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Obesity, hypertension, and diabetes are independently associated with cardiac remodeling and frequently co-cluster. The conjoint and separate influences of these conditions on cardiac remodeling have not been investigated. We evaluated 5,741 Framingham Study participants (mean age 50 years, 55% women) who underwent echocardiographic measurements of left ventricular (LV) mass (LVM), LV ejection fraction (LVEF), global longitudinal strain (GLS), mitral E/e', left atrial end-systolic (peak) dimension (LASD) and emptying fraction (LAEF). We used multivariable generalized linear models to estimate the adjusted-least square means of these measures according to cross-classified categories of body mass index (BMI; normal, overweight and obese), hypertension (yes/no), and diabetes (yes/no). We observed statistically significant interactions of BMI category, hypertension, and diabetes with LVM, LVEF, GLS, and LAEF (p for all 3-way interactions <0.01). Overweight and obesity (compared to normal BMI), hypertension, and diabetes status were individually and conjointly associated with higher LVM and worse GLS (p<0.01 for all). We observed an increase of 34% for LVM and of 9% for GLS between individuals with a normal BMI and without hypertension or diabetes compared to obese individuals with hypertension and diabetes. Presence of hypertension was associated with higher LVEF, whereas people with diabetes had lower LVEF. Obesity, hypertension, and diabetes interact synergistically to influence cardiac remodeling. These findings may explain the markedly heightened risk of heart failure and cardiovascular disease when these factors co-cluster.

Background Stigma significantly impacts individuals with Parkinson’s disease (PD) and their caregivers, exacerbating social isolation, psychological distress, and reducing quality of life (QoL). Although considerable research has been conducted on PD’s clinical aspects, the social and emotional challenges, like stigma, remain underexplored. Addressing stigma is crucial for enhancing well-being, fostering inclusivity and improving access to care and support. The review aims to fill this knowledge gap by synthesising existing literature on PD stigma, examining its effects on individuals and families affected, and identifying areas where interventions could reduce stigma’s impact. Methods This systematic review was conducted following Joanna Briggs Institute guidance. Studies were identified through searches in six databases, relevant websites, and reference lists. Covidence was used for duplicate removal, screening, and data extraction. Thematic analysis identified key themes from qualitative data, while narrative synthesis integrated findings from qualitative and quantitative studies. The review protocol was registered on PROSPERO (CRD42023399343). Results This review included 22 studies published between 2002 and 2024, using both qualitative and quantitative methodologies. Five key themes emerged. The first highlighted stereotypes in PD, such as misconceptions about symptoms, age stereotyping, and supernatural beliefs. The second explored drivers and facilitators of stigma, identifying factors like duration since diagnosis, disease severity, lack of public education, and media representation. The third theme revealed stigma’s impact on mental health and well-being, exacerbating feelings of shame, embarrassment, and social isolation. The fourth, responses and consequences of stigma, detailed strategies employed by individuals with PD to manage stigma, including seeking social support and adopting coping mechanisms. The fifth theme, beyond stigma, explored positive aspects of living with PD, highlighting resilience, positive interactions, and advocacy efforts. Conclusion This systematic review underscores the significant impact of stigma on individuals with PD and their caregivers, manifesting as social isolation, diminished QoL, and psychological distress. Key drivers include public misconceptions, cultural biases, and limited awareness and addressing these challenges requires targeted interventions. Recommendations include education to dispel myths, public awareness campaigns and advocacy efforts to reduce stigma, enhance support, and improve QoL.

Orthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular disease risk. The relations of OH and OHT with heart failure (HF) risk in the community are unclear and there remains a paucity of data on the relations with HF subtypes [HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)]. Relate OH and OHT with HF risk and its subtypes. Prospective observational cohort. Community-based individuals in the Framingham Heart Study Original Cohort. 1,914 participants (mean age 72 years; 1159 women) attending examination cycle 17 (1981-1984) followed until December 31, 2017 for incident HF or death. OH or OHT, defined as a decrease or increase, respectively, of ≥20/10 mmHg in systolic/diastolic BP upon standing from supine position. At baseline, 1,241 participants had a normal BP response (749 women), 274 had OH (181 women), and 399 had OHT (229 women). Using Cox proportional hazards regression models, we related OH and OHT to risk of HF, HFrEF, and HFpEF compared to the absence of OH and OHT (reference), adjusting for age, sex, body mass index, systolic and diastolic BP, hypertension treatment, smoking, diabetes, and total cholesterol/high-density lipoprotein. On follow-up (median 13 years) we observed 492 HF events (292 in women; 134 HFrEF, 116 HFpEF, 242 HF indeterminate EF). Compared to the referent, participants with OH [n = 84/274 (31%) HF events] had a higher HF risk (Hazards Ratio [HR] 1.47, 95% CI 1.13-1.91). Moreover, OH was associated with a higher HFrEF risk (HR 2.21, 95% CI 1.34-3.67). OHT was not associated with HF risk. Orthostatic BP response may serve as an early marker of HF risk. Findings suggest shared pathophysiology of BP regulation and HF, including HFrEF.

