Self-Administered Gentle Yoga and Yoga Breathing Intervention Improves Burden and Stress Biomarkers in Caregivers of Persons Living with Dementia.

Family caregivers of adults with Alzheimer's disease and related dementias (ADRD) are the fastest growing group of informal healthcare providers in the United States. These individuals experience high levels of stress and physical and psychosocial symptoms related to their caregiving role. We provided 20 ADRD caregivers (≥ 55 years of age) with training and access to a mobile health app for at-home practice of gentle yoga and yoga breathing exercises. Here, we report secondary outcomes, including changes in caregiver physical and mental function, burden, fatigue, sleep, and biological stress markers (salivary cortisol and 1,5-anhydroglucitol [1,5-AG] assays) from Baseline (Week 1) to Study End (Week 12). Self-reported questionnaire data were collected online via the Research Electronic Data Capture system, and biomarker data were collected via saliva samples. Results supported indications for slight improvement in outcomes of caregiving burden among ADRD caregivers using the gentle yoga and yoga breathing app. Furthermore, slight improvements in mental health were observed; the greatest gains were made by those reporting higher burden and having family members with more severe dementias. Findings indicate that those experiencing the greatest improvement in caregiver burden scores spent the most time doing gentle yoga and yoga breathing exercises. Salivary stress biomarkers moved in a favorable direction (decreased cortisol; increased 1,5-AG) among caregivers practicing the exercises most often. This is among the first studies of gentle yoga and yoga breathing exercises for relieving ADRD caregiver burden and the first we are aware of to incorporate stress biomarker measurement.

App providing psychosocial and educational supports benefits caregivers of children with newly diagnosed food allergies.

Background: Approximately 6 million children in the United States have a diagnosed food allergy, and 32% of caregivers experience significant psychological distress due to the diagnosis. Despite substantial impacts on psychosocial health and quality of life, few interventions aim to help caregivers of newly diagnosed children. There is a clear, unmet need for interventions to address caregiver distress, especially after the initial diagnosis. Objective: We developed a mobile psychosocial health intervention, the Food Allergy Symptom Self-Management with Technology (FASST) app. Primary end points were to determine the app's feasibility and caregiver satisfaction. Methods: This was a phase II, randomized controlled, implementation study (4-week duration) in caregivers (N = 30) of children ≤ 18 years of age who were newly diagnosed with a food allergy (≤90 days after the diagnosis). Caregivers (n = 20) were randomized to use the FASST app (intervention group) with access to individualized, self-help symptom relief interventions and food allergy support, and educational resources; or to use a limited app with a basic FASST interface and links to a few educational resources (control group [n = 10]). Ten participants (intervention group, n = 5; control group, n = 5) participated in semistructured interviews at week 4. Results: Both groups found the app relatively easy to use. The intervention group scores for safety preparedness during social activities increased by 24%, whereas those in the control group experienced a 1% decline. The intervention group participants increased the use of websites to find food allergy information by 17% at week 4 compared with 4% for the control group. Although the intervention group participants showed greater gains than did those in the control group in their confidence to prepare for and prevent allergic reactions, and greater declines in perceived social limitations, more participants in the control group endorsed confidence in their ability to recognize (11% versus 5%, respectively) and treat (10% versus 6%, respectively) allergic reactions. Conclusion: Analysis of our results suggests that the FASST app may provide a feasible means of delivering psychosocial and educational supports to caregivers of children recently diagnosed with a food allergy.Clinical trial NCT04512924, www.clinicaltrials.gov.

Perspectives on the Medical, Quality of Life, and Economic Consequences of Hiccups.

PURPOSE OF REVIEW: Singultus or hiccups (HU) is a common, usually temporary, event. Its potentially serious consequences are often overlooked. This review explores published evidence describing HU burden (clinical, economic, and quality of life [QoL] consequences) across patient populations. RECENT FINDINGS: Literature review identified 81 articles (including 57 individual case reports). We extracted relevant information to better understand the burden of HU and to identify knowledge gaps for future study. HU are physiologic events that can complicate existing medical conditions and treatments regardless of duration. Relatively short episodes can have devastating consequences in patients who have pre-existing conditions. HU appear to impact physical and psychological health, diminish QoL, increase healthcare resource use, and increase costs. A better understanding of HU burden is needed.

Cardiovascular risk factor control in communities--update from the ASH Carolinas-Georgia Chapter, the Hypertension Initiative, and the Community Physicians' Network.

The prevalence of hypertension dictates that blood pressure must be managed effectively in primary care. The American Society of Hypertension (ASH) regional chapters and clinical hypertension specialists represent a positive response by ASH to the growing problems of hypertension and metabolic syndrome-related risks and disease. To have a significant public health effect, the impact of clinical hypertension specialists must be leveraged. Key activities in the community include educating other providers locally, delivering care for complex referral patients, and fostering growth of a practice network with a central database in collaboration with academic partners. The database supports practice audit and feedback reports to enhance quality improvement, identify continuing medical education topics, and facilitate clinical trials to test new therapeutic and best-practice approaches to risk factor management. The ASH regional chapters serve as a forum for community and academic hypertension specialists to collaborate with like-minded individuals and organizations. The collaboration among the ASH Carolinas-Georgia chapter, the Hypertension Initiative, and the Community Physicians' Network provides a model for other ASH chapters and health delivery groups to partner in delivering continuing medical education programs focused on cardiovascular risk factor management, recruiting practices into the network, and developing and maintaining a centralized patient database. Evidence suggests that this collaboration is facilitating application of evidence-based medicine and risk factor control.

