Impact of a nurse-led limited risk factor modification program on arrhythmia outcomes in patients with atrial fibrillation undergoing catheter ablation.

BACKGROUND: We have previously demonstrated the feasibility of a nurse-led risk factor modification (RFM) program for improving weight loss and obstructive sleep apnea (OSA) care among patients with atrial fibrillation (AF). OBJECTIVE: We now report its impact on arrhythmia outcomes in a subgroup of patients undergoing catheter ablation. METHODS: Participating patients with obesity and/or need for OSA management (high risk per Berlin Questionnaire or untreated OSA) underwent in-person consultation and monthly telephone calls with the nurse for up to 1 year. Arrhythmias were assessed by office ECGs and ≥2 wearable monitors. Outcomes, defined as Arrhythmia control (0-6 self-terminating recurrences, with ≤1 cardioversion for nonparoxysmal AF) and Freedom from arrhythmias (no recurrences on or off antiarrhythmic drugs), were compared at 1 year between patients undergoing catheter ablation who enrolled and declined RFM. RESULTS: Between 1 November 2016 and 1 April 2018, 195 patients enrolled and 196 declined RFM (body mass index, 35.1 ± 6.7 vs 34.3 ± 6.3 kg/m2 ; 50% vs 50% paroxysmal AF; P = NS). At 1 year, enrolled patients demonstrated significant weight loss (4.7% ± 5.3% vs 0.3% ± 4.4% in declined patients; P < .0001) and improved OSA care (78% [n = 43] of patients diagnosed with OSA began treatment). However, outcomes were similar between enrolled and declined patients undergoing ablation (arrhythmia control in 80% [n = 48] vs 79% [n = 38]; freedom from arrhythmia in 58% [n = 35] vs 71% [n = 34]; P = NS). CONCLUSION: Despite improving weight loss and OSA care, our nurse-led RFM program did not impact 1-year arrhythmia outcomes in patients with AF undergoing catheter ablation.

What predicts regression from pre-diabetes to normal glucose regulation following a primary care nurse-delivered dietary intervention? A study protocol for a prospective cohort study.

INTRODUCTION: Pre-diabetes is a high-risk state for the development of type 2 diabetes mellitus (T2DM) and cardiovascular disease. Regression to normoglycaemia, even if transient, significantly reduces the risk of developing T2DM. The primary aim of this mixed-methods study is to determine if there are clinically relevant differences among those with pre-diabetes and excess weight who regress to normoglycaemia, those who have persistent pre-diabetes and those who progress to T2DM following participation in a 6-month primary care nurse-delivered pre-diabetes dietary intervention. Incidence of T2DM at 2 years will be examined. METHODS AND ANALYSIS: Four hundred participants with pre-diabetes (New Zealand definition glycated haemoglobin 41-49 mmol/mol) and a body mass index >25 kg/m2 will be recruited through eight primary care practices in Hawke's Bay, New Zealand. Trained primary care nurses will deliver a 6-month structured dietary intervention, followed by quarterly reviews for 18 months post-intervention. Clinical data, data on lifestyle factors and health-related quality of life (HR-QoL) and blood samples will be collected at baseline, 6 months, 12 months and 24 months. Sixty participants purposefully selected will complete a semi-structured interview following the 6-month intervention. Poisson regression with robust standard errors and clustered by practice will be used to identify predictors of regression or progression at 6 months, and risk factors for developing T2DM at 2 years. Qualitative data will be analysed thematically. Changes in HR-QoL will be described and potential cost savings will be estimated from a funder's perspective at 2 years. ETHICS AND DISSEMINATION: This study was approved by the Northern A Health and Disability Ethics Committee, New Zealand (Ethics Reference: 17/NTA/24). Study results will be presented to participants, published in peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER: ACTRN12617000591358; Pre-results.

Parental experience of counselling about food and feeding practices at the child health centre: A qualitative study.

