Death burden of high systolic blood pressure in Sichuan Southwest China 1990-2030

Beyond the Burden: A Qualitative Inquiry into the Experiences of Chinese Informal Caregivers for People Living with HIV or AIDS

Purpose

Informal caregivers are defined as families or close friends of patients, which take considerable responsibilities for providing care to people living with HIV/AIDS (PLWHA). Although there have been a number of studies in caregiver of PLWHA, research studies that sought to quantify the effects of informal caregiving for the caregivers failed to successfully provide empirical understanding of the nature of caregiving experience. Therefore, this study adopted a qualitative approach to explore the experiences and feelings of caregivers of PLWHA during the long-term care process.

Methods

The qualitative study was conducted in August 2023 in Beijing, China. Data were collected through individual in-depth semi-structured interviews with informal caregivers of PLWHA. Theme analysis was used to identify themes from the interview transcripts.

Results

A total of 21 participants were recruited into our study, 16 were family members of PLWAHA, and 5 were homosexual lover or close friend of PLWHA. Three major themes and ten sub themes were identified by thematic analysis: (1) care burden experience (including 5 sub-themes: negative emotional experience, psychological burden, economic burden, physical health loss and limitation of social interaction); (2) benefit findings from care (including 3 sub-theme: positive emotional experience, perceived social support, health promotion); (3) Demands for caregiving capacity (including 2 sub-theme: inadequate caregiving capacity and inadequate psychological comfort capacity).

Conclusion

This qualitative study provides a comprehensive exploration of the experiences faced by informal caregivers of PLWHA in China, uncovering the complex spectrum of psychological, physical, social, and economic challenges inherent in their caregiving roles, while predominantly challenging, caregivers also reported personal growth, increased social support, and emotional fulfillment. The research results could help in developing effective interventions to reduce the caregiver burden and improve their mental health.

Does an antihypertensive diet cost more? Analysis from the Chinese Heart-Healthy diet trial

OBJECTIVE

To determine whether the Chinese heart-healthy diet (Sichuan cuisine version) (CHH diet-SC) was more expensive than the conventional Sichuan diet and explore the food groups and nutrients that mainly affected the cost of CHH diet-SC.

DESIGN

Cost analysis of 4-week intervention diets in the Sichuan center representing southwestern China in the CHH diet study.

SETTING

A multicentre, parallel-group, single-blind, randomised feeding trial evaluating the efficacy of lowering blood pressure with the cuisine-based CHH diet.

PARTICIPANTS

Totally, fifty-three participants with hypertension aged 25-75 years in the Sichuan center were randomised into the control group (n 26) or the CHH diet-SC group (n 27).

RESULTS

The CHH diet-SC was more expensive than the control diet (¥27·87 ± 2·41 v. ¥25·18 ± 2·79 equals $3·90 ± 0·34 v. $3·52 ± 0·39, P < 0·001), and the incremental cost-effectiveness ratio for a 1-mm Hg systolic blood pressure reduction was ¥9·12 ($1·28). Intakes and the cost of seafood, dairy products, fruits, soybeans and nuts, whole grains and mixed beans were higher for the CHH diet-SC than for the control diet (P < 0·001). Intakes of vitamin B1, vitamin B6, vitamin C, Mg and phosphorus were positively correlated with the cost (P < 0·05).

CONCLUSIONS

The CHH diet-SC costs more than the conventional Sichuan diet, partly due to the high cost of specific food groups. Positive correlations between the intakes of vitamin B1, vitamin B6, vitamin C, Mg, phosphorus and the dietary cost could be a direction to adjust the composition within the food groups to reduce the cost of the CHH diet-SC.

Effects of the Chinese heart-healthy diet (Sichuan cuisine) on lowering blood pressure in adults with hypertension: a randomized controlled feeding trial

BACKGROUND AND OBJECTIVES

Sichuan cuisine is characterized by high salt and oil content. We aimed to evaluate the effects of the Sichuan cuisine version of Chinese heart-healthy diet (CHH diet-SC) on blood pressure reduction among hypertensive adults.

METHODS AND STUDY DESIGN

The Chinese heart-healthy diet (CHH) trial was a multicenter randomized controlled feeding trial among Chinese hypertensive people. We conducted a secondary analysis of the CHH trial using data from the Sichuan center in Southwest China. Fifty-three people aged 25 to 75 years with a mean systolic blood pressure (SBP) between 130 and 159 mmHg were enrolled. Eligible participants underwent a 1-week run-in period with the typical local diet and were randomized 1:1 to consume the CHH diet-SC (n=27) or typical local diet (n=26) for the next 4-week. The primary outcome was the net change in SBP, the secondary outcomes included diastolic blood pressure (DBP), mean arterial pressure (MAP), and the rate of BP control.

