Lifestyle Modification Change Research Articles

Health Impact of a Mobile-Delivered Diabetes Intervention to Control Blood Pressure in Older Adults

IntroductionPatient education is an effective modality to reinforce self-care practices for chronic disease management. The purpose of this study was two-fold: (1) to assess the health impact of a phone delivered diabetes intervention and (2) to identify predictors of telehealth message use among adults, aged 18-65 with diabetes in a primary care setting using the TAM theoretical framework. MethodsA pretest-posttest experimental study design was employed. Participants were randomized to received seven-weeks of telehealth self-care messages or to the routine care group. Outcome measures included a) telehealth use among patients who received weekly telehealth messages, b) self-care behavior management derived from the Behavior Score Instrument (BSI) and c) clinical outcomes measures. ResultsWe enrolled 150 patients, and of these, 138 (18-65 years) completed the study. Participants, aged 53 ± 9.6 (mean ± SD) years were mainly females (n = 93; 76%), and the majority received government sponsored health insurance (n=75; 54%). Age was a strong predictor of telehealth use, p<.001. Among patients who received telehealth messages, systolic and diastolic blood pressure measures (140/78 mmHg vs. 134/74 mmHg) were statistically significant at follow-up, p=.001 and p=.007, respectively. ConclusionsDigital support tools can play a valuable role in supporting lifestyle modification changes and reinforcing good diabetes self-care practices in older adults. Providing accessible tools and resources empowers adults to take an active role in their own health.

Polycystic ovary syndrome and thyroid disorder: a comprehensive narrative review of the literature.

Published data on the relationship between polycystic ovary syndrome (PCOS) and thyroid dysfunction are sparse and confusing. To comprehensively review data available in the literature regarding the relationship between PCOS and the thyroid function, and its abnormalities. Nine main areas of interest were identified and analyzed according to the available evidence: 1) Evaluation of thyroid function for PCOS diagnosis; 2) Epidemiology data on thyroid function/disorders in patients with PCOS, and vice versa; 3) Experimental data supporting the relationship between thyroid function/disorders and PCOS; 4) Effects of thyroid function/disorders on PCOS features, and vice versa; 5) Effect of thyroid alterations on the cardiometabolic risk in women with PCOS; 6) Effect of thyroid abnormalities on reproductive outcomes in women with PCOS; 7) Relationship between thyroid function/abnormalities in patients with PCOS who are undergoing fertility treatment; 8) Effect of treatments for thyroid diseases on PCOS; and 9) Effect of treatments for PCOS on thyroid function. An extensive literature search for specific keywords was performed for articles published from 1970 to March 2023 using PubMed and Web of Science. Data were reported in a narrative fashion. PCOS is a diagnosis of exclusion for which diagnosis is possible only after excluding disorders that mimic the PCOS phenotype, including thyroid dysfunctions. However, the tests and the cutoff values used for this are not specified. Many experimental and clinical data suggest a relationship between perturbations of the thyroid function and PCOS. Direct and unequivocal evidence on the effects of thyroid function/disorders on PCOS features are lacking. High thyroid-stimulating hormone levels and subclinical hypothyroidism may be associated with significant worsening of several intermediate endpoints of cardiometabolic risk in women with PCOS. Thyroid abnormalities may worsen reproductive outcomes, especially in patients undergoing fertility treatment. To date, there are no data demonstrating the efficacy of thyroid medications on fertility and cardiometabolic risk in women with PCOS. Lifestyle modification changes, metformin, and vitamin D seem to improve thyroid function in the general population. PCOS and thyroid disorders are closely related, and their coexistence may identify patients with a higher reproductive and metabolic risk. Regular screening for thyroid function and thyroid-specific autoantibodies in women with PCOS, particularly before and during pregnancy, is highly recommended.

ARE THE PERSISTENT SYMPTOMS TO PROTON PUMP INHIBITOR THERAPY DUE TO REFRACTORY GASTROESOPHAGEAL REFLUX DISEASE OR TO OTHER DISORDERS?

