Beneficial Lifestyle Changes Research Articles

Population screening for cirrhosis.

In response to the growing health crisis of liver-related morbidity and mortality, screening for liver cirrhosis has emerged as a promising strategy for early detection and timely intervention. By identifying individuals with severe fibrosis or compensated cirrhosis, screening holds the promise of enhancing treatment outcomes, delaying disease progression, and ultimately improving the quality of life of affected individuals. Clinical practice guidelines from international scientific societies currently recommend targeted screening strategies, investigating high-risk populations with known risk factors of liver disease. While there is good evidence that screening increases case finding in the population, and a growing number of studies indicate that screening may motivate beneficial lifestyle changes in patients with steatotic liver disease, there are major gaps in knowledge in need of clarification before screening programs of cirrhosis are implemented. Foremost, randomized trials are needed to ensure that screening leads to improved liver-related morbidity and mortality. If not, screening for cirrhosis could be unethical due to overdiagnosis, overtreatment, increased health care costs, negative psychological consequences of screening, and futile invasive investigations. Moreover, the tests used for screening need to be optimized toward lower false positive rates than the currently used FIB-4 while retaining few false negatives. Finally, barriers to adherence to screening and implementation of screening programs need to be elucidated. This review provides a comprehensive overview of the current landscape of screening strategies for liver cirrhosis and the promises and pitfalls of current methods for early cirrhosis detection.

Associations between diabetes mellitus and subsequent non-communicable diseases in Indonesia

ObjectiveTo understand how diabetes mellitus (DM) diagnosed at different ages of adulthood are associated with various incident subsequent non-communicable diseases (NCDs).MethodsWe performed a nationwide population-based analysis comparing 212 participants first diagnosed with DM at 20–39, 40–49, 50–59, or 60–69 years of age, with 17,541 participants without DM history, using data from the Indonesian Family Life Survey. Subsequent NCDs that were examined included hypertension, lung diseases, heart diseases, arthritis, liver diseases, kidney diseases, and digestive diseases. We estimated weighted risk ratios and 95% confidence intervals using Poisson regression, adjusting for age, sex, urbanicity, and tobacco use history.ResultsThose diagnosed with DM in all age groups had significantly higher risk of hypertension, compared with those without DM history. Compared with those without DM history, younger individuals with DM diagnosed at 20–39 years of age had significantly higher risks of lung diseases and arthritis, and those with DM diagnosed at 20–49 years of age had significantly higher risk of digestive diseases. Older individuals with DM diagnosed at 40–69 years of age had significantly higher risk of liver diseases, and those with DM diagnosed at 40–59 years of age had significantly higher risk of heart diseases, compared with those without DM history. Participants with DM were diagnosed with subsequent NCDs at younger ages compared with those without DM history.ConclusionOur findings contribute to health surveillance and may promote beneficial lifestyle changes in those with early-onset and later-onset DM, which can help prevent subsequent NCDs and improve public health.

Impact of a Discontinuous Training Program on Sedentary Behavior in Italian Type 2 Diabetes Older Patients: The Results of the TRIPL-A Randomized Controlled Trial.

Background: Physical activity is an important predictor of quality of life in older adults with type 2 diabetes (T2D). Unfortunately, most T2D adults adopt a sedentary lifestyle. The randomized, controlled TRIPL-A trial aims to verify the effect of a personalized, discontinuous exercise program on a sedentary lifestyle of T2D older adults. Methods: A total of 305 T2D patients (mean age ± SD: 68.8 ± 3.3 years) were divided into a control arm receiving only behavioral counseling and an intervention arm of an 18-month supervised discontinuous exercise program (ERS). The primary outcomes were the changes in sitting time (ST) and metabolic equivalent (MET) values, both evaluated by the International Physical Activity Questionnaire short form. A repeated measures ANOVA with Bonferroni correction for multiple comparisons was used to compare study outcomes. Results: The ST and MET differed significantly during the study compared to the control group (p = 0.028 and p = 0.004, respectively). In the intervention group, a decrease from baseline in ST at 6 months (p = 0.01) and an increase in MET values at 6 months (p = 0.01) up to 12 months (p < 0.01) were found. No significant differences were found for the other variables. Conclusions: Beneficial lifestyle changes were found within the first year of intervention. These results align with the theory of change.