A major determinant of blood pressure waveform (BPW) morphology is vascular impedance, governed by material properties of the arterial wall and hemodynamics of blood flow. Analysis of BPW morphology can be an effective means of assessing cardiovascular health. A transmission line model of the mechanical impedance of the arterial tree was implemented to recreate physiologically realistic BPWs. We then examined the sensitivity of existing vascular measures, including augmentation index (AI), pulse wave velocity (PWV), and the recently proposed harmonic distortion (HD), to structural and mechanical parameters of vessel walls and blood flow. All three measures are primarily sensitive to structural stiffness while HD and AI also correlate strongly with geometric parameters. Further, in a simulated set of randomly constructed arterial trees using model parameters within a physiological range, the indexes are strongly correlated with stiffness. When controlling for all confounding factors, HD demonstrates a stronger correlation with arterial stiffness than AI for stiffness values higher than the average. Our study provides a mechanistic understanding of the determinants of AI and HD, with the latter being a promising measure of cardiovascular risk due to its ease of calculation and access, meeting key limitations set by AI and PWV.

Background Parkinson’s disease (PD) is a progressive neurological disorder characterised by motor and non-motor symptoms that significantly impact quality of life (QoL). Despite its growing prevalence, public awareness and understanding of PD remain limited, contributing to stigma and social isolation. This study evaluates public knowledge and perceptions of PD across Ireland to identify educational gaps and inform public health initiatives. Methods A cross-sectional survey was conducted from January to April 2024, using a modified version of existing questionnaires on PD knowledge. The survey was distributed online via social media platforms and charity networks, targeting adults residing in Ireland. Descriptive statistics and chi-square tests were employed to analyse the data. Ethical approval for this study was obtained from the Faculty of Medicine and Health Sciences, Queen’s University Belfast (MHLS23_132). Results A total of 796 respondents completed the survey, predominantly female (83.4%) and aged 18–24 (31.7%). While 92.9% recognised PD as a neurological disorder, misconceptions about its classification persisted. Awareness of motor symptoms like tremor and bradykinesia was high, but non-motor symptoms such as chronic fatigue were less recognised. Only 42% were aware of available treatments, and 33.7% had encountered PD-related stigma. Social media emerged as the preferred platform for raising awareness, cited by 46.2% of participants. Conclusion The findings reveal critical knowledge gaps and stigma regarding PD, emphasising the need for targeted educational initiatives. Public health campaigns, particularly leveraging social media, are essential to enhance understanding, reduce misconceptions, and improve QoL for individuals with PD. By addressing awareness and encouraging a supportive environment, these initiatives can contribute to better public perception and management of PD.

The global impact of dementia is a key healthcare priority, and although it is possible to live well with dementia, public perception is often negative. Serious digital games are becoming a credible delivery method to educate/train individuals in the business and health sectors and to challenge perceptions. The main objective of the study was to evaluate the effectiveness of a digital game prototype on individual attitudes towards dementia. A digital game to improve public knowledge and understanding about dementia ( www.dementiagame.com ) was co-designed with people living with dementia and student nurses. The Game was evaluated using a pretest-posttest design. Participants for the evaluation were recruited via social media in one UK university and completed the Approaches to Dementia Questionnaire (ADQ) before and after playing the game. Overall, 457 individuals completed both pre and post test questionnaires. The total ADQ score demonstrated a significant improvement in positive attitudes (p < 0.001), and both subscales of Hope and Recognition of Personhood also saw significant improvements (p < 0.001). The use of a serious digital game has demonstrated a significant effect on the respondents’ perceptions of dementia. Overall, there was a more positive view of the abilities of people with dementia and what their capabilities were. They were also more likely to be recognised as unique individuals with the same values as any other person. The benefit of using digital gaming to improve perceptions of dementia has been demonstrated, nonetheless further research is required to reach a more diverse population and test as a Randomised Control Trial to provide definitive evidence for use in policy and practice.

Influenza is a serious global healthcare issue that is associated with between 290,000 to 650,000 deaths annually. The aim of this study is to evaluate the effect of a 'serious game' about influenza, on nursing student attitude, knowledge and uptake of the influenza vaccination. 1306 undergraduate nursing students were invited, via email, to play an online game about influenza between September 2018 and March 2019. 430 nursing students accessed the game and completed an 8-item questionnaire measuring their attitudes to influenza between September 2018 and March 2019. In April 2019, 356 nursing students from this sample completed a follow-up 2-item questionnaire about their uptake of the influenza vaccination. A larger separate 40-item knowledge questionnaire was completed by a year one cohort of 124 nursing students in August 2018 prior to receiving access to the game and then after access to the game had ended, in April 2019. This sample was selected to determine the extent to which the game improved knowledge about influenza amongst a homogenous group. In the year preceding this study, 36.7% of the sample received an influenza vaccination. This increased to 47.8% after accessing to the game. Nursing students reported perceived improvements in their knowledge, intention to get the vaccination and intention to recommend the vaccination to their patients after playing the game. Nursing students who completed the 40-item pre- and post-knowledge questionnaire scored an average of 68.6% before receiving access to the game and 85.2% after. Using Paired T-Tests statistical analysis, it was determined that this 16.6% increase was highly statistically significant (P < 0.001). The research highlights that the influenza game can improve knowledge and intention to become vaccinated. This study suggests that improvement in influenza knowledge is likely to encourage more nursing students to receive the influenza vaccination.