bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation of workplace well-being programs in the Russian Federation: development of the on-line tools package and results of its piloting
Authors: Antsiferova AA , Kontsevaya AV
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction. Most of the working-age population spends a significant part of their life at workplace. On the one hand, working conditions can cause stress, and therefore an increase unhealthy lifestyle, on the other hand, the workplace is a convenient organizational model for health promotion. In 2019 a big federal project "Public health" started aimed to improve population health and one of its important components is increasing implementation of effective workplace health promotion programs. Model workplace well-being programs have been developed within the framework of the Federal Project «Public Health».

Purpose is to develop and pilot a package of tools for planning and implementing workplace well-being programs.

Methods. Planning stage of the program has to include situation analysis with three components: available infrastructure analysis, employee interviews and comprehensive program development. We developed two types of questionnaires: for employers and for employees. After testing it in paper on limited N of participants it was corrected and electronic version was developed. The link to the instrument was distributed through the regional centers for public health who are responsible for implementation workplace health promotion programs in the regions.

Results. In spring 2020, 558 completed questionnaires were received (among them 35 from employers, and 553 from employees). Among employers, 53.1% were familiar with workplace well-being programs, such programs were approved at 43.8% of enterprises. Employers believe that the most appropriate implementation of the following components are measures to increase the level of physical activity (22.9%), measures to prevent smoking (18.1%) and psychological relief (18.1%).

There was a predominance of female among surveyed employees (66,5%), the average age was 39.8 ± 10.7 years and 42.6 ± 11.1 years for men and women, respectively. The following factors worried the employees on the workplace: distance from their place of residence (12.1%), continuous tension and stress (11.3%), noise (7.8%) and other factors. The level of presenteeism (measured by Copenhagen Psychosocial Questionnaire) was also analyzed, the low level of presenteeism was 38.9% and 42.4%, and the average level was 59.9% and 55.9% for men and women, respectively.

Conclusion. We developed the set of instruments which must be useful for implementation of the workplace well-being programs.  Surveys of employers contribute to obtaining a snapshot of the attitudes and priorities of employers in the region to plan targeted measures to stimulate the implementation of workplace well-being programs at the regional level. Questionnaires for employees can be used for an in-depth assessment of the priorities on the concrete workplace and development of a targeted program to the needs of a particular enterprise.
Does shift work affect blood pressure values and hypertension risk? a systematic review and meta-analysis
Authors: Gamboa Madeira S , Fernandes C , Paiva T , Santos Moreira C , Caldeira D
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Fundação para a Ciência e Tecnologia (FCT) and Fundo Social Europeu (FSE)

Introduction

Modern societies function 24h/day which accounts for shift work (SW) encompassing already more than 20% of the European workforce. While the relationship between blood pressure (BP) and cardiovascular events is a continuous, hypertension (HTN) remains the major preventable cause of cardiovascular disease (CVD) in our continent. SW has been associated with sleep disturbances, circadian misalignment and unhealthy behaviours, possibly conducting to several chronic diseases. Therefore, we aimed to determine if shift workers have higher BP values and/or HTN risk.

Methods

This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed on MEDLINE, EMBASE and Cochrane electronic databases. Included studies reported HTN diagnosis using current thresholds and/or BP values, in both shift workers and in a control group of day workers. SW was categorized in 4 subgroups, focused mostly on night work. Pooled mean difference and 95% Confidence Intervals (95%IC) were estimated for continuous outcomes, Systolic BP (SBP) and diastolic BP (DBP), and pooled Odds Ratio and 95%IC were determined for HTN risk. The Newcastle-Ottawa Quality Assessment Scale was used for quality evaluation of included studies.

Results

Forty-five independent studies were included engaging 117252 workers. Of these, 41 studies were included in the meta-analysis for SBP, 39 for DBP and 14 for HTN. Most studies provided cross-sectional data (n = 42), were developed in Asia (n = 21), in an industrial setting (n = 25) and included only men (n = 26). Most studies were rated as satisfactory quality (n = 23) with confounder adjustment being the weakest parameter.

We found a statically significant increase for both systolic and diastolic BP among permanent night workers, 2.52mmHg [0.75–4.29] and 1.77mmHg [0.39–3.15] respectively. Amongst rotational shift workers, both with and without night work, we found a significant increase only for SBP, namely 1.28 mmHg [0.18–2.39] and 0.65 mmHg [0.07–1.22]. For HTN risk, none of SW types showed significant differences.

Conclusions

Certain groups of shift workers may be at special risk for increased BP. This is the first review assessing the impact of SW specifically on BP values. Although the increases were generally modest, these may play an important role among already susceptible individuals exposed overtime. The effect of SW was more consistent for SBP, which has a major impact on CVD risk. Hence, occupational health services should embrace a holistic CVD preventive approach including atypical risk factors such as SW, with active monitoring across the lifespan of more vulnerable workers.
Comparison between the 6-minute walking test (6MWT) and gait speed (GS) during outpatient cardiac rehabilitation
Authors: Rossini D , Venturini E , Barni L , Dardi O , Bonaguidi E , Cavicchioli P , Lucchesi N
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): USL TOSCANA CENTRO USL TOSCANA NORD-OVEST

Background

6MWT is the gold standard for the functional and prognostic evaluation of patients (P) undergoing cardiac rehabilitation (CR), documenting the increase in exercise capacity induced by CR intervention. However, 6MWT requires an adequate space of at least 30 meters and a non-negligible operator time. GS has been proposed as a test of rapid execution, that can be performed even in a small space. Due to the limited experiences, the aim of the present study was to validate GS in CR in comparison with 6MWT.

