Practice Facilitation and Peer Coaching for Uncontrolled Hypertension Among Black Individuals: A Randomized Clinical Trial.

Importance: Rural Black participants need effective intervention to achieve better blood pressure (BP) control. Objective: Among Black rural adults with persistently uncontrolled hypertension attending primary care clinics, to determine whether peer coaching (PC), practice facilitation (PF), or both (PCPF) are superior to enhanced usual care (EUC) in improving BP control. Design, Setting, and Participants: A cluster randomized clinical trial was conducted in 69 rural primary care practices across Alabama and North Carolina between September 23, 2016, and September 26, 2019. The participating practices were randomized to 4 groups: PC plus EUC, PF plus EUC, PCPF plus EUC, and EUC alone. The baseline EUC approach included a laptop for each participating practice with hyperlinks to participant education on hypertension, a binder of practice tips, a poster showing an algorithm for stepped care to improve BP, and 25 home BP monitors. The trial was stopped on February 28, 2021, after final data collection. The study included Black participants with persistently uncontrolled hypertension. Data were analyzed from February 28, 2021, to December 13, 2022. Interventions: Practice facilitators helped practices implement at least 4 quality improvement projects designed to improve BP control throughout 1 year. Peer coaches delivered a structured program via telephone on hypertension self-management throughout 1 year. Main Outcomes and Measures: The primary outcome was the proportion of participants in each trial group with BP values of less than 140/90 mm Hg at 6 months and 12 months. The secondary outcome was a change in the systolic BP of participants at 6 months and 12 months. Results: A total of 69 practices were randomized, and 1209 participants' data were included in the analysis. The mean (SD) age of participants was 58 (12) years, and 748 (62%) were women. In the intention-to-treat analyses, neither intervention alone nor in combination improved BP control or BP levels more than EUC (at 12 months, PF vs EUC odds ratio [OR], 0.94 [95% CI, 0.58-1.52]; PC vs EUC OR, 1.30 [95% CI, 0.83-2.04]; PCPF vs EUC OR, 1.02 [95% CI, 0.64-1.64]). In preplanned subgroup analyses, participants younger than 60 years in the PC and PCPF groups experienced a significant 5 mm Hg greater reduction in systolic BP than participants younger than 60 years in the EUC group at 12 months. Practicewide BP control estimates in PF groups suggested that BP control improved from 54% to 61%, a finding that was not observed in the trial's participants. Conclusions and Relevance: The results of this cluster randomized clinical trial demonstrated that neither PC nor PF demonstrated a superior improvement in overall BP control compared with EUC. However, PC led to a significant reduction in systolic BP among younger adults. Trial Registration: ClinicalTrials.gov Identifier: NCT02866669.

The association between social functioning and health literacy among rural Southeastern African Americans with hypertension.

African Americans living in low socioeconomic circumstances are at high risk of poor health outcomes; this is particularly true for those with hypertension. Many African Americans with chronic hypertension living in the rural impoverished Southeastern USA have low health literacy and are socially isolated. These factors are known to have a negative impact on health outcomes, but it is possible that social support may overcome some of the effect of low health literacy. Since little has been reported about this association, we examined the association between social functioning and health literacy in a rural African American population in the Southeast USA. We used baseline data from participants in the Southeastern Collaboration to Improve Blood Pressure Control, a pragmatic trial that recruited rural African Americans with persistently uncontrolled hypertension and collected survey data. Overall, 33.5% of the 1221 person sample reported social isolation, 26.0% reported low instrumental support, 36.0% reported low emotional support, and 63.4% had inadequate health literacy. All three domains of low social functioning were significantly associated with low health literacy, and this effect was robust to multivariable adjustment for sociodemographics and cognitive functioning for social isolation (adjusted odds ratio 1.62, 95% confidence intervals 1.20-2.20). In conclusion, the majority of this sample living in the NC and AL Black Belt had high social functioning but inadequate health literacy. Tests of interventions to improve social support, especially social isolation, may be warranted to overcome low health literacy in this high-risk rural population.

The design and rationale of a multicenter real-world trial: The Southeastern Collaboration to Improve Blood Pressure Control in the US Black Belt - Addressing the Triple Threat.

