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ScopeGut microbiota alterations are associated with obesity and type 2 diabetes. Yeast β-glucans are potential modulators of the innate immune-metabolic response, by impacting glucose, lipid, and cholesterol homeostasis. The study examines whether yeast β-glucan interacts differentially with either an obese healthy or obese diabetic gut microbiome, to impact metabolic health through hepatic effects under high-fat dietary challenge.Methods and resultsMale C57BL/6J mice are pre-inoculated with gut microbiota from obese healthy (OBH) or obese type 2 diabetic (OBD) subjects, in conjunction with a high-fat diet (HFD) with/without yeast β-glucan. OBD microbiome colonization adversely impacts metabolic health compared to OBH microbiome engraftment. OBD mice are more insulin resistant and display hepatic lipotoxicity compared to weight matched OBH mice. Yeast β-glucan supplementation resolves this adverse metabolic phenotype, coincident with increasing the abundance of health-related bacterial taxa. Hepatic proteomics demonstrates that OBD microbiome transplantation increases HFD-induced hepatic mitochondrial dysfunction, disrupts oxidative phosphorylation, and reduces protein synthesis, which are partly reverted by yeast β-glucan supplementation.ConclusionsHepatic metabolism is adversely affected by OBD microbiome colonization with high-fat feeding, but partially resolved by yeast β-glucan. More targeted dietary interventions that encompass the interactions between diet, gut microbiota, and host metabolism may have greater treatment efficacy.

Hypertension is an increasingly prevalent condition in Ireland, affecting in excess of 50% of those over 50 years of age. While many of them undergo adequate clinical treatment, the standard of blood pressure control still remains sub-optimal mainly due to poor medication adherence fuelled by poor awareness level. The main objective of the study was to explore the impact of a structured hypertension educational intervention on patient knowledge, lifestyle behaviours and blood pressure control. Subjects for this study were recruited from disadvantaged/underserved communities in Mayo, Ireland. A multidisciplinary team comprising of specialist nurses, physiotherapist, dietitian, cardiovascular consultants and research assistants were responsible for screening and recruiting participants, collecting patient data and delivering the educational programme. Eligible participants (adults of 40 years and older) with high blood pressure were randomly assigned to either a control group or an intervention group. The control group were given standard care which included blood pressure and body mass index (BMI) measurements, lifestyle guidance and referral to general practitioner in accordance with European Society of Cardiology (ESC) guidelines. The interventional group received an educational session to improve knowledge and understanding of hypertension. A follow-up assessment was conducted for all participants 4–6 months after the educational interventional programme. A total of 102 participants were included in this study. Baseline records showed no significant difference in gender proportion, mean age, mean BMI, mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) between control and intervention groups. At the follow-up assessment, a statistical reduction of mean SBP (p=0.007) and mean DBP (p=0.004) was observed in the intervention group in comparison to baseline records along with a significant increase in self-reported weekly exercise time, reduction in the number of active smokers and units of alcohol consumed weekly. Intervention group subjects had greater blood pressure reductions (mean decrease in mmHg and absolute percentage reduction) compared to control group subjects for each of the four blood pressure indicators. Providing a tailored education to individuals with hypertension can positively impact on hypertension control, knowledge and self-care management within community-based settings.

The impact of reduced adherence in randomized clinical trials is well documented in the literature. Nonadherence can negatively affect the trial sample size and estimation of the treatment effect. This protocol aims to evaluate the effects of a telephone call reminder on the adherence rates of participants to interventions in a cardiovascular randomized trial. This is a study within a trial (SWAT). The host trial is evaluating the effectiveness of a multidisciplinary 16-wk cardiovascular disease prevention program on risk factor profile among patients with carotid artery stenosis. Simultaneously, this SWAT will evaluate the effectiveness of telephone call reminders on the participants' adherence to the host trial intervention. The primary outcome is adherence to the protocol of the host trial. Secondary outcomes are level of adherence, number of dropouts, and time to drop out from the host trial.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited., Preventive cardiology encompasses the whole spectrum of cardiovascular disease (CVD) prevention, at individual and population level, through all stages of life. This includes promotion of cardiovascular (CV) health, management of individuals at risk of developing CVD, and management of patients with established CVD, through interdisciplinary care in different settings. Preventive cardiology addresses all aspects of CV health in the context of the social determinants of health, including physical activity, exercise, sports, nutrition, weight management, smoking cessation, psychosocial factors and behavioural change, environmental, genetic and biological risk factors, and CV protective medications. This is the first European Core Curriculum for Preventive Cardiology, which will help to standardize, structure, deliver, and evaluate training in preventive cardiology across Europe. It will be the basis for dedicated fellowship programmes and a European Society of Preventive Cardiology (EAPC) subspecialty certification for cardiologists, with the intention to improve quality and outcome in CVD prevention.