RESULTS

Compared with the control group, the CHH diet-SC decreased cooking salt, oil, and red meat content and increased inclusion of whole grains, fruits, seafood, low-fat dairy, soybean, and nuts; the SBP experienced reductions of 7.54, 8.60, 9.14, and 10.1 mmHg at the end of weeks 1 through 4; the DBP was reduced 4.01 mmHg at week 4; the MAP was significantly reduced 6.02 mmHg finally; and rate of BP control significantly increased (p<0.05).

CONCLUSIONS

Adoption of the CHH diet-SC for 4 weeks can significantly reduce BP and increase the rate of BP control in hypertensive adults.

There was a similar U-shaped nonlinear association between waist-to-height ratio and the risk of new-onset hypertension: findings from the CHNS

Background

The association between waist-to-height ratio (WHtR) with hypertension has not been adequately explained, so in this study we sought to clarify the predictive role of WHtR on the incidence of hypertension as well as the potential nonlinear associations in the general population.

Methods

In this large prospective cohort study, a total of 4,458 individuals from the China Health and Nutrition Survey (CHNS) were included in the analysis. Multivariate Cox regression analyses, subgroup analyses, receiver operator characteristic (ROC) and restricted cubic spline (RCS) analyses were used to examine the association of WHtR with the risk of new-onset hypertension.

Results

Hypertension occurred in 32.8% of participants during the maximum six-year follow-up period. Compared with the group with lower WHtR, the group with higher WHtR had a higher incidence of hypertension (p < 0.001). Multivariate Cox regression analysis showed that the risk of hypertension was 1.45 times higher in the high WHtR group than in the low WHtR group, and that the risk of hypertension increased by 30.4% for every 0.1 unit increase in WHtR (p < 0.001). Subgroup analyses also validated the stratified associations between WHtR and the risk of new-onset hypertension in most subgroups (p < 0.05). ROC analyses also revealed that WHtR was superior to body mass index in predicting new-onset hypertension (AUC: 0.626 vs. 0.607, p = 0.009). Further RCS analysis detected a nonlinear association between WHtR and risk of new-onset hypertension (P for nonlinearity <0.001).

Conclusion

WHtR was nonlinearly associated with the risk of new-onset hypertension in the general population.

Global burden of rheumatic heart disease: trends from 1990 to 2019

Background

Rheumatic heart disease (RHD) is a critical public health issue worldwide, and its epidemiological patterns have changed over the decades. This article aimed to estimate the global trends of RHD, and attributable risks from 1990 to 2019.

Methods

Data on RHD burden were explored from the Global Burden of Disease Study 2019. Trends of the RHD burden were estimated using the estimated annual percentage change (EAPC) and age-standardized rate (ASR).

Results

During 1990–2019, increasing trends in the ASR of incidence and prevalence of RHD were observed worldwide, with the respective EAPCs of 0.58 (95% confidence interval [CI] 0.52 to 0.63) and 0.57 (95%CI 0.50 to 0.63). Meanwhile, increasing trends commonly occurred in low and middle Socio-Demographic Index (SDI) regions and countries. The largest increasing trends in the ASR of incidence and prevalence were seen in Fiji, with the respective EAPCs being 2.17 (95%CI 1.48 to 2.86) and 2.22 (95%CI 1.53 to 2.91). However, death and disability-adjusted life years (DALYs) due to RHD showed pronounced decreasing trends of ASR globally, in which the EAPCs were − 2.98 (95%CI − 3.03 to − 2.94) and − 2.70 (95%CI − 2.75 to − 2.65), respectively. Meanwhile, decreasing trends were also observed in all SDI areas and geographic regions. The largest decreasing trends of death were observed in Thailand (EAPC = − 9.55, 95%CI − 10.48 to − 8.61). Among the attributable risks, behavioral risk-related death and DALYs caused by RHD had pronounced decreasing trends worldwide and in SDI areas.

Conclusions

Pronounced decreasing trends of death and DALYs caused by RHD were observed in regions and countries from 1990 to 2019, but the RHD burden remains a substantial challenge globally. The results would inform the strategies for more effective prevention and control of RHD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13075-022-02829-3.

