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Tramontt CR, Mouti S, Lima Do Vale M, Li X, Golubic R, Ray S. Do markers of adiposity and glycaemia mediate the association between low carbohydrate diet and cardiovascular risk factors: findings from the UK National Diet and Nutrition Survey (NDNS) 2008-2016. BMJ Nutr Prev Health 2023; 6:153-163. [PMID: 38618540 PMCID: PMC11009521 DOI: 10.1136/bmjnph-2022-000551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/05/2023] [Indexed: 04/16/2024] Open
Abstract
Objectives To examine the associations between low carbohydrate diet (LCD) and conventional cardiovascular risk factors and investigate whether these associations are mediated by body mass index (BMI), waist circumference (WC) and haemoglobin A1c (HbA1c) applying causal mediation analyses. Methods We included 3640 adults aged 45-80 years from the UK National Diet and Nutrition Survey programme (2008-2016) with data on dietary intake, anthropometric and biochemical parameters. Four hypothetical interventions were examined: (1) LCD, (2) Low carbohydrate (LC) and high fibre diet (LCHF), (3) LC and high saturated fat diet (LCHS) and (4) LC and high unsaturated fat diet (LCHU). BMI and WC were used as markers of obesity. Biochemical markers included HbA1c, total cholesterol, high-density lipoprotein and low-density lipoprotein (LDL) cholesterol, triglycerides, systolic and diastolic blood pressure and C reactive protein (CRP). BMI, WC and HbA1c were used as a mediator of the effects. The analysis was adjusted for sociodemographic characteristic, smoking, estimated total energy intake, alcohol consumption and antihypertensive medication. To identify a potential causal effect of LCD on cardiovascular disease (CVD) risk, we estimated the average treatment effect, and corresponding p values and CI for the total, indirect and direct effect of the treatment on the outcome. Results BMI, WC and HbA1c fully mediated the association between LCD and triglycerides and fully mediated the effects of LCHF on LDL, although BMI and WC were not sufficient to fully mediate the effects of LCHF on triglycerides and CRP. BMI alone fully mediated the effects of LCHS on HbA1c, triglycerides, LDL and CRP. None of these mediators explained the effect of LCHU on CVD risk markers. Conclusion The causal hypotheses tested in this study demonstrate that individuals on LCD with high fibre intakes improved their CVD markers as expected, but those on LCD who increase fat intake had no effects on CVD markers mediated by obesity and diabetes.
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Affiliation(s)
| | - Saad Mouti
- Consortium for Data Analytics in Risk, University of California, Berkeley, California, USA
| | | | - Xunhan Li
- NNEdPro Global Institute for Food Nutrition and Health, Cambridge, UK
| | - Rajna Golubic
- NNEdPro Global Institute for Food Nutrition and Health, Cambridge, UK
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Sumantra Ray
- NNEdPro Global Institute for Food Nutrition and Health, Cambridge, UK
- School of Biomedical Sciences, Ulster University at Coleraine, Coleraine, UK
- Fitzwilliam College, University of Cambridge, Cambridge, UK
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Loureiro Diaz J, Foster LD, Surendran PJ, Jacob P, Ibrahim O, Gupta P. Developing and delivering a hybrid Cardiac Rehabilitation Phase II exercise program during the COVID-19 pandemic: a quality improvement program. BMJ Open Qual 2023; 12:bmjoq-2022-002202. [PMID: 37257915 DOI: 10.1136/bmjoq-2022-002202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
The COVID-19 pandemic resulted in the cessation of approximately 75% of cardiac rehabilitation (CR) programmes worldwide. In March 2020, CR phase II (CRP2) services were stopped in Qatar. Multiple studies had shown safety, effectiveness, reduced cost of delivery and improved participation with hybrid CR. A multidisciplinary team reviewed various alternative models for delivery and decided to implement a hybrid CRP2 exercise programme (HCRP2-EP) to ensure continuation of our patient care. Our aim was to enrol in the HCRP2-EP 70% of all eligible patients by 30 September 2020. Institute for Health Care Improvement's collaborative model was adopted. Multiple plan-do-study-act cycles were used to test change ideas. The outcomes of the project were analysed using standard run chart rules to detect the changes in outcomes over time. This project was implemented from March 2020, and the male patients enrolled between August 2020 and April 2021, with sustained monthly median enrolment above target of 70% throughout. As for our secondary outcome, 75.8% of the male patients who completed HCRP2-EP showed a meaningful change in peak exercise capacity of ≥10% (mean change 17%±6%). There were no major adverse events reported, and the median Patient Satisfaction Score was 96% well above the institutional target of 90%. This shows a well-designed quality improvement programme is an appropriate strategy for implementing HCRP2-EP in a clinical setting, and HCRP2-EP is a feasible, effective and safe intervention in eligible male patients with cardiovascular disease.