There is a global imperative for the prevention of cardiovascular disease which includes primordial, primary, and secondary prevention. Prevention requires a multifactor risk reduction approach because of the multifaceted aetiology of cardiovascular disease. Components of cardiovascular disease prevention include behavioural strategies to encourage the adoption of healthy lifestyle habits (abstaining from tobacco, adopting a cardioprotective diet, achieving optimal physical activity and exercise levels, and achieving a healthy body weight and shape), the use of medications to manage biological risk factors, and strategies to manage psychological conditions such as anxiety and depression. Nurses have an important role to play in the implementation of prevention programmes which, when led by this professional group working in interdisciplinary models with physicians and allied professionals, are successful in reducing total mortality. Risk estimation allows the detection of those at highest risk, so they can be identified for management as a priority. Settings for the delivery of prevention and rehabilitation programmes include hospital-based conventional cardiac rehabilitation and initiatives based in primary care and the community. All have been shown to be successful when all of the components described previously are included. Integrating digital technology can address barriers to participation in programmes and improve adherence. Professional societies, associations, and heart foundations play an important role in supporting healthcare professionals, patients, and caregivers to maximize the effectiveness of prevention initiatives.

Background: Lifestyle modification is the cornerstone of management for patients with severe and complicated obesity, but the effects of structured lifestyle programmes on quality of life, anxiety and depression scores and cardiovascular risk factors are not well-described. We sought to describe changes in self-reported quality of life and mental health-related outcomes as well as cardiovascular risk factors in patients completing a 10-week multidisciplinary lifestyle-modification programme. Methods: We conducted a prospective cohort study of all patients referred from our bariatric service who completed the programme between 2013 and 2019. In addition to weight, body mass index (BMI), blood pressure, HbA1c, lipid profile and functional capacity, we quantified health-related quality of life using the Dartmouth COOP Questionnaire and the European Quality of Life Questionnaire Visual Analogue Scale (EQVAS) and mental health using the Hospital Anxiety and Depression Scale (HADS). Results: Of 1122 patients who started the programme, 877 (78.2%) completed it and were included in per protocol analyses. Mean age was 47.3 ± 11.9 years, 66.9% were female, 34.8% were in full- or part-time employment and 69.4% were entitled to state-provided medical care. BMI decreased from 47.0 ± 7.8 to 46.2 ± 7.8 kg m−2 and weight decreased from 131.6 ± 25.5 to 129.5 ± 25.4 kg (both p < 0.001). There were significant reductions in anxiety and depression scores and improvements in all Dartmouth COOP domains. The EQVAS score increased from 52 ± 22 to 63 ± 19 (p < 0.001). Small but statistically significant reductions in LDL cholesterol, systolic blood pressure and HBA1c were also observed. Conclusions: Adults with severe and complicated obesity completing a specialised bariatric lifestyle-modification programme showed significant improvements in self-reported mental health and quality of life, in addition to reductions in cardiovascular risk factors.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness of mobile health technologies to improve walking distance in people with intermittent claudication.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Service Executive Health and Wellbeing, Saolta University Healthcare Group OnBehalf Croí the West of Ireland Cardiac Foundation, Galway, Ireland and the National Institute for Prevention and Cardiovascular Health Introduction People living with obesity are at an increased risk of cardiovascular disease (CVD). While development of obesity is multifactorial, lifestyle modification is fundamental to obesity treatment and risk factor reduction. We sought to measure the effects of a structured lifestyle modification programme on the physical and mental health of people living with obesity. Purpose This study investigated the impact of a 10-week, community based, lifestyle modification programme on CVD risk factors in people living with obesity (BMI ≥35kg/m2 with a co-morbidity or BMI ≥40kg/m2) who were referred from a specialist bariatric service. Methods Delivered by an interdisciplinary team (Nurse, Dietitian & Physiotherapist) the programme included weekly group-based exercise sessions and health promotion workshops. A wide range of topics were addressed in workshops, including nutrition, food labels, emotional eating, physical activity, sedentary behaviour, stress management and CVD risk factor reduction. Outcomes were measured at initial and end of programme assessments. Results 1122 people participated in the intervention between 2013 and 2019 with 78% (n = 877) completing the programme. At initial assessment 26.7% of participants had a diagnosis of type 2 diabetes; 37.3% were at high or very high risk of CVD; 44.7% were hypertensive and 31.4% had a history of depression. Mean BMI was 47.0kg/m2 with 56.4% of participants having a BMI >45kg/m2. The intervention had significant positive impacts on key outcomes such as psychosocial health, lipid profiles, blood pressure, adiposity and cardiovascular fitness. One of the most significant outcomes observed was the improvement in psycho-social health. Scores of anxiety and depression, assessed using the HADS, decreased by 1.5 and 2.2 points respectively (p 3% of initial bodyweight. The percentage of participants achieving the recommended physical activity guidelines increased by 31% (p Conclusions A lifestyle modification programme delivered by an interdisciplinary team, aimed at individuals living with obesity, is not only acceptable to participants but also significantly reduces CVD risk factors. These findings should influence the design of future programmes and healthcare policies in Ireland and abroad.

