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Macklin J, Samson B, Zsager A, Ross H, Pinto A, Gibson JL. Cardiovascular disease management and healthcare delivery for people experiencing homelessness: a scoping review. BMC Health Serv Res 2024; 24:1080. [PMID: 39289676 PMCID: PMC11406789 DOI: 10.1186/s12913-024-11503-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND People experiencing homelessness have increased prevalence, morbidity, and mortality of cardiovascular disease (CVD), attributable to several traditional and non-traditional risk factors. While this burden is well-known, mainstream CVD management plans and healthcare delivery have not been developed with people experiencing homelessness in mind nor tailored to their unique context. The overall objective of this work was to explore and synthesize what is known about CVD management experiences, programs, interventions, and/or recommendations specifically for people experiencing homelessness. METHODS We conducted a scoping review to combine qualitative and quantitative studies in a single review using the Arksey and O'Malley framework and lived experience participation. We performed a comprehensive search of OVID Medline, Embase, PsychINFO, CINAHL, Web of Science, Social Sciences Index, Cochrane, and the grey literature with key search terms for homelessness, cardiovascular disease, and programs. All dates, geographic locations, and study designs were included. Articles were analyzed using conventional content analysis. RESULTS We included 37 articles in this review. Most of the work was done in the USA. We synthesized articles' findings into 1) barriers/challenges faced by people experiencing homelessness and their providers with CVD management and care delivery (competing priorities, lifestyle challenges, medication adherence, access to care, and discrimination), 2) seven international programs/interventions that have been developed for people experiencing homelessness and CVD management with learnings, and 3) practical recommendations and possible solutions at the patient encounter level (relationships, appointment priorities, lifestyle, medication), clinic organization level (scheduling, location, equipment, and multi-disciplinary partnership), and systems level (root cause of homelessness, and cultural safety). CONCLUSIONS There is no 'one-size-fits all' approach to CVD management for people experiencing homelessness, and it is met with complexity, diversity, and intersectionality based on various contexts. It is clear, however, we need to move to more practically-implemented, community-driven solutions with lived experience and community partnership at the core. Future work includes tackling the root cause of homelessness with affordable housing, exploring ways to bring cardiac specialist care to the community, and investigating the role of digital technology as an avenue for CVD management in the homeless community. We hope this review is valuable in providing knowledge gaps and future direction for health care providers, health services research teams, and community organizations.
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Affiliation(s)
- Jillian Macklin
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada.
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Bethel Samson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alex Zsager
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Heather Ross
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Andrew Pinto
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Jennifer L Gibson
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, Toronto, ON, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
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Fu Y, Yu G, Maulana N, Thomson K. Interventions to tackle health inequalities in cardiovascular risks for socioeconomically disadvantaged populations: a rapid review. Br Med Bull 2023; 148:22-41. [PMID: 37724711 PMCID: PMC10724464 DOI: 10.1093/bmb/ldad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) has shown significant health inequalities for people with low socioeconomic status associated with more risk factors. This review was to synthesize interventions that targeted CVD risks and outcomes among socioeconomically disadvantaged populations and to understand the impact associated with these interventions. SOURCES OF DATA Cochrane CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL were searched for records published in the last decade using a systematic search strategy, complemented by screening the reference lists and citation indexes. Nineteen studies were included and a narrative synthesis with the effect direction plot was undertaken in which studies, interventions, participants and outcomes were examined according to the intervention type focusing on behaviours, lifestyle, education, medication and monitoring. AREAS OF AGREEMENT No universal definition of disadvantaged socioeconomic status was used with common factors relating to racial/ethnic minorities, low income and low or no health insurance. Mixed effects of interventions were reported on clinical outcomes including weight, body mass index, blood pressure, glycated haemoglobin and cholesterol. AREAS OF CONTROVERSY Inconsistent effect was reported due to a large variety of settings, participants and intervention components although they are considered necessary to address the complex health needs of socioeconomically disadvantaged populations. GROWING POINTS There is inadequate evidence to determine whether any of the intervention types are effective in optimising lipids management for socioeconomically disadvantaged populations. AREAS TIMELY FOR DEVELOPING RESEARCH Research is needed with mixed evidence using real world evaluation and lived experience combined with health economic evaluation, on both mental and physical health outcomes.
