bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obesity and COVID-19 in the octogenarians
Authors: Scarpone M , Bergami M , Cenko M , Bugiardini R , Manfrini O 
Published: October 2021

Abstract

Background
Obesity has been identified as the comorbidity more frequently associated with severe forms of COVID19. As the very elderly subjects are particularly prone to severe forms of the disease, but are less affected by obesity we specifically addressed the question on the influence of age on the relationship between BMI and COVID19 prognosis.

Purpose
To assess the relationship between obesity and early COVID-19 prognosis in octogenarians patients.

Methods
Patients were determined to have COVID-19 if they had a positive SARS-CoV-19 swab. We used logistic regression analyses to control for confounding by concomitant risk factors. Clinical characteristics and COVID-19 related outcomes (i.e. invasive mechanical ventilation [IMV], death and discharge by day 7 [D7]) were analyzed according to BMI status and age (older vs younger than 80 years).

Results
Among 601 patients with COVID-19 confirmed disease there 514 (85.5%) normal weight and 87 (14.5%) obese subjects (BMI &gt;30 kg/m2). In a multivariable adjusted model, the primary outcome (IMV and/or death by D7) was significantly associated with obesity in the overall population (OR 2.19; 95% CI: 1.26–3.8). After multivariable adjustment, primary outcome by D7 was significantly associated with obesity in patients aged younger than 80 years (OR 2.54; 95% CI: 1.38–4.68), while such an association was no longer found in those aged 80 years and older (OR 0.42; 95% CI: 0.05–3.33).

Conclusions
Obesity is associated with poor early prognosis in patients with confirmed COVID19 disease. The deleterious impact of obesity on COVID-19 prognosis is no longer observed in the elderly aged 80 years and older. Very advanced age by itself must be considered as a major risk for severe COVID-19 outcomes in all people irrespective of BMI status.

Funding Acknowledgement
Type of funding sources: None.
Effect of exercise training on vascular function and endothelial repair in heart failure with preserved ejection fraction: results from the OptimEx trial
Authors: Gevaert A , Boehm B , Hartmann H , Goovaerts I , Stoop T , Van De Heyning C M , Beckers P J , Baldassari F , Mueller S , Duvinage A , Wisloff U , Adams V , Pieske B , Halle M , Van Craenenbroeck E M ,   OptimEx study group
Published: October 2021

Abstract

Background
Exercise training improves peak oxygen uptake (VO2) in heart failure with preserved ejection fraction (HFpEF), but the underlying mechanisms are unknown. In other cardiovascular diseases, exercise training improves vascular function and increases levels of circulating endothelium-repairing cells. We aimed to investigate the effects of moderate continuous training (MCT) and high intensity interval training (HIIT) on vascular function and cellular endothelial repair in HFpEF.

Methods
This was a prespecified subanalysis of the Optimizing Exercise Training in Prevention and Treatment of Diastolic Heart Failure randomized trial. HFpEF patients (n=180) were randomized to HIIT, MCT or attention control. At baseline and after 12 weeks, we measured peak VO2, fingertip arterial tonometry (n=109), brachial artery flow-mediated dilation (n=59), aortic pulse wave velocity (n=94), and flow cytometry (n=136) for endothelial progenitor cells (CD45dimCD34+VEGFR2+) and angiogenic T cells (CD3+CD31+CD184+). Changes in these parameters were compared between groups using linear mixed models. Parameters were correlated using Spearman's rho.

Results
At 3 months, we did not observe significant differences between HIIT, MCT and control group regarding changes in vascular function throughout the vascular tree (fingertip arterial tonometry, brachial artery flow-mediated dilation and central arterial stiffness, Table 1) or levels of circulating endothelium-repairing cells (endothelial progenitor cells and angiogenic T cells, Table 1). Results were similar at 12 months and when restricting analysis to patients with at least 70% adherence to training sessions. Patients with higher peak VO2 at baseline had lower numbers of circulating endothelial progenitor cells (rho=−0.22, p=0.011).