Background/aims:Health promotion for cardiovascular disease risk factors management is essential to secondary prevention of cardiovascular disease events. In Ireland, post-cardiac rehabilitation patients are discharged into the care of community public health nurses, who have a health promotion role. Little is known of the public health nurses’ perceptions or knowledge surrounding their role in cardiovascular disease risk factor management. Underpinned by a constructivist viewpoint, this study aims to generate empirical evidence on the phenomenon directly from public health nurses’ encounters within the context of the current health service.Methods:This qualitative cross-sectional analysis involved face-to-face, semi-structured interviews with a purposeful sample of 17 public health nurses. Interviews were audio-recorded, transcribed, subjected to thematic content analysis and subsequently reported incorporating verbatim quotes.Results:A significant gap exists between evidence-based guidelines for cardiovascular disease prevention and current practices. Variations in public health nurses’ training, experience and knowledge result in inconsistent practices, and public health nurses feel this is specialised area for which they are not equipped. The changing public health nurse role and increasing workloads result in prioritisation of other nursing duties over health promotion. Ineffective systems for care delivery and a lack of community-based rehabilitation programmes also negatively impact on secondary prevention practices.Conclusions:Findings support the need to develop a community cardiovascular disease specialist role to effectively support ongoing cardiovascular disease risk factor management. Evaluation of the mechanisms of current service delivery is required to ensure a quality-assured equitable service, in line with community needs and current evidence-based guidelines for practice. A quantitative triangulation study is recommended.

Background Peripheral arterial disease (PAD) affects more than 200 million of the global population. PAD represents a marker for premature cardiovascular events. Patients with PAD, even in the absence of a history of myocardial infarction or ischemic stroke, have approximately the same relative risk of death from cardiovascular causes as patients with a history of coronary or cerebrovascular disease. Despite the high prevalence of PAD and the strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive appropriate treatment for their atherosclerotic risk factors than those who are being treated for coronary artery disease. Atherosclerotic risk factor identification and modification play an important role in reducing the number of adverse outcomes among patients with atherosclerosis. Risk reduction therapy decreases the risk of cardiovascular mortality and morbidity in patients with PAD. In this study, we aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors. Methods This is a randomised, parallel group, active-control trial to compare the effectiveness of the risk factor modification intervention programme to standard healthcare in a tertiary vascular care centre, in the reduction of modified risk factors in PAD patients. The primary outcome of this study is to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors at 3 and 12 months. The secondary outcomes are to compare the impact of the programme on clinical outcomes in PAD patients at 12 months. Secondary outcomes include amputation-free survival, clinical improvement, haemodynamic improvement, need for revascularisation procedures, outcomes of revascularisation procedures, changes in quality of life and the incidence of adverse events. Discussion This study will provide clear evidence on the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors, through a high-quality, well-powered clinical trial. Trial registration This trial was registered (11/07/2017) on the European Clinical Trials Database (EudraCT number 2017-002964-41) and ClinicalTrials.gov (NCT03935776) which was registered on 02 May 2019.

