Hypertension (HTN) is highly prevalent globally among low- and middle-income countries (LMICs). By 2020, cardiovascular disease (CVD) deaths related to HTN in LMICs are projected to increase by 75%. HTN control in LMICs is hindered by an acute shortage of physicians, limited diagnostic medical equipment, and a dearth of disease management resources. Despite the increasing prevalence of HTN in LMICs, scalable, evidence-based interventions to reduce morbidity and mortality attributed to HTN are rarely applied in these settings. The TAsk-Shifting Strategy for Hypertension (TASSH), a 5-year cluster-randomized controlled trial that has been implemented in community health centers in the Ashanti region of Ghana, is an evidence-based example of a scalable intervention strategy for LMICs that can effectively control HTN. The aims of this study were to: (a) conduct a systematic review of interventions for HTN control implemented in LMICs and assess the effect on blood pressure control as demonstrated in RCTs that stated “scale-up”; (b) identify the WHO/ExpandNet scale-up components (i.e., Inputs, Outputs, Outcomes, Impact, Cost effectiveness, Equity, Embedded within current health organization policy, Monitoring and evaluation, Sustainability); and (c) investigate the community health nurse stakeholders’ (n = 27) perceptions of the evidence-based TASSH cluster-randomized controlled trial in Ghana. Twenty-nine randomized-controlled trials describing potentially scalable HTN control intervention strategies and WHO/ExpandNet components were identified. Studies reported clinically significant differences in blood pressure, with 16 studies reporting statistically significant mean differences in BP (p < 0.05). Multicomponent interventions, including drug therapy and health education, provided the most benefit to participants. However, there was limited reporting on translation into existing institutional policy, cost effectiveness, stakeholder engagement, and sustainability. Patient goal setting, leadership engagement, and availability of resources, all of which were mentioned by TASSH nurses as important for successful implementation and eventual TASSH scale-up, emerged as major themes. LMICs need context-specific metrics and indicators to effectively evaluate and standardize the reporting of scale-up components and processes. In addition, infrastructure development, including capacity building at the individual, institutional, and systems levels, as well as stakeholder engagement (i.e., leadership), are necessary to address HTN-related morbidity and mortality and other diseases.

The present investigation compared the effectiveness of an autogenic feedback strategy and a Yoga-meditation strategy on the self-regulation of blood pressure. These strategies were compared with each other and with two control groups. Data were obtained from 19 males and 21 females on: 1) baseline and end of treatment pre-practice systolic blood pressure; 2) baseline and end of treatment pre-practice diastolic blood pressure; 3) baseline and end of treatment Medication Index; and 4) baseline and end of treatment Severity Index.It was anticipated that if there were an overall difference between group means on any of the dependent measures, the differences would occur between 1) the autogenic feedback strategy andthe control conditions, and 2) the Yoga-meditation strategy and the control conditions.A univariate analysis of variance was performed on the baseline data to insure that the groups were not statistically different at the start of treatment. A univariate analysis o variance was performed on the end of treatment data.The findings revealed that neither treatment strategy was more effective than the other, or more effective than the control groups at the end of treatment. The analysis of variance was performed on pre-practice measures which reflect "walking around" blood pressure comparable baseline measures. Even though there were moderate reductions in all four groups on pre-practice blood pressure levels and on the Medication and Severity Indices, the differences between groups were not significant. The validity and generalizability of these findings were discussed in light of previous research. Recommendations for further research were made.