Conclusions
In patients with HFpEF, exercise training did not change vascular function or levels of endothelium-repairing cells. Thus, improved vascular function likely does not contribute to the change in peak VO2 after training. These findings are in contrast with the benefits of exercise on vascular function in heart failure with reduced ejection fraction and coronary artery disease.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU Framework Programme 7 Table 1
New Onset of AV- Nodal Reentrant Tachycardia (AVNRT) in the elderly – an uncommon diagnosis?
Authors: Grosse A , Surber R , Kirsch K , Schulze P C 
Published: October 2021

Abstract

Background
Arrhythmias in elderly patients (&gt;70 years) are common in daily clinical practice. Most frequently, they are based on atrial fibrillation or other atrial tachycardia with an indication for oral anticoagulation and specific antiarrhythmic medications. The electrographic (ECG) documentation related to symptoms is essential before therapy initiation. In case of suspected AVNRT based on surface ECG, an electrophysiological study (EP) with ablation as curative strategy should be planned.

Methods
We analysed all patients &gt;70 years with AVNRT diagnosed by electrophysiologic (EP) studies between May 2018 and December 2020.

Results
An EP study for suspected AVNRT was performed in 27 patients &gt;70 years. The diagnosis of AVNRT was confirmed in 20 patients (75%). From all EP- studies with the diagnosis of AVNRT (n=93) in this period, 20 patients (22%) were older than 70 years (mean age 77 years with a range of 70–85 years), 12 were women. In most of the patients, the duration of symptoms was short (3 month). Only 4 patients had symptoms of paroxysmal tachycardia longer than 10 years. Except for 2 patients, all patients had at least one ECG- documentation (12- lead- ECG, Holter- ECG, telemetric ECG and/or in the loop recorder). In 12 patients, a 12- lead- ECG- documentation was available, in 5 patients the tachycardia has been registered in the Holter-ECG and in 1 in a loop recorder. In the 12- lead- ECG before ablation in sinus rhythm the PQ interval was with 196 (120- 300) ms in the upper range. In 16/ 20 patients was during the EP- study a sustained AVNRT (CL 410, 314- 538 ms) inducible. In the others, up to 3 typical AV- nodal- echo beats were induced in the EP- study. A slow pathway ablation/ modification was performed in all patients in typical position. In 2 patients, the implantation of a dual- chamber- pacemaker was necessary due to intermittent high- degree AV-nodal-block during the same hospital stay. In both patients, a first degree AV-block with PQ- interval of 250 and 300 ms was pre-existing.

Discussion
Especially for the elderly patients with new onset of clinical symptoms of arrhythmia, clinical anamnesis including an ECG- documentation is required for planning the therapeutic strategy. A borderline long PQ- interval as sign of an age- dependent fibrosis in the AV- node and, therefore, altered conduction properties in the AV node can be a cause of AVNRT in these older patients. In patients with pre-existing long PQ- interval (&gt;250 ms), the risk of pacemaker implantation after successful ablation is higher. In this group of patients, medical therapeutic options are limited and often associated with the need of pacemaker implantation.

Funding Acknowledgement
Type of funding sources: None.
Co-designing digital cardiac rehabilitation with patients living in rural and remote Australia – the Country Heart Attack Prevention (CHAP) Project
Authors: Nesbitt K , Beleigoli A , Du H , Champion S , Clark R A , Tirimacco R ,   The country heart attack prevention project
Published: October 2021

Abstract

Background/Significance
Web-based CR can provide an alternative, patient centred, flexible delivery option. Co-design with consumers and clinicians is recommended to tailor web-based CR to their needs and preferences as a means of increasing attendance.

Purpose
The objective of this study is to describe how patient-generated data through workshops on desired content and features informs technology and implementation specifications for the patient portal of a CR website.

Methods
This study used the UX Design theoretical framework to gain critical feedback and insights from participants. The System Usability Scale (SUS) measured objective feedback, with one-way ANOVA performed on the SUS means, informing on variance. Thematic analysis of participants perceptions, via voice recording provided themes.