The application of the acoustic shadowing facilitates guidance in radial artery puncture and cannulation teaching in standardized training for residents: a randomized controlled trial

BACKGROUND

Radial artery cannulation is a crucial investigative procedure for measuring patients' blood pressure invasively and serial blood gases. However, radial artery cannulation can be challenging for medical residents, and it is necessary to establish a facile and straightforward teaching strategy. This study aimed to evaluate the efficiency of acoustic shadowing-facilitated ultrasound guidance on radial artery cannulation teaching for medical residents.

METHODS

A total of 116 medical postgraduates who underwent standardized residency training programs in the Department of Anesthesiology were randomly divided into a new ultrasound-guided teaching group and a traditional ultrasound-guided teaching group. In the new ultrasound-guided teaching group, radial artery puncture technique was taught by acoustic shadowing-facilitated ultrasound guidance. The training included both theoretical and practical components. After the training, the success rate of the first puncture attempt, the success rate of the catheterization, the ultrasonic positioning time, and the catheterization time of the two groups were compared in a unified manner. A questionnaire on the subjective evaluation of the various aspects of the program by participants was conducted at the end of the training period.

RESULTS

The study included 101 medical residents. The success rate for radial artery puncture at the first attempt in the new ultrasound-guided teaching group was 78.43%. It was significantly higher than that of the traditional ultrasound-guided group (58.00%, odds ratio = 0.380; 95% CI = 0.159 to 0.908; p = 0.027). The success rate for the first arterial catheterization in the new ultrasound-guided teaching group was significantly higher than that of the traditional ultrasound-guided group (74.51% vs. 52.00%, odds ratio = 0.371; 95% CI = 0.160 to 0.858; p = 0.019). The ultrasonic positioning time and catheterization time in minutes in the new ultrasound-guided teaching group were significantly shorter than that of the traditional ultrasound-guided group (14.36 ± 3.31 vs. 18.02 ± 4.95, p < 0.001; 10.43 ± 2.38 vs. 14.78 ± 8.02, p = 0.012). However, no significant differences were observed in the incidence of local hematomas and teaching satisfaction scores between the two groups.

CONCLUSION

Acoustic shadowing facilitates ultrasound-guided radial artery puncture and catheterization is beneficial in the standardized training and teaching of residents. It improves the success rate of the first attempt at radial artery puncture and catheterization and shortens the time of ultrasound location and catheterization.

TRIAL REGISTRATION

Registered in the Chinese Clinical Trial Registry on 28 May 2021.

REGISTRATION NUMBER

ChiCTR2100046833 .

The Effects of Home-Based Self-Care Education on Blood Pressure and Self-Care Behaviors among Middle-Aged Patients with Primary Hypertension in Iran: A Randomized Clinical Controlled Trial

Self-care education (SCE) through home visit is one of the methods with potential effects on self-care. This study aimed to evaluate the effects of home-based SCE on blood pressure and self-care behaviors among middle-aged patients with primary hypertension in Iran. This randomized controlled trial was conducted on 110 middle-aged patients with hypertension recruited from public healthcare centers in the south of Tehran, Iran in September 2019. After convenience sampling, Participants were simple randomly allocated to control and intervention groups. Intervention group received a 2-month home-based SCE while control group received routine care services. Before and 2 months after the intervention, self-care behaviors were assessed using the Hypertension Self-Care Activity Level Effects (H-SCALE). Data were analyzed using the SPSS software (v. 16.0) at a significance level of less than .05. After 2 months, the posttest mean scores of self-care behaviors in medication adherence (17.42 ± 1.03 vs 14.49 ± 1.01, p = .04), physical activity (8.16 ± 0.39 vs 6.47 ± 0.52, p = .01), low-salt diet (52.51 ± 3.8 vs 35.36 ± 3.47, p = .001), and blood pressure control (3.47 ± 0.22 vs 2.42 ± 1.89, p = .001), in the intervention group were significantly greater than the control group. However, there were no significant between-group differences respecting the posttest mean scores of the weight management ( p = .06) and smoking cessation ( p = .2). Also, the mean blood pressure between the 2 groups changed after the intervention, but this difference was not statistically significant. This study suggests the effectiveness of home-based SCE in significantly improving self-care behaviors among patients with hypertension. But more studies are needed to measure the effectiveness of intervention on blood pressure.

IRCT code: IRCT20190623043985N1. Registered 06/30/2019, https://fa.irct.ir/trial/40351 .