Material and Methods

44 P (31 males and 13 females; age 68.2 ± 11.9 years) were enrolled consecutively in an outpatient rehabilitation program; 20 of them after cardiac surgery, 18 after acute cardiac syndrome and 6 with heart failure. After evaluating equilibrium and gait with the Tinetti scale (score ≥ 19), P performed 6MWT and GS at the beginning and at the end of the CR program. The speed at GS was calculated as the average of 3 tests. Data were expressed as mean ± SD. The results of 6MWT and GS at the initial and the final evaluation were compared with Student’s t-test for paired data (statistical significance at p <0.05). The Pearson correlation index (r) was calculated to evaluate the linearity relationship between distance traveled at 6MWT and velocity at GS; the  statistical significance was tested with ANOVA. The Statistical Package SPSS (version 24) was used for statistical analysis.

Results

the meters traveled at the initial and the final 6MWT were 434 ± 100 and 491 ± 96 respectively (p <0.001). The velocity in m/sec at the initial and the final GS was 1.68 ± 0.42 and 1.80 ± 0.44 respectively (p <0.001). The correlation between meters traveled and velocity is strong at baseline (r = 0.896) and after CR (r = 0.859), with p <0.001 in both cases.

Conclusions

certainly, aerobic capacity and resistance to exercise are better described by 6MWT. However, given the strong correlation between the distance traveled at 6MWT and the speed at GS, the latter test can be proposed as a tool for a rapid, precise and repeatable functional evaluation, even in clinical settings other than CR.
Digital home-based multidisciplinary cardiac rehabilitation: the way to counteract physical inactivity during the COVID-19 pandemic?
Authors: Pinto R , Lemos Pires M , Borges M , Linan Pinto M , Sousa Guerreiro C , Miguel S , Santos O , Ramalhinho M , Fiuza S , Cordeiro Ferreira M , Ricardo I , Cunha N , Alves Da Silva P , Pinto FJ , Abreu A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Centre-based cardiac rehabilitation (CR) programs have been forced to close due to the need for physical and social distancing imposed by COVID-19 pandemic. A major problem emerges concerning the potential harmful effects resulting from the suspension of the centre-based CR programs, leading to physical inactivity and unhealthy lifestyle routines. Therefore, the development of alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be organized and tested.

Purpose

To assess the physical activity (PA) levels in a group of patients with known cardiovascular disease (CVD), after completing 3-months of a home-based multidisciplinary digital CR program, organized as an alternative method to the centre-based CR suspended program.

Methods

One hundred and sixteen patients with CVD (62.6 ± 8.9 years, 95 males) who were previously attending a face-to-face CR program were included and the following parameters were assessed at baseline and 3 months: self-reported PA and sedentary behaviour, adherence to the online CR program, cardiovascular and non-cardiovascular symptoms, feelings towards the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted in a multidisciplinary digital CR program, including online exercise training sessions, online educational sessions, psychological online group sessions, risk factor control, nutritional and psychological consults and patient regular assessment by cardiologist and nurse.

Results

Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out). It was observed a significant increase from moderate-to-vigorous PA (230 ± 198 mins/week to 393 ± 378 mins/week, p < 0.001) and a decrease of the sedentary time at 3-months (6.47 ± 3.26 hours/day to 5.17 ± 3.18 hours/day, p < 0.001). Seventy percent of the patients met the PA recommendations and 41% reached more than 300 minutes per week of moderate to vigorous PA at 3 months. Almost half of the participants (46.9%) did at least more than one online exercise training session per week and attended at least one of the online educational sessions. There were no major adverse events reported and only one minor non-cardiovascular event occurred.

Conclusion

Patients with CVD, who suspended centre-based CR due to COVID-19 pandemic and started a home-based multidisciplinary digital CR program, had a significant improvement in moderate to vigorous PA after 3 months. Therefore, home-based CR programs showed to be a good option for selected clinically stable patients, who are eligible for CR and cannot attend a centre-based CR program due to COVID-19 pandemic or eventually other reasons.
Influence of long-term controlled therapeutic exercises on blood pressure profile parameters, elastic properties of arterial wall, metabolic and mineral indices in females with arterial hypertension
Authors: Petelina T , Bykova SG , Musikhina NA , Avdeeva KS , Zueva EV , Zyrynova LI , Shcherbinina AE
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia

Objective

To study the role of therapeutic exercises (TE) in the correction of blood pressure, stiffness of the vascular wall, metabolic indices of body structure (volume, mass, area of visceral fat)  and  bone mineral metabolism in postmenopausal hypertensive patients.

Methods. The study included 138 patients (mean age was 58.32 ± 7.61 years). All patients are divided into 3 groups. The first control group is 20 women without arterial hypertension and menopausе. The second group consisted of 58 patients with arterial hypertension (AH) and postmenopause who was not undergone complex of TE and the 3rd group - 60 women with AH and postmenopause who was undergone TE complex. Patients of all groups were examined in dynamics: at the starting point of the study and in 12 months after, ambulatory monitoring of blood pressure; sphygmography; densitometry and test for serum biochemistry parameters of blood samples, including sex hormones, vitamin D.