Results
Based on the feedback from participants in rural and remote SA, desired content and features were updated for improving user experience. We recruited 39 participants, into 6 workshops, across 5 regional Local Health Networks in SA. The median age of participants was 70 (IQR 17, minimum 40 – maximum 84), 19 (48.7%) were female and 39 (100%) had completed a cardiac rehabilitation program. More than half had experienced a myocardial infarction 24 (61.5%). A greater number used a smart phone (27, 69.2%) and Facebook (31, 79.5%). The SUS did not differ across the workshops (p=0.20), with a tendency to usability improving over time. Five themes were identified, input information, format of information, usability, support of health behaviour change and language.

Conclusion
The co-design process has contributed to the development of the CR website, improving desired content and features. Improved usability scores can be achieved through further incorporating consumer feedback into the development of the CR website.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Novartis Australia Figure 1. Mean SUS ScoresFigure 2. Workshop Themes
Costs analysis from a randomized comparison of immediate versus delayed angiography in patients successfully resuscitated after out-of-hospital cardiac arrest
Authors: Camaro C , Bonnes J L , Adang E M , Spoormans E M , Janssens G N , Meuwissen M , Van Der Horst I C C , Voskuil M , Stoel M , Vlaar A P J , Elbers P W G , Van De Ven P M , Lemkes J S , Van Royen N ,   COACT investigators
Published: October 2021

Abstract

Background
In out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation, immediate coronary angiography did not improve clinical outcomes when compared to delayed angiography in the Coronary Angiography after Cardiac Arrest (COACT) trial (1,2). Whether one of the two strategies has benefits in terms of healthcare resource use and costs is currently unknown. We assess the healthcare resource use and costs in patients with OHCA.

Methods
521 patients were eligible for a cost consequence analysis. Detailed healthcare resource use and cost-prices were collected from the initial hospital episode and compared between both groups. A generalized model (GLM) with a log link function and a gamma distribution was performed. Generic quality of life was measured with the RAND36 and collected at 12 months follow-up.

Results
Overall total mean costs were similar between both groups (EUR 33575±19612 vs EUR 33880±21044, P=0.86). GLM: (β 0.991 (95% CI 0.894–1.099), P=0.86. Mean procedural costs (CAG and/or PCI, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384±3447 vs EUR 3028±4220, P&lt;0.001). Costs concerning Intensive Care Unit and ward stay did not show any significant difference. The median for the RAND-36 questionnaire physical component score was 49.2 in the immediate angiography group and 50.4 in the delayed group, P=0.57.

Conclusions
The mean total costs between OHCA patients randomized to an immediate angiography or a delayed invasive strategy were similar. With respect to the higher invasive procedure costs in the immediate group, a strategy awaiting neurological recovery followed by coronary angiography and planned revascularization may be considered.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Supported by unrestricted research grants from the Netherlands Heart Institute, Biotronik, and AstraZeneca.
Assessment of cardiovascular risk factors in the health care centers among a Tunisian adults
Authors: Bannour R , Zammit N , Ghammem R , Ben Fredj S , Bennasrallah C , Mlouki I , EL Echi A , Maatoug J , Ghannem H 
Published: October 2021

Abstract

Background
Almost one third of deaths worldwide are attributable to cardiovascular diseases (CVD). In Tunisia, although a national strategy for the management of high blood pressure and diabetes has been implemented since 1999, CVD still represent a common cause of death. Purpose: To evaluate the assessment of cardiovascular risk factors in the health care centers among the adults of the governorate of Sousse, Tunisia.

Methods
Cross-sectional study was conducted in 2014 among 1977 adults living in 16 districts randomly selected from the delegations of the governorate of Sousse. Data collection was performed by trained doctors using a pre-tested questionnaire administered by interview to participants in their homes. Blood pressure and anthropometric measures were taken after each interview.

