Medicine and Health Sciences Commons^™

Medicine Adherence As A Determinant Of Complication Development In Diabetes And Hypertension Patients On A Medical Aid Scheme In Zimbabwe, Tsitsi Moyo

Walden Dissertations and Doctoral Studies

Pharmacotherapy is a significant component of chronic disease management; its efficacy depends on long term, correct, and consistent use; however, medicine adherence rates remain low. The cost of medicines is considered a significant barrier to adherence, especially in low-income settings. This quantitative cross-sectional study was conducted using data from Cimas Medical Aid Society collected between 2015 and 2019. The purpose of the study was to determine the extent of the association between medicine adherence, complication development, and cost of care among diabetic and hypertensive patients while controlling for age and gender on a population that does not experience cost barriers …

‘Doing’ Hypertension: Experiential Knowledge And Practice In The Self-Management Of ‘High Blood’ In The Philippines, Gideon Lasco, Alicia Renedo, Jhaki A. Mendoza, Maureen L. Seguin, Benjamin Palafox, Lia M. Palileo-Villanueva, Dina Balabanova, Martin Mckee

Development Studies Faculty Publications

Patients’ embodied experiences do not always correspond to the biomedical concepts of particular diseases. Drawing from year-long fieldwork in the Philippines that involved semi-structured interviews, focus group discussions and digital diaries, we examine how individuals ‘do’ hypertension through their embodied experiences and the knowledge and practice that emerge from them. Drawing inspiration from Annemarie Mol’s work on the notion of ‘multiplicity’ of disease, our analysis was informed by a commitment to privileging patients’ embodied experiences and the multiple ontologies of hypertension. We find that for patients diagnosed with hypertension in the Philippines, symptoms enact illness; patients rely on their …

Prevalence, Determinants And Outcomes Of Traditional, Complementary And Alternative Medicine Use For Hypertension Among Low-Income Households In Malaysia And The Philippines, Lia M. Palileo-Villanueva, Benjamin Palafox, Arianna Maever L. Amit, Veincent Christian F. Pepito, Fadhlina Ab-Majid, Farnaza Ariffin, Dina Balabanova, Mohamad-Rodi Isa, Nafiza Mat-Nasir, Mazapuspavina My

Ateneo School of Medicine and Public Health Publications

Background

Traditional, complementary and alternative medicine (TCAM) is used to treat a broad range of conditions. In low- and middle-income countries (LMICs), TCAM use is particularly common among those with low socio-economic status. To better understand the patterns and impact of TCAM use on the management of non-communicable diseases in these populations, this study examines the prevalence and characteristics of TCAM use for hypertension, its determinants, and its association with hypertension management outcomes and wellbeing among low-income adults in two Southeast Asian countries at different levels of economic and health system development, Malaysia and the Philippines.

Methods

We analysed cross-sectional …

Thinking Inside The Food Pantry Box, Elizabeth Shoaf

Doctor of Nursing Practice Projects

Background: Prior research has indicated a varying relationship between food security and obesity risk. Food insecurity is a known complication of men and women’s underlying health issues, such as hypertension and diabetes, because of altered food choices.

Objective: Provide healthier food options to the food insecure within the facility’s food distribution boxes, as available, for the two most common health issues (diabetes and high blood pressure).

Methods: Clients at a local food pantry were interviewed individually to learn more about food insecurity and complicating health issues, such as obesity, diabetes, and high blood pressure (hypertension) while simultaneously offering alternative food …

Impact Of Public Health Nurse Training On Their Perception To Provide Hypertension And Diabetes Care To Patients In Their Communities., Stephen Goggans, Jean O'Connor, Elena A. Wood, Elizabeth Sacksteder Laclair, Kathryn Martin, Paul Wallach

Journal of the Georgia Public Health Association

To evaluate the impact of protocol training by a medical school and public health department on nurses’ perceptions to deliver care to patients with hypertension and diabetes.

Training was delivered using the Georgia Diabetes and Hypertension Nurse protocols for public health nurses. A survey was developed and distributed post training to participants. The training included lectures, workshops, case discussions, simulation, and physical examination practice on standardized patients. Participants were asked about perceptions, both before and after training completion regarding frequency in changing practice and confidence in treating hypertension and diabetes for six items.