Results. In the course of the study, blood pressure, vascular wall stiffness parameters,  metabolic indices of body structure and disorder parameters of bone mineral metabolism  were comparable in group 2 and 3 against the background of significantly reduced levels of sex hormones. Multidirectional correlation relationships between the studied parameters are revealed. The basic therapy in combination with therapeutic exercises  led to a significant decrease in blood pressure and metabolic indices of body structure (p<.001) and to  a persistent tendency of decrease  the pulse wave velocity and increase of bone mineral metabolism in gr.3.

Conclusion. The result of the study indicates that the exercise therapy complex used in the form of regular classes  can be recommended for implementation in clinical practice with the aim of comprehensively affecting the patient’s body and developing personalized treatment tactics for postmenopausal women with hypertension.
Outcomes of a Cardiac Rehabilitation (CRH) Program after phase II: what about our patients almost 4 years later?
Authors: Borrego Rodriguez J , Palacios Echevarren C , Prieto Gonzalez S , Echarte Morales JC , Bergel Garcia R , Gonzalez Maniega C , Minguito Carazo C , Benito-Gonzalez T , Larrabide-Eguren I , Toribio-Garcia I , Santos-Garcia C , Menendez Suarez P , Garcia Bueno L , Montes Montes M , Fernandez-Vazquez F
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

CRH in patients with ischemic heart disease is recommended by the different clinical practice guidelines with an IA level of evidence, with an important role in reducing cardiovascular mortality and hospital readmissions during follow-up.

OBJECTIVE

The goal of this study is to show the 4-year clinical results of a population of patients who participated in an CRH program after an Acute Coronary Syndrome (ACS).

METHODS

Between May/2014 and September/2017, 221 patients who had recently presented an ACS completed the 12 weeks of phase II of the CRH program at our center. In May/2020 we collected epidemiological, clinical and echocardiographic information at the time of the acute cardiovascular event; and we evaluate the current vital status of the patients and the incidence of readmissions for: angina, HF, new ACS, or arrhythmic events.

RESULTS

Of the 221 patients, 182 were men (82%). The mean age of our population was 58.3 ± 7.8 years. 58% (129 patients) suffered from ST-elevation ACS. The mean time of hospital stay was 6.20 ± 2.9 days. An echocardiogram was performed at discharge, which showed an average LVEF of 56 ± 6%. Eight patients (4%) developed early Ventricular Fibrilation (VF) during the acute phase of ACS. Among the classic CVRF, smoking (79%) was the most prevalent, followed by dyslipidemia (53%) and hypertension (47%). The mean time from hospital discharge to the start of phase II RHC was 42 ± 16 days. The overall incidence of events was 9%: 10 patients suffered reinfarction during follow-up, and 7 were readmitted for unstable angina, all of whom underwent PCI; no patient was admitted for HF; and none of the 8 patients with early VF had a new tachyarrhythmia, registering a single admission for VT during follow-up. None of the patients had sustained ventricular tachyarrhythmias during exercise-training. At the mean 4.5-year follow-up, 218 patients were still alive (98%).

CONCLUSION

The incidence of CV events in the follow-up of our cohort was low, which can be explained by the fact that it is a young population, with an LVEF at low limits of normality at discharge, which is one of the most important predictors in the prognosis after an ischemic event. As an improvement, we must shorten the time until the start of phase II of the program. CRH shows once again its clinical benefit after an ACS, in consonance with the existing evidence.

Abstract Figure. Outcomes of a CRH program.
Clinical management of young competitive athletes with premature ventricular beats: a prospective cohort study
Authors: Cavigli L , Di Florio A , Fusi C , Anselmi F , Focardi M , Cameli M , Valente S , Bonifazi M , Zorzi A , Corrado D , Mondillo S , D"ascenzi F
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Premature ventricular beats (PVBs) are not an unusual finding and their interpretation is sometimes challenging. Unfortunately, few data on the characteristics of PVBs that correlate with the risk of an underlying heart disease are available in athletes.

Objectives. The aim of this prospective study was to investigate the diagnostic and prognostic value of PVBs characteristics in competitive athletes.

Methods. From a cohort of 1,751 athletes evaluated at our sports cardiology centre, we enrolled 112 competitive athletes <40 years of age (mean age 21 ± 10 years) and with no known heart disease referred for PVBs. All athletes underwent physical examination, ECG, 12-lead ambulatory ECG monitoring, exercise testing, and echocardiography. Further investigations including cardiac magnetic resonance were performed for abnormal findings at first-line evaluation or for specific PVBs characteristics.

Results.  The majority (79%) of athletes exhibited monomorphic PVBs with a fascicular or infundibular pattern (common morphologies). A definitive diagnosis of cardiac disease was reached in 26 athletes (23% of the entire population) and correlated with uncommon PVBs morphology (p < 0.001) and arrhythmia complexity (p < 0.001). The number of PVBs/24-hour was lower in athletes with cardiac disease than in those with normal heart (p < 0.05). During the follow-up a spontaneous reduction of PVBs and no adverse events were observed.