Improvements in walking speed experienced by elders participating in a cardiovascular exercise program.

PURPOSE: The purpose of this retrospective investigation was to determine: (1) whether a cardiovascular exercise program was capable of improving treadmill gait speed of elderly individuals, and (2) if such an improvement was associated with specific determinants. METHODS: Twenty residents of a retirement community were assessed at baseline and followed up after approximately 1 year (mean=10.7 +/- 1.1 months) of participation in a prescribed cardiovascular exercise program. On each individual's initial visit, self-regulated walking time for one-quarter mile on a Star Trac 4500 motorized treadmill with no incline was recorded. Individuals were then placed on a cardiovascular exercise program that emphasized walking, which they performed 3 to 5 sessions/week for 20 to 30 minutes/session. At follow-up, individuals repeated the one quarter-mile treadmill walk, and times were compared to those obtained on the initial visit. RESULTS: Mean walking treadmill times decreased significantly (p < 0.05) from 7.7 +/- 2.7 minutes to 5.7 +/- 2.1 minutes, with both male and female participants showing similar changes. Baseline walk time and change in walk time at follow-up were highly correlated (r = .682/p < .0001), but participants with slower baseline walk times showed the greatest gains. Participant age was also correlated to change in walk time (r = .389/p = .045). CONCLUSION: All program participants showed some degree of improvement in walking speed, suggesting that benefits may be applicable to a wide range of elderly groups. However, individuals with the slowest baseline walk times demonstrated the greatest improvement.

Prevalence, treatment, and control of chest pain syndromes and associated risk factors in hypertensive patients.

BACKGROUND: Prevalence of chest pain syndromes (CPS)-chest pain, angina pectoris, chronic angina, and preinfarction angina/intermediate coronary syndrome (ICS)-among hypertensive patients and medical management of these disorders in primary care are not well defined. METHODS: The Hypertension Initiative primary care database with 72,508 hypertensives was analyzed to characterize prevalence and management of CPS. Patients with more than one CPS were categorized by the most severe diagnosis. RESULTS: Eleven percent of hypertensives had a CPS. Of these patients, 66% (5284) were diagnosed with chest pain only, 15% (1204) with angina, and 19% (1508) with ICS. More men than women were diagnosed with angina (18% v 4%) and ICS (21% v 10%). More women than men were diagnosed with chest pain only (86% v 61%). African Americans received more chest pain diagnoses (71% v 62%), similar angina diagnoses (14% v 16%), and slightly fewer ICS diagnoses (15% v 22%) than whites. Most striking, women and African Americans with CPS received fewer medications than men and whites, both overall and within diagnostic categories. Prescription rates differed more by gender (male/female) than by ethnic group (white/African American) for angiotensin-converting enzyme inhibitor, diuretics, aspirin, statins, and nitrates. Hypertensives with CPS received more medications and achieved better risk factor control than non-CPS hypertensives, but the majority remained above goal levels. CONCLUSIONS: Primary care physicians treat cardiovascular risk factors relatively aggressively in hypertensives with CPS. However, substantial numbers of these patients do not reach goal levels. Demographic differences in treatment represent opportunities to reduce disparities.

Ethnic differences in blood pressure control among men at Veterans Affairs clinics and other health care sites.

BACKGROUND: Differential access to health care may contribute to lower blood pressure (BP) control rates to under 140/90 mm Hg in African American compared with white hypertensive patients, especially men (26.5% vs 36.5% of all hypertensive patients in the National Health and Nutrition Examination Survey 1999-2000). The Department of Veterans Affairs (VA) system, which provides access to health care and medications across ethnic and economic boundaries, may reduce disparities in BP control. METHODS: To test this hypothesis, BP treatment and control groups were compared between African American (VA, n = 4379; non-VA, n = 2754) and white (VA, n = 7987; non-VA, n = 4980) hypertensive men. RESULTS: In both groups, whites were older than African Americans (P<.05), had lower BP (P<.001), and had BP controlled to below 140/90 mm Hg more often on their last visit (P<.01). Blood pressure control to below 140/90 mm Hg was comparable among white hypertensive men at VA (55.6%) and non-VA (54.2%) settings (P = .12). In contrast, BP control was higher among African American hypertensive men at VA (49.4%) compared with non-VA (44.0%) settings (P<.01), even after controlling for age, numerous comorbid conditions, and rural-urban classification. African American hypertensive men received a comparable number of prescriptions for BP medications at VA sites (P = .18) and more prescriptions at non-VA sites than did whites (P<.001). African Americans had more visits in the previous year at VA sites (P<.001) and fewer visits at non-VA sites (P<.001) compared with whites. CONCLUSIONS: The ethnic disparity in BP control between African Americans and whites was approximately 40% less at VA than at non-VA health care sites (6.2% vs 10.2%; P<.01). Ensuring access to health care could constitute one constructive component of a national initiative to reduce ethnic disparities in BP control and cardiovascular risk.