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Affiliation(s)
- Yu Fu
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, 1-3 Brownlow Street, Liverpool, L69 3GL, UK
| | - Ge Yu
- King’s Health Economics, Health Services and Population Research, Department of Psychiatry, Psychology & Neuroscience, King’s College London, David Goldberg Centre 18 De Crespigny Park, London, SE5 8AF, UK
| | - Naswa Maulana
- Population Health Sciences Institute, Faculty of Medical Sciences Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Katie Thomson
- Population Health Sciences Institute, Faculty of Medical Sciences Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
- National Institute for Health Research Applied Research Collaboration, North East and North Cumbria, Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust St Nicholas Hospital Gosforth, Newcastle Upon Tyne NE3 3XT, UK
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Morgan TL, Faught E, Ross-White A, Fortier MS, Duggan M, Jain R, Lane KN, Lorbergs A, Maclaren K, McFadden T, Tomasone JR. Tools to guide clinical discussions on physical activity, sedentary behaviour, and/or sleep for health promotion between primary care providers and adults accessing care: a scoping review. BMC PRIMARY CARE 2023; 24:140. [PMID: 37420229 PMCID: PMC10326959 DOI: 10.1186/s12875-023-02091-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Health care providers have reported low knowledge, skill, and confidence for discussing movement behaviours (i.e., physical activity, sedentary behaviour, and sleep), which may be improved with the use of tools to guide movement behaviour discussions in their practice. Past reviews have examined the psychometric properties, scoring, and behavioural outcomes of physical activity discussion tools. However, the features, perceptions, and effectiveness of discussion tools for physical activity, sedentary behaviour, and/or sleep have not yet been synthesized. The aim of this review was to report and appraise tools for movement behaviour discussions between health care providers and adults 18 + years in a primary care context within Canada or analogous countries. METHODS An integrated knowledge translation approach guided this review, whereby a working group of experts in medicine, knowledge translation, communications, kinesiology, and health promotion was engaged from research question formation to interpretation of findings. Three search approaches were used (i.e., peer-reviewed, grey literature, and forward searches) to identify studies reporting on perceptions and/or effectiveness of tools for physical activity, sedentary behaviour, and/or sleep. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. RESULTS In total, 135 studies reporting on 61 tools (i.e., 51 on physical activity, one on sleep, and nine combining two movement behaviours) met inclusion criteria. Included tools served the purposes of assessment (n = 57), counselling (n = 50), prescription (n = 18), and/or referral (n = 12) of one or more movement behaviour. Most tools were used or intended for use by physicians, followed by nurses/nurse practitioners (n = 11), and adults accessing care (n = 10). Most tools were also used or intended to be used with adults without chronic conditions aged 18-64 years (n = 34), followed by adults with chronic conditions (n = 18). The quality of the 116 studies that evaluated tool effectiveness varied. CONCLUSIONS Many tools were positively perceived and were deemed effective at enhancing knowledge of, confidence for, ability in, and frequency of movement behaviour discussions. Future tools should guide discussions of all movement behaviours in an integrated manner in line with the 24-Hour Movement Guidelines. Practically, this review offers seven evidence-based recommendations that may guide future tool development and implementation.
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Affiliation(s)
- Tamara L Morgan
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, K7L 3N6, Canada.