Conclusions. Infundibular and fascicular PVBs were the most common morphologies observed in athletes with ventricular arrhythmias referred for cardiological evaluation. Morphology and complexity of PVBs, but not their number, predicted the probability of an underlying disease. Athletes with PVBs and negative investigation showed a good prognosis.

Abstract Figure.
Early detection with speckle tracking echocardiography of biventricular systolic dysfunction, and its relationship with fatigue, in patients with multiple sclerosis
Authors: Michelotto E , Oliva MC , Amoruso MT , Giovannetti G , Battista C , Andreani M , Mazzilli D , Amico AP , Tota A , Megna M , D"agostino C , Palmieri VO , Colonna P
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Fatigue is a frequent and debilitating symptom of multiple sclerosis (MS), affecting 90% of patients. Symptoms seems multifactorial, but little is known about the contribution of cardiovascular morpho-functional alterations linked to comorbidities, to lifestyle, to MS itself or to drugs (i.e. mitoxantrone).

Aim

to investigate the presence of cardiac alterations in MS patients, and to evaluate their impact on fatigue.

Methods

 24 patients with relapsing-remitting MS (RR-MS) underwent an electrocardiogram (ECG), a transthoracic echocardiographic (TTE), a six minutes walking test (6MWT) with Borg scale (BS), and two fatigue self-assessment scales, the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS). The patients were divided into 2 groups: group 1, without traditional cardiovascular risk factors (CVRF: smoke, hypertension, diabetes, hypercholesterolemia; n = 12, 11 females), and group 2, with at least one CVRF (n = 12, 5 females). None of the patients had ever been on mitoxantrone therapy. No new control group was studied due to the SARS-CoV-2 pandemic restrictions , so the comparison was performed with general healthy population in internationally validated previous studies.

Results

No arrhythmias were found. In both MS groups all the TTE left ventricular (LV) systolic function parameters were depressed compared to the healthy population, but only the mean global longitudinal strain (GLS), the mean longitudinal strain rate (LSR) of LV and estimated pulmonary artery systolic pressure (PAPs) were statistically significant depressed compared to the healthy general population (p < 0.005): see table. This reduction was observed in both MS groups, while there were non significant differences among the two groups. TTE LV function depression significantly correlated to variation of parameters of fatigue , especially considering LV GLS in relation to BS values.

Conclusions

Subclinical biventricular systolic dysfunction is present in MS patients, and it seems to be linked to the disease itself without being influenced by CVRF. This dysfunction, detected by speckle tracking echocardiographic techniques, seems to contribute to the symptom of fatigue in patients with MS. It is important to include TTE in the workup and follow-up of MS patients, in order to promptly treat cardiac dysfunction and relieve fatigue.

Echocardiography and LV strain MS total MS no CVRF MS + CVRF Healthy population LV GLS 17.7 ± 2.2* 18.0 ± 2.1* 17.4 ± 2.4* 22.6 ± 1.7 LV LSR 1.0 ± 0.1* 1.0 ± 0.1* 1.0 ± 0.2* 1.2 ± 0.1 PAPs 25.0 ± 2.6* 24.8 ± 2.9* 25.2 ± 2.5* 14.0 ± 6.0 * p < 0.05 vs healthy population
Quality of life of elderly men and women with ischemic heart disease
Authors: Ibatov A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

The purpose. To study quality of life and emotional status of elderly men and women with ischemic heart disease (IHD). 

Methods. The first group  - 79 elderly  (60 years and older) men with IHD  (average age 64.81 ± 0.5 years) and the second group  - 46 elderly women with IHD  (average age 64.2 ± 0.5 years) were examined. All patients of the first and second group had the angina pectoris (II-IV functional class). A level of quality of life was estimated by Seattle Angina Questionnaire of quality of life (SAQ). A level of anxiety and the depression were examined by the Hospital Anxiety and Depression Scale (HADS), personality characteristics - by the Mini-Mult questionnaire - short form MMPI questionnaire.

Results. The groups did not differ in class of angina pectoris and treatment. The quality of life in the 1st and 2nd group was accordingly 56.2 ± 1.9 and 48.1 ± 1.6 score on Physical limitation scale (p < 0.05), 44.4 ± 2.3 and  44.8 ± 3.7 score on Angina stability scale (p > 0.05), 54.9 ± 2.6 and 57.8 ± 3.3 score on Angina frequency scale (p > 0.05), 66.8 ± 1.4 and  62.4 ± 1.9 score on Treatment satisfaction scale (p > 0.05), 54.6 ± 1.6 and 49.7 ± 2.2 score on Disease perception scale (p > 0.05), 57.2 ± 1.3 and 52.6 ± 1.5 score on Total score scale of quality of life (p < 0.05).  The patients of 1st group had level of anxiety 6.8 ± 0.4 score and level of depression  5.3 ± 0.4 score accordingly. The patients of 2nd group had  accordingly 9.2 ± 0.5 score (p < 0.01) level of anxiety and 7.2 ± 0,4 score (p < 0.05)  level of depression. The patients of 1st and 2nd group  had such personality characteristics accordingly: on scale of Hypochondriasis – 55.5 ± 0.7 and 61.9 ± 1.2 T-score (p < 0.01); on scale of Depression – 48.7 ± 1.1 and 59.2 ± 1.4 T-score (p < 0.01); on scale of Hysteria – 51.0 ± 0.6 and 58.9 ± 0.8 T-score (p < 0.01); on scale of Psychopathic Deviate – 44.3 ± 1.2  and 50.3 ± 1.5 T-score (p < 0.01); on scale of Paranoia – 51.5 ± 1.4 and 59.8 ± 1.9 T-score (p < 0.01); on scale of Psychasthenia – 46.8 ± 1.2 and 55.8 ± 1.5 T-score (p < 0.01); on scale of Schizophrenia – 46.9 ± 1.1 and 56.5 ± 1.6 T-score (p < 0.01); on scale of Hypomania – 45.5 ± 1.9 and 52.9 ± 1.7 T-score (p < 0.01).