Insights, Life Changes and Lifestyle Changes Reported by Individuals Consuming Ayahuasca in Naturalistic Settings: Nature, Frequency and Associations with Mental Health and Wellbeing

Background: In the context of increasing scientific interest in the potential therapeutic use of psychedelic agents and their underlying psychotherapeutic mechanisms, we undertake the first detailed assessment of insights and life and lifestyle changes associated with ayahuasca consumption. Methods: An international cross-sectional study of ayahuasca drinkers in a variety of settings was performed (n = 8907). Bivariate analysis and multivariate linear and logistic regressions were used to explore associations between a range of covariates and insights, life changes and lifestyle changes. The least absolute shrinkage and selection operator variable selection method (LASSO) was used to select the variables most relevant for inclusion in models assessing broader wellbeing and mental health associations. Results: Insights are almost universally reported as part of the ayahuasca experience and are highly valued by drinkers and strongly predictive of subsequent beneficial life and lifestyle changes. A range of personal, vocational, religious/spiritual and health-related life changes (attributed to ayahuasca) are also commonly identified, as are various beneficial lifestyle and health behavior changes. Demographic and ayahuasca drinking variables that are predictive of such phenomena are reported, along with associations between insights, life and lifestyle changes and perceived growth in psychological wellbeing and current mental health status (Kessler 10 and SF-12 MCS). Conclusion: Insights and subsequent life and lifestyle changes appear to have a central role in the transformative effects reported by individuals consuming ayahuasca, with these occurring across contexts of use and demographic groups.

The medium-term consequences of a COVID-19 lockdown on lifestyle among Spanish older people with hypertension, pulmonary disease, cardiovascular disease, musculoskeletal disease, depression, and cancer.

This study investigated the associations of chronic diseases with changes in lifestyle and health behaviours in older people following the coronavirus disease 2019 (COVID-19) lockdown in Spain and compared the differences in changes over time. 1,092 participants (80.3±5.6 years; 66.5% female) from 2 Spanish cohorts were included. Telephone-based questionnaires were conducted to evaluate lifestyle and health risk behaviours at the end of lockdown and 7 months post-lockdown. Participants were classified as having physician-diagnosed chronic diseases based on self-reported data. Cox proportional models adjusted for major confounders were used. Compared to those without the corresponding chronic diseases, older people with hypertension were less likely to report increased alcohol consumption (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55 to 0.99). Pulmonary diseases were associated with lower risks of increased sedentary time (HR, 0.58; 95% CI, 0.39 to 0.86) and worsened sleep quality (HR, 0.56; 95% CI, 0.36 to 0.87), while cardiovascular diseases were associated with a lower risk of decreased sedentary time (HR, 0.58; 95% CI, 0.38 to 0.88). Depression was linked to a higher likelihood of improved diet quality (HR, 1.53; 95% CI, 1.00 to 2.36). Cancer pacients were less likely to have worsened sleep quality (HR, 0.44; 95% CI, 0.22 to 0.89) but more likely to have reduced their frequency of social contact (HR, 2.05; 95% CI, 1.05 to 3.99). Older people with chronic diseases showed beneficial changes in lifestyle and health risk behaviours after the COVID-19 lockdown. In particular, older people with hypertension, pulmonary disease, and cancer tended to make beneficial lifestyle and health behaviour changes. However, older people with cardiovascular disease and depression engaged in more health risk behaviours.