Perceived levels of confidence for all questionnaire …

Improving Medication Adherence For African American Patients With Hypertension, Kimberly Fitzgerald

Walden Dissertations and Doctoral Studies

Adherence to antihypertensive medications is essential for positive outcomes in treating hypertension (HTN). But the rate of nonadherence to antihypertensive medications among African Americans (AA) is low. The purpose of this DNP project was to develop a clinical practice guideline (CPG) that would assist in improving hypertensive medication adherence in the AA patient population as well as assess whether the CPG would be recommended by a team of content experts for use in their practice. The Hypertension Medication Adherence CPG incorporated the medication adherence model and the transtheoretical model to generate evidence-based interventions. Grading of Recommendations Assessment, Development, and Evaluation …

Implementation Of Standardized Protocols For Office Blood Pressure Measurement, Steven Nevers, Alice Tran, Carol Gambrill, Anush Pillai

Gulf Coast Division GME Research Day 2022

No abstract provided.

Hypertension Pharmacological Treatment In Adults: A World Health Organization Guideline Executive Summary, Akram Al-Makki, Donald Dipette, Paul K. Whelton, M Hassan Murad, Reem A. Mustaf, Shrish Acharya, Hind Mamoun Beheiry, Beatriz Champagne, Kenneth Connell, Unab I. Khan

Department of Family Medicine

Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient's values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.

The Role Of Mitochondrial Genetic Background In Cellular Function, Response To Cell Stress And Disease Susceptability, Jamelle A. Brown

All ETDs from UAB

There is a differential susceptibility associated with several diseases including cardiovascular disease (CVD) and hypertension, with Blacks being more likely to develop these conditions. Blacks are also more likely to die from these diseases. To explain the genetic etiology underlying CVD pathogenesis, the primary focus has been on nuclear genetics-environmental interactions, whereas the contribution of mitochondrial genetics is less explored. Therefore, we sought to determine whether differences exist in cellular function and response to cell stress in healthy and diseased individuals with distinct mitochondrial genetic backgrounds. To determine this, we sought first to develop a technique to detect and quantify …

Demographic, Clinical, And Co-Morbidity Characteristics Of Covid-19 Patients: A Retrospective Cohort From A Tertiary Hospital In Kenya, Reena Shah, Jasmit Shah, Nancy Kunyiha, Sayed Karar, Shahin Sayed, Salim Surani, Mansoor Saleh

Internal Medicine, East Africa

Introduction: The first documented case of COVID-19 in Kenya was recorded March of 2020. Co-morbidities including hypertension and diabetes have been associated with increased morbidity, hospitalization, and mortality among COVID-19 patients. This retrospective study describes the clinical characteristics, disease severity, and outcomes among the patient population at a tertiary hospital in Kenya.

Methods: This was a retrospective descriptive study of COVID-19 patients who were admitted between March 2020 and December 2020 at the Aga Khan University Hospital in Nairobi, Kenya. Data collected include patient demographic and baseline characteristics. Differences between patients who were known to have diabetes and hypertension during …

Disease And Diet-Induced Disruption Of Effector T Cell Homeostasis, Patrick Axel Molina

All ETDs from UAB

Homeostatic departure is a central feature across all diseases and disease processes. Currently, the average individual in the US consumes an inordinate quantity of salt. However, it is unclear if only individuals that have proven blood pressure elevation with an acute load of salt should be wary. Here we demonstrate, alongside a growing body of science, that the canonical definition of salt-sensitivity is insufficient. We show that salt-resistant mice demonstrate salt-sensitivity in non-blood pressure focused phenomena, such as the acute activation of CD4+ T cells to mobilize and induce a defective effector cytokine program with high salt. We demonstrate that …

The Relationship Between Morning Blood Pressure Surge And Asymptomatic Episodes Of Paroxysmal Atrial Fibrillation In Patients With Systemic Arterial Hypertension, Ümmü Taş, Sedat Taş, İdi̇l Yavuz

Turkish Journal of Medical Sciences

Background/aim: Hypertension is a known risk factor for developing atrial fibrillation. However, there is limited data to investigate the association between morning blood pressure surge (MBPS) and paroxysmal atrial fibrillation (PAF). We conducted the present study to determine whether there is a relationship between asymptomatic PAF and MBPS and whether MBPS may be a predictor of asymptomatic PAF episodes. Materials and methods: This prospective study comprised 264 adult patients who were newly diagnosed with essential hypertension or were previously diagnosed but not receiving regular antihypertensive therapy. We evaluated the patients in 2 groups according to their 24-h electrocardiography monitoring results: …

A Differential Response To Antihypertensive Therapy In African Men And Women: Insights From The Creole Trial, Dike B. Ojji, Gabriel L. Shedul, Mahmoud Sani, Okechukwu S. Ogah, Anastase Dzudie, Felix Barasa, Charles Mondo, Prossie M. Ingabire, Erika S.W. Jones, Brian Rayner, Damasceno Albertino, Elijah Ogola, Wynand Smythe, Nicky Hickman, Veronica Francis, Pandie Shahiemah, Grace Shedul, Akinyemi Aje, Karen Sliwa, Simon Stewart, For The Creole Investigators

IHR Papers and Journal Articles

Background: We sought to address the paucity of data to support the evidence-based management of hypertension to achieve optimal blood pressure (BP) control on a sex-specific basis in Africa.

