10 research outputs found
Identifying Predictors of High Sodium Excretion in Patients with Heart Failure: A Mixed Effect Analysis of Longitudinal Data
Get PDFBACKGROUND: A low-sodium diet is a core component of heart failure self-care but patients have difficulty following the diet.
AIM: The aim of this study was to identify predictors of higher than recommended sodium excretion among patients with heart failure.
METHODS: The World Health Organization Five Dimensions of Adherence model was used to guide analysis of existing data collected from a prospective, longitudinal study of 280 community-dwelling adults with previously or currently symptomatic heart failure. Sodium excretion was measured objectively using 24-hour urine sodium measured at three time points over six months. A mixed effect logistic model identified predictors of higher than recommended sodium excretion.
RESULTS: The adjusted odds of higher sodium excretion were 2.90, (95% confidence interval (CI): 1.15-4.25, pp=0.007) for patients with diabetes; and 2.22 (95% CI: 1.09-4.53, p=0.028) for patients who were cognitively intact.
CONCLUSION: Three factors were associated with excess sodium excretion and two factors, obesity and diabetes, are modifiable by changing dietary food patterns
Cross-cultural adaptation and validation of Behçet's disease quality of life questionnaire
Get PDF<p>Abstract</p> <p>Background</p> <p>Currently, there is one Behçet's disease (BD) specific self reporting questionnaire developed and published in the literature, The Leeds BD-quality of life (QoL). We conducted a cross-cultural adaptation and validation of the Arabic version of the Leeds BD-QoL</p> <p>Methods</p> <p>A cross-sectional study was conducted among 41 consecutive patients attending rheumatology clinics at the American University of Beirut Medical Center between June and December 2007. The BD-QoL questionnaire, the Katz Index of Activities of Daily Living (ADL) and the Lawton Instrumental Activities of Daily Living (IADL) questionnaires were co-administered during the same visit, and severity scores were calculated. Cross-cultural adaptation of BD-QoL was performed using forward and backward translations of the original questionnaire. Internal consistency and test-retest reliability of the final version were determined. Exploratory Factor Analysis (EFA) was used to assess the dimensionality of the scale items. External construct validity was examined by correlating Arabic BD-QoL with the severity score, ADL and IADL.</p> <p>Results</p> <p>The 30 items of the adapted Arabic BD-QoL showed a high internal consistency (KR-20 coefficient 0.89) and test-retest reliability (Spearman's test 0.91). The convergence of all 30 items suggests that the 30-item adapted Arabic BD-QoL scale is unidimensional. BD-QoL did not correlate with any of the patients' demographics. Still, it was positively correlated with patient severity score (r 0.4, p 0.02), and IADL (but not ADL).</p> <p>Conclusions</p> <p>This cross-cultural adaptation has produced an Arabic BD-QoL questionnaire that is now available for use in clinical settings and in research studies, among Arabic speaking patients.</p
Experiences and Health Outcomes of Emerging Adults with Type 1 Diabetes: A Mixed Methods Study
Get PDFBackground Emerging adults with type 1 diabetes are at risk of poorer diabetes-related health outcomes than other age groups. Several factors affecting the health and experiences of the emerging adults are culture and healthcare specific.Objectives The aim of this study was to explore the experience of emerging adults living with type 1 diabetes in Lebanon, describe their diabetes self-care and diabetes-related health outcomes (HbA1c and diabetes distress), and identify the predictors of these outcomes.Methods A convergent mixed methods design was used with 90 participants aged 18-29 years. Sociodemographic, clinical data, and measures of diabetes distress, social support, and self-care were collected. Fifteen emerging adults participated in individual semi-structured interviews. Multiple linear regression was used to determine predictors of diabetes outcomes. Thematic analysis was used to analyze qualitative data. Data integration was used to present the mixed methods findings.Results The study sample had a mean HbA1c of 7.7% (SD = 1.36) and 81.1 % reported moderate to severe diabetes distress levels. The participants had good levels of diabetes self-care and high levels of social support. HbA1c was predicted by insulin treatment type, age at diagnosis, and diabetes self-care; while diabetes distress was predicted by diabetes knowledge, blood glucose monitoring approach, and diabetes self-care. âLiving with type 1 diabetes during emerging adulthood: the complex balance of a chemical reactionâ was the overarching theme of the qualitative data, with three underlying themes: âBreaking of bonds: changes and taking ownership of their diabetesâ, âThe reactants: factors affecting the diabetes experienceâ, and âAiming for equilibriumâ. The integrated mixed methods results revealed one divergence between the qualitative and quantitative findings related to the complexity of the effect of received social support.Discussion The suboptimal health of the emerging adults despite good self-care highlights the importance of addressing cultural and healthcare specific factors such as diabetes knowledge and public awareness, social support, and availability of technology to improve diabetes health. Findings of this study can guide future research, practice, and policy development
Differences in cardiovascular event-free survival by age in adults with moderate and severe chronic kidney disease
