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Wrist-cuff oscillometric blood pressure monitors are very popular in the portable medical device market. However, its accuracy has always been controversial. In addition to the oscillatory pressure pulse wave, the finger photoplethysmography (PPG) can provide information on blood pressure changes. A blood pressure measurement system integrating the information of pressure pulse wave and the finger PPG may improve measurement accuracy. Additionally, a neural network can synthesize the information of different types of signals and approximate the complex nonlinear relationship between inputs and outputs. The purpose of this study is to verify the hypothesis that a wrist-cuff device using a neural network for blood pressure estimation from both the oscillatory pressure pulse wave and PPG signal may improve the accuracy.

A PPG sensor was integrated into a wrist blood pressure monitor, so the finger PPG and the oscillatory pressure wave could be detected at the same time during the measurement. After the peak detection, curves were fitted to the data of pressure pulse amplitude and PPG pulse amplitude versus time. A genetic algorithm-back propagation neural network was constructed. Parameters of the curves were inputted into the neural network, the outputs of which were the measurement values of blood pressure. Blood pressure measurements of 145 subjects were obtained using a mercury sphygmomanometer, the developed device with the neural network algorithm and an Omron HEM-6111 blood pressure monitor for comparison.

For the systolic blood pressure (SBP), the difference between the proposed device and the mercury sphygmomanometer is 0.0062 ± 2.55 mmHg (mean ± SD) and the difference between the Omron device and the mercury sphygmomanometer is 1.13 ± 9.48 mmHg. The difference in diastolic blood pressure between the mercury sphygmomanometer and the proposed device was 0.28 ± 2.99 mmHg. The difference in diastolic blood pressure between the mercury sphygmomanometer and Omron HEM-6111 was −3.37 ± 7.53 mmHg.

Although the difference in the SBP error between the proposed device and Omron HEM-6111 was not remarkable, there was a significant difference between the proposed device and Omron HEM-6111 in the diastolic blood pressure error. The developed device showed an improved performance. This study was an attempt to enhance the accuracy of wrist-cuff oscillometric blood pressure monitors by using the finger PPG and the neural network. The hardware framework constructed in this study can improve the conventional wrist oscillometric sphygmomanometer and may be used for continuous measurement of blood pressure.

This study aims to establish a Japanese-style healthcare program customized for Japan and Asia under ISO 9001: 2008 (ISO: International Organization for Standardization) to improve problem areas and to inspect the effectiveness of the program. Furthermore, the authors wanted to create this health program using the ISO widely available in Asian countries and make an international contribution.

The authors implemented a 6- to 10-month health program in Minowa Town, Matsumoto City and Nagano City in Japan. This study assessed findings from pedometric, anthropometric and blood pressure measurements and physical fitness, blood chemistry and brain function tests.

The comparisons were made by examining the interaction effects between groups of participants. Groups from three regions in Japan showed significant differences on the physical fitness tests; regarding the 10-meter obstacle walk, the results of the Minowa participants showed the greatest improvement and the Matsumoto participants showed the second greatest improvement. In the six-min walk, the time of the Minowa participants significantly improved.

This health education program, which has been conducted by the Japanese authors since 1998, measures anthropometry, brain function and physical fitness and performs blood tests before and after the program and it measures energy consumption with a pedometer during the program. With the aim of improving exercise via encouragement from friends and a sense of community with fellow participants, participants learn together with hands-on training in tai chi and aerobics about the importance of ongoing exercise and proper nutrition. This health education met the Health Education ISO in 2014.

Since 2010, Nagano Prefecture, including Minowa Town, Matsumoto City and Nagano City, where our study was carried out, has been the area with the highest life expectancy rates in Japan.

The authors want to make this health promotion through ISO widely available in Asian countries and an international contribution.

This study aimed to appropriately establish a Japanese-style healthcare program under the ISO 9001:2008 to improve problem areas and inspect its effectiveness.

Describes a methodological study to evaluate the quality of care for an elderly population in the treatment of hypertension from a fairly simple analysis of medical records in primary care, with or without the use of additional information from patients, and shows how this type of data can be used to point out shortcomings in primary care. The data derive from a community survey of elderly people in one area of Jerusalem and relied on personal interviews, blood pressure measurements and an analysis of medical records over a period of four years. The measures used are: the percentage of persons without blood pressure (BP) measurement in a given year; the maximum “gap” between consecutive BP measurements in a given year; the rate of BP measurement per clinic visit; the percentage of hypertensives treated; and the percentage of hypertensives under control. The prevalence rates for hypertension in this elderly population vary between 40 per cent and 59 per cent according to the definition used. Using a simple and straightforward analysis of sick‐fund records several shortcomings in the surveillance and control of hypertension were detected. Calculation of the percentage of untreated hypertensives required a separate information source ‐ the screening. A BP survey is an important complement to an analysis of records. An ongoing evaluation of the quality of care of hypertensives in an elderly population should be based on screening, interviews with patients and analysis of the physician′s records. These provide an overall picture of the care in each medical practice enabling the physician to improve the quality of care provided to his or her patients.