| | - Emma Faught
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Amanda Ross-White
- Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
| | | | - Mary Duggan
- Canadian Society for Exercise Physiology, Ottawa, ON, Canada
| | - Rahul Jain
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kirstin N Lane
- Canadian Society for Exercise Physiology, Ottawa, ON, Canada
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | | | | | - Taylor McFadden
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- Canadian Medical Association, Ottawa, ON, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, K7L 3N6, Canada
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Lo FMW, Wong EML, Ho KY. The effects of an integrated exercise and cardiovascular health education programme on community-dwelling older adults at risk of atherosclerotic cardiovascular diseases: A study protocol for a randomised controlled trial. PLoS One 2023; 18:e0286181. [PMID: 37224162 DOI: 10.1371/journal.pone.0286181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/01/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Although older adults are at an increased risk of atherosclerotic cardiovascular disease (ASCVD), the effect of an integrated exercise and cardiovascular health education programme based on self-efficacy theory has not been well investigated among older adults. This study aims at examining the effect of this programme on community-dwelling older adults at risk of ASCVD concerning physical activity level, exercise self-efficacy and ASCVD risk profile. METHODS A parallel two-arm randomised controlled trial with pretest-posttest design will be performed among 190 Chinese community-dwelling adults aged 60 or above in elderly community centres of the Guangdong-Hong Kong-Macao Greater Bay Area. Eligible participants will be randomised by computerised generation. Experimental group will receive a 12-week integrated exercise and cardiovascular health education programme, which comprises a one-hour group-based health education talk conducted at Week 1, a booklet, a lecture video, a tailor-made exercise video, and a booster intervention by text messaging starting from Week 1 to Week 12. Control group will receive placebo intervention including a talk on basic health issues, a lecture video and corresponding leaflet. The outcomes will be investigated through self-report questionnaires and physiological evaluations at baseline, Week 12, Week 24, and Week 36. Physical activity level, exercise self-efficacy and ASCVD risk profile will be assessed, with physical activity level at Week 24 considered the primary outcome. The main intervention effect (group differences on continuous outcome variables) will be examined via Generalized Estimating Equations with identity link. DISCUSSION This study findings will provide clues to the effect of the integrated exercise and cardiovascular health education programme, which is theoretically underpinned with self-efficacy theory, in older adults at risk of ASCVD. It will also enhance the quality of community health education by providing insight into the effective teaching strategies targeting older adults. TRIAL REGISTRATION This study has been registered on ChinicalTrial.gov (Trial ID: NCT05434273).
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Affiliation(s)
- Flora M W Lo
- Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Eliza M L Wong
- School of Nursing, Tung Wah College, Mongkok, Hong Kong SAR, China
| | - Ka Yan Ho
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
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Aycock DM, Clark PC, Hayat MJ, Salazar LF, Eriksen MP. Stroke Counseling Intervention for Young Adult African Americans: A Randomized Controlled Trial. Nurs Res 2023; 72:83-92. [PMID: 36729696 PMCID: PMC9991970 DOI: 10.1097/nnr.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND African Americans have a higher incidence of early-onset stroke and poorer stroke-related outcomes than other race/ethnic groups. OBJECTIVES Our two-arm, randomized controlled trial was implemented to assess efficacy of the nurse-led Stroke Counseling for Risk Reduction (SCORRE) intervention in reducing stroke risk in young African American adults by improving accuracy of perceived stroke risk and lifestyle behaviors (i.e., diet, physical activity, and smoking cessation). Stroke knowledge, behavior change readiness, and perceived competence to live a healthy lifestyle were also explored as secondary outcomes. METHODS African Americans aged 20-35 years, recruited from an urban university and surrounding community, were randomized to SCORRE or an attention placebo control group receiving safe sex education. Data were collected pre-intervention, immediate post-intervention, and at 8 weeks. Multilevel models were used for primary outcome analyses. RESULTS Participants ( n = 106) were mostly in their mid-20s, female, college students, and averaged about three modifiable stroke risk factors. Compared to the control group, participants in the intervention group had, on average, a significant increase in accuracy of perceived stroke risk post-intervention, a greater change in perceived competence to live healthy, and a greater increase in dietary components at 8 weeks. Significant changes were not found in physical activity and other outcomes. DISCUSSION These findings suggest that SCORRE is a promising intervention to reduce stroke risk among young African American adults. Results will inform a more robust, randomized controlled trial of SCORRE to have an age, culture, and gender-focused intervention that effectively reduces stroke risk among African Americans early in life.