The study was conducted in two phases. Phase I consisted of generating models of risk reduction behaviors in order to implement and test risk reduction interventions for Phase II. The purposes of Phase I were: (a) to identify among a group of African-Americans individual and group risk factors for hypertension, and to identify demographic and psychosocial variables most predictive of risk reduction behaviors for hypertension, (b) to design and test a model that combines important demographic and psychosocial determinants of risk reduction behaviors, and (c) to generate data based models of the predictors of each risk reduction behavior for hypertension in the group of African-Americans. The conceptual model for the study was developed by combining variables from the Health Belief Model--susceptibility, severity, and barriers with variables from social learning theory-health locus of control and self-efficacy. The focus of Phase I was to test the model to determine the interactions among the variables, because the assumptions of the underlying theories suggest multiplicative rather than linear relationships. One hundred forty-three subjects completed Phase I. The demographic variables age, gender, and education entered the model as direct effects and strong moderators. Education was a direct effect for stress reduction and moderated the effect of risk severity in diet fat. Age as a direct effect explained 19 percent of the variance in diet sodium intake and 21 percent of the variance in diet fat as a direct effect and moderating effect of risk severity. Twenty-seven percent of the variance in alcohol use was explained by age (B = -.24) difficulty (B =.26), and risk health value moderated by age (B = -.27). Sixty-three percent of the variance in smoking behaviors was explained by the direct effects of age (B = -.20), gender (B = -12) and difficulty (B =.25), and by the interaction of age and difficulty (B =.52). In Phase II, interventions were developed that used either motivational or educational skills strategies such as monetary incentives, screening, risk assessment, health education, dietary analysis, and self-monitoring. Twenty-eight subjects participated in the pilot test of Phase II. Participants were most interested in modifying their diet fat intake and increasing stress reduction. The findings that each risk reduction behavior was predicted by different variables and/or different interaction patterns of the same variables supports further study of each risk reduction behavior rather than looking at risk reduction behavior as a conglomerate or as a summed health-promotive behavior. The study also supported the underlying theoretical assumptions of the Health Belief Model, and Social Learning Theory that the relationships between the variables is multiplicative, as moderating effects were found, but no mediating effects were supported.

Liu, Qilin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 97-110). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese; appendixes includes Chinese.

Production and consumption of edible berries are increasing rapidly in the United States, mostly due to their superior flavor profile, and popular diet-related value with their human health relevant bioactives and nutritional benefits. However, bioactive and nutritional qualities, especially human health protective phenolic antioxidants and associated non-communicable chronic disease (NCD) relevant health benefits of berries vary widely among accessions/cultivars and due to different production practices (organic vs conventional). Therefore, the aim of this thesis was to screen and select high phenolic and high antioxidant serviceberry and blackberry accessions/cultivars and to investigate the effect of different weed management and fertilization (organic vs. conventional) practices on phenolic bioactive linked antioxidant and anti-diabetic properties of blackberry using in vitro assay models. Overall, high phenolic-bioactive linked antioxidant and anti-hyperglycemic properties were observed in both serviceberry and blackberry accessions/cultivars and further for blackberry it was significantly higher under organic weed management and fertilization practices.

Annually, hypertension is responsible for over 10 million deaths. During the span of a decade, low-middle income countries (LMICs) have experienced the most negative change in progress towards decreasing hypertension prevalence. It is estimated that 46% of the adult population in Sub-Saharan Africa (SSA) is hypertensive. When looking at solutions to address hypertension management in SSA, finding effective medication adherence interventions is the way forward. The purpose of this study was to promote the implementation of evidence-based interventions for successful treatment and improved life quality of hypertensive adults in Sub-Saharan Africa, with the input of healthcare stakeholders. The specific aims were to: 1) determine what interventions for antihypertension medication adherence have been successfully implemented in SSA and assess their implementation outcomes, and 2) conduct a focus group with health practitioners to evaluate what interventions and implementation practices were supported. The methods used to complete this study were a systematic review and focus group sessions. The systematic review was able to identify measurable implementation outcomes for the evidence based interventions found in the literature. The implementation outcomes identified in each of the included studies were categorized according to definitions derived from Proctor, et al.’s Outcomes for Implementation Research and Gyamfi, et al.’s Assessment of Descriptors of Scalability. The systematic review findings revealed that to establish antihypertensive medication adherence in SSA, the appropriateness of an intervention and the inclusion of health education are essential. Additionally, in order to have successful implementation of an intervention, stakeholders need to commit to addressing systematic challenges emphasized in the literature. The focus group sessions helped to identify tangible actions that can be implemented in order to improve antihypertensive medication adherence in the region. Thematic analysis was used to organize themes found across the focus group transcriptions. During the focus group sessions, health practitioners addressed the practicality of implementing evidence-based interventions found in the literature within their communities. The focus group findings reveal key recommendations including increasing government participation and addressing barriers to implementation. Overall, the data gathered across the studies shows that implementation is not easy to achieve. In addressing antihypertensive medication adherence, stakeholders must take into consideration how healthcare systems function as a whole. Although international and national guidelines provide excellent guidance for implementing evidence-based care, adjustments are needed in order to address population needs and scale interventions.

