Family Medicine Update

Effects of hypertension and hypercholesterolemia on cognitive functioning in patients with alzheimer disease.

Alzheimer Dis Assoc Disord. 2008 Oct-Dec;22(4):336-42

Authors: Goldstein FC, Ashley AV, Endeshaw YW, Hanfelt J, Lah JJ, Levey AI

This study investigated the relationship between the vascular comorbidities (VCs) of hypertension and hypercholesterolemia and the cognitive phenotype of Alzheimer disease (AD). Seventy-four AD patients underwent objective measurement of blood pressure and serum cholesterol levels, and they received a detailed neuropsychologic evaluation examining attention, memory, language, visuomotor/visuospatial skills, and executive functioning. Multiple regression analyses controlling for demographic variables, overall cognitive status, and the presence of diabetes/cardiac disease indicated that an increase in the number of VCs, but not their severity, was associated with poorer verbal and visual recall, visuoconstructive and spatial analysis, verbal reasoning, and set shifting. The findings demonstrate that VCs are associated with specific aspects of cognitive functioning in AD patients. The mechanisms likely involve the effects of VCs on cerebrovascular disease including white matter disruption. The results highlight the importance of controlling these risk factors in patients who carry the diagnosis of AD.

19068499

More: continued here

UK research staff perspectives on improving recruitment and retention to primary care research; nominal group exercise.

Fam Pract. 2008 Nov 14;

Authors: Graffy J, Grant J, Boase S, Ward E, Wallace P, Miller J, Kinmonth AL

BACKGROUND: Primary care studies often encounter recruitment difficulties, but there is little evidence to inform solutions. As part of a National Institute for Health Research School for Primary Care Research and UK Clinical Research Network programme, we elicited research staff perspectives on factors facilitating or obstructing recruitment. OBJECTIVE: To identify factors that experienced research staff consider important in successful recruitment and retention and their confidence in achieving them. METHODS: An iterative series of three workshops was held. The third used a modified nominal group technique to categorize whether factors related to the ‘context’ in which the research took place, the ‘content’ of the study or the recruitment ‘process’ and to prioritize them by their importance to success. RESULTS: Eighteen research staff participated in the prioritization workshop. They prioritized positive attitudes of primary care staff towards research and trust of researchers by potential participants as major contextual factors affecting recruitment. Studies needed to be considered safe and relevant by staff and fit with practice systems. They proposed that researchers strengthen relationships with staff and participants and minimize workload for primary care teams. Although confident in many recruitment processes, respondents remained uncertain how to achieve cultural change so that research became part of normal practice activity and how best to motivate patients to participate. CONCLUSIONS: Research workers taking part identified factors which might be important in recruitment, several of which they expressed little confidence in addressing. Understanding how to improve recruitment is crucial if current efforts to strengthen primary care research are to bear fruit.

19011173

More: continued here

The development of a minimal intervention strategy to address overweight and obesity in adult primary care patients in The Netherlands.

Fam Pract. 2008 Oct 31;

Authors: Fransen G, Hiddink G, Koelen M, van Dis S, Drenthen A, van Binsbergen J, van Woerkum C

BACKGROUND: Currently, overweight and obesity do not receive the attention they deserve from the Dutch GPs, mostly because of a lack of an effective intervention strategy to tackle this difficult health problem. OBJECTIVE: To develop a minimal intervention strategy (MIS) addressing overweight and obesity among adult primary care patients, resulting in a prototype. METHODS: Following the intervention mapping protocol, the MIS is based on literature study, existing interventions, psychosocial theories, stakeholder interviews and a questionnaire study among stakeholders. This led to the development of a prototype of the MIS materials: a screening flow chart and a treatment flow chart, a manual and patient education materials. A pre-test among 42 general practitioners and practice nurses was conducted to investigate the usefulness of the MIS materials at first sight. RESULTS: The stakeholder interviews and the questionnaire study resulted in insight on what the MIS should look like. For instance, the stakeholders indicated that the treatment needs to focus on helping patients to eat more healthy and exercise more, using techniques like motivational interviewing. The pre-test showed that most participants were enthusiastic about the materials, although they made some suggestions on improvements. CONCLUSION: The MIS materials seem to be useful and promising. A future pilot test is needed to investigate its usefulness in daily practice and to further improve the materials in preparation for a process and effect evaluation.

18978011

More: continued here