The impact of health apps on lifestyle behaviours and cardiovascular risk factors in patients with cardiovascular risk factors or established cardiovascular disease: a systematic review

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme Background Adequate levels of physical activity (PA) and a healthy diet can contribute to weight loss, improved blood pressure, improved lipid levels and higher insulin sensitivity and thus decrease the risk for the development of cardiovascular disease (CVD). Recently, mobile technologies, such as mobile applications (apps) have been developed for supporting adherence to a healthy lifestyle in an individualized and interactive manner. Purpose The aim of this systematic review was to summarize the effectiveness of such mobile apps targeting PA and/or dietary behavior and cardiovascular risk factors in primary and secondary prevention. Methods Four databases (Pubmed, Sportdiscus, Cinahl, Embase) were searched to identify prospective studies evaluating mobile apps targeting healthy diet and/or PA. Rayyan software was used for screening articles. Only interventional trials that assessed the effectiveness of health apps on diet, PA and/or cardiovascular risk factors were included. Quality assessment was performed using the MINORS tool. Qualitative synthesis was performed providing data summaries according to different subgroups: healthy adults, adults who are overweight, have obesity, hypertension, CVD or diabetes. Results Out of 7073 records identified, 52 articles, reporting on 44 studies with variable study designs, could be included in qualitative synthesis. Interventions targeted diet, PA and/or adherence to therapy/healthy lifestyle and reported on at least one cardiovascular risk factor. In 20 studies, weight loss was a target of the mobile intervention, the vast majority (17/20 studies) reported weight loss following app usage of at least similar extent as usual care. Twenty-six mobile interventions targeted PA and/or exercise training and 23 of them resulted in an increase in PA in the short term. Four studies performed in patients with CVD showed that health app usage could be related to increased PA and improved diet, resulting in similar health benefits as usual care. The most commonly employed behavioural change methods were goal setting and self-monitoring, the use of financial incentives for inducing beneficial lifestyle changes yielded inconclusive results. Main limitations of the studies were small sample sizes, short follow-up duration and lack of controlled trial design. Conclusion Mobile apps targeting healthy lifestyle for the management of cardiovascular risk factors seem to be valuable tools to add to current practice in preventive medicine. However, larger, controlled studies with longer follow-up duration are needed to confirm these early findings.

The effects of social distancing and self-isolation during the COVID-19 pandemic on adults diagnosed with asthma: A qualitative study

This study aimed to explore how social distancing and self-isolation measures, aimed at protecting vulnerable groups from COVID-19, affected the wellbeing and physical activity levels among adults diagnosed with asthma. Twenty-seven participants took part across four online focus groups. Transcripts were analysed using thematic analysis. Participants reported becoming more health conscious due to being labelled as vulnerable. Their relationship with the severity of their asthma was altered and they reported making positive changes to increase their physical activity levels. Findings suggest there is a window of opportunity to engage with people diagnosed with asthma to promote beneficial lifestyle changes and self-management.

Increasing the Duration of Light Physical Activity Ameliorates Insulin Resistance Syndrome in Metabolically Healthy Obese Adults.

Obesity is a well-known risk factor for insulin resistance syndrome (IRS). Nevertheless, limited data are available regarding the effects of physical activity (PA) intensity on the ability to modulate IRS. The study aim was to investigate the beneficial effects of the longer duration of light PA vs. a single bout of the acute moderate or vigorous PA for improvement in IRS indicators. Sixty metabolically healthy obese (MHO) participants, 30 males and 30 females, with body mass index (BMI) of ≥30 were enrolled in this study. PA levels were measured using an accelerometer, and the expression of monocytic surface markers was analyzed using flow cytometry. Plasma cytokines’ secretion was determined by enzyme-linked immunosorbent assay (ELISA). Univariate regression analysis evaluated the actigraphy-assessed PA measures, inflammatory cytokines, and insulin resistance. The longer duration of PA was found to be associated with the homeostatic model assessment of insulin resistance (HOMA-IR), a lower lipid profile, and the expression of inflammatory cytokines by monocytes. Even though, higher intensities of PA were found to be associated with lower body fat percentage, only the light intensity PA was found to be beneficial as it associated with the improved insulin sensitivity and lower expression of inflammatory markers. In conclusion, maintaining the longer duration of low-intensity PA throughout the day could be more beneficial for reducing inflammation and improving insulin resistance. This study supports a more feasible approach model to gain beneficial lifestyle changes for the prevention of IRS in metabolically healthy adults with obesity.