Conclusion. The elderly women with ischemic heart with disease had worse quality of life  and more expressed accentuated personality characteristics and higher  levels of anxiety and depression, in comparison with elderly men. The revealed features of quality of life,  personality characteristics and emotional status of  elderly patients with ischemic heart with disease have to be considered in treatment and rehabilitation.
Stress cardiovascular magnetic resonance and mortality in a registry of 2496 elderly patients with chronic coronary syndrome. Prognosis and decision-making
Authors: Gabaldon-Perez A , Garcia-Blas S , Gavara J , Rios-Navarro C , Perez-Sole N , De Dios E , Marcos-Garces V , Merenciano-Gonzalez H , Monmeneu JV , Lopez-Lereu MP , Nunez J , Chorro FJ , Bonanad C , Bodi V
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background. In recent guidelines, non-invasive imaging techniques play a pivotal role in the management of chronic coronary syndrome (CCS). The elderly represent a large percentage of our routine CCS population and risk stratification in this scenario is challenging. The potential of vasodilator stress cardiovascular magnetic resonance (CMR) for this purpose is unknown.

Purpose. We explore the prognostic value and the usefulness for decision-making of the ischemic burden determined by vasodilator stress CMR imaging in a large cohort of elderly patients with known or suspected CCS.

Methods. The study group was made up of 2496 patients older than 70 years submitted to vasodilator stress CMR for known or suspected CCS in our health department from 2001 to 2016 (mean age 76 ± 4 years, 52% male). Clinical and vasodilator stress CMR characteristics were prospectively recorded. The ischemic burden (number of segments with stress-induced perfusion deficit) was calculated following the 17-segment model. Its association with all-cause mortality and the effect of vasodilator stress CMR-guided revascularization (within the following 3 months) were analyzed retrospectively.

Results. During a median follow-up of 4.58 years, 430 deaths (17.2%) were recorded. A larger ischemic burden was an independent predictor of mortality: hazard ratio [95% confidence intervals]: 1.04 [1.01-1.07] for each additional ischemic segment, p = 0.006). This association also occurred in patients over 80 years of age and in women (p < 0.001). Compared to non-revascularized patients, revascularization associated with worse outcomes at low ischemic burden and exerted protective prognostic effect in patients with extensive ischemia both in the whole group (p for interaction = 0.003) and in 496 patients matched 1:1 by a propensity score (p = 0.06).

Conclusions. Vasodilator stress CMR represents a valuable tool to stratify risk in elderly patients with known or suspected CCS and might be helpful to guide decision-making in this scenario.

Abstract Figure 1
Improvement of the heart failure patient process for the prevention of new events through tele-education and continuous tele-optimization of the treatment by nursing staff
Authors: Perez Serrano M , Carlos Nicolas Perez Garcia CNP , Daniel Enriquez Vazquez DEV , Marcos Ferrandez Escarabajal MFE , Jesus Diz Diaz JDD , Noemi Ramos Lopez NRL , Isidre Vila Costa IVC , Mariam Bas Villalobos MBV , Christian Bengoa Terrero CBT , Alejandra Restrepo Cordoba ARC , David Vivas Balcones DVB , Josebe Goirigolzarri Artaza JGA , Ramon Bover Freire RBF , Carlos Macaya Miguel CMM
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

patients with heart failure (HF) are especially vulnerable to SAR-CoV-2 infection especially due to their worse prognosis for this disease.

Purpose

to demonstrate that patients with HF will present similar health outcomes if their education and pharmacological treatment is optimised remotely by a nurse rather than through conventional care.

Methods

 A single-centre, observational, prospective, non-randomized study was carried out in which two groups were compared. The experimental group had most of their care provided virtually by a nurse who could optimise their medication according to the clinical guides whilst the control group received conventional face-to-face care. During a follow-up period of 6 months, patients included in the study have an initial face-to-face consultation with a cardiologist and an evaluation of the patient where the treatment objectives are established. The rest of the follow-ups were done through videoconsultation with the nurse every 15 days for 6 months where the neurohormonal treatment was optimized and an educational program was carried out with different cardiovascular educational topics.

Results

  Thirty-seven patients have been included. Sex: 30 men (81.0%) and 7 women (19.0%) Mean age: 67.9 years (12.8). Range 42-87 years. Etiology: 61.2% ischemic and 38.8% non-ischemic mean LVEF at inclusion = 30.2%.

A total of 17 patients have completed the study: a 13% average improvement of FEVI, a reduction of NT-proBNP of and improvement in functional heart failure class.