Purpose: An outcomes’ evaluation of a community-based cardiovascular disease (CVD) prevention program in persons with newly diagnosed type 2 diabetes. Design: A prospective, observational study. Setting: A community-setting in Ireland. Participants: Persons with newly diagnosed type 2 diabetes, aged 40 years or older, and 2 or more cardiovascular risk factors. Intervention: A 16-week community-based, cardiovascular prevention program, with health promotion seminars, group exercise, and individual consultations, delivered by a multidisciplinary team. Measures: Medical, lifestyle, and well-being measures. Analysis: Changes in categorical and continuous variables were analyzed using the paired exact test and the t test/Wilcoxin matched-pairs test, respectively. Results: In total, 218 persons (134 men) participated, mean age was 59.8 (10.2) years. Completion rate was 75.2% (n = 164). The proportion achieving target glycosylated hemoglobin (HbA1c) increased from 53% at baseline to 75% ( P < .001) at end of program. Systolic and diastolic blood pressures reduced by 8.8 mm Hg (95% CI: −11.2 to −6.4, P < .001) and 5.2 mm Hg (95% CI: −6.9 to −3.5, P < .001), respectively. Mean low-density lipoprotein cholesterol reduced from 2.45 to 2.05 mmol/L ( P < .001). Significantly higher proportions met recommended targets in diet (6.9% vs 43.4%, P < .001) and physical activity (9.2% vs 56.6%, P < .001). Psychosocial measures significantly improved at end of program. The majority of improvements were sustained at 1 year. Conclusion: Participation in this CVD prevention program was associated with significant improvements in glycemia and CVD risk factors in newly diagnosed patients with type 2 diabetes.

In recent decades, cardiovascular mortality has reduced significantly. Among others, improved treatment options for cardiovascular disease (CVD) and a reduction of smoking since the 1960s have contributed to this decline.1 In many countries, smoking in public areas is prohibited. However, western dietary habits, including foods high in sugar, salt and fat, and lack of exercise are still persistent, leading to obesity, diabetes and hypertension. Yet, despite numerous guidelines on prevention and treatment of CVD with medication and lifestyle management, the incidence of CVD is still increasing in many countries, fuelled by rising obesity levels, sedentary lifestyles and increased longevity.2 In particular in the southern hemisphere CVD is on the increase, with high rates of obesity, diabetes and hypertension.3 Demographics are changing in low and middle income countries, fuelling the rise of chronic diseases and a persistent burden of infectious diseases overwhelming the limited health care resources.4 In western countries survival after CVD events has successfully improved; however, at the price of more patients living with chronic CVDs.5 These developments will lead to an increased demand on healthcare services now and in the years ahead for both the prevention and the management of CVD. The organisation and continuity of care through the various layers of the different national healthcare systems is challenging and calls for close collaboration between hospital specialists, general practitioners (GPs) and other primary care workers in the battle against CVD. GPs are key in identifying patients at risk of CVD and providing individualised, risk stratified preventive care

BackgroundStudying variability in the care provided to secondary prevention coronary heart disease (CHD) outpatients can identify interventions to improve their outcomes.MethodsWe studied outpatients who had an index CHD event in the preceding 6–24 months. Eligible CHD events included acute coronary syndrome (ACS) and coronary revascularisation for stable chronic coronary syndrome (CCS). Site training was provided by a core team and data were collected using standardised methods.ResultsBetween 2017 and 2019, we enrolled 721 outpatients at nine Irish study sites; 81% were men and mean age was 63.9 (SD ±8.9) years. The study examination occurred a median of 1.16 years after the index CHD event, which was ACS in 399 participants (55%) and stable-CCS in 322. On examination, 42.5% had blood pressure (BP) >140/90 mm Hg, 63.7% had low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/L and 44.1% of known diabetics had an HbA1c >7%. There was marked variability in risk factor control, both by study site and, in particular, by index presentation type. For example, 82% of outpatients with prior-ACS had attended cardiac rehabilitation versus 59% outpatients with prior-CCS (pConclusionsDespite international secondary prevention guidelines broadly recommending the same risk factor targets for all adults with CHD, we found marked differences in outpatient risk factor control and management on the basis of hospital location and index CHD presentation type (acute vs chronic). These findings highlight the need to reduce hospital-level and patient-level variability in preventive care to improve outcomes; a lesson that should inform CHD prevention programmes in Ireland and around the world.

