Adapting a clinical decision support system to improve identification of pediatric hypertension in a rural health system: Design of a pragmatic trial.

BACKGROUND: Identifying hypertension (HTN) early is crucial in preventing and lowering the long-term risk of heart disease, yet HTN in children often goes undiagnosed. An electronic health record linked, web-based clinical decision support (CDS) called PedsBP can help address this care gap and has been previously shown to increase recognition of HTN by primary care clinicians. OBJECTIVES: To adapt the PedsBP tool for use in a mostly rural health system and then to evaluate the effectiveness of PedsBP for repeat of hypertensive level blood pressure (BP) measurements and HTN recognition among youth 6-17 years of age in primary care settings, comparing low-intensity and high-intensity implementation approaches. METHODS AND DESIGN: PedsBP was evaluated through a pragmatic, clinic-randomized trial. The tool was piloted in 2 primary care clinics and modified prior to the full trial. Forty community-based, primary care clinics (or clusters of clinics) were randomly allocated in a 1:1:1 ratio to usual care, low-intensity implementation (CDS only), or high-intensity implementation (CDS plus in-person training, monthly use reports, and ongoing communication between study staff and clinics). Accrual of eligible patients started on August 1, 2022 and will continue for 18 months. Primary outcomes include repeating hypertensive level BP measurements at office visits and clinical recognition of HTN. Secondary outcomes include lifestyle counseling, dietician referral, and BP at follow-up. CONCLUSION: This report focuses on the design and feasibility of adapting and implementing PedsBP in a rural primary care setting. The trial and analysis are ongoing with main results expected in mid-2024.

Co-ingestion of whole almonds and almond oil with carbohydrate suppresses postprandial glycaemia in mice in an insulin-dependent and insulin-independent manner.

Co-ingestion of almonds with carbohydrate prevents excessive increase in plasma glucose level (PGL), but information about the functional fraction is limited. Identifying the functional fraction is necessary to use almonds more efficiently in terms of controlling postprandial glycaemia after a high-carbohydrate meal. In the present study, we evaluated the effects of almond skin, oil, water-soluble fraction and water-insoluble fraction on both postprandial glycaemia and insulinaemia. The effect of almond skin was tested by comparing the effect of whole almonds with the effect of skinless almonds. Male ICR mice were administered dextrin and 4 g/kg body weight test samples. After the administration, 2-h postprandial changes in glycaemia and insulinaemia were measured. Oil was the only fraction being able to blunt postprandial glycaemia. Interestingly, when co-ingesting with dextrin, almond oil did not change the insulin level compared with the control but whole almonds or skinless almonds triggered a 4-fold increase in insulin level. The co-ingestion of whole almonds or skinless almonds similarly suppressed the PGL at 15 and 30 min (P < 0·05), which means almond skin has no effect on postprandial glycaemia. Neither soluble nor insoluble fractions lead to any significant changes in postprandial glycaemia and insulinaemia. In conclusion, oil is the main functional component accounting for the glycaemia-lowering effect without altering insulin level.

Using focus groups to develop interventions to promote colorectal cancer screening among Vietnamese Americans.

BACKGROUND: Colorectal cancer is the third most common cancer in Vietnamese Americans. Their colorectal screening rates are lower than the rates of whites. METHODS: Four focus groups were conducted to identify Vietnamese American sources and credibility of health information, media utilization, and intervention approaches. RESULTS: Vietnamese Americans trusted doctors and patient testimonials and had access to, and received most of their health information from, Vietnamese- language print and electronic media. Recommended intervention approaches include promoting doctors' recommendation of screening and using Vietnamese-language mass media, print materials, and oral presentations. CONCLUSIONS: Focus groups are useful in determining communication channels and intervention approaches.