Prisoners' experience of health self-management: A qualitative study

PURPOSE

Among the noninstitutionalized population, health care is increasingly shifting from a paternalistic model toward promoting patients' involvement in decision-making and in managing their condition. This paradigm shift toward health self-management is less applicable to individuals in prison whose health management choices are limited. The aim of this study was to explore prisoners' health self-management needs and the strategies used to maintain health self-management in a highly restrictive prison environment.

DESIGN

A qualitative phenomenological study design was selected for this research.

METHODS

An interpretive phenomenological analysis was chosen to present the narratives of prisoners regarding their health self-management. Semi-structured interviews were conducted with 15 male prisoners followed by content analysis.

RESULTS

The analysis of the participants' narratives revealed four major themes: (1) "I thrive on the anger so I can turn it into some more sit-ups:" Initiating sporting activities (2) "Food shouldn't be that white…:" Prisoners' quest for healthier eating (3) "I felt I want more out of life…:" Avoiding an unhealthy lifestyle (4) "I want to be taken care of:" The struggle for better health care.

CONCLUSIONS

The findings suggest that prisoners can overcome the challenges of maintaining health in prison and become committed to better health management. Prisoners who serve as health resources may help reduce the load on correctional facilities' health care systems and the public.

Risk perception of cardiovascular disease among Turkish adults: a cross-sectional study

AIM

The aim of the study was to determine in adults the risk perception for cardiovascular disease (CVD) and the associated factors.

BACKGROUND

CVDs are the leading cause of death globally. In adults, perceptions related to the risk for CVDs have a considerable effect on decision-making processes related to one's own health.

METHODS

A cross-sectional study was conducted with 453 adult people from April to June 2019 in İzmir, Turkey. Data were collected with a sociodemographic characteristics questionnaire, perception of risk of heart disease scale (PRHDS), and health perception.

FINDINGS

The mean PRHDS score of adults was 48.88 ± 8.12. The risk perception for CVD was influenced by variables that were age, gender, education, marital status, employment status, health perception, familial cardiovascular disease history, chronic disease status, smoking status, and body mass index. Although CVDs are the most prominent cause of disease-related death in the world, risk perception for CVD was found to be low among the individuals included in this study. This finding indicates the importance of informing individuals about CVD risk factors, raising awareness, and training.

Effect of a Home-Based Mobile Health App Intervention on Physical Activity Levels in Patients With Heart Failure: A Randomized Controlled Trial

BACKGROUND

The use of mobile health applications (apps) is an effective strategy in supporting patients' self-management of heart failure (HF) in home settings, but it remains unclear whether they can be used to reduce sedentary behaviors and increase overall physical activity levels.

AIM

The aims of this study were to determine the effect of an 8-week home-based mobile health app intervention on physical activity levels and to assess its effects on symptom burden and health-related quality of life.

METHOD

In this study, we collected repeated-measures data from 132 participants with HF (60.8 ± 10.47 years) randomized into a usual care group (n = 67) or an 8-week home-based mobile health app intervention group (n = 65). The intervention was tailored to decrease the time spent in sedentary behavior and to increase the time spent in physical activities performed at light or greater intensity levels. Physical activity levels were monitored for 2 weeks before the intervention and during the 8-week intervention using the Samsung mobile health app. Heart failure symptom burden and health-related quality of life were assessed at baseline, 2 weeks from baseline assessment, and immediately post intervention.

RESULTS

At week 8, all participants in the intervention group demonstrated an increase in the average daily step counts above the preintervention counts (range of increase: 2351-7925 steps/d). Only 29 participants (45%) achieved an average daily step count of 10 000 or higher by week 6 and maintained their achievement to week 8 of the intervention. Repeated-measures analysis of variance showed a significant group-by-time interaction, indicating that the intervention group had a greater improvement in physical activity levels, symptom burden, and health-related quality of life than the usual care group.

CONCLUSION

Home-based mobile health app-based interventions can increase physical activity levels and can play an important role in promoting better HF outcomes.

Clustering of Signs and Symptoms of Oral Diseases in a Colombian Population

OBJECTIVE

The aim of this study was to estimate disease pattern clusters and co-occurrences of oral signs and symptoms in a Colombian population.

METHODS

A cross-sectional study was carried out through a telephone survey amongst 1155 people registered in the telephone directory from Pasto, Colombia. The calls were made from July to November 2019. A 14-item self-report questionnaire about signs and symptoms related to oral diseases that included sociodemographic characteristics was employed. Descriptive and multivariable analyses such as hierarchical clustering, multidimensional scaling, and generalized linear models were used to determine co-occurrences in different sex and age strata.