In light of health disparities involving African Americans having disproportionately high rates of obesity, type II diabetes, cancer risk, heart disease and hypertension, the study was conducted with an all-Black adult sample (n= 470). Some 53.0% were female and the sample had a mean age of 32 years. The study evaluated the Knowledge of Physical Activity and Dietary Intake Guidelines Survey (KOPA-DIGS-40) as a new True-False knowledge test—with all True items. The study found moderately high levels of knowledge using the KOPA-DIGS-40. Findings using paired t-tests found evidence that ratings for (1) knowledge of guidelines and (2) self-efficacy for adherence to guidelines were significantly higher after taking the test. The study found noteworthy predictors of a higher KOPA-DIGS-40 score to be older age, higher education, and higher Body Mass Index. The study focused on three time periods (1-before the COVID-19 pandemic, 2-during the pandemic, 3-currently) and ratings on four health dimensions (1-physical health, 2-mental/emotional health, 3-physical activity level, 4-eating a healthy diet). Findings showed declines on the four dimensions during the pandemic, yet by Spring 2023 there were significant improvements—with a return by Spring 2023 to pre-pandemic levels. Findings suggested evidence of resilience after experiencing the stress of a global pandemic. Thus, a resilience theory and framework may be vital in guiding a future era of health disparities research with African Americans. Further, the study found an increase in social support during the pandemic, which continued into their current lives. Future research should continue to utilize the innovation of the genre of research reflected in this study’s use of the new Knowledge of Physical Activity and Dietary Intake Guidelines Survey (KOPA-DIGS-40)—as a True-False test with all True items; this follows from evidence the KOPA-DIGS-40 served as a brief online e-health intervention associated with increases in (1) knowledge of the guidelines and (2) self-efficacy for adherence to physical activity and dietary intake guidelines. Given the high rates of obesity, type II diabetes, cancer risk, heart disease and hypertension for African Americans, the findings make an important contribution to the literature—while suggesting future directions in research and interventions.

A aterosclerose e suas complicações são a principal causa de morbidade e mortalidade no mundo ocidental. O aumento da espessura da camada médio-intimal da carótida está associado com risco para doenças cardiovasculares, pois representa um marcador de aterosclerose subclínica, podendo ser detectada precocemente em indivíduos assintomáticos. O objetivo desse estudo foi identificar variáveis clínicas e nutricionais associadas com a aterosclerose subclínica em mulheres hipertensas. Estudo transversal envolvendo uma amostra de conveniência composta por 116 mulheres hipertensas entre 40 e 65 anos. Dados clínicos, como pressão arterial (PA) sistólica e diastólica, história de tabagismo, atividade física, uso de medicamentos foram coletados; foi feita a análise do perfil lipídico, glicemia e proteína C reativa (PCR); a avaliação dietética obtida pelo Recordatório de 24 horas e pelo Registro de três dias. A espessura médio-intimal (EMI) de carótidas foi realizada pelo aparelho de ultrassonografia. As pacientes foram divididas em dois grupos, de acordo com os valores da espessura médio-intimal de carótidas: EMI 0,9mm ou EMI > 0,9mm. Houve diferença significativa entre os grupos em relação à idade (50,846,62 vs 53,547,13; p=0,044), PA sistólica (134,5216,54 vs 142,9821,47; p=0,020), pressão de pulso (PP) (49,3611,03 vs 60,15 17,77; p<0,001), HDL (48,988,54 vs 44,057,45; p=0,004) e PCR (2,311,21 vs 3,051,34; p=0,016). Não houve diferença significativa em relação aos parâmetros antropométricos, exceto em relação à reactância (65,199,69 vs 61,447,88; p=0,036), avaliada pela bioimpedância elétrica (BIA). Quanto ao padrão de consumo alimentar, somente o consumo de gordura monoinsaturada foi diferente entre os grupos, sendo o maior consumo no grupo com menor valor de EMI (7,882,09 vs 7,022,06; p=0,031). Não houve diferença em relação à frequência de tabagismo e atividade física. Quando foi feita a análise de correlação da amostra, foi encontrada uma correlação entre a EMI de carótidas e idade (r=0,25; p=0,0067), PAS (r=0,19; p=0,0086); PP (r=0,30; p=0,0009), LDL (r=0,19; p=0,0434), assim como com gordura monoinsaturada (r= -0,25; p=0,0087), PCR (r=0,31; p=0,007) e HDL (r=-0,33; p=0,0004), porém apenas as variáveis HDL, PCRus e pressão de pulso mostraram ser preditoras independentes da EMI de carótida após feita uma análise de regressão linear multivariada. A proteína C reativa, HDL colesterol e pressão de pulso são importantes preditores independentes de aterosclerose subclínica. / Atherosclerosis and its complications are the main cause of morbidity and mortality in the Western world. Increased carotid intima-media thickness is associated with cardiovascular risk,and it represents a marker of subclinical atherosclerosis, which can be detected early in asymptomatic individuals. The aim of this study was to identify clinical and nutritional variables associated with subclinical atherosclerosis in hypertensive women. Cross-sectional study involving a convenience sample composed by 116 hypertensive women aged between 40 and 65. Clinical data such systolic and diastolic blood pressure (BP), smoking history, physical activity, medication use were collected, a lipid profile, blood glucose and C-reactive protein (CRP)analysis was performed, the dietary assessment was obtained by dietary recall 24 hours and three days food record. Carotid intima-media thickness was performed by the high resolution ultrasound. Patients were divided into two groups according to the values of carotid IMT: IMT 0.9 mm or IMT > 0.9 mm. There was significant difference between the groups regarding age (50.846.62 vs 53.547.13; p=0.044), systolic BP(134.5216.54 vs 142.9821.47; p=0.020), pulse pressure (PP) (49.3611.03 vs 60.15 17.77; p<0.001), HDL-cholesterol (49.3611.03 vs 60.1517.77; p<0.001)and CRP(2.311.21 vs 3.051.34; p=0.016). There was no significant difference regarding to anthropometric parameters, except for the reactance (65.199.69 vs 61.447.88; p=0.036), measured by bioelectrical impedance analysis (BIA). Regarding the dietary pattern, only the monounsaturated fat intake was different between the groups 65.199.69 vs 61.447.88; p=0.036),. There was no difference in smoking and physical activity. In the correlation analysis, we have found a correlation between carotid IMT and age (r = 0.25, p = 0.0067), SBP (r= 0.19, p = 0.0086); PP (r = 0.30, p = 0.0009), LDL (r = 0.19, p = 0.0434), and monounsaturated fat (r = -0.25, p = 0.0087), CRP (r = 0.31, p = 0.007) and HDL (r =- 0.33, p = 0.0004), but only HDL-cholesterol, hsCRP and pulse pressure were shown to be independent predictors of carotid IMT after made a multivariate analysis. Conclude that C reactive protein, HDL-cholesterol and pulse pressure are important predictors for subclinical atherosclerosis.