BACKGROUND: Impoverished African Americans (AA) with hypertension face poor health outcomes. PURPOSE: To conduct a cluster-randomized trial testing two interventions, alone and in combination, to improve blood pressure (BP) control in AA with persistently uncontrolled hypertension. METHODS: We engaged primary care practices serving rural Alabama and North Carolina residents, and in each practice we recruited approximately 25 AA adults with persistently uncontrolled hypertension (mean systolic BP >140 mmHg over the year prior to enrollment plus enrollment day BP assessed by research assistants ≥140/90 mmHg). Practices were randomized to peer coaching (PC), practice facilitation (PF), both PC and PF (PC + PF), or enhanced usual care (EUC). Coaches met with participants from PC and PC + PF practices weekly for 8 weeks then monthly over one year, discussing lifestyle changes, medication adherence, home monitoring, and communication with the healthcare team. Facilitators met with PF and PC + PF practices monthly to implement ≥1 quality improvement intervention in each of four domains. Data were collected at 0, 6, and 12 months. RESULTS: We recruited 69 practices and 1596 participants; 18 practices (408 participants) were randomized to EUC, 16 (384 participants) to PF, 19 (424 participants) to PC, and 16 (380 participants) to PC + PF. Participants had mean age 57 years, 61% were women, and 56% reported annual income <$20,000. LIMITATIONS: The PF intervention acts at the practice level, possibly missing intervention effects in trial participants. Neither PC nor PF currently has established clinical reimbursement mechanisms. CONCLUSIONS: This trial will fill evidence gaps regarding practice-level vs. patient-level interventions for rural impoverished AA with uncontrolled hypertension.

Biología alimentaria de Prochilodus mariae durante la primera fase de crecimiento / The Prochilodus mariae feeding habits during their first growth phase / Biología alimentar de Prochilodus mariae durante a primeira fase de crescimento

Resumen Entre los más importantes peces del río Meta se encuentra Prochilodus mariae (bocachico llanero o coporo), tanto por su mayor tamaño dentro de los bocachicos de la cuenca, como por su aporte a la biomasa trófica y de las pesquerías de la región. En el presente trabajo se evaluó el régimen alimenticio de poslarvas (inicio de la alimentación exógena) del coporo Prochilodus mariae, hasta el inicio de la fase de alevino (aletas completas y cuerpo con escamas), en condiciones simuladas durante los primeros 30 días de alimentación exógena. Los estanques en tierra del IALL, asignados para el desarrollo de este trabajo, fueron abonados orgánicamente con (bovinaza y heno) teniendo en cuenta las condiciones que suceden cada año, a las entradas de aguas en las áreas de inundación de los afluentes, los que fueron sembrados con larvas obtenidas por reproducción inducida a densidad de veinte larvas / m2 y con el 80% de su saco vitelino absorbido. Cada dos días, durante 30 días, a las 8:00 h, fueron colectadas poslarvas junto con las muestras de zooplantcton y fitoplancton y fijados en formol bufferado al 4%. Los índices de frecuencia (IF) de los contenidos estomacales de siete poslarvas/estanque y los ítems alimenticios como oferta hallados en aguas y perifiton fueron evaluados. Los análisis se realizaron con un total de 156 ejemplares que oscilan entre intervalos de 6-8.99; 9-17.99; 18-26.99; 27-35.99; 36-44.99; 45-47.99 mm de longitud total. Las poslarvas del primer intervalo exploran organismos relacionados con el perifiton principalmente bacterias, protozoos y algas en este primer muestreo se caracterizó porque el 66.7% de las poslarvas presentaron estómagos vacíos. En las poslarvas del segundo intervalo el IF de los contenidos mostró una tendencia por el consumo de organismos pelágicos con preferencia por los cladóceros. En el último intervalo los alevinos inician el consumo de detritos (materia orgánica particulada, bacterias, hongos) y otras formas del fitoplancton cercano a las paredes y fondo del estanque.

Abstract Prochilodus mariae (bocachico llanero or coporo) is amongst the most important fish in the Meta River (a major left tributary of the Orinoco River); along with being the largest of the Prochilodus species in the river basin, flannel-mouth characiforms contribute greatly to the dynamics of the region's food chain and fisheries. This work was aimed at assessing Prochilodus mariae post-larvae feeding habits during their first thirty days of exogenous feeding until the beginning of the alevin stage. Simulations were made in the Instituto de Acuicultura de los Llanos (IALL) facilities' earthen fish ponds to closely resemble the fishes' natural annual water and feeding conditions. The ponds had been organically fertilised with cattle manure and hay and were then periodically inundated and drained to simulate the Meta River's tributaries natural/annual floodplains or areas that are periodically inundated by high water levels. The ponds were stocked with larvae obtained by artificial spawning at twenty larvae/m2 density when around 80% of their yolk sacs had been absorbed. Post-larvae and pond water samples containing zooplankton and phytoplankton were collected at 8 am every other day for 30 days and fixed in 4% buffered formalin. Seven post-larvae/pond stomach/gut contents (frequency of fullness index - FI) were analysed from 156 specimens divided into size intervals ranging from 6-8.99, 9-17.99, 18-26.99, 27-35.99, 36-44.99 and 45-47.99 mm in length. Food items' frequency of abundance (i.e. supply) in the pond water and periphyton were estimated. First-size interval post-larvae explore periphyton-related organisms for their food source (mainly bacteria, protozoans and algae). This first sampling was characterised by 66.7% of the post-larvae having empty stomachs. Second-size interval post-larvae FI tended reflect the consumption of pelagic organisms, having a preference for microcrustaceans (cladocerans and copepods). The longest alevins (45-47.99 mm long) started consuming detritus (particulate organic matter, bacteria and fungi) and other forms of phytoplankton close to the sides and bottom of the fishponds.