AIMS AND OBJECTIVES: To investigate how parents experience counselling about food and feeding practices and the use of a communication tool about diet at the child health centre. BACKGROUND: Food-related counselling is a key element in parents' consultations with public health nurses at child health centres. Public health nurses possess limited strategies and tools for addressing nutritional issues, especially in the context of client diversity. DESIGN: An interpretive description approach, fulfilling the COREQ checklist criteria. METHODS: Individual interviews performed between January 2017-May 2017 among parents (n = 12) of children (mean age 28 months) who had been exposed to a communication tool about diet, in regular child health centre consultations with their child. These consultations were included in clinical trial (ClinicalTrials.gov.: Identifier: NCT02266953). RESULTS: Counselling using the communication tool about diet was primarily based on the public health nurse presenting images of healthy food choices. After infancy, consultations sometimes became more time-pressured, inhibiting parents from asking questions related to the child's diet. The parents who had questions related to food allergy or breastfeeding of their child sometimes experienced limited support. Some parents felt overwhelmed with information about healthy food choices if their child's diet differed from the recommendations presented. CONCLUSIONS: The parents' existing expectations and needs had an impact on their satisfaction in relation to their perceptions of nutritional counselling. The use of the communication tool about diet to promote a two-way dialogue instead of providing one-way dietary information might be particularly useful in consultations for parents who do not follow customary recommendations. RELEVANCE TO CLINICAL PRACTICE: If the diet of the family differs from what is recommended, parents often experience limited support at the child health centre. Promoting a two-way dialogue in consultations using a communication tool about diet could help parents in their concerns related to feeding their child.

Implementation of a multicomponent telemonitoring intervention to improve nutritional status of community-dwelling older adults: a process evaluation.

OBJECTIVE: The present study aimed to conduct a process evaluation of a multicomponent nutritional telemonitoring intervention implemented among Dutch community-dwelling older adults. DESIGN: A mixed-methods approach was employed, guided by the process evaluation framework of the Medical Research Council and the Unified Theory of Acceptance and Use of Technology. The process indicators reach, dose, fidelity and acceptability were measured at several time points within the 6-month intervention among participants and/or nurses. SETTING: The intervention was implemented in the context of two care organisations in the Netherlands. SUBJECTS: In total, ninety-seven participants (average age 78 years) participated in the intervention and eight nurses were involved in implementation. RESULTS: About 80 % of participants completed the intervention. Dropouts were significantly older, had worse cognitive and physical functioning, and were more care-dependent. The intervention was largely implemented as intended and received well by participants (satisfaction score 4·1, scale 1-5), but less well by nurses (satisfaction score 3·5, scale 1-5). Participants adhered better to weight telemonitoring than to telemonitoring by means of questionnaires, for which half the participants needed help. Intention to use the intervention was predicted by performance expectancy (ß=0·40; 95 % CI 0·13, 0·67) and social influence (ß=0·17; 95 % CI 0·00, 0·34). No association between process indicators and intervention outcomes was found. CONCLUSIONS: This process evaluation showed that nutritional telemonitoring among older adults is feasible and accepted by older adults, but nurses' satisfaction should be improved. The study provided relevant insights for future development and implementation of eHealth interventions among older adults.

Intervenção sobre fatores de risco emcrianças e adolescentes / Risk factor intervention in children and adolescents

As doenças cardiovasculares estão entre as principais causas de mortalidade no mundo e não afligem apenas os adultos. Muitos trabalhos têm demonstrado que elas já podem ser vistas na infância. Entre os fatores de risco para a doença cardiovascular, pode-se destacar a dislipidemia, o baixo peso ao nascer e a obesidade infantil. A detecção de dislipidemia na infância é crucial, por ser considerada a fase estratégica para a implementação de medidas de prevenção da aterosclerose no âmbito populacional. Embora as causas ambientais ou poligênicas sejam as mais frequentes, é importante a identificação de formas genéticas como a hipercolesterolemia familiar e hipertrigliceridemias de base genética, pois medidas relacionadas aos hábitos de vida e terapêutica medicamentosa devem ser iniciadas preco-cemente, evitando-se complicações e mudando a história natural dos desfechos clínicos. Outros estudos têm demonstrado que o baixo peso ao nascer também contribui para o desenvolvimento tardio de hipertensão arterial, doença coronariana e disfunção endotelial. Possivelmente, por conta das agressões ao sistema vascular em desenvolvimento. No en-tanto, os mecanismos ainda são incertos. Evidências sugerem que alguns biomarcadores, tais como os níveis de ácido úrico e homocisteína e a baixa concentração de óxido nítrico observados em crianças com baixo peso ao nascer, podem estar associados a alterações deletérias na vida adulta. Por fim, o terceiro fator que deve ser considerado é a obesidade infantil. Essa desordem tem causa multifatorial e pode favorecer o surgimento das etapas iniciais da aterosclerose, como a disfunção endotelial, já na infância. Porém, é um fator de risco modificável, e as estratégias de prevenção e intervenção baseiam-se, na maioria dos casos, em mudanças do estilo de vida, como alimentação saudável e exercício físico.

