The Attitudes about Complex Therapy Scale (ACTS) in Type 2 Diabetes and Cardiovascular Disease: Development, Validity and Reliability

Background: Type 2 diabetes is associated with cardiovascular disease, and patients with both conditions are prescribed complex medication regimens. Aim: The aim was to develop a reliable and valid measure of attitudes associated with the prescription and management of multiple medicines in patients with Type 2 diabetes and cardiovascular disease. Methods: Principal component analysis (PCA) and Cronbach alpha assessed the reliability of the Attitudes about Complex Therapy Scale (ACTS). Examinations of relationships with related measures inform concurrent validity. Questionnaires were sent to a cross-sectional sample of 480 people prescribed multiple medicines for co-morbid Type 2 diabetes. Results: Cronbach alpha was 0.76, indicating the scale had good internal reliability. PCA rotated a four factor model accounting for 37% of the variance. Four subscales identified; 1. Concerns about multiple medicines and increasing numbers of medicines; 2.Anxiety over missed medicines; 3. Desires to substitute medicines and reduce the number of medicines prescribed and; 4. Perceptions related to organising and managing complex therapy. The ACTS showed significant relationships with measures of anxiety, depression, general beliefs about medicines and self-efficacy. Also, the ACTS significantly correlated with adherence to medicines, showing good predictive validity. Conclusion: The ACTS was designed to assess negative attitudes towards complex therapy and multiple medication management. This tool could aid prescribing decisions and may identify people who are intentionally non-adherent to all or some of their medicines

How Can Consuming a Plant-Based Diet Reduce the Risk of Cardiovascular Disease in Postmenopausal Women?

Despite the fact that women suffer higher rates of cardiovascular events after menopause, there exists a significant underrepresentation of women—especially postmenopausal women—in cardiovascular clinical trials to date. Fortunately, current evidence reveals that cardiovascular events in the general population are largely preventable through modifiable lifestyle factors, with dietary intervention being one of the most important (Amiri et al., 2022). As the impact of whole-diet interventions on cardiovascular risk factors is further explored, it has been determined that a plant-based dietary pattern may favorably influence the prevention of cardiovascular events in postmenopausal women (Barańska et al., 2021). Evidence also reveals that certain phytochemicals which are provided in bulk by a plant-based diet, such as phytoestrogens, may be particularly beneficial to the health of the postmenopausal population (Barańska et al., 2021). This comprehensive literature review will attempt to evaluate exactly how a plant-based diet can reduce the risk of cardiovascular disease in postmenopausal women by examining relevant clinical trials, identifying and explaining the beneficial effects of various cardioprotective phytochemicals, and by considering how popular plant-based diets like the Mediterranean Diet are conducive to heart health. As early as 2006, Chin-Hua Fu et al. established that a plant-based diet may be a natural and effective approach to reduce the risk of cardiovascular disease in postmenopausal women (Fu et al., 2006). This review concludes that more well-designed controlled clinical trials should be conducted with this population to achieve more conclusive results regarding the most effective diet for cardiovascular risk reduction in postmenopausal women

Examining Relationship Between Food Deserts and Health

The purpose of this research is to examine the relationships that exist between food deserts, fruit and vegetable consumption and health on individuals. Using quantitative data collected through surveys that were distributed to students attending an urban higher education setting in Chicago, data was analyzed to determine relationships between the communities they live in, the amount of fresh produce they consume and their current health. The survey looked at factors such as race, income, community of residence, daily fruit and vegetable consumption, current health, diagnosis of diet-related illness for respondent and family along with the distance travelled to purchase fresh produce. The findings support the idea that the further one must travel to purchase fresh produce the more likely they are to consume less. The findings also show that those who consume less fruits and vegetables are more likely to report poorer health. The implications are to address communities who lack access to fresh fruits and vegetables in order to increase the over all health outcomes for individuals. Creating policies that encourage current storeowners or new stores that will sell fresh fruits and vegetables is one way to address the lack of access in these communities. This study shows those who must travel far to purchase fresh fruits and vegetables are less likely to consume the daily recommended amounts and also have poorer health

How Can Consuming a Plant-Based Diet Reduce the Risk of Cardiovascular Disease in Postmenopausal Women?

Despite the fact that women suffer higher rates of cardiovascular events after menopause, there exists a significant underrepresentation of women—especially postmenopausal women—in cardiovascular clinical trials to date. Fortunately, current evidence reveals that cardiovascular events in the general population are largely preventable through modifiable lifestyle factors, with dietary intervention being one of the most important (Amiri et al., 2022). As the impact of whole-diet interventions on cardiovascular risk factors is further explored, it has been determined that a plant-based dietary pattern may favorably influence the prevention of cardiovascular events in postmenopausal women (Barańska et al., 2021). Evidence also reveals that certain phytochemicals which are provided in bulk by a plantbased diet, such as phytoestrogens, may be particularly beneficial to the health of the postmenopausal population (Barańska et al., 2021). This comprehensive literature review will attempt to evaluate exactly how a plant-based diet can reduce the risk of cardiovascular disease in postmenopausal women by examining relevant clinical trials, identifying and explaining the beneficial effects of various cardioprotective phytochemicals, and considering how popular plant-based diets like the Mediterranean Diet are conducive to heart health. As early as 2006, Chin- Hua Fu et al. established that a plant-based diet may be a natural and effective approach to reducing the risk of cardiovascular disease in postmenopausal women (Fu et al., 2006). This review concludes that more well-designed controlled clinical trials should be conducted with this population to achieve more conclusive results regarding the most effective diet for cardiovascular risk reduction in postmenopausal women