Background With the prevalence of coronary heart disease increasing globally it is imperative that we explore alternative methods of delivering cardiac rehabilitation (CR) to improve patient outcomes in accordance with national and international CR guidelines. This study examines the feasibility and effectiveness of delivering a community based CR programme on medical and lifestyle risk factor management in the west of Ireland. Methods Patients with coronary heart disease; meeting the inclusion criteria for referral to CR were invited to attend a 12- week CR programme consisting of a professional multi-disciplinary (nurse, dietitian, physiotherapist) lifestyle intervention, with appropriate risk factor and therapeutic management delivered within a community setting. Risk factors such as blood pressure, lipids, smoking, BMI (body mass index), waist circumference and estimated MET max were assessed at baseline and end of programme (EOP). Results 255 patients enrolled in the CR programme. Mean age of the participants was 66.6 yrs, 72.9% were male and 35.4% had previous cardiac history. The programme adopted an integrated approach to care and in addition to cardiac patients it included a cohort of Stroke (17%) and Peripheral Vascular Disease (PVD) (4%) patients. Outcome data on 196 patients who completed the 12 week programme were analysed (table 1). Conclusions Data from this multi-component comprehensive community based CR programme suggest that the management of CR patients can be successfully integrated and delivered within a community setting by a specialist multi-disciplinary team (MDT). This study has demonstrated improvements in patient outcomes across biomedical, anthropometric and lifestyle risk factors. Benefits were also noted in the psychosocial health and wellbeing of the participants including improvements in quality of life (QoL) measures.

Aims:The purpose of this study was to examine the impact of an icon-based menu labelling initiative on consumer buying behaviour.Methods:This quasi-experimental study recruited a convenience sample of eight food service establishments, all with at least one menu item meeting the heart healthy criteria. Data from sales of all menu items sold over an 8-week period were collated 4 weeks prior to and 4 weeks during the display of information icons related to healthy food choices on menus.Results:The absolute change in menu item sales showed a non-significant trend towards an increase in healthier menu item selections. Furthermore, there was no association between the type of food service establishment and the percentage change in labelled menu item sales.Conclusion:The study did not find a statistically significant influence of the icon-based menu labels on consumer food choice. Given the limited amount of research that examines alternative menu labelling formats in real-world settings, more studies are necessary to confirm these results. Further research is needed to identify the optimal format, content and impact of menu labels on consumer behaviour.

Background With the prevalence of Type 2 diabetes increasing globally it is imperative that we explore models of care that seek to improve diabetes outcomes in accordance with the recommended total Cardiovascular(CVD) risk approach to prevention. Purpose: This study examines the effectiveness of a community-based CVD prevention programme on medical and lifestyle risk factor management in a cohort of patients with Type 2 diabetes. Methods Patients with Type 2 diabetes and their family members were invited to attend a 16 week programme consisting of a professional multi-disciplinary (nurse, dietician, physical activity specialist) lifestyle intervention, with appropriate risk factor and therapeutic management in a community setting. Risk factors such as blood pressure, lipids, smoking, blood glucose, BMI (body mass index), waist circumference and physical activity levels were assessed at baseline, end of programme and at 1 year. Results As this study is ongoing, outcome data on patients who completed the 16 week programme and attended the 1 –Year follow-up were analysed (table 1). As of December 2016, 218 patients were invited to attend End of Programme (EOP) assessment, resulting in a 75% response rate (n=164), and 166 were invited to attend 1 Year follow-up (1 year) of which 64.5% responded. Overall a high programme uptake rate of 99% was observed. Conclusions Data from this ongoing lifestyle intervention programme suggests that the management of diabetes and cardiovascular disease can be successfully integrated. In addition, this model of care can improve diabetes outcomes with improvements in biomedical, anthropometric and lifestyle risk factors not only being observed at EOP but being sustained at 1 year.