The Health Promoting Mindfulness or Qigong Educational Programs for Beneficial Lifestyle Changes of Cancer Survivors.

This study used heart rate variability (HRV) to monitor levels of cancer-related fatigue (CRF) and quality of life (QOL) of cancer survivors subjected to program measures at different psychosomatic or functional levels. A longitudinal study was conducted at a cancer center in Taiwan. Fifty-two cancer survivals were randomly assigned to either the mindfulness group (n = 25) or the Qigong group (n = 27). Both groups received a 12-week mindfulness and Qigong programs, respectively. Improvements in CRF, QOL, and HRV after a 12-week program and at the 3-month follow-up point. For the long-term effects in both mindfulness and Qigong groups, CRF showed a significant downward trend (p < 0.05), but a significant upward trend was observed in HRV (p < 0.001). Mindfulness and Qigong exhibited different effectiveness in individuals, indicating that the mental and physical aspects of health are equally essential and should be addressed in a complementary combination. These findings are worthy of being shared with cancer survivors to benefit their physical and mental well-being. We suggest that healthcare professionals incorporate mindfulness and Qigong in cancer survivors' daily life as means to encourage lifestyle changes for improving their health.

The pharmacist's role in improving the treatment of erectile dysfunction and its underlying causes.

Erectile dysfunction (ED), which worldwide is likely to affect in excess of 300 million men by 2025, is often either untreated or insufficiently treated. It can be a prelude to other serious illnesses and may be a cause or consequence of depression in affected individuals. Among men younger than 60 years of age, ED can be a robust early-stage indicator of vascular disease and type 2 diabetes. Untreated or inadequately treated ED can also be a sign of poor communication between health professionals and service users of all ages. Improved treatment of ED could cost-effectively prevent premature deaths and avoidable morbidity. The extension of community pharmacy‒based health care would enable more men living with ED to safely access effective medications, along with appropriate diagnostic services and support for beneficial lifestyle changes such as smoking cessation in conveniently accessible settings. The task of introducing improved methods of affordably addressing problems linked to ED exemplifies the strategic challenges now facing health care systems globally. Promoting professionally supported self-care in pharmacies has the potential to meet the needs of aging populations in progressively more effective ways.

Symptom Experience, Self-Care Adherence, and Quality of Life Among Heart Transplant Recipients in South Korea.

Among heart transplant recipients, the perceived quality of life (QOL) is a key indicator of successful transplantation. QOL is affected by posttransplant treatments, including immunosuppressive therapy or self-care. However, few studies have evaluated QOL after heart transplantation in South Korea. This study aimed to investigate posttransplant symptoms associated with immunosuppressant, self-care adherence, and QOL in 105 heart transplant recipients in South Korea. Educational status (β = -1.05, p = .013), symptoms (β = -3.98, p = .004), and diet (β = 0.38, p < .001) were found to affect subjects' overall QOL. In addition to these factors, caregivers and the duration of heart disease (years) were found to be influencing factors, depending on the individual QOL subdimension. These findings highlight the importance of controlling symptoms and managing medications as well as of self-care (particularly dietary compliance). Educational programs targeting beneficial changes in lifestyle, including diet, are needed.

A scoping review of skills and tools oral health professionals need to engage children and parents in dietary changes to prevent childhood obesity and consumption of sugar-sweetened beverages.

Increased consumption of sugar-sweetened beverages (SSBs) has been linked to obesity. Obesity now affects one in six children in the United States. The purpose of this scoping review is to identify and review published studies that discuss skills and tools oral health professionals can use with children (under age 12) and their parents to encourage dietary changes to aid in preventing childhood obesity and reducing consumption of SSBs. Key search terms were identified and used to examine selected databases via PubMed, EMBASE, CINAHL, and Cochrane Database of Systematic Reviews. A total of 637 records were identified. After duplicates were removed and records were screened for eligibility, 33 remained. Six met established inclusion/exclusion criteria and were included in the review. Only two full-text articles included dental-office-based weight interventions. Patient response to education on healthy habits and weight maintenance in the dental setting was favorable. Literature supports oral health professionals expanding their role in health care delivery by offering nutrition and physical activity recommendations to prevent and/or reduce chronic disease. Active listening and motivational interviewing were techniques identified to promote beneficial lifestyle changes. There is limited research on behavior modification tools and skills that have been effectively implemented in the dental setting to decrease risk of obesity. Oral health professionals are uniquely positioned to address consumption of SSBs and promote positive dietary habits for improved weight management. Future studies are needed to identify effective techniques that techniques that oral health professionals can integrate into preventive patient care.