Calculation of extraocular muscle volume in patients with Graves' Ophthalmopathy and the correlation with disease severity and clinical activity of the Graves' disease

INTRODUCTION Graves’ disease (GD) is an autoimmune disease affecting the thyroid gland, orbital soft tissues and subcutaneous tissues of the extremities. Ophthalmic signs are clinically evident in 25-50% of patients with GD and 3-10% of cases develop severe disease. This study discusses the current understanding of the pathophysiology of GD and the associated ophthalmopathy. It summarises the clinical features of the condition and examines the numerous scoring systems used to measure and monitor the ophthalmic features of the disease. The three main radiological techniques used to image the orbit, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) are discussed. Although CT is regarded as the radiological investigation of choice for imaging orbit details subtle changes related to Graves’ ophthalmopathy (GO) can be missed. To accurately calculate extraocular muscle volume we have developed a computer software package, the Volume Estimation Tool. This software allows outlining of structures from a CT image and then calculates the volume of the structure. The aim of this study is to determine if extraocular muscle volume and orbital volume estimates from CT imaging correlate with clinical signs and scores of disease activity or severity. METHODS Study Design This is a retrospective study comparing the orbital CT scan findings in patients with GD with their clinical activity, as close as possible to the time of the scan, and their disease severity. The initial hope had been to use high definition 3 dimensional ultrasound to calculate muscle volume. This proved inaccurate and non-reproducible for calculating muscle volumes. We therefore, worked in conjunction with the Christchurch Hospital Medical Physics department to develop a computer programme to estimate muscle volume from coronal slices of CT scans. This volume estimation tool was used to calculate the volume of muscles and soft tissue orbits in a series of patients with clinical evidence of GO. The same muscle and orbital volumes were calculated for a set of matched controls without GO. In addition, methods of measuring disease state in patients with GO were compared. Disease activity and severity were calculated from the clinical records of the patients with GD as close as possible to time of the CT scan. The activity of the GO and the severity of the disease were then correlated with the muscle and orbital volumes to see what relationships there are. The clinical symptoms and signs of GO were then related to muscle volume to determine which have the greatest impact on clinical activity and disease severity. Participants A record of all patients with thyroid eye disease was compiled by correlating records of patients seen in both the thyroid clinic, Nuclear Medicine Department and the ophthalmology clinic at Christchurch Hospital. From this cohort, we used radiology department records to obtain a subset of patients for whom head/neck CT scans had been ordered. A control group of patients with no history of GD and CT scans with normal radiology reports from the same period were selected. Outcome Measures Clinical activity and disease severity were calculated by different methods and compared. The activity and severity were also compared to the estimated muscle and orbital volumes to determine any possible relationships. RESULTS In patients with GO muscle volume may be a more sensitive indicator of muscle enlargement than subjective viewing of the CT images looking for enlargement of muscle bellies. Muscle volume for patients with GO was significantly higher than for patients with no GO (p<0.0001). Patients with GO also have larger orbital volumes than patients without GO (p=0.003). Muscle volume in patients with GO also correlates positively with clinical activity (p<0.0001) and disease severity (p<0.0001). When individual clinical features are examined there is a weak correlation between muscle volume and proptosis (p=0.05), but no association with lid retraction and muscle volume (p=0.12). Neither is there a correlation between horizontal or vertical muscle restriction and muscle volume (p=0.56 and p=0.44 respectively). CONCLUSIONS The results show that accurate calculation of extraocular muscle volume using this software package is possible. We confirm that calculating extraocular muscle volume in patients with GO gives additional useful information for assessing and managing patients with GO. Muscle volume correlates positively with clinical activity and disease severity. Patients with more active and more severe disease have greater changes in muscle volume than those without. For 2 patients with optic nerve compromise there was a high percentage of orbital volume taken up by muscle. This suggests this ratio, rather than muscle volume alone, may predict risk of optic nerve damage. However, patients with very active disease or severe residual disease do not have an increased risk of restrictive eye movements despite having larger total muscle volumes

Healthcare professionals’ perceptions of risk in the context of genetic testing for the prediction of chronic disease: a qualitative metasynthesis

