The Nurse Practitioner Workforce in Western Canada: A Cross-Sectional Practice Analysis Comparison.

Regular examination of health workforce data is essential given the pace of health system and legislative changes. Health workforce studies pertaining to nurse practitioner (NP) practice are needed to examine the gaps between work activities, policy, human resource supply, or for population needs. Jurisdictional comparison studies can provide essential information about NP practice for governments to respond to health workforce deficiencies or engage in service planning. In Canada, there is limited provincial-territorial jurisdictional NP workforce data to support health planning or policy change. This descriptive cross-sectional study was to examine the similarities and differences in practice patterns of Canadian NPs. In 2016 and 2017, an electronic survey was sent to all 852 registered NPs in three Canadian provinces, yielding a large convenience sample of 375 NP respondents. The results of this study underscore the value of NPs' extensive registered nurse expertize as well as their ability to serve diverse patient populations, work in varied healthcare settings, and provide care to medically complex patients. The study findings also show that NPs in all three jurisdictions work to their full scope of practice, in both rural and urban settings. This study is the first to compare NP workforce data across multiple Canadian jurisdictions simultaneously. Studies of this type are valuable tools for understanding the demographics, education, integration, and employment activities of NPs and can aid governments in addressing workforce planning.

A structural equation model of empowerment factors affecting nurse practitioners competence.

Role competence and patient safety (PS) competence among healthcare professionals are rapidly developing issues due to increasing patient acuity and complexity in the healthcare system. Upon graduation, nurse practitioners (NP) provide autonomous healthcare for populations with complex health needs, thus role and PS competence is imperative. The study aim was to test a hypothesized model of the relationships between educational structural empowerment (SE), psychological empowerment (PE), NP role competence, and PS competence. The sample was drawn from newly graduated NPs from across Canada, accessed through twenty professional nurse organizations. The study survey included socio-demographic questions, the Conditions of Learning Effectiveness Questionnaire, the PE Scale, the NP Competence Survey, and the Health Processional Education in PS Survey. One hundred and ninety Canadian educated NPs who completed their studies in the preceding 2-year time period responded. The study model tested the effect of educational SE on NP role competence and PS competence partially mediated by PE. PE partially mediated the positive relationship for educational SE and PS competence, yet no mediation effect occurred for educational SE and NP role competence. Nurse educators need to consider educational SE strategies as NPs' positive perceptions of role competence have the potential to influence greater levels of PS competence.

Disambiguating pharmacological mechanisms from placebo in neuropathic pain using functional neuroimaging.

BACKGROUND: A lack of objective outcome measures and overreliance on subjective pain reports in early proof-of-concept studies contribute to the high attrition of potentially effective new analgesics. We studied the utility of neuroimaging in providing objective evidence of neural activity related to drug modulation or a placebo effect in a double-blind, randomized, placebo-controlled, three-way crossover trial. METHODS: We chronically administered pregabalin or tramadol (first-line and second-line analgesics, respectively), recommended for neuropathic pain, in 16 post-traumatic neuropathic pain patients. We measured subjective pain reports, allodynia-evoked neural activity, and brain resting state functional connectivity from patients during the three sessions and resting state data at baseline from patients after washout of their current medication. All data were collected using a 3 T MRI scanner. RESULTS: When compared with placebo only, pregabalin significantly suppressed allodynia-evoked neural activity in several nociceptive and pain-processing areas of the brain, despite the absence of behavioural analgesia. Furthermore, placebo significantly increased functional connectivity between the rostral anterior cingulate and the brainstem, a core component of the placebo neural network. CONCLUSIONS: Functional neuroimaging provided objective evidence of pharmacodynamic efficacy in a proof-of-concept study setting where subjective pain outcome measures are often unreliable. Additionally, we provide evidence confirming the neural mechanism underpinning placebo analgesia as identified in acute experimental imaging studies in patients during the placebo arm of a clinical trial. We explore how brain penetrant active drugs potentially interact with this mechanism. CLINICAL TRIAL REGISTRATION: NCT0061015.

Concentrations and geographic distribution of selected organic pollutants in Scottish surface soils.

