Improving hypertension control and patient engagement using digital tools | Who gained coverage from the ACA? | Predictive performance of a Fall Risk Assessment Tool (FRAT-up)
Hypertension is present in 30% of the adult US population and is a major contributor to cardiovascular disease. The established office-based approach yields only 50% blood pressure control rates and low levels of patient engagement. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record. The authors evaluated blood pressure control in 156 patients with uncontrolled hypertension enrolled in a home-based digital-medicine blood pressure program and compared them with 400 patients (matched to age, sex, body mass index, and blood pressure) in a usual-care group after 90 days. Digital-medicine patients completed questionnaires online, were asked to submit at least one blood pressure reading/week, and received medication management and lifestyle recommendations via a clinical pharmacist and a health coach. A digital hypertension program is feasible and associated with significant improvement in blood pressure control rates and lifestyle change. Use of a virtual health intervention using connected devices improves patient activation and is well accepted by patients.
The first young adults to gain coverage via the Affordable Care Act-dependent coverage expansion were largely white college students with better health status compared with other young adults.
Can a Fall Risk Tool (FRAT-up) accurately predict future falls? Data about fall risk factors from four European studies -- from Germany, England, Italy, and Ireland -- that used other fall risk tools were compared to the FRAT-up tool for each of those cohorts. It was found that FRAT-up was a valid tool for measuring future risk of falls. More studies should be done to try to understand the reasons for similarities across studies and to refine the tool.
While antimicrobial peptides in cervicovaginal secretions are altered during pregnancy, the protective effect of cervicovaginal fluid against HIV in an in-vitro model is not compromised.
Diet interventions may reduce the risk of urinary stone formation and its recurrence, but there is no consensus regarding the effectiveness of dietary interventions and recommendations about specific diets for patients with urinary calculi. The authors evaluated the effect of physiologic doses of L-methionine on urinary pH. High methionine foods include nuts, beef, lamb, cheese, turkey, pork, fish, shellfish, soy, eggs, dairy, and beans. In normal subjects, L-Methionine decreased urine pH and theoretically should decrease the risk of phosphate stones that typically form when urine pH is high. Regardless of the underlying cause of the stone disease, a mainstay of conservative management is the forced increase in fluid intake to achieve a daily urine output of 2 liters.
Obesity remains a significant threat to the current and long-term health of US adolescents. This study estimated adolescent obesity at the county level for the contiguous US and then explored the association between area-based correlates of obesity and ecologic obesity prevalence. Adolescent obesity varies geographically, with clusters of high prevalence in the Deep South and Southern Appalachian regions. Measures of the macrosocial and relational domain, including community socioeconomic status, community health, and social marginalization, were the strongest correlates of county-level obesity.
Brain magnetic resonance imaging (MRI) has demonstrated brain injury and differences in the brain structures of children with congenital heart disease (CHD). These children are at increased risk of neurodevelopmental impairment. In this study, infants with biventricular CHD underwent brain MRI and neurodevelopmental testing at 1 year of age and were compared with healthy controls. Infants with CHD had reductions in total brain, cerebral white matter, and brainstem volumes. White matter volume correlated with language development, but not broader developmental indices. Abnormalities in white matter development detected months after corrective heart surgery may contribute to language impairment. Language should be monitored closely at follow-up visits.
Swedish researchers found that obese patients who underwent bariatric surgery had a 29% lower risk of developing atrial fibrillation over 20 years, with younger individuals at an even lower risk, compared with those who didn't undergo surgery. The findings in the Journal of the American College of Cardiology revealed those in the surgery group lost a mean 25% of their body weight within one year, compared with no changes in the control group.
An analysis of 29 studies found eating a handful of nuts each day may reduce the risk of heart disease, cancer, respiratory conditions, diabetes and infections, researchers reported in BMC Medicine. "We found a consistent reduction in risk across many different diseases, which is a strong indication that there is a real underlying relationship between nut consumption and different health outcomes," said researcher Dagfinn Aune of Imperial College London.
Health care providers are taking steps to deal with the push for greater price transparency, but providing accurate estimates for the cost of medical care before patients receive the services has been a challenge. Critical pieces include robust estimation tools and outreach to help patients understand their insurance coverage, such as Boston-based Steward Health Care's call center that handles patient insurance information.
An analysis of 19 studies found both physician-directed and organization-directed interventions led to small reductions in physician burnout, researchers reported in JAMA Internal Medicine. Researchers said, however, the impact was greater for organization-directed initiatives than for physician-directed interventions.
Family-centered discharge planning is key for children with complex medical needs, and it should include parental priorities, preferences and goals, researchers reported in Pediatrics. Hospital-to-home transition issues unique to these families include prioritizing normal routines and supporting child development along with recovery, said researcher JoAnna Leyenaar of Dartmouth-Hitchcock Medical Center.
Survey data from Gallup-Healthways showed people ages 55 and older had higher levels of well-being than younger adults across five measures: financial well-being, community, purpose, social and health. Older people in Hawaii, Arizona and New Hampshire had the highest well-being levels, while those in West Virginia, Kentucky and Oklahoma had the lowest levels.
The road leading to a goal does not separate you from the destination; it is essentially a part of it.
Charles de Lint, writer
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