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Affiliation(s)
- Javier Loureiro Diaz
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Liam David Foster
- Cardiac Rehabilitation Department, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Prasobh Jacob
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Omar Ibrahim
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Poonam Gupta
- Performance Improvement Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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3
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Marques-Sule E, Deka P, Almenar L, Pathak D, López-Vilella R, Klompstra L. Physical Activity Readiness in Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316332. [PMID: 36498402 PMCID: PMC9738390 DOI: 10.3390/ijerph192316332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 05/29/2023]
Abstract
The aim of this study was to explore the readiness for physical activity (PA) and its related factors in patients with heart failure. This cross-sectional study included 163 patients with heart failure (mean age 66 ± 16, 50% female). The ability to safely engage in PA was assessed with the PA Readiness Questionnaire (PAR-Q). Psychological readiness was measured using two questionnaires, namely: Exercise Self-efficacy Scale and the Motivation for PA and Exercise/Working Out. A multivariate analysis of covariance was conducted to test the effect of background variables on readiness for PA. 64% (n = 105) of patients reported not being able to safely engage in PA, 80% (n = 129) reported low self-efficacy, and 45% (n = 74) were extrinsically motivated indicating external factors drove their motivation. Factors that positively influenced the PA readiness included lower age (p < 0.01), being male (p < 0.01), being married (p < 0.01), having higher education (p < 0.01), being in NYHA-class I compared with II (p < 0.01), less time since diagnosis (p < 0.01), lower BMI (p = 0.02), and not suffering from COPD (p = 0.02). Prior to recommending exercise, assessment of safety to engage in PA along with self-efficacy and motivation in patients with heart failure is essential.
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Affiliation(s)
- Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Unidad de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Pallav Deka
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA
| | - Luis Almenar
- Unidad de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Dola Pathak
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA
| | - Raquel López-Vilella
- Unidad de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, 58183 Linkoping, Sweden
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Irani F, Coquoz E, von Wolff M, Bitterlich N, Stute P. Awareness of non-communicable diseases in women: a cross-sectional study. Arch Gynecol Obstet 2022; 306:801-810. [PMID: 35426002 PMCID: PMC9411077 DOI: 10.1007/s00404-022-06546-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 03/21/2022] [Indexed: 12/24/2022]
Abstract
Chronic non-communicable diseases (NCD) are the major reason for death, morbidity, loss of independency and public health cost. NCD prevalence could be significantly reduced by adopting a healthy lifestyle. This cross-sectional cohort study (online survey) in 221 women aimed to assess NCD awareness, knowledge about NCD prevention and willingness to adopt a healthier lifestyle in women. Overall, NCD awareness level was quite high with, however, information mainly originating from lay media, probably being one reason for false estimations of age groups mainly affected by NCD, impact of NCD on quality of life, NCD mortalities, and the extent of NCD prevention by lifestyle interventions, respectively. Furthermore, also due to mainly lay media, half of women knew online NCD risk calculators, most of them would like to know their NCD risk, but only few had been offered NCD risk calculation by their physician. The mean threshold for willing to adopt a healthier lifestyle was a roughly calculated 37% 5-10 years risk to develop a certain NCD. Acceptance of non-pharmacological interventions for NCD prevention was high, however, major barriers for not implementing a healthier lifestyle were lack of expert information and lack of time. In conclusion, future public health strategies should focus on distributing better understandable and correct information about NCD as well as meeting the individuals' request for personalized NCD risk calculation. Furthermore, physicians should be better trained for personalized NCD prevention counseling.