The purpose of the present study is to evaluate chocolate consumption effects with a non invasive metodology. There is evidence that the consumption of dark chocolate and cocoa with high flavonoid content could have positive effects on blood pressure (BP) and weight management (WM); however, there are complications at the moment of obtaining blood samples to evaluate on children at a primary school level.

A total of 54 healthy scholars were included; consumption of 70 per cent cacao dark chocolate was integrated into the daily snack during a 30-day period. Blood pressure, body fat, total content of polyphenols in urine and total antioxidant capacity of saliva were measured. The results obtained were divided in relation of two groups of students, A and B, with lesser or higher difficulties to WM in a self-assessment test; variables were then statistically evaluated.

Consumption of chocolate produced changes in the total content of polyphenols (from 5.6 to 6.8 µg/mL, p < 0.016) and salivary antioxidant capacity [(14.76 ± 5.4 and 16.14 ± 3.9) TEU nmol versus. t = 0; p < 0.029 and p < 0.001 at 15 and 30 days, respectively]. Group B, which presented higher difficulties concerning WM, presented a body fat reduction of about 0.63 per cent after chocolate consumption (p = 0.045) and a diastolic blood pressure reduction of −2.8 mm Hg in average (p < 0.025). A significant weight gain (p < 0.023) was observed only in Group A.

Despite the reduced sensitivity of the non-invasive methodology, differences in urine and salivary content of polyphenols and antioxidant capacity suggest that the design used could be feasible, although extended studies are needed to corroborate it.

A non-invasive study for screening the potential health benefits of dark chocolate was assayed. The results suggest that dark chocolate consumption in children as part of the daily snack could be a complementary element in weight management and in prevention of future risk factors to chronic diseases.

Studies problems related to modelling, control and monitoring of circulatory systems with an artificial heart. First, presents a pulsatile model of cardiovascular systems. This model has a well‐grounded physiological basis and includes several reflex control systems, such as baroreceptor feedback loops, and nonlinearities of vessel compliance, which are inherent in the body. In addition, develops a model of an artificial heart. Based on these models, proposes a pulse frequency modulated (PFM) control scheme for the circulatory systems with an artificial heart. This scheme enables us to regulate the blood pressure and volume of the circulatory systems properly. To monitor the behaviour of the circulatory systems with an artificial heart an observation scheme is finally presented, with which the blood pressure and stroke volumes of the circulatory system can be estimated by using only the measurements of the driving pressure of the artificial heart.

Some studies on anthocyanins have revealed their antioxidant activity and beneficial effects for diabetes control and reducing the risk of coronary heart diseases. It has been found that sour cherries contain high levels of anthocyanins that possess insulin‐releasing stimulatory properties on pancreatic β‐cells in vitro. The purpose of this paper is to investigate whether concentrated sour cherry juice (CSCJ) beneficially alters serum glucose and some cardiovascular risk factors in diabetes type 2 subjects.

In this quasi‐experimental study, 19 diabetic women with FBS ≥ 110 mg/dl were recruited from patients referred to the Diabetes Clinic of Shariati Hospital. Subjects were asked to consume 40 g of CSCJ daily for 6 weeks. Before the onset of the study (week 0) and after 6 weeks, weight and blood pressure measurements were done and fasting blood samples were drawn. FBS, hemoglobin A1c (HbA1c) and blood lipid profiles were measured. In addition, a 24‐hour food record was taken from all of the individuals in both stages. The Wilcoxon signed test was used for statistical analysis.

After six weeks' consumption of CSCJ, significant reductions in body weight (p < 0.01), blood pressure and HbA1c (p < 0.05) was seen. Total cholesterol and LDL‐C decreased significantly in a sub‐group of patients (n = 12) with LDL‐C ≥ 100 mg/dl as well.

Based on the results of this study, consuming 40 g/day of CSCJ decreases body weight, blood pressure and HbA1c in diabetes type 2 women after 6 weeks and improves blood lipids in diabetic patients with hyperlipidemia.

This study aims to examine the effects of a self-management program (SMP) on self-care behavior, blood pressure and quality of life among older adults with uncontrolled hypertension.