Concentrations of selected persistent organic pollutants (POPs) representing three chemical classes (polycyclic aromatic hydrocarbons (PAH), polybrominated diphenyl ethers (PBDE) and polychlorinated biphenyls (PCB) and the organic pollutant diethylhexyl phthalate (DEHP), were determined in surface soil samples (0-5 cm) collected at 20 km grid intersects throughout Scotland over a three-year period. Detectable amounts of all chemical classes and most individual congeners were present in all samples. There were no consistent effects of soil or vegetation type, soil carbon content, pH, altitude or distance from centres of population on concentrations which exhibited extreme variation, even in adjacent samples. It is concluded that soil POPs and DEHP concentrations and associated rates of animal and human exposure were highly variable, influenced by multiple, interacting factors, and not clearly related to local sources but possibly related to wet atmospheric deposition and the organic carbon content of the soil.

Geographic variation in tissue accumulation of endocrine disrupting compounds (EDCs) in grazing sheep.

Muscle tissue was collected from ewes and lambs derived from farms throughout Scotland and sample concentrations of five endocrine disrupting compound groups were determined. Farms of origin were categorised according to geographic region. There were few statistically-significant differences with region or distance from cities. However, the magnitude of the difference between the highest and lowest mean values in ewe muscle from different regions exceeded 30% for 13 of the 15 compounds that were consistently detected in muscle, with animals derived from the industrialised region having the highest mean values for 11 of the 13 compounds. A less marked trend was apparent in the lamb muscle (8 of 13 highest were in the industrialised region). The physiological effects of such small differences in exposure to mixtures of pollutants remain to be determined.

Assessment of thrombin generation measured before and after cardiopulmonary bypass surgery and its association with postoperative bleeding.

BACKGROUND: Bleeding after cardiopulmonary bypass (CPB) is a major cause of morbidity and mortality and consumes large amounts of blood. Identifying patients at increased risk of bleeding secondary to hemostatic impairment may improve clinical outcomes by allowing early intervention. METHODS: This present study recruited 77 patients undergoing CPB and measured coagulation screens, coagulation factors, TEG(®), Rotem(®) and thrombin generation (TG) before surgery and 30 min after heparin reversal. The tests were analyzed to investigate whether they identified patients at increased risk of excess bleeding (defined as > 1000 mL) in the first 24 h postoperatively. RESULTS: Patients who bled > 1000 mL had a lower: platelet count (P < 0.02), factors (F)IX, X and XI (P < 0.005), endogenous thrombin potential (ETP) and an initial rate of TG (P < 0.02) and higher activated partial thromboplastin time (aPTT) (P < 0.001) than patients who bled < 1000 mL. Receiver operating characteristic (ROC) analysis was significant for post-operative TG and aPTT (P < 0.001). Furthermore, reduced pre-operative TG was associated with increased postoperative bleeding (P < 0.02). Pre- and postoperative TG were correlated (ρ = 0.7, P < 0.001). TEG(®), Rotem(®) and prothrombin time (PT) at either time point were not associated with increased bleeding. CONCLUSION: These data suggest that pre-operative defects in the propagation phase of hemostasis are exacerbated during CPB, contributing to bleeding post-CPB. TG taken both pre- and postoperatively could potentially be used to identify patients at an increased risk of bleeding post-CPB.

Maternal and fetal tissue accumulation of selected endocrine disrupting compounds (EDCs) following exposure to sewage sludge-treated pastures before or after conception.

Liver concentrations of selected pollutant classes were determined in groups of sheep fetuses and their dams, at 55 (Experiment 1) and 110 (Experiment 2) days of gestation (term = 145 d) following exposure, throughout their breeding lives and after mating, to pasture treated with either inorganic fertiliser (control, CC) or with sewage sludge (treated, TT). In a unique study designed to separate the respective contributions of environmental sources and mobilised tissue to the available EDC burden, in additional groups of animals, pollutant burdens at 110 days gestation were assessed following exposure to the respective treatments, either throughout their breeding lives until mating, but not thereafter (TC), or only between mating and slaughter (CT) (Experiment 3). With very few exceptions, maternal and fetal liver concentrations of diethylhexyl phthalate (DEHP) and selected polychlorinated biphenyls (PCBs), and polybrominated diphenyl ethers (PBDE) and polycyclic aromatic hydrocarbons (PAHs) were not significantly affected by sludge exposure in any group. In some cases, maternal and fetal tissue EDC concentrations were different but the differences were not consistent, and maternal and fetal concentrations of none of the classes of chemical were significantly correlated. It was not possible to identify a single chemical, or class of chemical, that may be responsible for previously observed physiological effects of exposure to sludge-treated pastures. It is concluded that exposure of sheep to pastures fertilised with sewage sludge was not associated with increased liver concentrations of EDCs, irrespective of the stage of development at which they were measured and of maternal tissue mobilisation and EDC release during gestation. Thus, retrospective measurements of EDC tissue burdens could not be used to accurately assess earlier fetal EDC insults.