SUPPORT Findings: Smartphone App Bolsters Drug Adherence and Beneficial Lifestyle Changes in Myocardial Infarction Patients

The SUPPORT trial, involving 166 patients (mean age, 58 years) with acute myocardial infarction being treated with ticagrelor, demonstrated the value of an interactive smartphone app in boosting drug adherence and adopting/continuing healthy cardiovascular lifestyle changes. This and other disease-specific apps could be used to complement secondary prevention strategies.

National diabetes prevention program (DEHKO): awareness and self-reported lifestyle changes in Finnish middle-aged population

ObjectivesThe national development programme for the prevention and care of diabetes was carried out in Finland during 2000–2010. One of the programme goals was to raise awareness of diabetes and its risk factors in the whole population through various activities, e.g. media campaigns and health fares. In addition, a targeted implementation project on the prevention of type 2 diabetes, FIN-D2D, was carried out in selected districts during 2003–2008. The aim of this analysis was to examine the changes in overall awareness of the programme and its association with self-reported lifestyle changes within the adult population during the FIN-D2D project period in the FIN-D2D area compared with the area not participating in the FIN-D2D (the control area). Study designHealth behaviour and health among the Finnish Adult Population –postal survey. MethodsThe structured questionnaire mailed to a random population sample included questions on participants' sociodemographic background, medical history, health habits, and recent lifestyle changes. Awareness of the national diabetes programme was also enquired. Data (n = 10 831) from the 2004–2008 postal surveys were used for this investigation. ResultsIn the FIN-D2D area, 25% (347/1384) of men and 48% (797/1674) of women reported being aware of the programme. In the control area, the proportions were 20% (702/3551) and 36% (1514/4222), respectively. The overall awareness increased among both genders and in all areas during the project period, but the level of awareness was consistently higher in the FIN-D2D area. Female gender and higher age were associated with increasing awareness of the programme in both areas. Self-reported lifestyle changes were more common among women, but associated with the level of awareness of the programme more often among men than women. ConclusionsThe awareness of diabetes and its risk factors increased among men and women in both implementation and control areas during the FIN-D2D project period. The activities of the implementation project may at least partly explain the differences in lifestyle changes between areas, especially among men. The results suggest that health promotion campaigns increase the population awareness about the prevention of chronic diseases and as a result, especially men may be prompted to make beneficial lifestyle changes.

4Ps medicine of the fatty liver: the research model of predictive, preventive, personalized and participatory medicine-recommendations for facing obesity, fatty liver and fibrosis epidemics.