Methods: We undertook a post hoc analysis of the multicenter, randomized CREOLE (Comparison of Three Combination Therapies in Lowering Blood Pressure in Black Africans) Trial to test the hypothesis that there would be clinically important differences in office BP control between African men and women. We compared the BP levels of 397 and 238 hypertensive women (63%, 50.9 ± 10.5 years) and men (51.2 ± 11.3 years) from 10 sites across …

Role Of Hypertension In Low-Birth-Weight Racial Disparities Among Virginian Women, Ashli Owen

Walden Dissertations and Doctoral Studies

Low birth weight (LBW) is a leading cause of infant mortality globally, but it disproportionately burdens the Black community in the United States, with a rate twice that of White women. Further, hypertensive disorders of pregnancy (HDsP) increase LBW incidence. The purpose of the study was to assess the association between HDsP and LBW, maternal race and LBW, and the moderation effect of HDsP on race and LBW on Black and White women in Virginia. The theoretical framework for this study was based on the lifecourse health development model, which states that health should be viewed as an outcome of …

Risk Of Developing Alzheimer's Disease And Related Dementias In Association With Cardiovascular Disease, Stroke, Hypertension, And Diabetes In A Large Cohort Of Women With Breast Cancer And With Up To 26 Years Of Follow-Up, Xianglin L Du, Lulu Song, Paul E Schulz, Hua Xu, Wenyaw Chan

Student and Faculty Publications

BACKGROUND: No study on the long-term incidence of Alzheimer's disease (AD) and related dementias (ADRD) has been reported in women with breast cancer by vascular diseases.

OBJECTIVE: to determine the risk of ADRD in association with cardiovascular diseases (CVD), stroke, hypertension, and diabetes in women with breast cancer.

METHODS: Study identified 246,686 women diagnosed with breast cancer at age≥65 years in 1991-2015 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Women were free of ADRD at the time of cancer diagnosis and followed from 1991 to 2016.

RESULTS: Cumulative incidence of AD over 26 years of follow-up varied …

Racial Disparities In Treatments And Mortality Among A Large Population-Based Cohort Of Older Men And Women With Colorectal Cancer, Xianglin L Du, Lulu Song

Student and Faculty Publications

BACKGROUND: There were racial disparities in treatment and mortality among patients with colorectal cancer, but few studies incorporated information on hypertension and diabetes and their treatment status.

PATIENTS AND METHODS: The study identified 101,250 patients from Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in the United States who were diagnosed with colorectal cancer at age ≥65 years between 2007 and 2015 with follow-up to December 2016.

RESULTS: There were substantial racial and ethnic disparities in the prevalence of hypertension and diabetes in patients with colorectal cancer, in receiving chemotherapy and radiation therapy, and in receiving antihypertensive and antidiabetic treatment. …

Associations Between Vascular Diseases And Alzheimer's Disease Or Related Dementias In A Large Cohort Of Men And Women With Colorectal Cancer, Xianglin L Du, Lulu Song, Paul E Schulz, Hua Xu, Wenyaw Chan

Student and Faculty Publications

BACKGROUND: Long term risk of Alzheimer's disease (AD) and related dementias (ADRD) associated with vascular diseases in people with colorectal cancer is unknown.

OBJECTIVE: to determine the risk of ADRD in association with cardiovascular diseases (CVD), stroke, hypertension, and diabetes in a cohort of patients with colorectal cancer.

METHODS: This retrospective cohort study consisted of 210,809 patients diagnosed with colorectal cancer at age≥65 years in 1991-2015 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database with follow-up from 1991-2016, who were free of any ADRD at the baseline (< 30 days after the date of cancer diagnosis).

RESULTS: The crude 26-year cumulative incidence of total ADRD in …

Using Implementation Mapping For The Adoption And Implementation Of Target:Bp In Community Health Centers, Melissa A Valerio-Shewmaker, Natalia I Heredia, Catherine Pulicken, Patenne D Mathews, Roshanda Chenier, Tracy L Swoboda, Ella R Garza, Fernanda Velasco-Huerta, Maria E Fernandez

Student and Faculty Publications

BACKGROUND: Despite the availability of multilevel evidence-based interventions for blood pressure management, poor hypertension control is common among community health center patient populations across the state of Texas and the United States.