Effects of individualized administration of folic acid on prothrombotic state and vascular endothelial function with H-type hypertension: A double-blinded, randomized clinical cohort study

BACKGROUND

Hypertension and hyperhomocysteinemia (HHcy) have long been associated with adverse cardiovascular and cerebrovascular health outcomes. This study evaluated the effect of individualized administration of folic acid (FA) on homocysteine (Hcy) levels, prothrombotic state, and blood pressure (BP) in patients with H-type hypertension (combination of HHcy and hypertension).

METHODS

In this double-blinded, randomized clinical cohort study, 126 patients with H-type hypertension who were treated at our hospital were randomly divided into treatment and control groups (n = 55 each). The control group was treated with oral levamlodipine besylate tablets 2.5 mg and placebo, once a day (in the morning). The treatment group was first treated with oral levamlodipine besylate 2.5 mg and FA tablets 0.8 mg, once a day (in the morning), for 12 weeks. Then, in a second 12-week phase, the FA dose was adjusted using the methylene tetrahydrofolate reductase C677 polymorphism genotype. The levels of Hcy and coagulation factors, prothrombotic state parameters, BP, and adverse drug reactions were compared between the 2 groups.

RESULTS

Pretreatment general patient characteristics, including Hcy levels, were similar between the 2 groups (P > .05). BP and prothrombotic status did not differ before and after the first phase of treatment (P > .05). However, Hcy and endothelin-1 (ET-1) levels decreased, while nitric oxide levels increased significantly in the intervention group (P < .05). In the second phase, after 3 months' treatment with an FA dose adjusted according to methylene tetrahydrofolate reductase C677T genotype, the Hcy and ET-1/NO levels were significantly decreased in the intervention group and were lower than those after the first treatment phase and lower than in the control group (P < .01). BP, D-dimer levels, and fibrinogen scores were significantly lower after the second treatment phase (P < .01). There was no significant difference in the incidence of adverse drug reactions between the 2 groups (P > .05).

CONCLUSIONS

Individualized administration of FA tablets can effectively reduce BP, and Hcy and coagulation factor levels, and significantly improve prothrombotic status in patients with H-type hypertension.

Different impact factors for accurate oscillometric blood pressure measurement between sinus rhythm and atrial fibrillation

This study was conducted to evaluate whether the impact factor on the accuracy of oscillometric blood pressure (BP) is different between the patients with atrial affiliation (AF) and sinus rhythm (SR). This study included 124 AF patients and 98 SR patients who underwent coronary arteriography. Upper arm oscillometric and intro-aortic BP were simultaneously measured three times, and the averages were recorded as final values, respectively. The difference between oscillometric and intro-aortic BP was recorded as delta BP. For reducing the influence of baseline BP on delta BP, a percentage difference (PD-BP) was calculated with the formula: PD-BP = delta BP/intro-aortic BP × 100%. The oscillometric SBP and DBP levels slightly underestimated intro-aortic BP (by 2.2/1.6 mmHg) in the SR group, but significantly underestimated (by 5.8/4.8 mmHg) in the AF group. Age was negatively correlated with delta SBP and positively with delta DBP in SR patients, but not correlated in AF patients. Otherwise, ventricular rate (VR) was negatively correlated with delta SBP or delta DBP in AF, which indicated that the accuracy of oscillometric BP declined as the VR increased. With intro-aortic BP as reference, the accuracy of oscillometric BP in AF patients is lower than SR patients. Meanwhile, age may impact the oscillometric BP accuracy in SR patients, but VR may impact that in AF patients.

The Elderly's Demand for Community-Based Care Services and Its Determinants: A Comparison of the Elderly in the Affordable Housing Community and Commercial Housing Community of China

With the rapid aging of the world population, great pressure has been placed on the provision of community-based care in China. This paper aimed to compare the demand and its determinants for various community-based care services among the elderly in the affordable housing community (AHC) and commercial housing community (CHC) of China. Two community-based surveys were conducted separately in the AHC and CHC of Nanjing City, China. In total, 408 valid questionnaires were returned from the Daishan AHC while 8422 valid questionnaires were received from the CHCs. The chi square test indicated that the respondents in the AHC had significantly higher demands for five types of services (the meal-aid service, the cleaning-aid service, the bath-aid service, the rehabilitation therapy service, and the first-aid service) than those in the CHCs of Nanjing. Further, the Cochran–Mantel–Haenszel test showed that factors influencing the elderly's demands for these services varied across communities. Several policy implications could be obtained to improve the efficiency of community-based care provision.