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Shim SY, Jung SJ, Kim SU, Kim HC. Ideal cardiovascular health metrics and the risk of nonalcoholic fatty liver disease in Korean adults. Clin Hypertens 2023; 29:3. [PMID: 36641485 PMCID: PMC9840828 DOI: 10.1186/s40885-022-00227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/26/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The association between cardiovascular risk factors and nonalcoholic fatty liver disease (NAFLD) is well established, but whether cardiovascular health (CVH) metrics is associated with NAFLD had not been fully studied. Thus, we examined the association between CVH metrics and NAFLD in the middle-aged Korean population. METHODS We used data of 2,928 (851 men and 2,077 women) participants aged 30-64 years from the Cardiovascular and Metabolic Disease Etiology Research Center study. CVH metrics were measured using a modified version of Life's Simple 7 by the American Heart Association. NAFLD diagnosis was based on the fatty liver index or liver-to-spleen ratio on computed tomography. A multiple logistic regression model was used to investigate the cross-sectional and longitudinal associations between CVH metrics and NAFLD. RESULTS In the cross-sectional analysis, the odds ratio for NAFLD was lower in participants with ideal CVH (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.08-0.18), while it was higher in individuals with poor CVH (OR, 2.87; 95% CI, 2.13-3.86). Similarly, the risk of new-onset NAFLD was lower in participants with ideal CVH (OR, 0.28; 95% CI, 0.11-0.74), and higher in individuals with poor CVH (OR, 2.20; 95% CI, 0.50-9.72) in the longitudinal analysis of a subgroup. CONCLUSIONS Ideal CVH was associated with a lower risk of NAFLD while poor CVH was associated with a higher risk of NAFLD. These findings suggest that making efforts to encourage people to manage their CVH to the ideal level may prevent and manage NAFLD.
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Affiliation(s)
- Sun Young Shim
- grid.15444.300000 0004 0470 5454College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Sun Jae Jung
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Up Kim
- grid.15444.300000 0004 0470 5454Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeon Chang Kim
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea ,grid.413046.40000 0004 0439 4086 Institute for Innovation in Digital Healthcare, Yonsei University Health System, Seoul, Republic of Korea
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Freeley S, Broughan J, McCombe G, Casey M, Fitzpatrick P, Frawley T, Morrisey J, Treanor JT, Collins T, Cullen W. Promoting nurse-led behaviour change interventions to prevent cardiovascular disease in disadvantaged communities: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2071-2095. [PMID: 35695081 PMCID: PMC10084375 DOI: 10.1111/hsc.13867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/07/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Cardiovascular diseases (CVD) are the leading cause of death worldwide and they disproportionally affect people living in disadvantaged communities. Nurse-led behaviour change interventions have shown great promise in preventing CVD. However, knowledge regarding the impact and nature of such interventions in disadvantaged communities is limited. This review aimed to address this knowledge gap. A six-stage scoping review framework developed by Arksey and O'Malley, with revisions by Levac et al., was used. The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR). Three electronic databases were searched (PUBMED/MEDLINE, CINAHL Plus, and Cochrane CENTRAL), and included studies were analysed using Braun and Clarke's 'Thematic Analysis' approach. Initial searches yielded 952 papers and 30 studies were included in the review following duplicate, title/abstract, and full-text screening. The included studies indicate that nurse-led behaviour change primary prevention interventions in disadvantaged areas are largely effective; albeit the considerable variety of intervention approaches, study populations and outcome measures used to date make it difficult to ascertain this. Other identified key areas in the promotion of nurse-led behaviour change included tailoring interventions to specific populations, providing adequate training for nurses, overcoming patient access difficulties and encouraging patient engagement. Overall, the findings indicate that nurse-led behaviour change interventions for high-risk CVD patients in disadvantaged areas show much promise, although there is considerable variety in the interventions employed and studied to date. Further research is needed to examine the unique barriers and facilitators of interventions for specific disadvantaged groups.