METHODS: We used Implementation Mapping (IM) to identify barriers and facilitators influencing the adoption and implementation of the

RESULTS: As part of the needs and capacity assessment, we collected data through interviews with CHC staff, examining gaps in needs and services (e.g., what do clinics need to implement

DISCUSSION: This paper provides an example of using Implementation Mapping to develop strategies to increase the adoption and implementation of …

Home Exercise For Patients With Limited Access And Resources, Justin L. Esteban

Family Medicine Clerkship Student Projects

Patients with limited resources and who are socioeconomically disadvantaged, don’t have the time or resources available to partake/pursue exercise. Having a home workout program may prove to be beneficial to patients who don't have access to a gym, equipment, or are otherwise constrained by time.

Incidence And Potential Co-Morbidities In Facial Pigmentary Demarcation Lines In Indian Populations, Lakkireddygari Sujana, Savitha L. Beergouder, Alekhya Rallapalli, Sujatha Alla, Prasanthi Chidipudi

Engineering Management & Systems Engineering Faculty Publications

Background: The most noticeable part of human body is face. The obvious boundaries on the skin known as Pigmentary Demarcation Lines (PDL) found over face and have clear borders of abrupt transition between more hyper-pigmented skin and areas of normal skin pigmentation due to differences in melanocyte distribution that may be influenced by multiple factors. Facial pigmentary demarcation lines (PDL) directly reflect on patient’s physical appearance and self-image as they may contribute to dysmorphism and even central to depressive illness in susceptible individuals posing cosmetic concern for the patient and a challenge for dermatologist. Therefore, it is important for early …

Easy And Accurate Transition Between Common Beta Blockers: A Qi Project, Sam Short, Amalia Kane

Family Medicine Clerkship Student Projects

Hypertension is a common condition that often worsens with disease progression and/or age alone. The management of hypertension often requires multiple drug therapy. Beta blockers can be useful for this, and are often prescribed for other comorbid conditions such as angina or heart failure. Yet, not all beta blockers have the same effect on blood pressure and it can be advantageous to transition patients to non-selective agents such as carvedilol. However, dose conversions are not 1:1 and inappropriate transition can be dangerous. No readily accessible resources are available to aid the clinical management of this problem. This project aims to …

Increasing Healthcare Delivery To The Abenaki People Through Health Screenings, Warrick Sahene

Family Medicine Clerkship Student Projects

Utilizing health screenings can increase the number of Abenaki individuals identified with comorbidities related to diabetes and hypertension. Education and resources for health maintenance are also provided to this patient population through physician counseling.

Accessibility Of Nutritious And Healthy Foods To Older Adults, Kristen Wright

Family Medicine Clerkship Student Projects

Food insecurity rates are high among older adults who have chronic conditions and/or are homebound. These patients have functional limitations, comorbidities limiting their mobility, and often are socially isolated or live alone, all of which impact their ability to access or make healthy meals. As food insecurity rises, so do the health care costs related to inaccessibility to healthy food, involving the increased risk or prevalence of chronic conditions like hypertension, diabetes, and cancer. This project aimed to understand the barriers older adults face in accessing and making healthy meals, and to educate health care providers and patients on recognizing …

The International Database Of Central Arterial Properties For Risk Stratification: Research Objectives And Baseline Characteristics Of Participants, Lucas S. Aparicio, Qi-Fang Huang, Jesus D. Melgarejo, Dong-Mei Wei, Lutgarde Thijs, Fang-Fei Wei, Natasza Gilis-Malinowska, Chang-Sheng Sheng, José Boggia, Teemu J. Niiranen

School of Medicine Publications and Presentations

OBJECTIVE

To address to what extent central hemodynamic measurements, improve risk stratification, and determine outcome-based diagnostic thresholds, we constructed the International Database of Central Arterial Properties for Risk Stratification (IDCARS), allowing a participant-level meta-analysis. The purpose of this article was to describe the characteristics of IDCARS participants and to highlight research perspectives.

METHODS

Longitudinal or cross-sectional cohort studies with central blood pressure measured with the SphygmoCor devices and software were included.

RESULTS

The database included 10,930 subjects (54.8% women; median age 46.0 years) from 13 studies in Europe, Africa, Asia, and South America. The prevalence of office hypertension was 4,446 …