RESULTS

Age- and condition-specific clusters of signs and symptoms were identified, while sex differences were limited. Calculus and denture sore mouth were related in 18- to 34-year-olds; tooth loss and calculus in 35- to 54-year-olds, and teeth holes or pits (dental caries) and dental abscess in those aged 55 years and older. We found stronger associations between periodontal disease (bleeding gums) and dental caries (odds ratio [OR], 2.484; 95% confidence interval [CI], 1.812-3.405; P < .001) as well as grinding/clenching and facial tension (OR, 7.162; 95% CI, 5.227-9.814; P < .001).

CONCLUSIONS

Age-specific clustering of signs and symptoms and diagnostic patterns wer present in ths Colombian cohort.

Sex Differences in the Association Between Inflammation and Event-Free Survival in Patients With Heart Failure

BACKGROUND

Heart failure (HF) is associated with chronic inflammation, which is adversely associated with survival. Although sex-related differences in inflammation have been described in patients with HF, whether sex-related differences in inflammation are associated with event-free survival has not been examined.

AIM

The aim of this study was to determine whether the association between inflammation as indicated by tumor necrosis factor-α and event-free survival differs between men and women with HF after controlling for demographic and clinical variables.

METHOD

This was a secondary analysis of data from 301 male (age, 61.0 ± 11.4 years) and 137 female (age, 60.3 ± 12.1 years) patients with HF. Serum levels of soluble tumor necrosis factor receptor 1 were used to indicate inflammatory status. Patients were grouped according to median split of soluble tumor necrosis factor receptor 1 level and sex into male with low inflammation (≤1820 pg/mL) (n = 158) or high inflammation (>1820 pg/mL) (n = 143), and female with low inflammation (n = 63) or high inflammation (n = 74). Cox regression models were run separately for men and women to determine whether inflammation contributed to differences in event-free survival between sexes with HF.

RESULTS

There were 84 male (27.9%) and 27 female (19.7%) patients who had an event. Event-free survival in women did not differ by the severity of inflammation in the Cox regression analysis. In contrast, men with high inflammation had 1.85 times higher risk for an event compared with men with low inflammation.

CONCLUSION

These data provide evidence that inflammation contributed to differences in event-free survival in men but not women with HF. Clinicians should be aware that men who have higher inflammation may be at a greater risk of HF or cardiac-related events than others with HF.

Knowledge and cardiovascular disease risk perception from the perspectives of prisoners and staff in a Scottish prison: a qualitative study

PURPOSE

Prisoners have an increased risk of cardiovascular disease (CVD) compared to the general population. Knowledge and risk perception of CVD can influence engagement in preventative behaviours that lower an individual's CVD risk. This paper aims to explore prisoners' knowledge of CVD, and prisoners and staff's perceptions of prisoners' CVD risk.

DESIGN/METHODOLOGY/APPROACH

This was a qualitative study in which semi-structured interviews were conducted with 16 prisoners and 11 prison and National Health Services staff in a Scottish prison. Data were analysed thematically using the framework method.

FINDINGS

Most prisoners had limited knowledge of CVD as they could not describe it or could only identify one or two risk factors or cardiovascular events. Both prisoners and staff viewed prisoners' CVD risk as either pertaining to one individual, or pertaining to the general prisoner population. Unhealthy behaviours that were believed to increase CVD risk were linked to three perceived consequences of imprisonment: mental health problems, boredom and powerlessness.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this is the first study to explore the CVD knowledge of prisoners, and perceptions of CVD risk from the perspectives of prisoners and prison staff. Findings from this study indicate that CVD education needs to be a priority for prisoners, addressing knowledge of CVD, its risk and risk perceptions. Additionally, the findings indicate that individual and socio-environmental factors linked to prisoners' CVD risk need to be targeted to reduce this risk. Future research should focus on socio-environmental interventions that can lead to reducing the CVD risk of prisoners.