A quasi-experimental design with repeated measures was conducted in two primary care units in Krabi, Thailand. One hundred and fifty-six older adults with uncontrolled hypertension were selected based on the inclusion criteria and divided into experimental and control groups with 78 participants in each. The experimental group received the SMP, including the intervention related to the self-management process (from the 1st to 4th weeks) and a follow-up phase (from the 5th to 16th weeks). The control group received standard care. The outcomes were measured over time, including self-care behavior (baseline, 4th and 16th weeks), blood pressure (baseline, 4th, 8th, 12th and 16th weeks) and quality of life (baseline and 16th week).

The generalized estimating equations showed that the SMP, compared with the control group, statistically significantly improved self-care behavior (p < 0.001), decreased blood pressure (p < 0.001) and improved quality of life (p < 0.001) at the 16th week.

The SMP improved the self-care behavior, decreased blood pressure and improved the quality of life among older adults with uncontrolled hypertension. Registered nurses could administer this program for long-term benefits and help reduce the burden on primary care services.

Purpose – A placebo effect is a (positive) change in health outcomes that is due to a (positive) change in beliefs about the value of a treatment. Placebo effects might be “behavioral,” in the sense that revised beliefs lead to behavioral changes or new actions that in turn yield changes in health outcomes. Placebo effects might also include a “physiological” component, which refers broadly to non-behavioral, brain-modulated mechanisms by which new beliefs cause changes in health outcomes. Nearly all formal economic models of human behavior are consistent with behavioral placebo effects, but strongly inconsistent with their physiological counterparts. The reason is that the latter effects can imply that expectations enter, rather than multiply, state-contingent preferences. It is therefore unfortunate that little evidence exists on physiological placebo effects. We report data from novel clinical experiments with caffeine that seek to provide such evidence.

Methods – Subjects visit the clinic on multiple occasions. On each visit they ingest either a placebo or caffeine pill. Subjects only know the probability with which the pill includes caffeine. We obtain physiological measurements prior to ingestion and at 30, 60, and 90min after ingestion. Importantly, we constrain subjects to remain seated and read pre-selected magazines during the interval between treatment and outcome measurement.

Findings – Our design provides particularly clean inference because it (i) eliminates the possibility of behavioral confounds; (ii) provides for measurements at the individual level; (iii) manipulates beliefs without deception; and (iv) uses salient rewards. We find evidence for the existence of physiological placebo effects mediated by expectations.

Implications – Our results are consistent with the possibility that the prefrontal cortex provides external, top-down control that modulates physiological outcomes, and make a case for the importance of research geared toward developing appropriate and tractable frameworks that accommodate non-linear relationships between expectations and preferences.

The paper's purpose is to document a clinical study of children with Henoch‐Schonlein Purpura that facilitated decision‐making with regard to investigations, follow up and timely referral to a nephrologist.

A retrospective analysis of clinical records of 33 children diagnosed with Henoch‐Schonlein purpura who attended the Whiston Hospital Paediatric unit over a 60‐month period between January 2001 and December 2005 was performed.

In the study 53 per cent (n 17) of the patients were boys. The commonest age group affected was between five to ten years (n 17), with mean age of 7.2 years (range 1 to 17 years). Of the cases , 71 per cent (n 22) presented between July and December. Four patients (13 per cent) had haematuria on dipstick examination at presentation. Eight patients (25 per cent) had neither blood pressure measurement on admission nor a documented plan for urine dipstick or blood pressure measurement on discharge. Daily urine dipstick was performed in 47 per cent (n 15) patients with one patient having checks twice a week. Information to parents was not documented in 72 per cent (n 23) of case notes.

The need to provide better parental education and support in the form of an information leaflet was identified.

This study highlights the importance of follow up of children with HSP with emphasis on regular urine dipstick examination and measurement of blood pressure even if they remain asymptomatic to ensure that they do not develop long‐term renal impairment.

This paper seeks to examine an intervention program which was developed in order to improve the performance and skills of technical medical personnel at the military recruitment medical committees.

Evaluation of the technician soldiers' performance was carried out by the usage of a specifically farmed survey, comprising a designed questionnaire, and direct observation of their work, including appraisal of their measurements and interpretation skills.

Prior to intervention, analysis revealed: insufficient knowledge of normal range of blood pressure and pulse values, visual acuity of color vision, urinalysis and their relation to the classification process at medical committees; and inadequate technicalities such as incorrect weight and height measurements.

The model of the intervention program could be modified and adopted by medical committees, sports medicine examinations, periodic screening procedures, and primary care medicine in order to improve the quality of medical records and medical care.