Low carbohydrate diets have been studied for many years as nutritional therapy for treating patients with type 2 diabetes mellitus (T2DM). Type 2 diabetes is an inflammatory disease that is defined by high blood glucose and HbA1c, lipid levels, BMI, central adiposity, and cholesterol levels, are some among the many indicators that can signal risk for diabetes or help to diagnose diabetes. These indicators are used in studies to evaluate the effectiveness of the nutritional therapy in producing positive health outcomes. Many medications are available for the treatment of T2DM; however, they have a host of side effects, and nutritional therapy has been shown to at least help reduce the dosage of these medications needed by the patients. There are other forms of nutritional therapy besides low carbohydrate diets, and some controversy remains about low carbohydrate diets that in the long term, replacing carbohydrates with fats and proteins could result in increased cholesterol and lipid levels, creating an increased risk for cardiovascular disease. Although some studies have found that low carbohydrate diets, especially very low carbohydrate ketogenic diets (VLCK), do result in increased cholesterol, it is generally an increase in HDL, which is considered good cholesterol and not harmful. Overall weight loss benefits from reduced central adiposity, BMI, and reduced HbA1c levels outweigh the increase in HDL as a side effect. A few different variations of low carbohydrate diets are compared in this review, such as very low carbohydrate ketogenic diets, moderate carbohydrate calorie restricted diets, and moderate carbohydrate low (MCD) Glycemic Index (GI) diets. Due to the ability to exchange carbohydrates with high GI for carbohydrates with low GI, the MCD with low GI sounds promising for good adherence and positive health outcomes in the long run. Although very low carbohydrate ketogenic diets produce many positive health outcomes, the nutritional therapy must be very well designed and followed up, and care must be taken that fiber and nutrients are maintained in the diet. Adherence is a key part of the success of nutritional therapy and a study design plays a major role in that. Providing behavioral development classes, nutritional information classes, and intermittent classes focused on physical activity and healthy habit formation leads to overall increased positive affect which is better for the patient and thus, for the study as well. The easier the nutritionist or dietician can make the therapy transition for the participant, the more likely they are also to stay and try to stick with it. For example, in the studies where the study coordinator provided some small food provisions at the beginning or throughout the study seemed to be successful because the patients were less likely to fall to making their own choices poorly and being inconsistent. Although there were many diets that resulted in many positive health outcomes, ultimately a well-designed, adherence focused, very low carbohydrate ketogenic diet seemed to be the most effective at decreasing HbA1c and producing other positive health outcomes as well. In the long term however, a VLCKD, may be unsustainable for the patient and the body, given the extreme reduction in important carbohydrates.

The emission of green house gases from animal agriculture has grown in recent years and is contributing to climate change and increased risk for chronic diseases. Red and processed meat can have positive health effects, such as getting enough nutrients as vitamins and protein to your diet, but can also increase the risk for cancer, cardiovascular disease and diabetes type 2. The objective of this study was to determine the meat consumption in adults and the factors that may affect this consumption. A secondary objective of this study was to find out if consumer’s are informed about the health risks regarding meat consumption. A questionnaire was sent out on Facebook where anyone could answer and later these answers where analyzed and compiled. The results show that men had a more positive attitude to meat consumption and health effects than women. Individuals who consume more meat is likely to think it effects them positively, this may be due to either ignorance or lack of information. Individuals avoiding or consuming less meat, did it in concern for the animals and to diminish the negative effects on their health and the environment. The conclusion of this study is that there are still people who think meat consumption has only positive health effects and therefore information needs to be uniformed so there can be no misunderstandings or doubts about the health effects from meat consumption.

Philosophiae Doctor - PhD / Cardiovascular disease is amongst the top three leading causes of mortality in South Africa and the world. The effects of cardiovascular disease can be seen in limitations of function within all spheres of life, including work function. Cardiac rehabilitation programmes have been documented to improve functional abilities, but little is known about the return to work rate after cardiac rehabilitation. Access to cardiac rehabilitation programmes in the Western Cape is limited. This study aimed to determine the return to work rates and influencing factors after cardiac rehabilitation as well as to design an intervention programme that is accessible and could facilitate return to work for individuals with cardiovascular disease.

Magister Pharmaceuticae - MPharm / Cardiovascular diseases (CVDs) such as ischaemic heart diseases, heart failure and stroke remain a major cause of death globally. Various deep-rooted factors influence CVD development; these include but are not limited to elevated blood lipids, high blood pressure, obesity and diabetes. A considerable number of proteins are involved directly and indirectly in the transport, maintenance and elimination of plasma lipids, including high and low-density lipoprotein cholesterol (HDL-C and LDL-C). There are several mechanisms involved in the removal of LDL particles from systemic circulation. One such mechanism is associated with the gene that encodes proprotein convertase subtilisin/kexin type 9 (PCSK9), which has become an exciting therapeutic target for the reduction of residual risk of CVDs. Currently, statins are the mainstay treatment to reduce LDL-C, and a need exists to further develop more effective LDL-C-lowering drugs that might supplement statins.