Background Hypertension is a leading modifiable risk factor for cardiovascular disease and is estimated to be responsible for at least 45% of ischaemic heart disease mortality and 51% of stroke mortality globally. Irish studies indicate a prevalence of 64% of hypertension amongst adults over 50 years with accompanying low levels of patient knowledge, and sub-optimal clinical management. Purpose This study was designed to explore the impact of a structured hypertension educational intervention on patient knowledge, lifestyle behaviours and blood pressure (BP) control. Methods Participants were recruited through community-based screening events; and those with hypertension were randomly assigned to control and intervention groups. At baseline, both groups received standard care which included; completing a knowledge questionnaire, BP assessment supported by lifestyle advice and referral to General Practice in accordance with ESC best practice guidelines. The intervention group received an additional educational intervention delivered by a multidisciplinary team. Educational topics included understanding and taking control of BP, the effects of exercise and diet on BP, smoking cessation, stress management, and medication updates and adherence. Both groups were followed up at 4 months. Results 200 individuals were recruited to the study with 118 meeting the eligibility criteria and being randomised to the intervention (n=59) and control group (n=59). Significant improvements (p Conclusion Providing tailored education to individuals with hypertension can positively impact patient knowledge, engagement and self-care management thus leading to improved BP control. Given that elevated BP is a leading risk factor for disease burden globally, it is imperative that new models of care are developed to improve hypertension management in the community.

Background: Selecting outcome measures in cardiovascular prevention trials should be informed by their importance to selected populations. Major vascular event outcomes are usually prioritized in these trials with considerably less attention paid to cognitive and functional outcomes. Aim: To examine views on importance of outcome measures used in clinical trials. Design: Cross-sectional survey. Methods: Of 367 individuals approached, 280 (76%) participated: outpatients attending cardiovascular prevention clinics (n = 97), active retirement groups members (n = 75), medical students (n = 108). Participants were asked to rank, in order of importance, outcome measures, which may be included in cardiovascular prevention trials. Results were compared between two groups: = 65s (n = 104). Results: When asked what outcomes were most important to measure in cardiovascular prevention trials, respondents reported: death (31.6%) stroke (28.5%), dementia (26.9%), myocardial infarction (MI) (7.9%) and requiring nursing home (NH) care (5.1%). When asked the most relevant outcomes regarding successful ageing respondents reported; maintaining independence (32.4%), avoiding major illness (24.3%), good family life (23.6%), living as long as possible (15.8%), avoiding NH care (3.1%) and contributing to society (0.8%) as most important. When asked what outcome concerned them most about the future, respondents reported: dementia (32.6%), dependence (30.4%), death (12.8%), stroke (12.5%), cancer (6.2%) requiring NH care (4.8%) and MI (0.7%). Maintaining independence was considered most important in younger and older cohorts. Conclusion: Cognitive and functional outcomes are important patient-relevant outcomes, sometimes more important than major vascular events. Incorporating these outcomes into trials may encourage patient participation and adherence to preventative regimens.

The Iraqi refugee population in Jordan has become a sustained humanitarian emergency, and Jordan must take new action to respond. The inability of Jordan to address the needs of Iraqi refugees causes not only the suffering of those refugees, but also that of the larger native populations, as needy Iraqis depend upon Jordan's already strained resources. In addition, non-governmental organizations cannot keep up with Iraqi refugee needs due to funding restrictions. Moreover, the UNHCR and other aid agencies may not be suited to performing the task of addressing the Iraqi refugee crisis as a majority of this response relates to humanitarian aid, not addressing the political roots of the problem. There are also fundamental statistical issues relating to Iraqi refugees in Jordan. Numerical discrepancies and political connections make it difficult to determine whether the currently purported number of 450,000 Iraqi refugees in Jordan is accurate. The clear benefits Jordan receives from aid might give rise to su...

Hypertension is a leading modifiable risk factor for premature cardiovascular disease. Research indicates a growing prevalence of hypertension among adults worldwide, with accompanying low levels of patient knowledge, and sub-optimal clinical management. This study aims to explore the impact of a structured hypertension educational intervention on patient knowledge, lifestyle behaviours and blood pressure control. An observational, prospective cohort design was selected. Participants were recruited through a public blood pressure screening event in a community-based setting. They were asked to complete a self-report questionnaire followed by an assessment of their blood pressure. Participants with high blood pressure were randomly assigned to either a control group or an intervention group. Those in the intervention group received an educational intervention on hypertension 4 weeks later. Both groups were recalled 4 months later for a repeat of the same initial assessment. Eighty-one participants with a mean age of 64 years were included in this study. There were no significant differences in the baseline measures between the two groups. Significant improvements were found in the intervention group compared with the control group in levels of hypertension knowledge and awareness (p =