Gastroesophageal reflux disease (GERD) is a clinical condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Transient lower esophageal sphincter relaxation is the main pathophysiological mechanism of GERD. Symptoms and complications can be related to the reflux of gastric contents into the esophagus, oral cavity, larynx and/or the lung. Symptoms and other possible manifestations of GERD are heartburn, regurgitation, dysphagia, non-cardiac chest pain, chronic cough, chronic laryngitis, asthma and dental erosions. The proton pump inhibitor (PPI) is the first-choice drug and the most commonly medication used for the treatment of GERD. The most widespread definition of Refractory GERD is the clinical condition that presents symptoms with partial or absent response to twice-daily PPI therapy. Persistence of symptoms occurs in 25% to 42% of patients who use PPI once-daily and in 10% to 20% who use PPI twice-daily. The objective is to describe a review of the current literature, highlighting the causes, diagnostic aspects and therapeutic approach of the cases with suspected reflux symptoms and unresponsive to PPI. Initially, the management of PPI refractoriness consists in correcting low adherence to PPI therapy, adjusting the PPI dosage and emphasizing the recommendations on lifestyle modification change, avoiding food and activities that trigger symptoms. PPI decreases the number of episodes of acid reflux; however, the number of "non-acid" reflux increases and the patient continues to have reflux despite PPI. In this way, it is possible to greatly reduce greatly the occurrence of symptoms, especially those dependent on the acidity of the refluxed material. Response to PPI therapy can be evaluated through clinical, endoscopic, and reflux monitoring parameters. In the persistence of the symptoms and/or complications, other causes of Refractory GERD should be suspected. Then, diagnostic investigation must be initiated, which is supported by clinical parameters and complementary exams such as upper digestive endoscopy, esophageal manometry and ambulatory reflux monitoring (esophageal pH monitoring or esophageal impedance-pH monitoring). Causes of refractoriness to PPI therapy may be due to the true Refractory GERD, or even to other non-reflux diseases, which can generate symptoms similar to GERD. There are several causes contributing to PPI refractoriness, such as inappropriate use of the drug (lack of patient adherence to PPI therapy, inadequate dosage of PPI), residual acid reflux due to inadequate acid suppression, nocturnal acid escape, "non-acid" reflux, rapid metabolism of PPI, slow gastric emptying, and misdiagnosis of GERD. This is a common cause of failure of the clinical treatment and, in this case, the problem is not the treatment but the diagnosis. Causes of misdiagnosis of GERD are functional heartburn, achalasia, megaesophagus, eosinophilic esophagitis, other types of esophagitis, and other causes. The diagnosis and treatment are specific to each of these causes of refractoriness to clinical therapy with PPI.

The Role of Colchicine in the Prevention of Cerebrovascular Ischemia.

Despite the proven efficacy of anti-thrombotic, lipid-lowering, anti-hypertensive therapies and lifestyle modification changes for secondary ischemic stroke prevention, the risk of recurrent stroke, coronary events and vascular death remains substantial even for patients treated with high rates of established secondary preventive medications. In the present review, we summarize available literature data on the association between systemic inflammation and symptomatic atherosclerosis including recurrent cerebral ischemia. We also highlight the potential role of colchicine in the suppression of atherosclerosis-induced inflammation, plaque stabilization and thromboembolism prevention. Accumulating evidence suggests that inflammation is of key importance in the pathophysiology of atherosclerotic plaque de-stabilization and thromboembolism, with inflammatory cells being involved in all stages of atherosclerosis development. Therefore, anti-inflammatory therapies targeting the atherosclerotic plaque inflammation may be important contributors in plaque stabilization and in the prevention of thromboembolic events. Colchicine is known to have multiple anti-inflammatory properties including inhibition of microtubule polymerization, leading to reduced secretion in monocyte-macrophages. Currently the randomized controlled CONVINCE trial is enrolling stroke patients to evaluate the effect of a daily low-dose of colchicine in reducing the rate of recurrent stroke and major vascular events. Inflammatory pathways seem to be key mediators in the development of atherosclerotic process, atheromatous plaque destabilization and thromboembolism. Colchicine as a novel therapeutic agent could be a safe and effective inhibitor of the inflammation cascade in patients with extra- or intracranial atherosclerosis or arteriolosclerosis, resulting in reduced vascular events.

Three-year dynamics and unsolved problems of lipid-lowering therapy

Aim. To study the lipid-lowering therapy, the adequacy of its control, as well as the awareness of patients at a high cardiovascular risk of atherosclerosis problems and the dynamics of these parameters in 3 years. Material and methods. Patients with dyslipidemia (113 patients in 2011 and 100 patients in 2014) who were treated in the cardiology clinic were examined. Patient survey on the lipid-lowering therapy and its monitoring was conducted. Medical records of patients were studied also. Results. The number of patients informed on atherosclerosis aspects increased from 52% to 59% (p>0.05) in 3 years. Laboratory control of lipid metabolism remained inadequate. Insufficient lifestyle modification changes (diet, smoking, physical inactivity) were present. Lipid-lowering drugs were regularly taken by 26% of the patients in 2011 and 29% in 2014 (p>0.05) and a control of lipid metabolism was absent in 12% and 14% of the patients, respectively (p>0.05). Only 27% of the patients gave the importance of lipid-lowering therapy 10 points on a 10-point scale. Conclusion. Dynamics of patients awareness on atherosclerosis and measures taken to correct and control lipid metabolism disorders were insignificant within 3 years. High costs of medication and the underestimation of treatment importance by the patient play an important role in poor adherence.

The Management of Asymptomatic Carotid Plaque Disease: Our Assumptions When We are Less Radical

The management of asymptomatic carotid artery stenosis (CAS) has been the subject of extensive debate. Current evidence suggests that the annual risk of stroke in patients with CAS and without previous cerebrovascular symptoms is 1% which makes carotid endarterectomy unjustifiable. Conservative treatment with statins and antiplatelets, the identification of the high risk individuals as well as aggressive life style modifications are considered sufficient measures for the protection of these patients. However, there are reasons to believe that this approach may be less effective than we think. Best medical treatment is only effective when compliance is adequate and lipid or blood pressure target levels are achieved. However this is not always the case and the same applies regarding life style modification changes such as smoking. In addition, there is no consensus regarding the identification of the high risk individuals despite recent encouraging evidence. The introduction of a structured network of risk factor modification clinics in conjunction with the vascular clinics and the identification of ways to objectively risk-stratify patients with asymptomatic CAS could enable us to optimize the management of these patients when we decide to be less radical.