A aterosclerose e suas complicações são a principal causa de morbidade e mortalidade no mundo ocidental. O aumento da espessura da camada médio-intimal da carótida está associado com risco para doenças cardiovasculares, pois representa um marcador de aterosclerose subclínica, podendo ser detectada precocemente em indivíduos assintomáticos. O objetivo desse estudo foi identificar variáveis clínicas e nutricionais associadas com a aterosclerose subclínica em mulheres hipertensas. Estudo transversal envolvendo uma amostra de conveniência composta por 116 mulheres hipertensas entre 40 e 65 anos. Dados clínicos, como pressão arterial (PA) sistólica e diastólica, história de tabagismo, atividade física, uso de medicamentos foram coletados; foi feita a análise do perfil lipídico, glicemia e proteína C reativa (PCR); a avaliação dietética obtida pelo Recordatório de 24 horas e pelo Registro de três dias. A espessura médio-intimal (EMI) de carótidas foi realizada pelo aparelho de ultrassonografia. As pacientes foram divididas em dois grupos, de acordo com os valores da espessura médio-intimal de carótidas: EMI 0,9mm ou EMI > 0,9mm. Houve diferença significativa entre os grupos em relação à idade (50,846,62 vs 53,547,13; p=0,044), PA sistólica (134,5216,54 vs 142,9821,47; p=0,020), pressão de pulso (PP) (49,3611,03 vs 60,15 17,77; p<0,001), HDL (48,988,54 vs 44,057,45; p=0,004) e PCR (2,311,21 vs 3,051,34; p=0,016). Não houve diferença significativa em relação aos parâmetros antropométricos, exceto em relação à reactância (65,199,69 vs 61,447,88; p=0,036), avaliada pela bioimpedância elétrica (BIA). Quanto ao padrão de consumo alimentar, somente o consumo de gordura monoinsaturada foi diferente entre os grupos, sendo o maior consumo no grupo com menor valor de EMI (7,882,09 vs 7,022,06; p=0,031). Não houve diferença em relação à frequência de tabagismo e atividade física. Quando foi feita a análise de correlação da amostra, foi encontrada uma correlação entre a EMI de carótidas e idade (r=0,25; p=0,0067), PAS (r=0,19; p=0,0086); PP (r=0,30; p=0,0009), LDL (r=0,19; p=0,0434), assim como com gordura monoinsaturada (r= -0,25; p=0,0087), PCR (r=0,31; p=0,007) e HDL (r=-0,33; p=0,0004), porém apenas as variáveis HDL, PCRus e pressão de pulso mostraram ser preditoras independentes da EMI de carótida após feita uma análise de regressão linear multivariada. A proteína C reativa, HDL colesterol e pressão de pulso são importantes preditores independentes de aterosclerose subclínica. / Atherosclerosis and its complications are the main cause of morbidity and mortality in the Western world. Increased carotid intima-media thickness is associated with cardiovascular risk,and it represents a marker of subclinical atherosclerosis, which can be detected early in asymptomatic individuals. The aim of this study was to identify clinical and nutritional variables associated with subclinical atherosclerosis in hypertensive women. Cross-sectional study involving a convenience sample composed by 116 hypertensive women aged between 40 and 65. Clinical data such systolic and diastolic blood pressure (BP), smoking history, physical activity, medication use were collected, a lipid profile, blood glucose and C-reactive protein (CRP)analysis was performed, the dietary assessment was obtained by dietary recall 24 hours and three days food record. Carotid intima-media thickness was performed by the high resolution ultrasound. Patients were divided into two groups according to the values of carotid IMT: IMT 0.9 mm or IMT > 0.9 mm. There was significant difference between the groups regarding age (50.846.62 vs 53.547.13; p=0.044), systolic BP(134.5216.54 vs 142.9821.47; p=0.020), pulse pressure (PP) (49.3611.03 vs 60.15 17.77; p<0.001), HDL-cholesterol (49.3611.03 vs 60.1517.77; p<0.001)and CRP(2.311.21 vs 3.051.34; p=0.016). There was no significant difference regarding to anthropometric parameters, except for the reactance (65.199.69 vs 61.447.88; p=0.036), measured by bioelectrical impedance analysis (BIA). Regarding the dietary pattern, only the monounsaturated fat intake was different between the groups 65.199.69 vs 61.447.88; p=0.036),. There was no difference in smoking and physical activity. In the correlation analysis, we have found a correlation between carotid IMT and age (r = 0.25, p = 0.0067), SBP (r= 0.19, p = 0.0086); PP (r = 0.30, p = 0.0009), LDL (r = 0.19, p = 0.0434), and monounsaturated fat (r = -0.25, p = 0.0087), CRP (r = 0.31, p = 0.007) and HDL (r =- 0.33, p = 0.0004), but only HDL-cholesterol, hsCRP and pulse pressure were shown to be independent predictors of carotid IMT after made a multivariate analysis. Conclude that C reactive protein, HDL-cholesterol and pulse pressure are important predictors for subclinical atherosclerosis.