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Affiliation(s)
- Sarah Freeley
- School of MedicineHealth Sciences Centre, University College DublinDublinIreland
| | - John Broughan
- School of MedicineHealth Sciences Centre, University College DublinDublinIreland
| | - Geoff McCombe
- School of MedicineHealth Sciences Centre, University College DublinDublinIreland
| | - Mary Casey
- School of Nursing, Midwifery, and Health SystemsHealth Sciences Centre, University College DublinDublinIreland
| | - Patricia Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College DublinHealth Sciences CentreDublinIreland
- St. Vincent's University HospitalDublinIreland
| | - Timothy Frawley
- School of Nursing, Midwifery, and Health SystemsHealth Sciences Centre, University College DublinDublinIreland
- Ireland East Hospital GroupDublinIreland
| | | | | | | | - Walter Cullen
- School of MedicineHealth Sciences Centre, University College DublinDublinIreland
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Devaraj SM, Rockette-Wagner B, Miller RG, Arena VC, Napoleone JM, Conroy MB, Kriska AM. The Impact of a Yearlong Diabetes Prevention Program-Based Lifestyle Intervention on Cardiovascular Health Metrics. J Prim Care Community Health 2021; 12:21501327211029816. [PMID: 34236004 PMCID: PMC8274083 DOI: 10.1177/21501327211029816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The American Heart Association created “Life’s Simple Seven” metrics to estimate progress toward improving US cardiovascular health in a standardized manner. Given the widespread use of federally funded Diabetes Prevention Program (DPP)-based lifestyle interventions such as the Group Lifestyle Balance (DPP-GLB), evaluation of change in health metrics within such a program is of national interest. This study examined change in cardiovascular health metric scores during the course of a yearlong DPP-GLB intervention. Methods Data were combined from 2 similar randomized trials offering a community based DPP-GLB lifestyle intervention to overweight/obese individuals with prediabetes and/or metabolic syndrome. Pre/post lifestyle intervention participation changes in 5 of the 7 cardiovascular health metrics were examined at 6 and 12 months (BMI, blood pressure, total cholesterol, fasting plasma glucose, physical activity). Smoking was rare and diet was not measured. Results Among 305 participants with complete data (81.8% of 373 eligible adults), significant improvements were demonstrated in all 5 risk factors measured continuously at 6 and 12 months. There were significant positive shifts in the “ideal” and “total” metric scores at both time points. Also noted were beneficial shifts in the proportion of participants across categories for BMI, activity, and blood pressure. Conclusion AHA-metrics could have clinical utility in estimating an individual’s cardiovascular health status and in capturing improvement in cardiometabolic/behavioral risk factors resulting from participation in a community-based translation of the DPP lifestyle intervention.
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Affiliation(s)
- Susan M Devaraj
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | - Rachel G Miller
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Vincent C Arena
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Jenna M Napoleone
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Molly B Conroy
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrea M Kriska
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Aycock DM, Clark PC, Anderson AM, Sharma D. Health Perceptions, Stroke Risk, and Readiness for Behavior Change: Gender Differences in Young Adult African Americans. J Racial Ethn Health Disparities 2019; 6:821-829. [PMID: 30895478 PMCID: PMC6669899 DOI: 10.1007/s40615-019-00581-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 01/14/2023]
Abstract
The presence of traditional cardiovascular risk factors has increased among young African American (AA) adults, making them more susceptible to stroke. We examined baseline data from the Stroke COunseling for Risk REduction (SCORRE) study to describe health perceptions, stroke risk, and readiness for behavior change along with gender differences in a cohort of young AA. Self-administered questionnaires were used to assess perceptions of general health, stroke risk, competence to live a healthy lifestyle, and readiness for behavior change. Actual stroke risk was measured using the American Heart Association (AHA) Life's Simple 7® (LS7) program. Data were collected from 116 participants (86 women, 30 men) who had a mean age of 24.6 (SD = 4.5). On average, participants had 2.6 (SD = 1.1) out of 7 risk factors for stroke, rated their overall health at the midpoint of the scale ("good"), perceived a low risk of future stroke, felt competent they could live a healthy lifestyle, but were not at a stage of readiness for behavior change. A significantly higher proportion of men than women met AHA recommendations for physical activity (77% vs. 49%; p < 0.01), but had blood pressure readings > 120/80 (70% vs. 34%; p < 0.01), and smoked cigarettes/cigars (20% vs. 2%; p < 0.01). Fewer men than women were at a stage of readiness for behavior change to reduce stroke risk (13% vs. 40%; p < 0.01). Stroke risk needs to be assessed early in AA and the LS7 can be used to assess and communicate risk. Understanding gender differences may help with tailoring stroke prevention education and treatment programs.