BACKGROUND: Atherosclerotic cardiovascular (ASCVD) disease is the leading cause of death in the United States. Longstanding poor nutrition habits and lack of exercise contribute to chronic inflammation and promote the development ASCVD. In clinical trials, the Dietary Approaches to Stop Hypertension (DASH) eating pattern, a diet rich in nutrients with anti-inflammatory and antioxidant properties, has been shown to reduce the risk of hypertension. Its role in overall cardiovascular (CV) health, both alone and in combination with an active lifestyle, is less clear. OBJECTIVES: The primary goal of this study is to examine the relationships between the DASH eating pattern, physical activity, the development of incident cardiovascular disease (CVD). Specifically, we will evaluate the independent and combined effects of DASH and moderate to vigorous physical activity (MVPA) on cardiovascular event risk among men and women in the Framingham Heart Study Offspring (FOS) cohort. METHODS: The DASH score was derived from two sets of three-day dietary records gathered during examination visits 3 and 5 in the prospective FOS cohort. Activity was self-reported and used to generate a composite score for MVPA. Scores were constructed for each individual by multiplying the number of hours spent during each day in sedentary, light, moderate, and vigorous activity by a standard weights reflecting the intensity of that activity. Subjects included 2503 individuals (1137 men and 1366 women), aged 30 years and older. Individuals were free of type II diabetes mellitus (T2DM), cancer, and cardiovascular disease at baseline. The DASH score was categorized according to adherence to the eating pattern, first as low, moderate, or high adherence and then dichotomized (DASH score <4.45 vs. ≥4.45). The MVPA score was classified into quintiles and also dichotomized (MVPA score <6.1 vs. ≥6.1). The dichotomous DASH and MVPA scores were then cross-classified and each subject was assigned to one of the following categories: (1) low DASH score / low activity (referent), (2) low DASH / high activity, (3) high DASH / low activity, and (4) high DASH / high activity. Follow-up started at exam 5 and continued through the ninth examination cycle in 2014. Cox proportional-hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all subjects and for men and women independently, adjusting for confounding by age, BMI, cigarettes smoked per day, and grams per day of alcohol consumed. Factors found not to confound the effects of DASH and MVPA on CV risk were excluded from final models. RESULTS: During a median follow-up of approximately 20 years, 286 and 177 incident CVD cases were documented among men and women, respectively. Women in the highest DASH adherence category had approximately 28% lower total CVD risk than women in the lowest adherence group (HR, 0.72; 95% CI: 0.48-1.10). Effects in men were weaker. Women in the highest quintile of MVPA score had approximately 44% lower risk of CVD than women in the lowest quintile (HR, 0.66; 95% (0.40-1.10). Overall, CVD risk was 26% lower (HR: 0.74 (95% CI: 0.55-0.99) for those in quintile 5 vs. quintile 1. Women in the High DASH/High MVPA category had a 43% lower total CVD risk than women in the Low DASH/Low MVPA group (High DASH/High MVPA: HR, 0.57; 95% (0.36-0.90)). These associations ere generally stronger in women than men. CONCLUSIONS: In this prospective cohort study, active individuals with higher adherence to DASH was associated with a lower atherosclerotic CVD risk compared to those with lower activity and DASH adherence. The beneficial effects of diet in particular were stronger among women than men.