Factors contributing to the time taken to consult with symptoms of lung cancer: a cross-sectional study.

OBJECTIVES: To determine what factors are associated with the time people take to consult with symptoms of lung cancer, with a focus on those from rural and socially deprived areas. METHODS: A cross-sectional quantitative interview survey was performed of 360 patients with newly diagnosed primary lung cancer in three Scottish hospitals (two in Glasgow, one in NE Scotland). Supplementary data were obtained from medical case notes. The main outcome measures were the number of days from (1) the date participant defined first symptom until date of presentation to a medical practitioner; and (2) the date of earliest symptom from a symptom checklist (derived from clinical guidelines) until date of presentation to a medical practitioner. RESULTS: 179 participants (50%) had symptoms for more than 14 weeks before presenting to a medical practitioner (median 99 days; interquartile range 31-381). 270 participants (75%) had unrecognised symptoms of lung cancer. There were no significant differences in time taken to consult with symptoms of lung cancer between rural and/or deprived participants compared with urban and/or affluent participants. Factors independently associated with increased time before consulting about symptoms were living alone, a history of chronic obstructive pulmonary disease (COPD) and longer pack years of smoking. Haemoptysis, new onset of shortness of breath, cough and loss of appetite were significantly associated with earlier consulting, as were a history of chest infection and renal failure. CONCLUSION: For many people with lung cancer, regardless of location and socioeconomic status, the time between symptom onset and consultation was long enough to plausibly affect prognosis. Long-term smokers, those with COPD and/or those living alone are at particular risk of taking longer to consult with symptoms of lung cancer and practitioners should be alert to this.

Knowledge, motivation and barriers to diabetes control in adults in Jamaica / Conocimientos, motivación, y obstáculos en relación con el control de la diabetes de adultos en Jamaica

In this descriptive study, individual structured interviews were conducted on a random sample of 35 men and 98 women from a population (n = 510) of clinic patients. Open questions sought to determine the extent of knowledge, motivation and barriers to lifestyle changes for control of diabetes mellitus (DM) in Jamaican adults. These were coded into themes and described. Other data were analysed using SPSS. Men (61.8 +/- 14.8 years) were older than women (54.9 +/- 13.7 years) and demonstrated less knowledge (p = 0.006). The respondents (71%) indicated the need for more education. Barriers to lifestyle changes and glycaemic control included a low education level (64%), inadequate knowledge (80%), lack of perceived risk (80.4%) and lack of self-monitoring (93%). Only 23% were controlled to HbA1c < or = 6.5%. The patients' reference to the physicians as a primary source of information indicated the need for a collaborative team approach, and the incorporation of diabetes education as an indispensable service at this clinic.

En este estudio descriptivo, se realizaron entrevistas estructuradas individuales a una muestra aleatoria de 35 hombres y 98 mujeres de una población (n = 510) de pacientes clínicos. Las preguntas abiertas buscaban determinar la extensión de los conocimientos, la motivación, y los obstáculos a los cambios en el estilo de vida para el control de la diabetes mellitus (DM) en adultos jamaicanos. Estas fueron codificadas en forma de temas, y descritas. Otros datos fueron analizados usando el paquete estadístico SPSS. Los hombres (61.8 ±14.8 años) fueron mayores que las mujeres (54.9 ± 13.7 años) y demostraron menos conocimientos (p = 0.006). Los respondientes (71%) indicaron la necesidad de más educación. Los obstáculos a los cambios en el estilo de vida y el control glicémico, incluyeron un bajo nivel educacional (64%), conocimientos inadecuados (80%), falta de percepción de riesgos (80.4%) y falta de auto-monitoreo (93%). Sólo el 23% se mantenían bajo un control de HbA1c # 6.5%. La referencia de los pacientes a los médicos como fuente primaria de información indicó la necesidad de un enfoque colaborativo en equipo, y de la incorporación de la educación para la diabetes como un servicio indispensable en esta clínica.