The primary objective was to compare the proportion of neurohormonal drugs prescribed, as well as the mean of the maximum doses reached in each after 6 months of follow-up, as well as mean ejection fraction, NYHA class and mean NT-proBNP (Table 1)

Conclusions

Telemedicine offers us valuable tools that allow us to take care of chronic patients, reducing exposure to the virus as much as possible. Efficient use of virtual tools and human resources makes close monitoring possible. Specialized nursing is a key element in the education, pharmacological optimization and monitoring of these patients.

Parámetros analíticos Valores iniciales Valores finales NT-proBNP ( pg/mL) 3469,7 (± 4057,3) 1446,4 (± 1305,2) Creatinina (mg/dL) 1,10 (± 0,24) 1,12 (± 0,39) TFG (mL/min/1,73m2 ) 65,4 (± 21,2) 62,7 (± 23, 6) Potasio (meq /L) 4,5 (± 0,5) 4,6 (± 0,4) Fevi 29,4 % (± 7,2) FEVI 42,7 % (± 9,6)
Delivering a dietetic intervention to cardiovascular patients in the Covid era
Authors: Rodgers A , Edwards W , Garrity J , Latimer D , Wilson D , Connolly S
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Department of Health

Introduction

Healthy diet and body composition are core components of cardiac rehabilitation. Following the COVID outbreak in March 2020, our face-to-face cardiac rehabilitation programme (Our Hearts Our Minds) was suspended. The programme was then quickly moved to a virtual platform to continue to deliver the programme.

Purpose

Here we describe how the OHOM programme adapted our service to deliver the dietetic assessment and intervention on a virtual platform.

Methods

Pre-Covid the dietary component of OHOM consisted of a face-to-face Initial Assessment (IA) with a dietitian, group education sessions and an End of Programme assessment (EOP). Anthropometric measures and dietary habits were assessed including adherence to the Mediterranean diet via the Mediterranean Diet Score (MDS) toolkit. Using behaviour change techniques, tailored dietary advice was provided and goals agreed to educate on healthier food choices, increase adherence to Mediterranean diet and (if appropriate) promote weight loss and reduce central obesity. The assessment and intervention is now delivered virtually via telephone or video. Anthropometrics are self-reported with tape-measures supplied to assess waist circumference and advice provided on home-weighing. MDS is still assessed. The programme includes fortnightly coaching telephone consultations to review and reset goals, the option to attend a dietitian-led virtual group education session, access to a filmed educational video and submission of food diaries via the Fitbit app.

Results

From April to November 2020, 114 patients completed the virtual programme (65 telephone, 39 video). Dietetic outcomes are outlined in Table 1 with inclusion of data for a similar period one year previously (face-to-face) for comparison. Reductions in anthropometric measures and increased adherence to a cardio-protective diet were noted and the results for the two time periods are remarkably similar.

Conclusion

Delivery of a virtual dietetic component in cardiac rehabilitation is feasible, acceptable and just as effective as face-to-face based on preliminary data.

Table 1: Dietary outcomes at IA and EOP Face-to-face assessments (April - March 2019) Virtual assessments (April - November 2020) IA EOP Change IA EOP Change Mean weight (in those with BMI >25kg/m2) 86.5 85.2 -1.3 91.4 88.6 -2.8 Waist circumference (cm) 104.3 103 -1.3 107 102 -5 Mean MDS (Range 1-14) 4.4 7.5 +3.1 4.8 7.8 +3 % Consuming oily fish once per week 20 57 +37 25 68 +43 Achieving fruit and vegetable target 16 61 +45 21 57 +36

Abstract Figure. Dietitian waist circumference tutorial
The impact of health apps on lifestyle behaviours and cardiovascular risk factors in patients with cardiovascular risk factors or established cardiovascular disease: a systematic review
Authors: Buys R , Claes J , Cornelis N , Alen L , Bogaert T , De Buck E , Decorte E , Herbots J , Steyaert R , Theunis L , Verhaegen T , Cornelissen VA
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme

Background

 Adequate levels of physical activity (PA) and a healthy diet can contribute to weight loss, improved blood pressure, improved lipid levels and higher insulin sensitivity and thus decrease the risk for the development of cardiovascular disease (CVD). Recently, mobile technologies, such as mobile applications (apps) have been developed for supporting adherence to a healthy lifestyle in an individualized and interactive manner. 

Purpose

 The aim of this systematic review was to summarize the effectiveness of such mobile apps targeting PA and/or dietary behavior and cardiovascular risk factors in primary and secondary prevention. 

Methods

Four databases (Pubmed, Sportdiscus, Cinahl, Embase) were searched to identify prospective studies evaluating mobile apps targeting healthy diet and/or PA. Rayyan software was used for screening articles. Only interventional trials that assessed the effectiveness of health apps on diet, PA and/or cardiovascular risk factors were included. Quality assessment was performed using the MINORS tool. Qualitative synthesis was performed providing data summaries according to different subgroups: healthy adults, adults who are overweight, have obesity, hypertension, CVD or diabetes. 

