a wide range of parameters