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Affiliation(s)
- Dawn M Aycock
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 4019, Atlanta, GA, 30302, USA.
| | - Patricia C Clark
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 4019, Atlanta, GA, 30302, USA
| | - Aaron M Anderson
- Department of Neurology 201 Dowman Drive, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Dhruvangi Sharma
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 4019, Atlanta, GA, 30302, USA
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How do nurse practitioners work in primary health care settings? A scoping review. Int J Nurs Stud 2017; 75:51-57. [DOI: 10.1016/j.ijnurstu.2017.06.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 12/26/2022]
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Pirani N, Khiavi FF. Population Attributable Fraction for Cardiovascular Diseases Risk Factors in Selected Countries: A comparative study. Mater Sociomed 2017; 29:35-39. [PMID: 28484352 PMCID: PMC5402361 DOI: 10.5455/msm.2017.29.35-39] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/28/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the most common cause of death. The prevalence of cardiovascular diseases was reported to be 3,500 per 100,000. And it is predicted that these numbers will increase in the near future. By removing the main factors responsible for non-communicable diseases, cardiovascular disease can be prevented by 80%. AIM The aim of this study was to compare the population attributable fraction for cardiovascular diseases' risk factors in Iran, USA and Spain. METHODS This study was a comparative study and the population consisted of Iran, USA and Spain. The required information was collected from printed and electronic documentations and articles published in reliable databases, in the period 2007-2015. RESULTS The cardiovascular diseases' Population Attributable Risk or Fraction for blood pressure was calculated to be 11.37%, 54% and 60%, diabetes 7.32%, 13% and 18%, and high cholesterol 6.85%, 13% and 20%, for Iran, USA and Spain respectively. Among risk factors, blood pressure was the most relevant factor to cardiovascular disease. CONCLUSIONS The risk factor for high blood pressure had a more population attributable fraction than other physiological factors in the development of cardiovascular disease. Hence, by implementing comprehensive health policies, educating healthy lifestyle, screening and finding related cases as well as conducting health promotion programs, these diseases can be prevented.
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Affiliation(s)
- Narges Pirani
- School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farzad Faraji Khiavi
- Social Determinants of Health Research Center (SDHRC), School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Phillips SA, Martino S, Arena R. Research Opportunities and Challenges in the Era of Healthy Living Medicine: Unlocking the Potential. Prog Cardiovasc Dis 2017; 59:498-505. [PMID: 28132853 DOI: 10.1016/j.pcad.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 01/21/2017] [Indexed: 12/28/2022]
Abstract
Non-communicable diseases, such as cardiovascular disease (CVD), obesity, cancer, pulmonary disease, and diabetes are a very high global health concern. The health costs of risk factors for CVD, such as hypertension (HTN), is mounting and are unrelenting. As an example, it is estimated that direct and indirect costs due to HTN amounted to $46.4 billion in 2011 and projections of six-fold increases by 2030; the importance of low-cost nonpharmacological interventions involving collaborative teams of health care professionals is at a critical junction. Certainly, the data supported by research including some clinical trials for healthy living interventions support deploying health education, nutrition, smoking cessation, and physical activity(PA) in preventing CVD risk, such as HTN. Exercise training (ET) for blood pressure (BP) control has been shown to be an effective and integral component of BP management. However, less is known about what optimization of PA/ET modalities with nutrition and lifestyle tracking with modern era technologies will bring to this equation. New research methods may need to consider how to collaborate to collect data in using teams of researchers while interacting with community centers, school systems, and in traditional health care practices. This review will discuss and present what is known about the research that support modern era healthy living medicine and how this data may be integrated in venues that support health lifestyle in the community (i.e. schools and the work place).