Cardiovascular disease is one of the leading causes of mortality in the world and does not affect adults alone. Many papers have shown that it can already be seen in childhood. The most significant risk factors for cardiovascular disease include dyslipidemia, low birth weight and childhood obesity. Screening for dyslipidemia in childhood is crucial as this is considered a strategic phase for the implementation of measures aimed at preventing atherosclerosis in the population setting. Although environment or polygenic causes are the most common, it is important to identify genetic forms such as familial hypercholesterolemia and hypertriglyceridemia, since measures related to lifestyle and pharmacotherapy must be initiated early in life to avoid complications and change the natural history of clinical outcomes. Other studies have shown that low birth weight also contributes to the late development of hypertension, coronary artery disease and endothelial dysfunction, possible due to injury to the developing vascular system. However, the mechanisms are still uncertain, and evidence suggests that some biomarkers, such as uric acid and homocysteine levels, and the low concentration of nitric oxide observed in low birthweight children, may be associated with deleterious changes in adulthood. Finally, the third factor to be considered is childhood obesity. This disorder has a multifactorial etiology and may favor the onset of the first stages of atherosclerosis, such as endothelial dysfunction, in young children. However, it is a modifiable risk factor, and prevention and intervention strategies are largely based on lifestyle changes such as healthy diet and exercise

Counselling parents on young children's healthy diet: A modified scoping review.

AIMS AND OBJECTIVES: To map and describe key information in existing research about counselling of parents of children aged 0-2 years on the child's healthy diet in preventive healthcare settings, particularly in public health nursing. BACKGROUND: Many parents are likely to be concerned with their infant's food-related happiness "here and now," disregarding the child's long-term health and development related to feeding practices. Hence, a focus on counselling parents in considering young children's healthy diet is important. DESIGN: A modified scoping review with an inductive qualitative content analysis of selected empirical studies. METHODS: Systematic searches in EMBASE (1996-2015 Week 46), Ovid Nursing Database (1946-2015 November Week 1), Ovid MEDLINE and Ovid OLDMEDLINE (2000-18 November 2015) and CINAHL (2000-22 December 2015), using search terms based on aims. RESULTS: Eight included studies, with participants per sample ranging from 19->500. Research designs were focus group discussions and/or interview study (n = 2), cluster-randomised trials (n = 2), randomised controlled trials (n = 2), a follow-up interview study (n = 1) to a previous randomised controlled trial and a cross-sectional electronic questionnaire study (n = 1). The studies included a total sample of 2,025 participants, 42 of them in interview studies. Findings indicate parents' perceptions of inconsistency, misconceptions and uncertainty related to the recommendations on child feeding from the authorities. Thus, adapted advice could impact healthier child diet. Maternal knowledge on child feeding and reduced use of food as a reward are mediators for improved diet quality in children. CONCLUSIONS: Counselling on young children's healthy diet should be anticipatory, consistent and adapted to the family. RELEVANCE TO CLINICAL PRACTICE: Due to inconsistent recommendations and omitted focus on anticipatory counselling on child feeding, parents might perceive pressure and uncertainty related to the child's diet.

"Palavras desenhadas": uma proposta de orientação alimentar através de desenhos na consulta de enfermagem / "Drawn words": a food orientation proposal through drawings during nursing consultations

Em 2001, realizamos consultas de enfermagem através do APQV na Unidade de Saúde Coinma do GHC. O APQV é um projeto de pesquisa e desenvolvimento pertencente ao Grupo de Estudos Interdisciplinares do Gênero, Saúde e Trabalho (GENST) da EE/UFRGS. Nessas consultas, observamos um grande número de pacientes que apresentavam dificuldades de seguir as orientações alimentares escritas, apesar de haver toda uma orientação oral durante a consulta, além do reforço dessas informações. Com o objetivo de trabalharmos no sentido de educar em saúde, pensamos em alternativas metodológicas para uma nova forma de trabalhar a temática da orientação alimentar. Dentre as alternativas, pensou-se na construção conjunta, enfermeira e paciente, de uma proposta através de desenhos. Assim, este trabalho visa sistematizar a reflexão para que se torne nossas práticas de consultório mais eficientes e resolutivas.(AU)

In 2001, we realized nursing consultations through APQV, which was localized at the COINMA Health Unit of GHC. APQV is a research and development project of the Interdisciplinary Gender, Health and Work Study Group (GENST) at EE/UFRGS. During these nursing consultations, we observed a large number of patients who presented difficulties in following written food orientations, although oral orientation was given during the consultations, which was reinforced in subsequent consultations. With a view to health education, we considered methodological alternatives for a new way of working with food orientation. One of the alternatives considered was the joint construction, involving nurse and patient, of a proposal by means of drawings. Thus, this study aims to systemize reflections, with a view to making our consulting practices more efficient and resolving.(AU)