Relationship between adipose tissue and fatty liver, and its possible evolution in fibrosis, is supported by clinical and research experience. Given the multifactorial pathogenesis of non-alcoholic fatty liver disease (NAFLD), treatments for various contributory risk factors have been proposed; however, there is no single validated therapy or drug association recommended for all cases which can stand alone. Mechanisms, diagnostics, prevention and treatment of obesity, fatty liver and insulin resistance are displayed along with recommendations and position points. Evidences and practice can get sustainable and cost-benefit valuable outcomes by participatory interventions. These recommendations can be enhanced by comprehensive research projects, addressed to societal issues and innovation, market appeal and industry development, cultural acceptance and sustainability. The basis of participatory medicine is a greater widespread awareness of a condition which is both a disease and an easy documented and inclusive clue for associated diseases and unhealthy lifestyle. This model is suitable for addressing prevention and useful for monitoring improvement, worsening and adherence with non-invasive imaging tools which allow targeted approaches. The latter include health psychology and nutritional and physical exercise prescription expertise disseminated by continuous medical education but, more important, by concrete curricula for training undergraduate and postgraduate students. It is possible and recommended to do it by early formal teaching of ultrasound imaging procedures and of practical lifestyle intervention strategies, including approaches aimed to healthier fashion suggestions. Guidelines and requirements of research project funding calls should be addressed also to NAFLD and allied conditions and should encompass the goal of training by research and the inclusion of participatory medicine topics. A deeper awareness of ethics of competences in health professionals and the articulation of knowledge, expertise and skills of medical doctors, dieticians, health psychologists and sport and physical exercise graduates are the necessary strategy for detectin a suboptimal health status and achieving realistically beneficial lifestyle changes. “The devil has put a penalty on all things we enjoy in life. Either we suffer in health or we suffer in soul or we get fat” (Albert Einstein); the task of medical research and intervention is to make possible to enjoy life also without things that make sufferance in health and souls and which excessively increase body fat.

Perceptions of illness, lifestyle and support after an acute myocardial infarction

After an acute myocardial infarction (AMI), people are encouraged to adopt a healthy lifestyle. But they are not always motivated to maintain the necessary lifestyle changes and need the right support to do it. In sparsely populated areas, people afflicted by an AMI have difficulty in finding standard rehabilitation programmes near their homes during the recovery, so they need alternative forms of support. The aim was to describe individual perceptions of their lifestyle and support, 1 year after an AMI, with or without mentorship. This study has a qualitative, descriptive design with data collected in individual interviews. Twenty men and women were interviewed 1 year after their first AMI, and 11 had been offered contact with mentors who had had an AMI. Content analysis was used to analyse the data. Those with and without mentors had similarities and tendencies to variation in their perceptions, with both a positive and negative view of life. The participants were aware of the necessity of living a healthy lifestyle but some resisted doing so. They wished to live as before, and all saw the future positively. Having a mentor with the same experience could be valuable for some people, but more research is needed to understand the lack of motivation to make beneficial lifestyle changes after a serious health event as AMI.

Abstract P250: How to Successfully Manage Adolescents’ Metabolic Syndrome. Keep it Simple!

Background: The metabolic syndrome prevalence in adolescents is still rising (with up to 8% in some populations); this increase is mainly attributable to the obesity epidemic. Consequently, the long-term cardiovascular risk of these adolescents is very high. Unfortunately, despite this elevated risk, motivation and adherence to weight reduction programs still remain very low. Hypothesis: To verify if the combination of motivational interviewing, nutritional and physical education, and a close follow-up in a multidisciplinary, family-based weight-reduction pediatric clinic is effective to initiate and sustain beneficial lifestyle changes at 6 months. Subjects and Method: Fifty (50) families with adolescents (10-17 years old) characterized by obesity and metabolic syndrome were recruited with their families. The cardiometabolic risk profile (including body mass index, waist circumference, blood pressure, glucose, insulin, lipids and apolipoprotein B levels) of every subject was evaluated and explained to the adolescent and his/her parents. With motivational interviewing techniques and educative approaches, adolescents were brought to set up, at the first visit, a one month, one health challenge change. In subsequent visits, anthropometric measurements were recorded and, based on their first month’s success, new healthy challenges were proposed by the adolescent. Results: Adolescents participating in this program were initially highly motivated to initiate a one month healthy challenge with an average score of 7/10. Eighty percent of them chose to stop drinking juice or soda beverages as their first challenge. At one month, over 80% of them observe a weight reduction or no weight gain. At this point, the adolescents’ perception of success is the main source of motivation to introduce new health challenges in their life. At 3 and 6 months, healthy habits are still present in over 70% of them. Interestingly, these changes are accompanied by modifications in anthropometric covariables. At 6 months, we observe a significant reduction of body mass index (p=0.027) and waist circumference (p=0.047) in addition to a trend towards a reduction of mean weight (p=0.054). Conclusion: With counselling based on education, motivational techniques and a family approach, a high proportion of adolescents have initiated and maintained healthy changes. At 6 months, waist circumference reduction was the strongest change. This combined familial approach appears promising to reduce metabolic syndrome prevalence in adolescents. The prospective data collection is still ongoing, with the first adolescents recruited now reaching the one-year follow-up.