Results

Out of 7073 records identified, 52 articles, reporting on 44 studies with variable study designs, could be included in qualitative synthesis. Interventions targeted diet, PA and/or adherence to therapy/healthy lifestyle and reported on at least one cardiovascular risk factor. In 20 studies, weight loss was a target of the mobile intervention, the vast majority (17/20 studies) reported weight loss following app usage of at least similar extent as usual care. Twenty-six mobile interventions targeted PA and/or exercise training and 23 of them resulted in an increase in PA in the short term. Four studies performed in patients with CVD showed that health app usage could be related to increased PA and improved diet, resulting in similar health benefits as usual care. The most commonly employed behavioural change methods were goal setting and self-monitoring, the use of financial incentives for inducing beneficial lifestyle changes yielded inconclusive results. Main limitations of the studies were small sample sizes, short follow-up duration and lack of controlled trial design. 

Conclusion

Mobile apps targeting healthy lifestyle for the management of cardiovascular risk factors seem to be valuable tools to add to current practice in preventive medicine. However, larger, controlled studies with longer follow-up duration are needed to confirm these early findings.
Risk stratification score for acute myocardial infarction and sudden cardiac death in type 2 diabetes mellitus
Authors: Lee S , Zhou J , Guo CL , Wu WKK , Wong WT , Liu T , Wong ICK , Jeevaratnam K , Zhang Q , Tse G
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Acute myocardial infarction (AMI) and sudden cardiac death (SCD) are major cardiovascular adverse outcomes in patients with type 2 diabetic mellitus. Although there are many risk scores on composite outcomes of major cardiovascular adverse outcomes or cardiovascular mortality for diabetic patients, these existing scores did not account for the difference in pathogenesis and prognosis between acute coronary syndrome and lethal ventricular arrhythmias. Furthermore, recent studies reported that HbA1c and lipid levels, which were often accounted for in these risk scores, have J/U-shaped relationships with adverse outcomes.

Purpose

The present study aims to evaluate the application of incorporating non-linear J/U-shaped relationships between mean HbA1c and cholesterol levels into risk scores for predicting for AMI and non-AMI related SCD respectively, amongst type 2 diabetes mellitus patients.

Methods

This was a territory-wide cohort study of patients with type 2 diabetes mellitus above the age 40 and free from prior AMI and SCD, with or without prescriptions of anti-diabetic agents between January 1st, 2009 to December 31st, 2009 at government-funded hospitals and clinics in Hong Kong. Risk scores were developed for predicting incident AMI and non-AMI related SCD. The performance of conditional inference survival forest (CISF) model compared to that of random survival forests (RSF) model and multivariate Cox model.

Results

This study included 261308 patients (age = 66.0 ± 11.8 years old, male = 47.6%, follow-up duration = 3552 ± 1201 days, diabetes duration = 4.77 ± 2.29 years). Mean HbA1c and high-density lipoprotein-cholesterol (HDL-C) were significant predictors of AMI under multivariate Cox regression and were linearly associated with AMI. Mean HbA1c and total cholesterol were significant multivariate predictors with a J-shaped relationship with non-AMI related SCD. The AMI and SCD risk scores had an area-under-the-curve (AUC) of 0.666 (95% confidence interval (CI)= [0.662, 0.669]) and 0.677 (95% CI= [0.673, 0.682]), respectively. CISF significantly improves prediction performance of both outcomes compared to RSF and multivariate Cox models.

Conclusions

A holistic combination of demographic, clinical, and laboratory indices can be used for the risk stratification of type 2 diabetic patients against AMI and SCD.
Evaluating capacity strengthening for social and behavior change communication: a systematic review
Authors: Awantang Grace N , Helland Anna , Velu Sanjanthi , Gurman Tilly
Published: May 2021

International social and behavior change communication (SBCC) programs often include capacity strengthening (CS). Quality evaluations of CS can help justify investing in these activities and guide the design of future CS activities. To inform and improve future CS efforts, a comprehensive examination of ways in which activities aimed at strengthening capacity for improved SBCC are assessed is needed. Unfortunately, systematic literature reviews about the assessment of CS activities in SBCC programs are rare. This systematic review helped fill this gap and explored ways in which CS interventions for improved SBCC in low- and middle-income countries (LMICs) evaluated their success. A search of electronic research databases yielded a total of 1033 potentially eligible publications. Reviewers identified 19 eligible publications that assessed the effects of activities for improved SBCC capacity. Reviewers identified seven findings, including the fact that evaluating CS for improved SBCC is rare, with only three publications having focused exclusively on evaluating SBCC capacity. This current review also identified several shortcomings around the quality of writing as well as sufficient detail to support certain claims and conclusions, especially around issues of sustainability. Until quality evaluations of CS activities are better documented, future CS activities for SBCC will find it difficult to identify effective CS approaches and demonstrate their contribution to improved SBCC in LMICs. The review discusses several implications and offers practical recommendations regarding ways to improve the evaluation of CS activities in SBCC.
Systemic antisense therapeutics inhibiting DUX4 expression ameliorates FSHD-like pathology in an FSHD mouse model
Authors: Lu-Nguyen Ngoc , Malerba Alberto , Herath Shan , Dickson George , Popplewell Linda
Published: May 2021