The purpose of this project was to evaluate the effectiveness of an educational lifestyle modification (LM) intervention on blood pressure (BP) among adults with prehypertension. Prehypertension is a precursor to hypertension (HTN) and is a public epidemic in the United States. Approximately 68 million (31%) U.S. adult’s aged ≥18 years have hypertension. Hypertension can cause significant target organ damage, lead to coronary heart disease, heart failure, stroke, and kidney failure. Early identification and the primary treatment of persons with prehypertension with LM have the potential to minimize the progression and delay the onset of comorbidities associated with hypertension. This quality improvement project retrospectively reviewed changes in blood pressure for a small sample (n=5) of patients diagnosed with prehypertension who received education about modifying lifestyle behaviors according to nationally accepted clinical practice guidelines. Blood pressure measurements were extracted from the medical record beginning at the time of the education through a three month period. Descriptive data indicates that all five patients had a decrease in systolic and diastolic blood pressure. The median systolic blood pressure at baseline was 129 mmHg decreasing to 121 mmHg at end of study period. The median diastolic blood pressure was 86 mmHg decreasing to 76 mmHg. Integration of lifestyle modification education and subsequent blood pressure monitoring during a routine primary care visit is feasible and may help motivate patients to implement changes and subsequently reduce blood pressure. Future studies should include identifying strategies for improving patient participation.