Resumo Entre os peixes mais importantes do rio Meta encontra-se Prochilodus mariae (bocachico llanero ou coporo), devido a ser dos maiores bocachicos da bacia, assim como a sua contribuição para a biomassa trófica e pesca da região. O presente trabalho pretende avaliar a dieta das pós-larvas do coporo Prochilodus mariae, até ao início da fase de alevinos em condições simuladas durante os primeiros trinta dias de alimentação exógena. Os estanques do IALL destinados ao desenvolvimento deste trabalho, foram fertilizados organicamente com (esterco bovino e feno) atendendo às condições que ocorrem a cada ano, na entrada de água nas áreas de alagamento dos afluentes, que foram semeados com larvas obtidas por reprodução induzida na densidade de vinte larvas / m2 e com 80% do saco vitelino absorvido. A cada dois dias, durante 30 dias, às 8:00 da manhã, as pós-larvas eram recolhidas juntamente com a água, e fixadas em formalina tamponada a 4%. Foram avaliados os índices de frequência (IF) do conteúdo estomacal de sete pós-larvas/tanque e itens alimentares encontrados nas águas e perifiton. As análises foram realizadas com um total de 156 espécimes entre 6-8,99; 9-17,99; 18-26,99; 27-35:99; 36-44,99; 45-47,99mm de comprimento total. As pós-larvas do primeiro intervalo exploram organismos relacionados com o perifiton principalmente bactérias, protozoários e algas, esta primeira amostragem foi caracterizada porque 66,7% das pós-larvas apresentavam estômagos vazios. Nas pós-larvas do segundo intervalo o IF do conteúdo estomacal mostrou uma tendência para o consumo de organismos pelágicos com preferência pelos cladóceros. No último intervalo, os alevinos começam a consumir detritos (partículas orgânicas, bactérias, fungos) e formas de fitoplâncton ligadas às superfícies do substrato (feno) e ao fundo do tanque.

Hábitos alimenticios de Leporinus friderici (Anostomidae: Teleostei) durante un ciclo hidrobiológico en el río Vaupés, Colombia / Feeding habits of Leporinus friderici (Anostomidae: Teleostei) during a hydrobiological cycle in Vaupés River, Colombia

ResumenLa especie más importante de la pesquería del río Vaupés es un pez conocido como Warakú tres puntos (Leporinus friderici), un carácido migratorio representativo del departamento del Vaupés, Colombia, de importancia para la seguridad alimentaria de comunidades indígenas. Con el propósito de contribuir en el conocimiento biológico básico de la especie, el presente estudio determinó los hábitos y preferencias alimenticias de Leporinus friderici durante un ciclo hidrobiológico (marzo 2014 a mayo 2015) en el río Vaupés, Colombia. Fueron muestreados tres lugares, dos a lo largo del río Vaupés (comunidades indígenas de Yacayacá y Santa Cruz) y uno en el río Cuduyarí afluente del río Vaupés (comunidad de Piracemo). Se analizaron 316 contenidos estomacales aplicando los métodos de frecuencia de ocurrencia (FO), índice gravimétrico (W), coeficiente de vacuidad (CV) e índice de importancia relativa (IIR). De igual modo, se determinaron parámetros físicos y químicos del agua superficial y profunda. La profundidad del río en época de aguas ascendentes fue de 3.7 ± 0.6 m, aguas altas de 5.9 ± 1.4 m, aguas descendentes 4.6 ± 1.3 m y en aguas bajas 2.4 ± 1.0 m; se registró mayor acidez y turbidez del agua en las ascendentes. El CV fue de 14.5 %; sin embargo, el CV alcanzó un valor del 40 % en aguas ascendentes. En general se observó una mayor FO de material vegetal en los estómagos de los individuos muestreados (44.4-66.7 %), seguido por los insectos (21.1-33.3 %, dietas secundarias). Los índices gravimétricos reflejaron que el material vegetal fue el ítem consumido en mayor cantidad, seguido de los insectos y en casi igual proporción invertebrados y material animal. Las diferencias en la composición de la dieta confirman la naturaleza oportunista de esta especie con predominio de hábitos omnívoros.Este estudio puede ser utilizado como parte integral del conocimiento de la ecología trófica de la especie, con el fin de crear estrategias para la protección del L. friderici en la región del Vaupés.