Self-care, compliance and glycaemic control in Jamaican adults with diabetes mellitus / Autocuidado, cumplimiento y control glicémico en los adultos jamaicanos con diabetes mellitus

Appropriate self-care practices, including nutrition and medication compliance, are essential to satisfactory control of diabetes mellitus (DM). This descriptive study assesses self-care practices, and their relationships to glycaemic control in adults with DM in Jamaica. A pre-tested structured interview and anthropometric measurements were carried out on 98 women and 35 men, randomly selected from a population (n = 510) of adult clinic patients. HbA1c was used as the index of glycaemic control. Self-care practice scores indicated the extent of compliance with appropriate lifestyle practices. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Men (median age, 62 years) were significantly older (z = -2.64, p = 0.008) than the women (55 years). The median duration of DM was: men, seven years; women: 10.5 years. Sixty-nine per cent were being treated with insulin. Only 45reported full compliance with medications. Their median body mass index (BMI) was 29.1, (16.6-47.4) kg/m2. Eighty-one per cent were overweight or obese. Forty-six per cent described diet and/or obesity as contributing to their diabetes. Eighty-five per cent had consulted a dietitian but only 56.4reported being on a [quot ]special diet[quot ]. Only 16.5reported not taking any sugar. Self-care scores were inversely related to HbA1c(p = 0.008), BMI (p = 0.001), sugar intake (p = 0.005) and were lowest in the area of weight control and exercise. Only 23had blood glucose controlled to HbA1c < or = 6.5. In women, HbA1clevels were inversely related to compliance with medication (p = 0.004). Glycaemic control in adults with diabetes mellitus is related to their self-care practices, especially weight control, exercise and medication compliance.

Las prácticas apropiadas de autocuidado, incluyendo cumplir con los requerimientos de la nutrición y la medicación, son esenciales para el control satisfactorio de la diabetes mellitus (DM). Este estudio descriptivo evalúa las prácticas de autocuidado, y sus relaciones con el control glicémico en adultos con DM en Jamaica. Una entrevista estructurada, previamente probada, así como mediciones antropométricas, fueron llevadas a cabo en 98 mujeres y 35 hombres, seleccionados aleatoriamente de una población (n = 510) de pacientes de una clínica de adultos. La prueba HbA1c se usó como índice de control glicémico. Las puntuaciones de la práctica de autocontrol indicaron el grado de conformidad con prácticas de estilo de vida apropiadas. Los datos fueron analizados utilizando el denominado Paquete Estadístico para la Ciencias Sociales (SPSS). Los hombres (edad mediana, 62 años) eran significativamente mayores (z = -2.64, p = 0.008) que las mujeres (55 años). La duración mediana de la DM fue como sigue: los hombres, siete años; las mujeres 10.5 años. El sesenta y nueve por ciento fue tratado con insulina. Sólo el 45% reportó cumplimiento total con los medicamentos. El índice de la masa mediana de su cuerpo (BMI) fue 29.1 (16.6–47.4) kg/m. El ochenta y uno por ciento resultaró estar por encima del peso o ser obesos. El cuarenta y seis por ciento describió la dieta y/o la obesidad como factores que contribuían a su diabetes. El ochenta y cinco por ciento había consultado a un dietista, pero sólo el 56.4% reportó estar haciendo una "dieta especial". Sólo el 16.5% reportó no estar ingiriendo azúcar ninguna. Las puntuaciones de autocuidados se hallaron en proporción inversa al por ciento resultante de la prueba HbA1c% (p = 0.008), BMI (p = 0.001), ingestión de azúcar (p = 0.005) y fueron los más bajos en el área de control de peso y ejercicios. Sólo el 23% tenía la glucosa en sangre controlada en correspondencia con HbA1c # 6.5%. En las mujeres, los niveles de...

Knowledge, motivation and barriers to diabetes control in adults in Jamaica.