Introduction: Cardiovascular diseases (CVD) remain the leading cause of death in the United States (U.S.), accounting for one in three deaths annually. Within the U.S., disparities in CVD outcomes and risk factors exist across demographic groups and geographic areas, such as the Central Appalachian region where the burden is higher than state and national rates. Patient-centered care (PCC), is a model of health care delivery that has been shown to improves disease outcomes and quality of life, and is critical in addressing disparities in health care. However, little is known about how high-risk Central Appalachian populations understand or perceive such a model. As such, the objective of this study was to examine the perceptions of PCC among community-dwelling CVD patients/caregivers in the region. Methods: A qualitative study design applying thematic analysis was utilized for data collection and analysis. Seven focus group discussions across six states in Central Appalachia were conducted, and comprised of 78 middle-aged participants selected through purposive sampling. Sessions were guided by standardized instrument regarding current efforts in their communities concerning CVD; challenges and needs; appropriate approaches to their cardiovascular issues; understanding and views about patient-centeredness; and related priorities. The discussions were audio-recorded, transcribed, and then coded for thematic analysis using NVivo qualitative data analysis software. Dependability of data analysis was achieved through an audit trail tracking the NVivo process. Results: Data analysis identified interpersonal relationships with health care providers (HCPs) as the most important aspect of PCC among participants. When asked what PCC meant to them, each group discussed the interpersonal relationship they wanted from HCPs, barriers that kept them from achieving this relationship, and how it impacted their care. Within this theme, two overarching subthemes emerged: (1) developing long-term relationships with HCPs, and (2) developing partnerships with HCPs. The first theme had subthemes that included: turnover of HCPs in their geographical location, the disappearance of family physicians, and preferences related to seeing a physician versus a physician’s assistant or nurse practitioner. The second theme’s subthemes included: communication, feeling cared for as an individual, and input into care. Conclusion: Patients/caregivers stressed the importance of interpersonal relationships with providers in the delivery of PCC. However, patients recognized when PCC was not being provided, provided examples of interactions that were not conducive to providing PCC, and reported feeling disempowered as a person and a patient. The results of this research can be utilized to understand patient/caregiver perceptions of PCC, and indicates the need for further research to reconcile these viewpoints with those of providers to improve the delivery of care, and health outcomes.

Most cardiac tumors are metastatic tumors, which are 20–40 times more common than primary tumors of the heart. Most primary tumors of the heart are benign, with atrial myxomas being the most common. Primary cardiac tumors are extremely rare with an incidence of less than 0.1 percent. Virtually all types of sarcomas have been reported in the heart as isolated case reports. We present a rare case of biatrial high-grade osteosarcoma. A fifty-four-year-old Hispanic female presented with shortness of breath and was cyanotic on the exam while visiting Mexico. Due to abnormal chest x-ray, echocardiogram concerning for bilateral atrial myoma she was referred to a cardiothoracic surgeon. She underwent bi atrial intracardiac tumor resection in Mexico. Several months prior to her resection she noted numbness on the side of the face that was evaluated by her physicians in the United States with a Brain MRI and carotid Ultrasound/Doppler that was unrevealing. She also remembered an episode of uncontrolled hypertension two years prior to surgery requiring admission to a local hospital in East Tennessee with cardiology evaluation that did not include an echocardiogram. Surgical pathology showed extensive undifferentiated spindle cell proliferation with multifocal osteoid production and foci of osseocartilaginous differentiation. There was prominent necrosis and moderately high mitotic rate (10-19/HPF). Tumor cells were positive for SatB2 and negative for vascular, muscular, or neural markers. This is consistent with a primary cardiac high-grade osteosarcoma. These occur very rarely, usually in the atria, and behave aggressively. Post resection staging PET-CT showed hypermetabolic mixed lytic and sclerotic lesion of T10 concerning for metastasis disease. She received approximately 6 cycles of adriamycin and ifosfamide chemotherapy. Adriamycin was discontinued due to left ventricular dysfunction with an ejection fraction of 30-35%, multiple segmental abnormalities, diffuse left ventricular hypokinesis, and moderate to severe mitral valve regurgitation. Despite intracardiac tumor, resection, concern for metastatic disease, chemotherapy, and systolic dysfunction patient is asymptomatic and does have robust performance status. A follow-up PET-CT five months after cessation of treatment reveals no significant evidence of uptake other than abnormalities in the T10 vertebra. A repeat echocardiogram continues to reveal a depressed ejection fraction of 35%. The patient is completely asymptomatic, seemingly fit with an ECOG performance status of 0-1. Osteosarcomas are aggressive with a high incidence of recurrence and metastasis. Fewer than 50 cases of primary cardiac osteosarcomas have been reported in the literature. Currently, it is postulated that they arise from undifferentiated mesenchymal stem cells in the endocardium that transform into active osteoblasts. Even though complete resection can be achieved in some cases, long-term results are usually poor. No standard therapy has been established due to the tumor's low incidence rate and lack of clinical trial data. Our case highlights the importance of evaluating common symptoms thoroughly since it may be a harbinger of rare and serious disorders. This case reflects the heterogeneous nature of sarcoma histology, the consequent tumor biology and hence varied clinical course and prognosis.