Ethnic, gender, and age-related differences in treatment and control of dyslipidemia in hypertensive patients.

BACKGROUND: Demographic differences in management of concomitant lipid disorders among hypertensive patients may contribute to health disparities. OBJECTIVES: Assess demographic differences in lipid control rates and treatment patterns among dyslipidemic hypertensive patients in primary care. METHODS: Demographic information, blood pressure, LDL-cholesterol, and medications were obtained on 72,351 hypertensive patients from 262 primary care providers at 69 sites in the Southeast. Analysis focused on a dyslipidemic hypertensive subset. RESULTS: Among 72,351 hypertensives, 38,116 were dyslipidemic. Fifty-two percent of patients did not have a cholesterol measurement documented in the past year. Women and patients <40 years old were less likely to have an annual cholesterol measurement than men and older, same-race counterparts (P < or = .001). Thirty-five percent of all hypertensive dyslipidemic patients had not been prescribed any anti-lipidemic medication, whereas 15% were on a statin and another anti-lipidemic. Women received fewer statin prescriptions than men (47.7% vs 65.1%, P < or = .0001). Fewer African Americans (AA) than Caucasians (C) reached LDL levels of <100 or <130 mg/dL (P < or = .0001). Among C and AA patients, those <40 years old were less likely than older, same-race counterparts to have reached LDL < 100 or <130 mg/dL (p < or = 001). Younger patients had fewer annual cholesterol measurements and were less likely to receive antilipidemic medication and to have LDL controlled than older, same-race counter-parts in each ethnic group (P < or = .0001). CONCLUSIONS: Demographic characteristics of hypertensive patients, especially younger age group, are associated with significant differences in diagnostic testing, treatment, and control of hyperlipidemia in primary care. This primary care information can be used to guide education and policy interventions to improve outcomes and reduce disparities.

Reducing disparities for African Americans with diabetes: progress made by the REACH 2010 Charleston and Georgetown Diabetes Coalition.

Racial and Ethnic Approaches to Community Health (REACH 2010) is a U.S. Centers for Disease Control and Prevention demonstration program that responds to the U.S. Department of Health and Human Services' goal to eliminate racial and ethnic disparities in health status by the year 2010. As part of REACH 2010, community projects were funded to develop, implement, and evaluate community action plans to improve health care and outcomes for racial and ethnic populations. This article describes the program and details the progress of the REACH 2010: Charleston and Georgetown Diabetes Coalition in reducing disparities in care. Approaches employed by the Coalition included community development, empowerment, and education related to diabetes; health systems change associated with access, care, and education; and coalition advocacy. Racial disparities were identified for 12,000 African Americans with diabetes in this urban/rural South Carolina community. After 24 months, significant differences that initially ranged from 11% to 28% in African Americans (when compared with whites/others) were not observed on 270 chart audits for A1C, lipid and kidney testing, eye examinations, and blood pressure control. Future efforts will focus on maintaining progress, eliminating other disparities, and identifying the contributions of each intervention in eliminating racial disparities.

People with diabetes: knowledge, perceptions, and applications of recommendations for diabetes management.

The purpose of this paper is to report results of the People with Diabetes survey conducted as part of the REACH 2010: Charleston and Georgetown Diabetes Coalition. The pilot data revealed that African Americans (AAs) (N=80) reported fewer A1c, lipid, and kidney testing, feet and eye exams, and less nutrition and diabetes self-management counseling during 1999-2000 than did Caucasians (Cs) (N=23). The survey was repeated in 2002 when data were collected from a convenience sample of 160 AAs and 150 Cs using the revised self-reported survey instrument. African Americans (AAs) were significantly likely to report that their understanding of results for the kidney function test were good as compared to Cs (P<.001) and were more likely to report receiving nutrition education (P=.003). Otherwise, there were no significant differences between AAs and Cs on the remaining items in the survey. Since REACH 2010 was actively involved in the AA community for 2 years between the pilot survey and the repeated survey, these results were anticipated and are also reflected in results of chart audits conducted within healthcare systems used by the same AA population.

Cardiovascular risk factor control and treatment patterns in primary care.

Previous research has shown that controlling hypertension and other cardiovascular (CV) risk factors reduces the number of CV events and racial/ethnic health disparities. The objectives of this study were to assess CV risk factor treatment, control, and disparities among patients with hypertension using data from retrospective medical record audits. Data were obtained from 63 primary care sites with 201 providers. In 49% of 35,940 patients with hypertension, the last blood pressure reading was less than 140/90 mm Hg. In 62% of 18,627 patients who also had dyslipidemia, low-density lipoprotein cholesterol was less than 130 mg/dL. In 49% of 6,616 patients with hypertension and diabetes, glycosylated hemoglobin levels were less than 7%. Multiple risk factor control was rare, especially among women and African Americans. It appears that programs to improve CV risk factor control using audit and feedback in primary care are feasible and instructive.