Context Cardiovascular disease is the most prevalent chronic medical condition in Canada. A strategy of managing cardiovascular disease risk based on routinely performing personalized risk estimates and progressively targeting interventions toward risk factors can reduce morbidity and mortality. One barrier to the widespread adoption of such a risk stratification approach in clinical practice is the lack of an easy-to-use tool that provides risk-based recommendations and encourages shared decision making. Objective To develop a patient-centred, clinical decision support tool for the primary prevention of cardiovascular disease that encourages evidence-based decision making. Design Systematic review. Methods The clinical practice guideline database of the Canadian Medical Association was reviewed for guidelines focused on the primary prevention of cardiovascular disease in adult populations. Review of the guidelines led to a search of PubMed for multivariable risk algorithms (key words: Framingham heart study) and a search of the Cochrane database for meta-analyses of recommended interventions (key words: cardiovascular disease and prevention); if meta-analyses were unavailable, PubMed was searched for randomized controlled trials. Results We created a Web-based application (www.cardiovascularcalculator.radarhill.net) that provides personalized multivariable risk estimates of developing coronary artery disease and stroke over the next 10 years based on age, sex, smoking status, family history of early coronary artery disease, systolic blood pressure, use of antihypertensive medication, and lipid profile. The application also presents personalized, risk-based recommendations for lifestyle modification and pharmaceutical intervention from 5 Canadian guidelines for the prevention of cardiovascular disease, in addition to modified risk estimates for developing cardiovascular disease over the next 10 years for selected interventions (smoking cessation, treatment of blood pressure with various agents and to various targets, treatment with cholesterol-lowering agents, and treatment with antiplatelet medication) and risk estimates of developing treatment-related adverse events. Outcomes are presented both graphically and numerically, as absolute risks with accompanying numbers-needed-to-treat estimates and optional confidence intervals. Conclusion We have developed an interactive, Web-based clinical decision support tool that can conveniently assess coronary heart disease and stroke risk and provide personalized, guideline-based recommendations with evidence-based risk reduction estimates for various lifestyle and pharmaceutical interventions. Research | FMF Research Proceedings 2014
Spontaneous fermentation has been identified to improve the quality characteristics of foods derived from them. When combined with cowpea fortification and nixtamalization, it is expected to improve the nutritional, functional, physico-chemical and sensory qualities of maize based foods thereby improving the qualities as well as broadening the food processing techniques in sub-Saharan Africa. This study was therefore aimed at investigating the influence of spontaneous fermentation on the functional, physico-chemical and sensory characteristics of maize-based cowpeafortified nixtamalized foods. A 3x3x2 factorial experiment with fermentation time (0, 24, 48 h), cowpea (0, 10 and 20%) and alkaline treatment (nixtamalized and nonnixtamalized maize) was used. Samples were analyzed for pH, titratable acidity and water absorption capacity (27°C and 70°C). The blends were dried using the cabinet drier, milled into flour and processed into a snack food. The cylinder probe test was used in a TA-TX2 Texture Analyzer to measure the hardness of processed snack foods and sensory analysis was conducted to determine the acceptability of the snack products. The pH of all the nixtamalized samples decreased with fermentation time and cowpea fortification with concomitant increase in titratable acidity. Cowpea addition caused decreases in the pH from 9.68 to 6.12 in the unfermented nixtamalized samples. Contrary to this trend, general increases in titratable acidity were observed with fermentation and cowpea addition of the products. The water absorption capacities at both 27°C and 70°C of all the nixtamalized blends generally decreased with fermentation time and cowpea fortification. The texture (hardness) of the formulated products were acceptable. Sensory evaluation indicated that the techniques of nixtamalization, fermentation and cowpea fortification used for the processing of the products did not influence their acceptability by the panel. Nixtamalized maize can therefore be subjected to spontaneous fermentation with cowpea fortification to enhance the functional, physico-chemical and sensory properties of products derived from them, thereby serving as alternative food technologies to maize processing in sub-Saharan Africa. Keywords : Maize, fermentation, cowpea-fortification, nixtamalization, functional properties.
