CONTEXT: Recent studies have considered the role of inflammation in the development of both cardiovascular disease (CVD) and musculoskeletal conditions, such as rheumatoid arthritis. Studies suggest that inflammation plays a significant role in the development of cardiovascular disease. In conditions of chronic pain, as with rheumatoid arthritis, inflammation has also been noted through elevated levels of inflammatory markers. There are currently no studies that examine the possible connection between inflammatory markers related to increased risk of cardiovascular disease and nonspecific chronic musculoskeletal pain (NCMP). OBJECTIVE: The purpose of this study was to determine whether urinary levels of microalbumin (MA) and F2-isoprostanes (F2-isoPs), inflammatory biomarkers associated with increased CVD risk, are elevated in persons with NCMP compared to nonpain case controls. NCMP refers to pain present for more than 3 days per week and for more than 12 weeks. This type of pain is not due to injury but is associated with interference of normal function. DESIGN: Nonrandomized observational study. METHODS: A cross-sectional study with 120 participants (60 pain subjects, 60 nonpain case-controls). A single first-morning void urine sample was collected from each subject. Urine specific gravity and total volume were measured and then a sample was sent to a lab for analysis of MA and F2-isoPs. Inflammatory biomarker levels in the pain and nonpain groups were compared. RESULTS: There were no significant differences in F2-isoPs levels between the chronic pain group (0.65ng/mg ± 0.05) and the nonpain group (0.80ng/mg ± 0.07) (95% CI (-0.32, 0.03)). However, MA levels were significantly higher in the chronic pain group (2.41mg/g ± 0.24) compared to the nonpain group (1.88mg/g ± 0.14) (95% CI (0.34, 1.68)). MACR levels were also significantly higher in the chronic pain group (2.07mg/g ± 0.31) compared to the nonpain group (1.14mg/g ± 0.14) (95% CI (0.32, 1.64)). CONCLUSION: These findings suggest a possible link between at least one inflammatory marker (microalbumin) and NCMP. This in turn allows for a limited but reasonable inference that NCMP may be a risk factor for cardiovascular disease, mediated through the MA inflammatory biomarker. Further research is needed to more fully understand the possible connection between NCMP and CVD.

Health literacy is widespread, but its potential is not recognized. By not recognizing health literacy, patients have the burden of coping with diabetes with renal complications without full knowledge of their responsibility to their health. The focus of the project was to assess participants with diabetes with low health literacy and low mean glomerular filtration rate (eGFR). The project goal was achieved by the assessment of the participants' health literacy and eGFR before and after education for their diabetes, then assessed to determine if teaching the participants would improve their health literacy, lab values, and overall health. Participants were recruited by being patients of the designated clinic and screened for diabetes and low eGFR, for a total of 30 participants. The Brief Health Literacy Screen was used to measure health literacy. The health of the participants was appraised by the laboratory values of eGFR and fasting glucose. The project methodology was an observational design using correlation and 2-sample t analysis with the variables eGFR, fasting glucose, and health literacy. The variables were compared before and after the participants' education. Results showed health literacy with patient education was associated with greater patient self-efficacy and improved fasting glucose numbers, eGFR flows, and health literacy scores. The current health climate shows value in different types of health providers. Social change was defined by the project launching a nurse practitioner as the leader for advancing the treatment plans of chronic kidney disease. This project impacts social change by showing patients in the process of improved health and empowering the patients to be advocates of their own health.