BACKGROUND Impaired sleep quality is common and associated with an increased risk of cardiovascular disease (CVD), thought to be mediated through adverse effects on established vascular risk factors, particularly hypertension. We determined if a web-delivered sleep intervention (sleep-hygiene education, stimulus control, and cognitive behavioral therapy) reduces blood pressure compared to vascular risk factor education (standard care) alone. METHODS Phase II randomized, blinded, controlled trial of 134 participants without CVD with mild sleep impairment and blood pressure 130-160/< 110 mm Hg. The primary outcome was the difference in the mean change in 24-hour ambulatory systolic blood pressure (SBP) over 8 weeks between intervention and control groups. Secondary outcomes included measures of sleep quality and psychosocial health, namely Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS Participants in the sleep intervention group showed significantly greater improvements in sleep quality, including ISI [difference in mean improvement 2.8; 95% confidence interval (CI), 1.3-4.4], PSQI (1.1; 95% CI, 0.1-2.2), sleep condition indicator (0.8; 95% CI, 0.2-1.4), and psychosocial health, including BDI (2.0; 95% CI, 0.3-3.7) and BAI (1.4; 95% CI, 0.02-2.8). The mean improvement in 24-hour ambulatory SBP did not differ between the sleep intervention (0.9 mm Hg) and control (0.8 mm Hg) arms, (difference in mean improvement 0.1; 95% CI, -3.4 to 3.2). CONCLUSION A simple, low-cost, web-delivered sleep intervention is feasible and significantly improves sleep quality and measures of psychosocial health in individuals with mild sleep impairment but does not result in short-term improvements in blood pressure.

Objective. To evaluate a 12-week group-based lifestyle intervention programme for women with prediabetes following gestational diabetes (GDM).Design. A two-group, mixed methods randomized controlled trial in which 50 women with a history of GDM and abnormal glucose tolerance postpartum were randomly assigned to intervention (n=24) or wait control (n=26) and postintervention qualitative interviews with participants.Main Outcome Measures. Modifiable biochemical, anthropometric, behavioural, and psychosocial risk factors associated with the development of type 2 diabetes. The primary outcome variable was the change in fasting plasma glucose (FPG) from study entry to one-year follow-up.Results. At one-year follow-up, the intervention group showed significant improvements over the wait control group on stress, diet self-efficacy, and quality of life. There was no evidence of an effect of the intervention on measures of biochemistry or anthropometry; the effect on one health behaviour, diet adherence, was close to significance.Conclusions. Prevention programmes must tackle the barriers to participation faced by this population; home-based interventions should be investigated. Strategies for promoting long-term health self-management need to be developed and tested.

Background Gestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Lifestyle intervention can prevent progression to type 2 diabetes in high risk populations. We designed a randomised controlled trial (RCT) to evaluate the effectiveness of an established lifestyle intervention compared to standard care for delaying diabetes onset in European women with recent GDM. Recruitment into the RCT was more challenging than anticipated with only 89 of 410 (22%) women agreeing to participate. This paper identifies factors that could enhance participation of the target population in future interventions. Methods We hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined, and secondly that it would be possible to predict participation on the bases of those risk factors. To test our hypothesis, we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3-5?years following GDM, reducing the sample to 43 participants and 73 decliners. We considered established diabetes risk factors: smoking, daily fruit and vegetable intake, participation in exercise, family history of diabetes, glucose values and BMI scores on post-partum re-screens, use of insulin during pregnancy, and age at delivery. We also analysed narrative data from 156 decliners to further understand barriers to and facilitators of participation. Results Two factors differentiated participants and decliners: age at delivery (with women older than 34 years being more likely to participate) and insulin use during pregnancy (with women requiring the use of insulin in pregnancy less likely to participate). Binary logistic regression confirmed that insulin use negatively affected the odds of participation. The most significant barriers to participation included the accessibility, affordability and practicality of the intervention. Conclusions Women with recent GDM face multiple barriers to lifestyle change. Intervention designers should consider: (i) the practicalities of participation for this population, (ii) research designs that capitalise on motivational differences between participants, (iii) alleviating concerns about long-term diabetes management. We hope this work will support future researchers in developing interventions that are more relevant, effective and successful in recruiting the desired population. Trial registration Current Controlled Trials ISRCTN41202110 © 2014 Infanti et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

