Interventions to improve adherence to multiple CV medication in a CHD population significantly improved the odds of being adherent. Simple one-component interventions might be a promising way to improve medication adherence in a CHD population, as they would be easier to replicate in different settings and on a large scale.

People with chronic kidney disease (CKD) need usable information on how to live well and slow disease progression. This information is complex, difficult to communicate, and changes during the course of the disease. We examined lifestyle-related printed CKD patient education materials focusing on actionability and visual aids. From a previous systematic review assessing readability of CKD patient information, we identified materials targeting nutrition, exercise, and self-management. We applied the Suitability Assessment of Materials (SAM) and Patient Education Materials Assessment Tool (PEMAT) to evaluate how easy materials were to understand (understandability) and act on (actionability). We created the 5C image checklist and systematically examined all visual aids for clarity, contribution, contradiction, and caption. Of the 26 materials included, one fifth (n = 5, 19%) were rated "not suitable" on SAM and fewer than half (n = 11, 42%) were rated "superior." PEMAT mean subdomain scores were suboptimal for actionability (52) and visuals (37). Overall, more than half of all 223 graphics (n = 127, 57%) contributed no meaning to the text. Images in three documents (12%) directly contradicted messaging in the text. CKD lifestyle information materials require focused improvements in both actionability of advice given and use of visual aids to support people with CKD to self-manage their condition. The fifth C is culture and is best evaluated by user-testing.

Interventions for improving health literacy in people with chronic kidney disease.

Background:The timed up and go test (TUGT) is a functional test to assess mobility and balance, by moving from sit-to-stand, turn and walk three metres. It has been proposed as a useful outcome measure and falls identification in patients with heart failure. However test-retest reliability in this population has not previously been determined.Design: Prospective cross-sectional study. The aims of this study were to determine: test-retest reliability of the TUGT; relationships between the TUGT and other variables; and predictors of the TUGT.Methods: This represented a sub-study of participants enrolled in a multicentre randomised controlled trial of exercise training in recently hospitalised patients with heart failure (EJECTION-HF). Assessments occurred at baseline. The TUGT was conducted twice to determine reliability. Other variables include the six minute walk distance (6MWD), quality of life (AQOL) and falls history in the past 12 months. Test-retest reliability was examined using intra-class correlation coefficient; relationships through correlations; and differences between fallers and non-fallers through non-parametric. Predictors were identified through multiple linear regressions.Results: Analysis was undertaken on 278 participants (mean age 62 years and 75% male). The TUGT had excellent within-day test-retest reliability (with an intra-class correlation coefficient of 0.93). Shorter TUGT time was associated with higher AQOL (r s =-0.31, p<0.001) and longer 6MWD (r=-0.81, p<0.001). The TUGT time was also longer for fallers (p<0.001). Independent predictors were the 6MWD and age, which accounted for 66% of the variance.Conclusions: The TUGT appears to be a reliable outcome measurement in patients with heart failure and can be used in heart failure exercise programs.http://dx.Background: Evidence indicates that myocardial infarction (MI) can be precipitated by physical exertion although this has not been well defined in an Australian population.Aim: To evaluate the role of aerobic and isometric physical exertion as a trigger of acute coronary occlusion.Methods: 311 patients admitted to Royal North Shore Hospital with confirmed coronary occlusion by angiography completed a questionnaire within 4 days of admission, addressing physical exertion in the 48hrs before symptom onset and their usual annual frequency. Case-crossover study methodology was used to determine relative risk (RR) compared with usual frequency, focussing on the 1 hour hazard period prior to symptom onset, in those who reported either aerobic or isometric physical exertion.Results: The average age was 58 years (SD 12.5) and 85% were men. Eleven participants reported aerobic exertion level 5 on the Metabolic Equivalent of Task (MET) scale (range 1-8), associated with a RR of symptom onset of 5.5 (95% CI 3.0 to 10.0) and 4 reported isometric exertion with RR 6.5 (95% CI 2.5 to 16.8). Twenty-nine participants reported aerobic exertion ≥6 MET, associated with a RR of 17.6 (95% CI 11.3 to 27.4) and 8 reported isometric exertion with RR 23.6 (6.1...

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