In this descriptive study, individual structured interviews were conducted on a random sample of 35 men and 98 women from a population (n = 510) of clinic patients. Open questions sought to determine the extent of knowledge, motivation and barriers to lifestyle changes for control of diabetes mellitus (DM) in Jamaican adults. These were coded into themes and described. Other data were analysed using SPSS. Men (61.8 +/- 14.8 years) were older than women (54.9 +/- 13.7 years) and demonstrated less knowledge (p = 0.006). The respondents (71%) indicated the need for more education. Barriers to lifestyle changes and glycaemic control included a low education level (64%), inadequate knowledge (80%), lack of perceived risk (80.4%) and lack of self-monitoring (93%). Only 23% were controlled to HbA1c < or = 6.5%. The patients' reference to the physicians as a primary source of information indicated the need for a collaborative team approach, and the incorporation of diabetes education as an indispensable service at this clinic.

Self-care, compliance and glycaemic control in Jamaican adults with diabetes mellitus.

Appropriate self-care practices, including nutrition and medication compliance, are essential to satisfactory control of diabetes mellitus (DM). This descriptive study assesses self-care practices, and their relationships to glycaemic control in adults with DM in Jamaica. A pre-tested structured interview and anthropometric measurements were carried out on 98 women and 35 men, randomly selected from a population (n = 510) of adult clinic patients. HbA1c was used as the index of glycaemic control. Self-care practice scores indicated the extent of compliance with appropriate lifestyle practices. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Men (median age, 62 years) were significantly older (z = -2.64, p = 0.008) than the women (55 years). The median duration of DM was: men, seven years; women: 10.5 years. Sixty-nine per cent were being treated with insulin. Only 45% reported full compliance with medications. Their median body mass index (BMI) was 29.1, (16.6-47.4) kg/m2. Eighty-one per cent were overweight or obese. Forty-six per cent described diet and/or obesity as contributing to their diabetes. Eighty-five per cent had consulted a dietitian but only 56.4% reported being on a "special diet". Only 16.5% reported not taking any sugar. Self-care scores were inversely related to HbA1c% (p = 0.008), BMI (p = 0.001), sugar intake (p = 0.005) and were lowest in the area of weight control and exercise. Only 23% had blood glucose controlled to HbA1c < or = 6.5%. In women, HbA1c% levels were inversely related to compliance with medication (p = 0.004). Glycaemic control in adults with diabetes mellitus is related to their self-care practices, especially weight control, exercise and medication compliance.

Coping with occupational stress in an accident and emergency department.

Kingston Regional Hospital's Accident and Emergency Department (A&E), located in a volatile area of Kingston, Jamaica, treats 90-170 patients daily. It does so with limited staff and a potentially stressful work environment. This study explores the factors associated with occupational stress in the Department, and the coping strategies used by the doctors and nurses working there. A pre-tested self-administered questionnaire was completed by 28 (84.8%) of the total population (n = 33) of health personnel working in the A&E. The participants were 15 (53.6%) doctors, eight (28.6%) registered nurses and five (17.8%) enrolled assistant nurses. The data were analyzed using Statistical Package for the Social Sciences (SPSS) Version 7.5. Qualitative data were analyzed by sorting texts into related themes and describing the ideas of the subjects. The median age was 32 years, range 23-50 years. Median duration of employment in the A&E was three years, range 0.5-22 years. Eighteen (60%) rated the A&E as "stressful". The major sources of stress were the external environment and the amount and quality of the workload. Ninety-six per cent reported experiencing one to seven emotional and physical symptoms. Forty-six per cent also reported behavioural symptoms. The emotional, physical and behavioural symptoms of stress were associated (p < 0.05). The number of behavioural symptoms experienced was associated with age (p < 0.05). The majority (89.2%) of doctors and nurses reported that they were satisfied with their jobs and had no intention of leaving their jobs within a year. This suggested the effectiveness of the reported humour, teamwork and "extracurricular" activities in buffering the effects of stress. Nurses were more likely to be "burned out" than doctors (p = 0.03). The respondents suggested increased monetary compensation, more staff and positive feedback from managers as factors which may relieve work stress. They suggested that organized counselling and stress management programmes would be useful.