The aim of this observational, descriptive study is to evaluate the impact of an intensive, evidence-based preventive cardiology programme on medical and lifestyle risk factors in patients at high risk of developing cardiovascular disease (CVD).Increased CVD risk patients and their family members/partners were invited to attend a 16-week programme consisting of a professional multidisciplinary lifestyle intervention, with appropriate risk factor and therapeutic management in a community setting. Smoking, dietary habits, physical activity levels, waist circumference and body mass index, and medical risk factors were measured at initial assessment, at end of programme, and at 1-year follow up.Adherence to the programme was high, with 375 (87.2%) participants and 181 (84.6%) partners having completed the programme, with 1-year data being obtained from 235 (93.6%) patients and 107 (90.7%) partners. There were statistically significant improvements in both lifestyle (body mass index, waist circumference, physical activity, Mediterranean diet score, fish, fruit, and vegetable consumption, smoking cessation rates), psychosocial (anxiety and depression scales and quality of life indices), and medical risk factors (blood pressure, lipid and glycaemic targets) between baseline and end of programme, with these improvements being sustained at 1-year follow up.These findings demonstrate how a holistic model of CVD prevention can improve cardiovascular risk factors by achieving healthier lifestyles and optimal medical management.

Objective:Impaired sleep quality is common, and is associated with an increased risk of cardiovascular disease and death, thought to be mediated by adverse effects on established vascular risk factors, particularly hypertension. The aim of this study was to determine if a web-delivered sleep interve

Introduction Deaths due to cardiovascular disease (CVD) number 4 million annually in Europe with significantly higher mortality rates seen in Central and Eastern Europe. Large numbers of citizens from these regions migrated to Ireland in the last decade with those of Polish nationality now comprising the largest minority ethnic group in the country. The health status of these immigrants and the potential impact of migration on national CVD risk levels has not been studied. There is no guidance from the European Society of Cardiology (ESC) to date as to which SCORE chart to use in the case of an individual from a high risk country who has immigrated to a low risk nation. Methods Immigrant adults over 18 years and from any of the high risk countries of Europe (according to the SCORE risk estimation tool) were recruited via convenience sampling in Limerick city. Screening was offered in occupational and community settings; a non-fasting lipid profile, blood pressure (BP) measurements, subjective questioning regarding physical activity levels, alcohol consumption and smoking status. The SCORE risk tool and relative risk categorisation were used to calculate CVD risk. Results 81 participants (mean age 41 years) took part in this study. The majority were Polish (n = 72, 89%) and 54% (n = 44) were male. Subjects were divided into two groups for data analysis; those aged ≥40 years (n = 38, 46.9%, mean age 52 years) and younger subjects (n = 43, 53.1%, mean age 30 years). Very high levels of hypertension (55%) and hypercholesterolaemia (61%) were observed in those aged ≥40 years and 42% (n = 16) of the older subjects displayed a high or very high ten-year risk of death due to CVD. SCORE was strongly correlated with age (r = 0.70, p Conclusions This study demonstrates that CVD risks inherent in a high risk population are preserved following immigration into a low risk area. As no current guidance exists from the ESC, the authors feel this cohort of people should undergo targeted risk factor modification in line with recommendations for high risk individuals. We have highlighted a deficiency in the SCORE risk charts, and feel further work is required to accurately assess the disease burden in this unique patient group.

Background Universal screening using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria has identified a prevalence of gestational diabetes mellitus (GDM) of 12.4% in women living in Ireland. Women with prior GDM are at increased risk of developing type 2 diabetes later in life. A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes, and medical management. No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM. Through a two-group, parallel randomised controlled trial (RCT), this study aims to assess the clinical impact, cost-effectiveness and psychological experience of the Croí MyAction intensive lifestyle modification programme for women with prior GDM. Methods/Design A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction (impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)), are randomly assigned to a control arm (n = 27) or to the Croí MyAction intervention group (n = 27). The control arm receives usual health care advice - written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required. The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croí MyAction. Croí MyAction involves 2.5 hour sessions once per week (for 12 weeks) comprising a group exercise programme, group health promotion or education seminars, and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions. Randomisation and allocation to the intervention arms is carried out by an independent researcher, ensuring that the allocation sequence is concealed from study researchers until the interventions are assigned. The primary analysis is based on glucose dysfunction, comparing a mean reduction in fasting plasma glucose (FPG) levels on a 75 gram oral glucose tolerance test (OGTT) in the two groups at a one-year, post-intervention follow-up. The trial is funded by the Irish Health Research Board (HRB). Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee, Galway University Hospitals, Health Service Executive of Ireland (Ref: C.A.691). Trial registration Current Controlled Trials ISRCTN41202110. © 2013 Infanti et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.