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Affiliation(s)
- Fiona Irani
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Eloïse Coquoz
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Michael von Wolff
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | | | - Petra Stute
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland.
- Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital Inselspital, Friedbuehlstrasse 19, 3010, Bern, Switzerland.
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Rodgers NH, Gerlach-Houck H. "Knowledge Without Action Means Nothing": Stakeholder Insights on the Behaviors That Constitute Positive Change for Adults Who Stutter. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1637-1652. [PMID: 35452272 DOI: 10.1044/2022_ajslp-21-00251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The aim of this study was to document the behaviors that adults who stutter (AWS) may engage in to make positive changes to living with stuttering. METHOD We interviewed 23 key stakeholders, including 11 AWS and 12 speech-language pathologists who specialize in stuttering therapy. The semi-structured interviews began with the primary question, "If an adult who stutters was making positive changes to living with stuttering, what would they be doing?" Follow-up probing questions focused the interviews on identifying actionable behaviors that would suggest positive changes. The interviews were transcribed and qualitatively analyzed using applied and reflexive thematic analyses to develop multilevel themes. RESULTS Meaningful units extracted from the interviews contributed to three high-order global themes: (a) noticing and adjusting physical behaviors involved in speaking, to the extent that it is personally important to do so; (b) developing neutral or positive thoughts and feelings about stuttering; and (c) participating more fully in social and professional activities, even if the person stutters or thinks they might stutter. We developed 35 low-order basic themes, which we grouped into 11 mid-order organizing themes, to richly illustrate the three global themes. CONCLUSIONS These findings extend the ongoing discussion regarding best practices for therapy targets in stuttering intervention. We identified measurable, multidimensional actions that clinicians can integrate in their therapy plans with AWS. While these actions represent a holistic approach to making positive changes, it grants clients and clinicians space to develop individualized intentions and outcomes.
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Affiliation(s)
- Naomi H Rodgers
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
| | - Hope Gerlach-Houck
- Department of Speech, Language and Hearing Sciences, Western Michigan University, Kalamazoo
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6
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De Bacquer D, Astin F, Kotseva K, Pogosova N, De Smedt D, De Backer G, Rydén L, Wood D, Jennings C. Poor adherence to lifestyle recommendations in patients with coronary heart disease: results from the EUROASPIRE surveys. Eur J Prev Cardiol 2021; 29:383-395. [PMID: 34293121 DOI: 10.1093/eurjpc/zwab115] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/14/2022]
Abstract
AIMS Despite the high use of cardioprotective medications, the risk factor control in patients with coronary heart disease (CHD) is still inadequate. Guidelines identify healthy lifestyles as equally important in secondary prevention as pharmacotherapy. Here, we describe reasons for poor lifestyle adherence from the patient's perspective. METHODS AND RESULTS In the EUROASPIRE IV and V surveys, 16 259 CHD patients were examined and interviewed during a study visit ≥6 months after hospital discharge. Data gathering was fully standardized. The Brief Illness Perception questionnaire was completed by a subsample of 2379 patients. Half of those who were smoking prior to hospital admission, were still smoking; 37% of current smokers had not attempted to quit and 51% was not considering to do so. The prevalence of obesity was 38%. Half of obese patients tried to lose weight in the past month and 61% considered weight loss in the following month. In relation to physical activity, 40% was on target with half of patients trying to do more everyday activities. Less than half had the intention to engage in planned exercise. Only 29% of all patients was at goal for all three lifestyle factors. The number of adverse lifestyles was strongly related to the way patients perceive their illness as threatening. Lifestyle modifications were more successful in those having participated in a cardiac rehabilitation and prevention programme. Patients indicated lack of self-confidence as the main barrier to change their unhealthy behaviour. CONCLUSION Modern secondary prevention programmes should target behavioural change in all patients with adverse lifestyles.