Coping with occupational stress in an accident and emergency department

Kingston Regional Hospital's Accident and Emergency Department (A&E), located in a volatile area of Kingston, Jamaica, treats 90-170 patients daily. It does so with limited staff and a potentially stressful work environment. This study explores the factors associated with occupational stress in the Department, and the coping strategies used by the doctors and nurses working there. A pre-tested self-administered questionnaire was completed by 28 (84.8) of the total population (n = 33) of health personnel working in the A&E. The participants were 15 (53.6) doctors, eight (28.6) registered nurses and five (17.8) enrolled assistant nurses. The data were analyzed using Statistical Package for the Social Sciences (SPSS) Version 7.5. Qualitative data were analyzed by sorting texts into related themes and describing the ideas of the subjects. The median age was 32 years, range 23-50 years. Median duration of employment in the A&E was three years, range 0.5-22 years. Eighteen (60) rated the A&E as [quot ]stressful[quot ]. The major sources of stress were the external environment and the amount and quality of the workload. Ninety-six per cent reported experiencing one to seven emotional and physical symptoms. Forty-six per cent also reported behavioural symptoms. The emotional, physical and behavioural symptoms of stress were associated (p < 0.05). The number of behavioural symptoms experienced was associated with age (p < 0.05). The majority (89.2) of doctors and nurses reported that they were satisfied with their jobs and had no intention of leaving their jobs within a year. This suggested the effectiveness of the reported humour, teamwork and [quot ]extracurricular[quot ] activities in buffering the effects of stress. Nurses were more likely to be [quot ]burned out[quot ] than doctors (p = 0.03). The respondents suggested increased monetary compensation, more staff and positive feedback from managers as factors which may relieve work stress. They suggested that organized counselling and stress management programmes would be useful

Ciliary neurotrophic factor injected icv induces adipose tissue apoptosis in rats.

Recent findings show that ciliary neurotrophic factor (CNTF) and leptin have similar effects on food intake and body weight, suggesting possible overlapping mechanisms. Intracerebroventricular (icv) injection of leptin results in adipose tissue apoptosis. To determine if CNTF has similar activity, male Sprague Dawley rats implanted with lateral cerebroventricular cannulas were randomly assigned to four treatment groups ( N = 8), including control (aCSF), 10 microg/day leptin, 1 microg/day CNTF, and 5 microg/day CNTF. Rats received daily icv injections for 4 successive days. Both leptin and CNTF (5 microg) decreased BW (8.6% and 11.77%, respectively, p <.05) and cumulative food intake was decreased 43% by leptin ( p <.05). Leptin and CNTF (5 microg) reduced adipose tissue mass in epididymal adipose (Epi) by 30 and 33.5%, ( p <.05), in inguinal adipose (Ing) by 51 and 55% ( p <.05), in retroperitoneal adipose (Rp) by 65 and 64% ( p <.05), and in intrascapular brown adipose (iBAT) by 34 and 25% ( p <.05), respectively. Gastrocnemius muscle was not affected. Leptin and CNTF (5 microg) increased apoptosis in Epi by 84 and 150%, respectively ( p <.05) and in Rp by 121 and 146%, respectively ( p <.05). Loss of adipocytes by apoptosis may provide an explanation for the unexpected delay in return to initial energy status following CNTF treatments.

Six-month hypertension intervention study. One year follow-up.

The aim of this study was to assess the long term impact of an educational and monitoring intervention on blood pressure control in patients (n = 80) who had blood pressure > 140/90 mm Hg in January 1999, and attended the Specialist Hypertension Clinic, the University Hospital of the West Indies. Forty-two of these patients (cases) attended the monthly educational and monitoring intervention for six months, in addition to their usual care. The other 38 (controls) attended only one educational intervention at the end of the six months. One year later, patients were traced by telephone or clinic attendance. Data were collected on 73 (91%) patients, 40 (95%) cases and 33 (87%) controls by clinic records or by direct measurement of blood pressure and weight. Three (7.5%) cases and two (6%) controls had died. One (2.5%) case and five (15%) controls had been referred to renal or cardiac clinics. Twenty-five (59.5%) cases, and 14 (36.8%) controls were still attending the clinic. At the end of the year, 26% (7/27) of the cases and 30% (6/20) of the controls had blood pressure (BP) controlled to < 140/90 mm Hg. These proportions compare to 28% (11/39) cases and 22% (8/36) controls at the end of the six-month intervention. At the end of one year, neither cases nor controls showed significant mean changes in BP, weight, nor body mass index (BMI). There was no significant difference between the median BMI of the cases, 31.2 kg/m2 and that of the controls, 29.3 kg/m2. Seventy-seven per cent (21/27) cases and 84.2% (16/19) controls had BMI > 25 kg/m2. These data, though limited, are consistent with reports that the impact of lifestyle interventions in chronic diseases may be short lived. This study suggests that therapeutic lifestyle intervention strategies need to be integrated with the overall management of patients so that the effect may be sustained.