Aberrant expression of the double homeobox 4 (DUX4) gene in skeletal muscle causes muscle deterioration and weakness in Facioscapulohumeral muscular dystrophy (FSHD). Since the presence of a permissive pLAM1 polyadenylation signal is essential for stabilization of DUX4 mRNA and translation of DUX4 protein, disrupting the function of this structure can prevent expression of DUX4. We and others have shown promising results using antisense approaches to reduce DUX4 expression in vitro and in vivo following local intramuscular administration. Here we demonstrate that further development of the antisense chemistries enhances in vitro antisense efficacy. The optimal chemistry was conjugated to a cell-penetrating moiety and was systemically administered into the tamoxifen-inducible Cre-driver FLExDUX4 double-transgenic mouse model of FSHD. After four weekly treatments, mRNA quantities of DUX4 and target genes were reduced by 50% that led to 12% amelioration in muscle atrophy, 52% improvement in in situ muscle strength, 17% reduction in muscle fibrosis and prevention of shift in the myofiber type profile. Systemic DUX4 inhibition also significantly improved the locomotor activity and reduced the fatigue level by 22%. Our data demonstrate that the optimized antisense approach has potential of being further developed as a therapeutic strategy for FSHD.
Immune Activation: A Link Between Food Insecurity and Chronic Disease in People Living With Human Immunodeficiency Virus
Authors: Tamargo Javier A , Hernandez-Boyer Jacqueline , Teeman Colby , Martin Haley R , Huang Yongjun , Johnson Angelique , Campa Adriana , Martinez Sabrina S , Li Tan , Rouster Susan D , Meeds Heidi L , Sherman Kenneth E , Baum Marianna K
Published: May 2021

Persistent immune activation is a hallmark of human immunodeficiency virus (HIV) infection and thought to play a role on chronic diseases in people with HIV (PWH). Food insecurity is disproportionately prevalent in PWH and is associated with adverse health outcomes. We determined whether food insecurity was associated with increased plasma levels of soluble CD14, CD27, and CD163 in 323 antiretroviral-treated PWH from the Miami Adult Studies on HIV cohort. Nearly half (42.7%) of participants were food insecure, and 85.5% were virally suppressed (<200 copies/mL). Food insecurity was independently associated with higher levels of soluble CD14 and soluble CD27. Very low food security was associated with increased soluble CD163 levels among those with lower CD4+ cell counts. Food insecurity may promote immune activation in PWH, suggesting a biological link between food insecurity and chronic disease among PWH. Improving financial security and access to high-quality diets could reduce the burden of disease in this highly vulnerable population.
Comparable Environmental Stability and Disinfection Profiles of the Currently Circulating SARS-CoV-2 Variants of Concern B.1.1.7 and B.1.351
Authors: Meister Toni Luise , Fortmann Jill , Todt Daniel , Heinen Natalie , Ludwig Alfred , Brüggemann Yannick , Elsner Carina , Dittmer Ulf , Steinmann Joerg , Pfaender Stephanie , Steinmann Eike
Published: May 2021

The emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern with increased transmission dynamics has raised questions regarding stability and disinfection of these viruses. We analyzed surface stability and disinfection of the currently circulating SARS-CoV-2 variants B.1.1.7 and B.1.351 compared to wild type. Treatment with heat, soap, and ethanol revealed similar inactivation profiles indicative of a comparable susceptibility towards disinfection. Furthermore, we observed comparable surface stability on steel, silver, copper, and face masks. Overall, our data support the application of currently recommended hygiene measures to minimize the risk of B.1.1.7 and B.1.351 transmission.
Coproduction in the management of individuals with cleft lip and palate in South Africa: the Ekhaya Lethu model
Authors: Hlongwa Phumzile , Rispel Laetitia C
Published: May 2021

Objective

Cleft lip and palate (CLP), one of the most common congenital anomalies of the craniofacial complex, has a worldwide prevalence rate of 1 in 700 live births. In South Africa, a middle-income country, the CLP prevalence rate is 0.3 per 1000 live births in the public health sector. The complexity of the condition requires that individuals with CLP be treated by a multi-disciplinary team of health professionals, with the integral involvement of caregivers and families.

Methods

Between 2015 and 2018, we conducted a cross-sectional study entitled: The epidemiology and care of individuals with cleft lip and palate in South Africa, in fulfilment of a Doctor of Philosophy degree. The study setting consisted of 11 specialized academic centres (nine central hospitals and two specialized dental hospitals) that are situated in six of South Africa’s nine provinces. The study used a combination of quantitative and qualitative methods and consisted of four distinct but inter-linked components. The first component consisted of a record review of CLP data over a 2-year period to determine the prevalence of CLP in the public sector of South Africa. The second component consisted of a survey of the leaders or heads of the health care teams in the 11 specialized centres to determine the current approach to CLP care provision. The third component consisted of a survey among CLP team members to measure inter-professional collaboration. The fourth component consisted of interviews with parents or caregivers on their perceptions of health service provision and support for children with CLP.

We draw on the findings of this large empirical study on CLP in South Africa’s public health sector and the theory and principles of health care service coproduction to present the Ekhaya Lethu model for the management of CLP.

Results

The conceptual design of Ekhaya Lethu derives from the findings of each of the study components. We describe the possible application of the model in the coproduction of health care to examine the roles, relationships and aims of the multidisciplinary team in CLP management. We highlight both the implications and challenges of coproduction in the care and management of CLP for multidisciplinary health teams, the caregivers and families of individuals with CLP, and for health managers and policy makers.

Conclusion

The proposed Ekhaya Lethu model introduces a discourse on coproduction in the design and implementation of quality health care to individuals with CLP in South Africa and other low-and middle-income countries.