At the heart of the matter: Cardiovascular health challenges among incarcerated women

Many factors appear to contribute to an increased risk for cardiovascular disease (CVD) among incarcerated women. Imprisonment is associated with a bodyweight gain and an increased prevalence of overweight and obesity. Inadequate physical activity and unhealthy nutrition further contribute to this positive energy balance. Classical CVD risk factors are common, including hypertension, diabetes mellitus, metabolic syndrome, and smoking. Moreover, imprisonment is associated with an increased incidence of mental health issues, such as depression and anxiety, with coping mechanisms, including substance abuse, being frequently adopted. Specific attitudes in the correctional environment, including hunger strikes, bullying, abuse and solitary confinement, are effectors of cardiovascular and mental ill-health. Furthermore, the plethora of psychological stressors induces an accelerated aging process, paired with CVD risk. Communicable diseases, mainly human immunodeficiency virus, opportunistic infections and inadequate sunlight exposure increase cardiovascular dysregulation. Health care needs associated with the female sex are not always met, adding to the frustration and compromised well-being. All these factors act independently and cumulatively, increasing CVD risk among incarcerated women.

The health outcomes of inflammation and obesity in patients with heart failure

BACKGROUND

Although obesity is a risk factor for cardiovascular disease, higher body mass index is related to longer event-free survival in patients with heart failure (HF). While previous research demonstrated that higher levels of inflammatory mediators were associated with shorter event-free survival, the effect of inflammation on the association between obesity and outcomes of HF have not been considered.

HYPOTHESIS

Based on the obesity paradox, we hypothesized that patients with higher baseline body mass index (BMI) would experience better event-free survival than those with lower BMI regardless of inflammatory status.

METHOD

A sample of 415 patients with HF (age 61 ± 11.5 years; 31% female) provided blood to measure soluble tumor necrosis factor receptor1 (sTNFR1), a biomarker of inflammation. Patients were divided into 4 groups based on BMI and a median split of sTNFR1 levels: (1) high BMI ≥ 30 and sTNFR1 > 1804 pg/ml, (2) high BMI ≥ 30 and low sTNFR1 ≤ 1804 pg/ml, and (3) low BMI < 30 and high sTNFR1 > 1804 pg/ml vs. (4) low BMI < 30 and sTNFR1 ≤ 1804 pg/ml. Patients were followed for an average of 365 days to determine the time to first event of either all-cause hospitalization or death.

RESULTS

There were 177 patients (43%) who experienced either an all-cause hospitalization or death. In a Cox regression, high BMI and high sTNFR1 category predicted time to event (hazard ratio = 1.7, 95% confidence interval = 1.01-2.9) with age, gender, race, left ventricular ejection fraction, New York Heart Association functional class (I/II versus III/IV), log-transformed N-terminal Pro-B-type natriuretic peptide levels, prescribed statin (yes/no), and comorbidity as covariates.

CONCLUSION

Being in a higher inflammation group was associated with shorter event-free survival regardless of BMI. This study provides evidence that inflammation is an important consideration in the association between obesity and better outcomes in patients with HF.

High Dietary Sodium Intake is Associated with Shorter Event-Free Survival in Patients with Heart Failure and Comorbid Diabetes

The aim was to determine whether 24-hour urine sodium excretion predicted event-free survival of patients with heart failure (HF) and diabetes mellitus (DM). Twenty-four hour urine sodium, as an indicator of dietary sodium, was collected from 107 patients with HF and comorbid DM. Patients were followed for a median period of 337 days to determine time to the first event of either all-cause hospitalization or cardiac-related mortality. There were 44 patients (41%) who had an event of death or hospitalization. Cox regression showed that higher urine sodium (>3.8 gm/day) was associated with 2.8 times greater risk for an event than lower urine sodium after controlling for age, gender, New York Heart Association class (I/II vs. III/IV), left ventricular ejection fraction, and body mass index. These data suggest that dietary sodium restriction may be beneficial for patients with HF and DM.

Perceptions related to cardiovascular disease and physical activity behavior in Arab men: A qualitative study

OBJECTIVES

To describe the daily physical activity of Arab men living in the United States and to understand how perceptions of cardiovascular disease (CVD) risk influence their inclusion of physical activity into their daily routine.

METHODS

A qualitative descriptive method using a semi-structured face-to-face interview with each participant was conducted. Twenty young college males (age 26 ± 4 years) were recruited from Arab American community centers.

RESULTS

The qualitative inductive content analysis revealed three main themes: impact of perceived CVD risk on physical activity behavior and perceived barriers and motivators to be physically active. Arab men primarily perceived gaining weight as the most important CVD risk factor that could promote their physical activity behavior.

CONCLUSIONS

These findings demonstrate that unawareness about CVD risk and barriers to regular physical activity must be considered in any intervention to engage Arab men in regular physical activity.