Six-month hypertension intervention study. One year follow-up

The aim of this study was to assess the long term impact of an educational and monitoring intervention on blood pressure control in patients (n = 80) who had blood pressure > 140/90 mm Hg in January 1999, and attended the Specialist Hypertension Clinic, the University Hospital of the West Indies. Forty-two of these patients (cases) attended the monthly educational and monitoring intervention for six months, in addition to their usual care. The other 38 (controls) attended only one educational intervention at the end of the six months. One year later, patients were traced by telephone or clinic attendance. Data were collected on 73 (91) patients, 40 (95) cases and 33 (87) controls by clinic records or by direct measurement of blood pressure and weight. Three (7.5) cases and two (6) controls had died. One (2.5) case and five (15) controls had been referred to renal or cardiac clinics. Twenty-five (59.5) cases, and 14 (36.8) controls were still attending the clinic. At the end of the year, 26 (7/27) of the cases and 30 (6/20) of the controls had blood pressure (BP) controlled to < 140/90 mm Hg. These proportions compare to 28 (11/39) cases and 22 (8/36) controls at the end of the six-month intervention. At the end of one year, neither cases nor controls showed significant mean changes in BP, weight, nor body mass index (BMI). There was no significant difference between the median BMI of the cases, 31.2 kg/m2 and that of the controls, 29.3 kg/m2. Seventy-seven per cent (21/27) cases and 84.2 (16/19) controls had BMI > 25 kg/m2. These data, though limited, are consistent with reports that the impact of lifestyle interventions in chronic diseases may be short lived. This study suggests that therapeutic lifestyle intervention strategies need to be integrated with the overall management of patients so that the effect may be sustained

Compliance and blood pressure control in women with hypertension

Compliance with treatment is a fundamental prerequisite for therapeutic benefit. The aim of this study is to determine the level of knowledge of hypertension, compliance with recommended antihypertensive therapy, and current blood pressure status in women with hypertension attending a Type V health centre. A pre-tested questionnaire with 37 in-depth items was administered to 30 (37.5) women, selected by quota sampling, from a population of 80 women with hypertension, on four consecutive regular clinic days in May/June 2001. Weights and the mean of two blood pressure measurements were recorded. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 7.5. The median age and weight of the respondents was 57 years (range 36-85 years) and 80.3 kg (range 66.8-150 kg). Median duration of hypertension was five years. Fifty per cent of the sample were diabetic. The longer the patient had been hypertensive, the greater the compliance with medication (p < 0.05). Twenty per cent of non-diabetics were controlled to blood pressure < or = 140/90 mmHg and 13 of the diabetics were controlled to blood pressure < or = 135/85 mmHg. Twenty per cent reported ill effects from medication; 60 used [quot ]folk remedies[quot] such as garlic. Only 27 of patients were fully compliant with medication. Sixty per cent did no exercise, 73 did less than one hour of exercise per week. Diabetics took more exercise than non-diabetics (Z = -2.1, p < 0.05) and were more compliant with medication than non-diabetics (Z = -2.3, p < 0.05). All respondents included salt in their diets and consumed fruits and vegetables only [quot]sometimes[quot]. One third believed that hypertension could be [quot]cured[quot]. The overall median knowledge score and median compliance score were 50 (range 16.7-100) and 31 (range 13-60) respectively. This group had inadequate knowledge of hypertension, poor compliance with recommended antihypertensive therapy (JNCVI) and limited BP control. Counselling of these patients in the areas of medication, diet, exercise and weight control is recommended. Further research, using randomized samples, to inform interventions to improve the knowledge, compliance and self-care management of patients with hypertension is indicated