Background: Cardiovascular disease (CVD) is the leading cause of death globally since the turn of the century. One major risk factor is tobacco smoking with a particular risk associated with early initiation/greater duration. Research also indicates that alcohol use can offer both risk or protective cardiovascular benefits depending on consumption characteristics (intensity, frequency, dose, type). The purpose of this study is to examine the early onset of smoking, heavy smoking, and alcohol behavior as they relate to CVD risk. Methods: Using the data from the 2019 National Survey on Drug Use and Health (N=56,136), logistic regression analysis were conducted to examine trends in heavy substance use predictive of CVD risk (Independent variables of heavy substance use: number of cigarettes smoked per day, ≤ 12 years of tobacco smoking, ≥ 5 drinks for males or ≥ 4 drinks for females on each of 5 or more days in the past 30 days; and the dependent variable - ever told by a doctor or other health care professional that you had heart condition) while controlling for sociodemographic factors. Results: Overall, 19.7% of the study population reported CVD conditions, 5.9% heavy alcohol consumption, and 4.9% early onset of smoking. Overall, the odds of having heart condition among heavy alcohol drinkers was 23.6% less than those who were not heavy alcohol drinkers (odds ratio (OR): 0.76, 95% confidence interval (CI): (0.63-0.92), 44% more among those smoked 26 or more cigarettes per day than 25 or less 1.44 (1.01-2.05), 49% more among those with early onset of smoking than none 1.49 (1.15-1.93). By age, we found that heavy alcohol consumption could be either risk factor or protective factor of heart condition or no effect on heart condition across different age groups: for aged 12-18, OR 1.69 (CI 0.69-4.16); 19-25, 0.75 (0.48-1.15), 26-29, 1.21 (0.57-2.53); 30-34, 0.80 (0.36-1.77); 35-49, 0.61 (0.40-0.93); 50-64, 1.12 (0.77-1.62); >64, 0.93 (0.57-1.52). Based on gender, CVD risk was higher in males than females, 1.22 (1.13-1.32). In terms of race, the odds of CVD risk were lower for all groups when compared with non-Hispanic White. Based on income, the odds of CVD risk were higher in high-income earners with at least a college education when compared to low-income earners with high school education or less (≥$50k vs.Conclusion: Study findings demonstrate that the association of heavy alcohol consumption related to CVD risk varied by age. For heavy tobacco smoking, early onset of tobacco smoking, being male, white race, having above high school level education, high income, and advanced age were found to be significant predictors of CVD risk. Future observational studies should be performed to determine the combined effects of heavy alcohol consumption and heavy smoking as it relates to CVD risk by other behavioral risk factors such as types of alcohol consumed (i.e, spirits vs wine) and related behaviors.

Syfte: Syftet med denna litteraturstudie var att undersöka hur kognitiva och motoriska funktionsnedsättningar kan påverka den orala hälsan och den oral hälsorelaterade livskvalitén hos strokedrabbade individer. Metod: En litteraturstudie genomfördes baserad på 18 vetenskapliga originalartiklar. Sökning efter samtliga artiklar genomfördes i databaserna CINAHL, Medline och DOSS där särskilda inklusion och exklusions kriterier styrde valet av vilka artiklar som skulle användas. Därefter kvalitetsgranskades de utvalda artiklarna. Resultat: Strokerelaterad motoriska funktionsnedsättningar påverkar individens förmåga att sköta munhygienen och att tugga och svälja. Det har även påvisat att strokerelaterade motoriska funktionsnedsättningar hade statistisk signifikant påverkan på parodontal status (p &lt;0,001). Kognitiva funktionsnedsättningar hos strokedrabbade individer visade en statistisk signifikant påverkan på hur ofta strokedrabbade individer borstade tänderna dagligen (p &lt;0,001) samt en statistisk signifikant koppling till parodontit. Både motoriska och kognitiva funktionsnedsättningar uppvisade en påverkan på individens dagliga välbefinnande. Slutsats: Strokerelaterade motoriska och kognitiva funktionsnedsättningar har visats ha en påverkan på oral hälsa och oral hälsorelaterad livskvalité. Dock skulle mer forskning inom detta område vara gynnsam för både allmänheten och tandvårdspersonalen.

Personal telehealth plays a crucial role in addressing global challenges of aging population and rising cost for health care. Tiny and wirelessly connected medical sensors, for example embedded in clothes or on the body, will be an integrated part of lifestyle, and will allow hospitals to remotely diagnose patients in their home.  In this thesis, a wireless bio-sensing with smart phone based monitoring system is proposed to provide a home based telehealth care for continuous monitoring. The system consists of two main parts: a wireless sensor and a health application on the smart phone. This thesis is to design the first part of the system - a wireless temperature and electrocardiography (ECG) sensor. The sensor integrates ECG front-end analog block, a micro-controller and a Bluetooth low energy (BLE) connectivity IC on a single board. To achieve the miniaturization of the sensor and users’ comfort in mind, the sensor is designed as a miniaturized hybrid system utilizing flexible batteries and printed electrodes. This can efficiently detect ECG signals and transfer them to a smart phone through BLE link.