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Affiliation(s)
- Shane A Phillips
- Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL.
| | - Sharon Martino
- Department of Physical Therapy, School of Health Technology and Management, Rehabilitation Research and Movement Performance Laboratory, Stony Brook University, Stony Brook, NY
| | - Ross Arena
- Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL
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Graham R, Stolte O, Hodgetts D, Chamberlain K. Nutritionism and the construction of ‘poor choices’ in families facing food insecurity. J Health Psychol 2016; 23:1863-1871. [PMID: 27682336 DOI: 10.1177/1359105316669879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The dominant research approach to both food insecurity and charitable meal provision is nutritionistic, deficit-orientated and ignores wider socio-economic issues. This reinforces existing power dynamics and overlooks the agency of people living food-insecure lives. We critique this dominant approach and draw on the everyday experiences of families facing food insecurity to ground an alternative approach that emphasises food as a social determinant of health.
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Staffileno BA, Murphy MP, Carlson E. Overcoming the Tension: Building Effective DNP-PhD Faculty Teams. J Prof Nurs 2016; 32:342-8. [DOI: 10.1016/j.profnurs.2016.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Indexed: 10/22/2022]
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15
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Yang Q, Zhang B, Deng P, Chen L, Wang JR, Fan DS. Assessing Cardiovascular Health Using Life's Simple 7 in a Chinese Population Undergoing Stroke Prevention. Chin Med J (Engl) 2016; 128:2450-6. [PMID: 26365961 PMCID: PMC4725556 DOI: 10.4103/0366-6999.164928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The American Heart Association/American Stroke Association proposed a metric called Life's Simple 7 (LS7) to define cardiovascular health (CVH). The presence of a large number of ideal components of CVH is associated with lower cardiovascular disease and all-cause mortality. We aimed to assess CVH using LS7 in a Chinese population undergoing primary and secondary stroke prevention. Methods: Patients with either ischemic stroke or cardiovascular risk factors were enrolled in the study from October 2010 to July 2013. LS7 components were scored as poor (0 points), intermediate (1 point), or ideal (2 points). The overall LS7 score was categorized as inadequate (0–4), average (5–9), or optimal (10–14) CVH. The Chi-square test, Mann–Whitney U-test, and Kruskal–Wallis test were used. Results: In total, 706 patients were enrolled. (1) The distribution of the overall LS7 score (n = 255) indicated that 9.4%, 82.4%, and 8.2% of the patients had inadequate, average, and optimal CVH, respectively. The proportion of patients with optimal CVH undergoing secondary stroke prevention was lower than that for patients undergoing primary stroke prevention (3.8% vs. 12.8%, P = 0.005). The vast majority of participants (76.1%) presented with ≤2 ideal health components. (2) The proportions of patients with poor, intermediate, and ideal status, respectively, for the following LS7 components were assessed: Total cholesterol (n = 275; 5.1%, 73.8%, and 21.1%), blood pressure (n = 351; 32.5%, 59.0%, and 8.5%), blood glucose (n = 280; 9.3%, 39.6%, and 51.1%), physical activity (n = 540; 90.7%, 8.7%, and 0.6%), diet (n = 524; 0.2%, 92.4%, and 7.4%), smoking (n = 619; 20.7%, 2.9%, and 76.4%), and body mass index (n = 259; 6.6%, 35.5%, and 57.9%). Conclusions: Few Chinese patients undergoing stroke prevention had optimal CVH (determined using LS7). Additionally, fewer patients undergoing secondary prevention had optimal CVH than those undergoing primary prevention. In particular, physical activity and diet status in this population require improvement.
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Affiliation(s)
| | | | | | | | | | - Dong-Sheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
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Bowers MT. Cardiovascular Health Among an Underserved Population: Clinical Implications. Nurs Clin North Am 2015; 50:457-64. [PMID: 26333603 DOI: 10.1016/j.cnur.2015.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite general efforts to reduce risk factors in cardiovascular disease in the United States over the previous decade, disparities in cardiovascular care remain more prevalent in the underserved population. Recent focus has shifted from treatment of disease to promotion of health. The impact goals for 2020 are improvement in 7 health metrics (smoking status, body mass index, physical activity, healthy dietary score, total cholesterol, blood pressure, and fasting plasma glucose) of cardiovascular health and reduction of cardiovascular disease and stroke by 20%. Identification of those at high risk for poor cardiovascular health in adulthood should begin during early adolescence.
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Affiliation(s)
- Margaret T Bowers
- Duke University School of Nursing, 3322 Duke University, Durham, NC 27710, USA.
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