No full textCardiovascular outcomes and death are major consequences of chronic kidney disease (CKD) occurring in the moderate and severe stages of the disease, prior to advancement into dialysis and transplantation. At all levels of kidney function, mortality increases with age; however, the risk of mortality decreases with age within CKD groups. Moreover, the relative risk of cardiovascular outcomes seems to be lower in older individuals. Clinical prognosis seems to vary by age, but age has not been adequately investigated as a prognostic indicator in these patients; previous studies have focused on the relationship between kidney function and outcomes. The purpose of the study was to examine the relationship between age and cardiovascular event-free survival in patients with moderate and severe CKD. This study was a secondary analysis of a cohort (aged 45â84 years) in the Multi-Ethnic Study of Atherosclerosis. The selected sample (n=762) exhibited a 15â¤estimated glomerular filtration rate (eGFR)\u3c60 ml/min/1.73m2 and was followed up for over 6 years. Kaplan Meier analysis and Cox proportional hazards regressions were performed to elaborate on the role of age on time to first event of combined outcome (cardiovascular events and mortality) and non-fatal cardiovascular events. Additionally, nonlinearity of the age and outcome relationship, and the interaction effect of age and eGFR were examined. Age had a highly significant predictive role on time to combined outcome and cardiovascular events in individuals with moderate (stage 3) and severe (stage 4) CKD. Importantly, however, the effect of age on outcomes dissipated in a subsample with eGFR values below 45 ml/min/1.73m2 (stages 3b and 4), with no significant differences noted in the risk of outcomes between younger and older individuals. This study elucidated the significant moderator role of eGFR on the relationship between age and outcome in CKD patients. These findings suggest a need for the consideration of age-specific approaches in the care of patients with moderate and severe CKD. Younger adults with CKD require routine examinations and early preventive measures for the reduction of cardiovascular morbidity and mortality. In older adults, therapeutic efforts may need to be directed at comorbidities rather than a focus on eGFR-related consequences
Differences in cardiovascular event-free survival by age in adults with moderate and severe chronic kidney disease
No full textCardiovascular outcomes and death are major consequences of chronic kidney disease (CKD) occurring in the moderate and severe stages of the disease, prior to advancement into dialysis and transplantation. At all levels of kidney function, mortality increases with age; however, the risk of mortality decreases with age within CKD groups. Moreover, the relative risk of cardiovascular outcomes seems to be lower in older individuals. Clinical prognosis seems to vary by age, but age has not been adequately investigated as a prognostic indicator in these patients; previous studies have focused on the relationship between kidney function and outcomes. The purpose of the study was to examine the relationship between age and cardiovascular event-free survival in patients with moderate and severe CKD. This study was a secondary analysis of a cohort (aged 45â84 years) in the Multi-Ethnic Study of Atherosclerosis. The selected sample (n=762) exhibited a 15â¤estimated glomerular filtration rate (eGFR)\u3c60 ml/min/1.73m2 and was followed up for over 6 years. Kaplan Meier analysis and Cox proportional hazards regressions were performed to elaborate on the role of age on time to first event of combined outcome (cardiovascular events and mortality) and non-fatal cardiovascular events. Additionally, nonlinearity of the age and outcome relationship, and the interaction effect of age and eGFR were examined. Age had a highly significant predictive role on time to combined outcome and cardiovascular events in individuals with moderate (stage 3) and severe (stage 4) CKD. Importantly, however, the effect of age on outcomes dissipated in a subsample with eGFR values below 45 ml/min/1.73m2 (stages 3b and 4), with no significant differences noted in the risk of outcomes between younger and older individuals. This study elucidated the significant moderator role of eGFR on the relationship between age and outcome in CKD patients. These findings suggest a need for the consideration of age-specific approaches in the care of patients with moderate and severe CKD. Younger adults with CKD require routine examinations and early preventive measures for the reduction of cardiovascular morbidity and mortality. In older adults, therapeutic efforts may need to be directed at comorbidities rather than a focus on eGFR-related consequences
Obesity, aldosterone excess, and mineralocorticoid receptor activation: Parallel or intersected circumstances?
No full textAbstract The obesity pandemic, with its associated comorbidities of hypertension and diabetes, constitutes a global public health issue. Importantly, there is an increasing prevalence of aldosterone excess related to obesity and resultant poor health outcomes. Nevertheless, the association between aldosterone and obesity still needs to be clarified. In this review, the authors discuss the role of white adipose tissue in linking obesity, aldosterone excess, and hypertension. The consequences of aldosterone excess in obesity are presented as genomic, nonâgenomic, and nonâepithelial effects. Moreover, the authors emphasize the value of interference with aldosterone pathophysiology (as with mineralocorticoid antagonists) in obesity, thus reducing the adverse clinical impact of aldosterone in myocardial infarction, heart failure, kidney dysfunction, and associated mortality
Cognitive Impairment in Chronic Kidney Disease: Vascular Milieu and the Potential Therapeutic Role of Exercise
No full textChronic kidney disease (CKD) is considered a model of accelerated aging. More specifically, CKD leads to reduced physical functioning and increased frailty, increased vascular dysfunction, vascular calcification and arterial stiffness, high levels of systemic inflammation, and oxidative stress, as well as increased cognitive impairment. Increasing evidence suggests that the cognitive impairment associated with CKD may be related to cerebral small vessel disease and overall impairment in white matter integrity. The triad of poor physical function, vascular dysfunction, and cognitive impairment places patients living with CKD at an increased risk for loss of independence, poor health-related quality of life, morbidity, and mortality. The purpose of this review is to discuss the available evidence of cerebrovascular-renal axis and its interconnection with early and accelerated cognitive impairment in patients with CKD and the plausible role of exercise as a therapeutic modality. Understanding the cerebrovascular-renal axis pathophysiological link and its interconnection with physical function is important for clinicians in order to minimize the risk of loss of independence and improve quality of life in patients with CKD
The Use of Artificial Intelligence in Estimating Arterial Stiffness: An Ongoing Scoping Review
No full textOngoing Scoping Review-AI and Arterial Stiffnes
