Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study.

BACKGROUND: According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. OBJECTIVE: We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50% of the patients would use the monitor at the rate required for the reimbursement of the device's cost (16 days of measurements in any 30-day period). METHODS: Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (≥16 days in any rolling 30-day window) and a lenient definition (≥1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. RESULTS: A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mm Hg and +3.31 (SE 0.71) mm Hg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5% (63/168) and 48.8% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6% (90/168) of the patients using their monitor at week 2 and only 25% (42/168) at week 11. Although only 25.6% (43/168) achieved the strict definition of compliance, 42.3% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8% (45/168) complied with the measurement rate that would result in device cost reimbursement. CONCLUSIONS: Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated.

COVID-19 monoclonal antibody treatment impact on symptoms and post-COVID conditions among high-risk patients at a Federally Qualified Health Center.

BACKGROUND: Monoclonal antibody (mAb) treatment for COVID-19 is associated with improved clinical outcomes. However, there is limited information regarding the impact of treatment on symptoms and the prevalence of post-COVID Conditions (PCC). Understanding of the association between time to mAb infusion and the development of PCC is also limited. METHODS: This longitudinal study was conducted among patients with COVID-19 who received mAb infusions at a Federally Qualified Health Center in San Diego, CA. A series of telephone interviews were conducted at baseline and follow-up (14 days and 28+ days). A comprehensive symptom inventory was completed and physical and mental health status were measured using PROMIS-29 and PHQ-2. Pearson's Chi-squared tests and independent two-sample t-tests were performed to test for association between time to mAb infusion and outcomes at follow-up. A Poisson regression model was used to analyze whether time to mAb infusion predicts risk of developing PCC. RESULTS: Participants (N = 411) were 53% female, ranged in age from 16 to 92 years (mean 50), and a majority (56%) were Latino/Hispanic. Cross-sectional findings revealed a high symptom burden at baseline (70% of patients had cough, 50% had fever, and 44% had headache). The prevalence of many symptoms decreased substantially by the final follow-up survey (29% of patients had cough, 3% had fever, and 28% had headache). Longitudinal findings indicated that 10 symptoms decreased in prevalence from baseline to final follow-up, 2 remained the same, and 14 increased. The severity of symptoms and most patient-reported physical and mental health measure scores decreased over time. The prevalence of PCC was 69% when PCC was defined as ≥ 1 symptom at final follow-up. Time to mAb infusion was not significantly associated with any outcome at follow-up. Time to infusion was not associated with PCC status at final follow-up in the crude or adjusted Poisson regression models. CONCLUSIONS: The prevalence of PCC was high among this patient population following COVID-19 mAb treatment. Time to mAb infusion did not predict the development of PCC. Further research in these areas is essential to answer urgent clinical questions about effective treatments of COVID-19.

Vacuum drying of Chilean papaya (Vasconcellea pubescens) fruit pulp: effect of drying temperature on kinetics and quality parameters.

Chilean papaya is grown in Central Chile and is considered to be an important source of fiber, sugars, and antioxidants. The effect of different vacuum drying temperatures (40, 50, 60, 70, and 80 °C) on the composition of papaya pulp was evaluated. The inhibitory effect of papaya extracts on α-glucosidase activity, as a regulator of blood sugar, was also evaluated. Drying reduced water activity of the pulp to less than 0.6, thereby, assuring the product stability, while maintaining simple sugars, vitamin C, and total flavonoids. Total phenolic content and antioxidant capacity by DPPH assay increased with respect to the fresh pulp by 1.5 and 2.6 times, respectively. The inhibitory effect of papaya extracts on α-glucosidase was evaluated by determining the IC50 for each sample and the acarbose equivalents. The results indicate the suitability of the dried extract of Chilean papaya as a regulator of glucose metabolism in Type II diabetes patients.

Effects of drying processes on composition, microstructure and health aspects from maqui berries.

The aim of this study is to determine the effects of different drying methods, including freeze drying (FD), convective drying, sun drying, infrared drying and vacuum drying (VD), on the chemical composition and microstructure of maqui berries as well as their anti-inflammatory and antidiabetic activities. Results showed that all dried samples have high unsaturated fatty acids contents (up to 83%) and high total dietary fiber contents (above 50%). Also, one hundred grams of dried berries provide between 11 and 21% of the recommended daily intake of α-tocopherol. Moreover, all dried maqui extracts reduced topical inflammation in treated mice. The highest anti-inflammatory effect against phorbol 12-myristate 13-acetate was found for VD and FD samples. Also, all dried maqui extracts showed antidiabetic activity by inhibiting α-glucosidase activity. The highest α-glucosidase inhibition activity was found for FD samples. The different biological activities of the dried maqui berries were related to differences in the extractability of metabolites due to microstructural changes during drying. The results indicated the potential use of dried maqui as a food ingredient with high unsaturated fatty acids, dietary fiber and α-tocopherol or as a natural extract with therapeutic agents.