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Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Felicity Astin
- Centre for Applied Research in Health, University of Huddersfield and Calderdale & Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - Nana Pogosova
- National Medical Research Centre of Cardiology, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Lars Rydén
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Catriona Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
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7
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Raffee LA, Alawneh KZ, Ibdah RK, Rawashdeh SI, Zoghoul S, Ewais AS, Al-Mistarehi AH. Prevalence, Clinical Characteristics, and Risk Among Patients with Ischemic Heart Disease in the Young Jordanian Population. Open Access Emerg Med 2020; 12:389-397. [PMID: 33235526 PMCID: PMC7678703 DOI: 10.2147/oaem.s272961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/27/2020] [Indexed: 01/18/2023] Open
Abstract
PURPOSE This study aims to evaluate the prevalence of ischemic heart disease (IHD) among the young population in Jordan. We examined the risk factors that might be involved in disease incidence. Clinical characteristics, patients' living standards, and various other risk factors were considered to conduct the study. METHODS A retrospective study was conducted at King Abdullah University Hospital. Data were collected from patients who visited this hospital between January 2013 and December 2017. Only young Jordanian adults of age <50 years were included in this study. The data of 358 patients were purposively collected and analyzed (as per the determined inclusion criteria), where information related to their baseline characteristics, clinical characteristics, and related biochemical assays was reviewed. RESULTS This study showed a high prevalence of IHD among young males in Jordan. It also revealed that increased age, smoking, hypertension, unfavorable lipid profile, and obesity were the major possible risk factors for the occurrence of disease. These patients were initially diagnosed with either unstable angina or acute myocardial infarction. Initial WBCs count, particularly monocytes differential, was high in about one-third of patients, besides cardiac biomarkers. CONCLUSION The high incidence of IHD was noticed among young individuals. We suggest that more efforts should be instigated for reducing the high prevalence of IHD by adopting a healthy lifestyle, preventive attitude, and nutritious food intake.
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Affiliation(s)
- Liqaa A Raffee
- Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaled Z Alawneh
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rashid K Ibdah
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sukaina I Rawashdeh
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sohaib Zoghoul
- Medical Education Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Abdel Salam Ewais
- Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Eshah NF, Mosleh SM, Al-Smadi A. The Decisional Balance Toward Health Behaviors Among Patients With Hypertension. Clin Nurs Res 2020; 30:977-984. [PMID: 33131320 DOI: 10.1177/1054773820967548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The decisional balance is related to the transtheoretical model, and involves weighting the pros and cons of performing a behavior. The study aimed to assess hypertensive patients' decisional balances about smoking, weight control, and physical exercise. A cross-section descriptive correlation design was used, and 110 patients were recruited using convenience sampling in outpatient clinics. The decisional balance was measured using "Decisional Balance Scales," which assess an individual's decisional balance related to smoking, weight control, and physical exercise behaviors. The results predicted that Jordanian hypertensive patients with higher physical exercise decisional balance and higher weight decisional balance had lower smoking decisional behaviors. Nurses can foster health promotion and behavioral change by employing interventions that improve decisional balances. Improving the decisional balance of one behavior would have a positive impact on other behaviors. Thus, designing multidimensional interventions might be effective for modifying different types of health behaviors, and fostering health promotion practices.
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Affiliation(s)
| | - Sultan M Mosleh
- Faculty of Nursing, Mutah University, Jordan, UAE.,Higher colleges of Technology, Fujairah, UAE
| | - Ahmed Al-Smadi
- Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
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