Effectiveness of provision of animal-source foods for supporting optimal growth and development in children 6 to 59 months of age (Review)

Objective: The objective of this review was to examine the best available evidence on the risk factors for hypertensive crisis in adult patients with hypertension. Introduction: Hypertensive crisis is an acute severe elevation in blood pressure, which can present as hypertensive urgency or emergency. In contrast to hypertensive urgency, which is a markedly elevated blood pressure without acute target organ damage, hypertensive emergency is associated with equally high blood pressure in the presence of potentially life-threatening target organ damage, such as myocardial infarction, stroke, pulmonary edema, or acute kidney injury. Hypertensive crisis results in adverse clinical outcomes and high utilization of health care. Inclusion criteria: This review considered studies of non-modifiable factors (age, sex, ethnicity) and modifiable factors such as socioeconomic factors (lack of medical insurance, lack of access to medical care), adherence to medical therapies, presence of comorbidities (diabetes, hyperlipidemia, coronary artery disease, history of stroke, chronic kidney disease, congestive heart failure), and substance abuse in persons of either sex, older than 18 years with a diagnosis of hypertension. Methods: A search of four databases, seven gray literature sites, and relevant organizational websites revealed 11,387 titles. After duplicates were removed, 9183 studies were screened by the title and abstract for eligibility. Forty full-text articles were retrieved, and each was assessed for eligibility. Twenty-one articles were excluded. The remaining 19 full-text studies were critically appraised and included in this review. Results: The risk of hypertensive crisis was higher in patients with a history of comorbid cardiovascular conditions, such as chronic kidney disease (odds ratio [OR] 2.899, 95% confidence interval [CI] 1.32, 6.364), coronary artery disease (OR 1.654, 95% CI 1.232, 2.222), or stroke (OR 1.769, 95% CI 1.218, 2.571). Patients with hypertensive emergency had higher mean systolic blood pressure (mean difference [MD] 2.413, 95% CI 0.477, 4.350) and diastolic blood pressure (MD 2.043, 95% CI 0.624, 3.461). Hypertensive emergency was more common in men (OR 1.390, 95% CI 1.207,1.601), older patients (MD 5.282, 95% CI 3.229, 7.335), and those with diabetes (OR 1.723, 95% CI 1.485, 2.000) and hyperlipidemia (OR 2.028, 95% CI 1.642, 2.505). Non-adherence to antihypertensive medications (OR 0.939, 95% CI 0.647,1.363) and hypertensive diagnosis unawareness (OR 0.807, 95% CI 0.564, 1.154) did not increase the risk of hypertensive emergency. Conclusions: Comorbid cardiac, renal, and cerebral comorbidities (coronary artery disease, congestive heart failure, cerebrovascular disease, and chronic kidney disease) increase the risk of hypertensive crisis. The risk of hypertensive crisis is higher in patients with unhealthy alcohol and recreational drug use. Systolic and diastolic blood pressure are marginally higher in patients with hypertensive emergency compared to patients with hypertensive urgency. Since these differences are small and not clinically significant, clinicians should rely on other symptoms and signs to differentiate between hypertensive urgency and hypertensive emergency. The risk of hypertensive emergency is higher in older adults. The coexistence of diabetes, hyperlipidemia, and chronic kidney disease increases the risk of hypertensive emergency. Systematic review registration number: PROSPERO (CRD42019140093)

These findings will be useful in efforts to achieve earlier recognition and better management or prevention of pediatric delirium. This may also help to prevent unnecessary laboratory testing and imaging studies, which can cause children and parents unnecessary pain and anxiety and increase hospital costs.

Aging persons with serious mental illness present unique challenges for community mental health services. This population is increasing in numbers in mental health treatment settings. The combination of serious mental illness with the vicissitudes of aging suggest that a broader conceptualization of this population may improve services. SAMHSA's 8 Dimension of Wellness offers a comprehensive strengths-based framework for interventions to maximize older persons' abilities and address the complex bidirectional effects of physical, emotional, social, spiritual, occupational, financial, intellectual, and environmental challenges to wellness. This systemic literature review identifies unidimensional and multidimensional wellness interventions for older adults with mental illness. Method: We conducted a systematic literature review to identify wellness interventions provided to persons with serious mental illness with a mean age of 45 or higher. Results: Twenty-six articles representing 14 distinct wellness interventions were identified. None of the articles used SAMHSA's 8 Dimensions of Wellness framework. The physical wellness (n ϭ 21) and social (n ϭ 15) dimensions were the most frequently described in the literature. There was no mention of either the intellectual or spiritual dimensions. The quality of the research of these interventions varied; 14 papers described a randomized controlled trial. Conclusions: The SAMHSA wellness framework has not been used to design interventions for older persons with serious mental illness. Interventions for aging persons should support comprehensive wellness, including the intellectual and spiritual domains. Impact and ImplicationsThis work has suggested the need for the development of a unified research agenda to systematically build knowledge of needs, preferences, and effective interventions to improve the state of the science, practices and ultimately outcomes used in helping older persons with serious mental illness continue to achieve recovery and community integration.

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