Advances in genomic technologies and a growing trend towards stratified and preventive approaches to medicine mean that increasing numbers of individuals may have access to information about their genetic makeup, and their risk of developing diseases. This is likely to impact on healthcare professionals involved in the delivery of genetic tests, or in supporting patients who are affected by a disease with a genetic risk factor. It is therefore important to understand health-care professionals’ perceptions about providing these services, and how they feel about communicating information about genetic risk to patients. This paper provides a systematic review and metasynthesis of qualitative research exploring healthcare professionals’ perceptions of genetic risk in the context of predictive genetic testing for chronic disease. Healthcare professionals expressed a range of reservations about the utility of predictive testing in this context. Professionals judged patients’ understanding of risk information to be limited and subject to bias and a range of sociocultural influences. Concerns about the psychosocial impact of genetic risk information were frequently cited, both in relation to individual patients and the wider impact on their families and communities. The need for provision of multidisciplinary support was described. The concept of responsibility was also an important theme. Healthcare professionals recognized the responsibility that accompanies risk knowledge, and that ultimately this responsibility lies with the patient, not the provider. Our analysis suggests that professionals’ evaluation of the utility of predictive genetic testing is influenced not only by resource deficits, but may also be interpreted as a response to challenging ethical and social issues associated with genetic risk, that are not well aligned with current medical practice

Healthcare professionals’ perceptions of interacting with patients of South Asian origin attending early inflammatory arthritis clinics

ObjectiveTo explore rheumatology healthcare professionals’ (HCPs) perceptions of interacting with patients of South Asian origin attending early inflammatory arthritis (EIA) clinics.MethodsWe used face to face semi structured interviews, designed in partnership with clinician partner to interview ten HCPs involved in running of EIA clinics across seven centres in the UK. Data were recorded, transcribed by an independent company and were analysed using inductive thematic analysis.ResultsThree emerging themes were identified that characterised consulting experiences of HCPs. [1] Varied approaches were used in early inflammatory arthritis clinic, [2] Rheumatology HCP’s challenges in managing and delivering information to patients of South Asian origin in early inflammatory arthritis clinic [3] Moving towards good practice: views on managing future patients of South Asian origin in early inflammatory arthritis clinics. Overall, HCPs found that they required additional skills to support the engagement and management for patients of South Asian origin living with inflammatory arthritis. HCPs felt that they were less effective in addressing self-management issues for this patient group and they found it difficult to determine adherence to medication. In such consultations, HCPs perceived their own limitation of inadequate training contributed towards poor consultations.ConclusionFor the first time, our data demonstrates that the management of patients of South Asian origin in EIA clinics is under served. To address this, HCPs have identified training needs to improve knowledge and skills in engaging with and supporting patients of South Asian origin. These findings provide a good direction for future research

General practitioners’ perspectives on campaigns to promote rapid help-seeking behaviour at the onset of rheumatoid arthritis

Objective. To explore general practitioners’ (GPs’ ) perspectives on public health campaigns to encourage people with the early symptoms of rheumatoid arthritis (RA) to seek medical help rapidly. Design. Nineteen GPs participated in four semistructured focus groups. Focus groups were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results. GPs recognised the need for the early treatment of RA and identified that facilitating appropriate access to care was important. However, not all held the view that a delay in help seeking was a clinically significant issue. Furthermore, many were concerned that the early symptoms of RA were often non-specific, and that current knowledge about the nature of symptoms at disease onset was inadequate to inform the content of a help-seeking campaign. They argued that a campaign might not be able to specifically target those who need to present urgently. Poorly designed campaigns were suggested to have a negative impact on GPs’ workloads, and would “clog up” the referral pathway for genuine cases of RA. Conclusions. GPs were supportive of strategies to improve access to Rheumatological care and increase public awareness of RA symptoms. However, they have identified important issues that need to be considered in developing a public health campaign that forms part of an overall strategy to reduce time to treatment for patients with new onset RA. This study highlights the value of gaining GPs’ perspectives before launching health promotion campaigns

Screening the medicines for Malaria Venture "Malaria Box" against the Plasmodium falciparum aminopeptidases, M1, M17 and M18

Malaria is a parasitic disease that remains a global health burden. The ability of the parasite to rapidly develop resistance to therapeutics drives an urgent need for the delivery of new drugs. The Medicines for Malaria Venture have compounds known for their antimalarial ac- tivity, but not necessarily the molecular targets. In this study, we assess the ability of the “MMV 400” compounds to inhibit the activity of three metalloaminopeptidases from Plasmo- dium falciparum, PfA-M1, PfA-M17 and PfM18 AAP. We have developed a multiplex assay system to allow rapid primary screening of compounds against all three metalloaminopepti- dases, followed by detailed analysis of promising compounds. Our results show that there were no PfM18AAP inhibitors, whereas two moderate inhibitors of the neutral aminopepti- dases PfA-M1 and PfA-M17 were identified. Further investigation through structure-activity relationship studies and molecular docking suggest that these compounds are competitive inhibitors with novel binding mechanisms, acting through either non-classical zinc coordina- tion or independently of zinc binding altogether. Although it is unlikely that inhibition of PfA- M1 and/or PfA-M17 is the primary mechanism responsible for the antiplasmodial activity re- ported for these compounds, their detailed characterization, as presented in this work, pave the way for their further optimization as a novel class of dual PfA-M1/PfA-M17 inhibitors uti- lising non-classical zinc binding groups