264: Myeloperoxidase, hs CRP and endothelial dysfunction in cardiovascular risk assessment in diabetic and hypertensive patients

Several inflammatory markers have been associated with a greater likelihood of cardiovascular diseases. Of those C-reactive protein (CRP) and myeloperoxidase (MPO) are the most well known. The development of sensitive rapid tests for MPO and hs-CRP, together with a simple hand-held reader promises to open up the possibility of identifying high-risk patients early enough for the introduction of prophylactic therapies or the adoption of beneficial life-style changes. We propose to evaluate the cardiovascular risk for 50 hypertensive and diabetic patients by rapid tests for MPO and hs-CRP and to compare with endothelial function and Framingham score. We evaluate prospectively 50 patients without cardiovascular events, the mean age is 53 years, 78% have mean or high CV risk according to the Framingham score and 38% presenting endothelial dysfunction. The statistical analysis showed a significant association between the rate of hs-CRP, the Framingham score (p=0,02, r=0,424), with the metabolic syndrome (p=0,0001), and endothelial dysfunction (p=0,001). MPO level is correlated with the sex (p=0,002), age (p=0,05), as well with the Framingham score (r=0,345), the metabolic syndrome (p=0,001), the endothelial dysfunction (p=0,001), and also with the LDL cholesterol. (p=0,04; r=0,3). In the same way, a significant Correlation was shown between hs-CRP and MPO (p=0,016; r=0,34). The hs-CRP test showed a good specificity (85%), and VPP (96%), a weak VPN (27%). However MPO test showed a low specificity (25%) low sensitivity (25%), VPP of (73%) and a low VPN (5%). The hs-CRP represents the inflammatory marker most relevant in the prediction of risk CV, better than the MPO. These markers reflect the clinical potential of atherothrombotic disease may allow more precise risk stratification and prognostication in high-risk populations, and perhaps earlier diagnosis and intervention in patients at risk for or with occult cardiovascular disease.

Special Considerations of Care and Risk Management for African American Patients With Type 2 Diabetes Mellitus

It is well documented that African American populations are disproportionately affected by type 2 diabetes mellitus compared with their white counterparts. They have a higher prevalence of diabetes, a higher rate of diabetes-related complications, greater disability from these complications, and poorer control and quality of care. In order to improve diabetes care and outcomes in African Americans (and indeed all patients with diabetes), a multifactorial approach is needed to target all risk factors-not solely hyperglycemia-simultaneously. Culturally appropriate initiatives to improve lifestyle behaviors are a first step in management. Community-based programs, including those mediated through church groups, have reported varying degrees of success in effecting such beneficial lifestyle changes. If these measures fail to achieve desirable levels of blood glucose, blood pressure, and serum lipids, pharmacologic therapy is indicated. However, few evidence-based recommendations regarding the use of some drugs in African Americans currently exist due to their underrepresentation in randomized controlled clinical trials. Other essential components of diabetes care include regular screening for diabetic nephropathy and neuropathy, and eye and foot examinations, with prompt referral to specialists when important clinical changes are detected.

Improving the treatment experience for patients with type 2 diabetes: Role of the nurse practitioner

Abstract Purpose: To discuss the role of nurse practitioners (NPs) in motivating and guiding patients with type 2 diabetes to self‐manage their disease, achieve their treatment goals, and have a more positive treatment experience.Data sources: Personal experience; clinical studies.Conclusions: NPs play a key role in educating patients and helping them understand the need for, and benefits of, improved diabetes control. Yet, achieving improved diabetes control goes far beyond sharing information. The NP can be pivotal in helping to motivate patients to be active players in their own diabetes management.Implications for practice: NPs can improve the treatment experience of patients with diabetes by educating and motivating them to make beneficial lifestyle changes and commit to treatments tailored to their individual needs and expectations.