AbstractThe most important fish species of the Vaupes river is known as a Warakú tres puntos (Leporinus friderici), the most representative migratory Characidae from the Vaupés state, Colombia, with a significant importance in food security of indigenous communities. To contribute with the knowledge of its basic biology, we determined the habits and food preferences of Leporinus friderici, during one hydrobiological cycle (March 2014 to May 2015) in the Vaupés river, Colombia. Three sites were sampled, two of them along the Vaupés river (Yacayacá and Santa Cruz communities) and the other one in the Cuduyarí river, tributary of the Vaupés river (Piracemo community). Physical and chemical water parameters from the surface and depth level of the river were determined. Stomach contents from 316 fish were analyzed by frequency of occurrence (FO), gravimetric index, vacuity index (VI) and relative importance index (RII). Vaupés's average depth in ascending water period was of 3.7 ± 0.6 m, during rainy season of 5.9 ± 1.4 m, in descending water period of 4.6 ± 1.3 m and during dry season of 2.4 ± 1.0 m. The higher acidity and turbidity were observed during the ascending water period. The average VI was 14.5 % for the period, but it reached 40 % in descending waters. In general, a FO of plant material was the most frequent (44.4-66.7 %), followed by insects (21.1-33.3 %, secondary diets). The gravimetric indices showed that plant material was the most consumed item, followed by insects, and in almost in equal proportion, invertebrates and animal material. The differences in diet composition confirm the opportunistic nature of this species with a predominance of omnivorous habits. This study can be used as an integral part of the feeding ecology of L. friderici knowledge, in order to develop strategies for its protection in the Vaupés region because of its importance for local communities.

Fecundidad y fertilidad de Macrobrachium amazonicum (Héller 1862) (Decápoda, Palaemonidae) del Piedemonte Llanero Colombiano / Fecundity and fertility of Macrobrachium amazonicum (Héller 1862) (Decápoda, Palaemonidae) of Colombian Piedemonte Llanero

Objetivo. Determinar la fecundidad y fertilidad de Macrobrachium amazonicum del Piedemonte llanero. Materiales y métodos. Los animales fueron capturados en una granja piscícola del municipio de Restrepo-Meta, Colombia y llevados a la estación piscícola del Instituto de Acuicultura, Universidad de los Llanos. Se utilizaron hembras ovígeras a las cuales se les determinó el peso corporal (g) y longitud total (mm), así como su fecundidad (número de huevos/ hembra) y fertilidad (número de larvas/hembra). En los huevos se midieron el diámetro y longitud, para calcular su volumen. Resultados. La fecundidad varió entre 120 a 549 huevos con una media de 331 ± 93. Con respecto a la fertilidad, las hembras evaluadas tuvieron 287 ± 19 larvas, con un intervalo entre 102 a 703. Tanto para fecundidad como para fertilidad se observó que existe una relación lineal positiva significativa (r2 entre 0.85 y 0.91) con respecto al peso corporal y la longitud total de las hembras (p< 0.001). El diámetro de los huevos fue de 750.7 ± 2.9 μm (rango: 500 – 1000 μm) y el largo 974.2 ± 3.6 μm (525 – 1200 μm). El tamaño de los huevos fue de 296.2 ± 9.7 μm3. Conclusiones. Los valores de la fecundidad y fertilidad para Macrobrachium amazonicum en el Piedemonte llanero son inferiores a los resultados obtenidos en otros estudios; sin embargo, el tamaño de sus huevos es mayor. Los resultados permiten inferir que la especie se reproduce durante todo el año y que su fácil manejo permitiría su cultivo en cautiverio.

Objective. To determine the fecundity and fertility of Macrobrachium amazonicum (freshwater shrimp) of the Piedemonte llanero. Materials and methods. The animals were caught at a fish farm, in the municipality of Restrepo, Meta, Colombia and transported to the fish station of the Institute of Aquaculture of the University of the Llanos. The body weight (g), and total length (mm) of mature females and the fecundity and fertility (number of eggs and larvae/female, respectively) were determined. The diameter and the length of the eggs were determined to calculate their volume. Results. The fecundity varied from 120 to 549 eggs with an average of 331 ± 93. Regarding fertility, the females showed 287 ± 19 larvae, with an interval between 102 and 703. A highly positive lineal regression (r2 between 0.85 and 0.91) was observed between fecundity and fertility, and body weight and total length (p < 0.001). The egg diameter was 750.7 ± 2.9 µm (range: 500 - 1000 µm) and egg length of 974.2 ± 3.6 µm (525-1200 µm). The egg size was 296.2 ± 9.7 µm3. Conclusions. The determination of fecundity and fertility for Macrobrachium amazonicum in the Piedemonte Llanero was lower to the results obtained in other studies; however, the size of the eggs was higher. The results could infer that the species breeds throughout the year and allows easy handling and farming in captivity.