Results
The mean age of the participants was 39.8 (± 13.8) years. The sex ratio F/M was 1.54. Among patients with hypertension, 72% of were unbalanced; while 26.2% of participants without a history of hypertension had high blood pressure. Assessment of physical activity, dietary behaviors and weight in the health centers during the previous year, were reported by 28.3%, 32.6% and 36.5% of participants respectively. Assessment of smoking status and waist circumference were rarer with frequencies of 13.5% and 5.6% respectively.

Conclusions
The current national Tunisian program for diabetes and hypertension management should be reformed. Healthy life style promotion should integrate this national program.

Key messages
Dispite thenational strategy for the management of high blood pressure and diabetes in Tunisia; Cardio vascular disease still represent a common cause of death. The current national Tunisian program for diabetes and hypertension management should be reformed.
Parental Beliefs on the Harmfull Effects of Third Hand Smoke: Systematic Review and Meta-analysis
Authors: Oktar D , Ozcan L , Onsuz MF , Metintas S 
Published: October 2021

Abstract

Background
Third-hand smoke (THS); occurs as a result of the reaction of tobacco smoke residues left on furnitures or on smokers with the chemical substances in the environment. Children are a risky group in terms of THS exposure because they spend a lot of time at home and touch surfaces frequently. The aim is to systematically compile and meta-analyze studies in which parents' beliefs that THS are harmful are evaluated.

Methods
Pubmed, Scpous and Web of Science databases were scanned until April 6, 2021. Selective keywords were ‘third-hand smoke', ‘third hand smoke', ‘thirdhand smoke' and ‘belief'. Articles that were found to be suitable for the purpose of the study were also included by manually searching the references of the included articles. The PRISMA checklist was followed in the study. Studies that could not be clearly differentiated from THS from second-hand tobacco smoke and were not performed in parents were excluded. Duplicates were eliminated and the remaining article abstracts were read double-blind. Study data were entered into the OpenMeta [Analyst] program. Fixed effects model in the presence of homogeneous groups and random effects model in the presence of heterogeneous groups were used.

Results
As a result of the first literature search, 302 articles were reached. A total of 7 studies were included in the meta-analysis. As a result of the analysis, 4274 (57.3%, 95% CI 51.5-63.2) of 7632 parents were smoking and 5864 (76.3%, 95 CI 64.3-88.4) believed THS harms the health of children. In 4 studies, 2037 of 3581 parents (45.2%, 95% CI 24.2-66.1) were implementing a smoking ban at home. In 3 studies, the belief that THS is harmful to child health was higher in the presence of smoking ban at home (OR: 2.03, 95% GA 1.45-2.85, p &lt; 0.001).

Conclusions
The frequency of smoking and smoking at home is high in parents. One in four parents does not believe THS is harmful to children's health.

Key messages
In order to protect children from THS harms, it is not enough just to not smoke in the house, and smoking should be evoided everywhere. Educational interventions should be planned to convince parents about the harmful effects of THS on child health.
Depicting socioeconomic disadvantage and social gradient in quality of life in Limassol, Cyprus
Authors: Middleton N , Theodorou E , Panayiotou A , Kleopa D , Ellina P , Kouta C 
Published: October 2021

Abstract

Background
The lack of validated and accepted area-level indices of socioeconomic disadvantage at national or regional level in Cyprus poses a barrier to “spatial thinking” among Public Health policy-makers and researchers.

Methods
A composite index of socioeconomic disadvantage was constructed by exploring the factor structure of 28 commonly used census indicators at city quarter (N = 38, median population 3894, IQR 2570-6169) and postcode level (N = 124, median 1320, IQR 798-2014). Predictive validity was explored in mixed random-effect regression models in term of associations with SF-36 health-related quality of life among a stratified random sample aged 45-64 (N = 450, 45 neighbourhoods).

Results
There was wide variability across communities in all indicators, for instance, 0.4%-25.9% unemployment, 41.1%-90.7% at most secondary level education, 3.6%-95.9% residences built prior to 1980. Two factors were identified: “socioeconomic disadvantage” (SED), with the same set of 11-12 indicators at the two levels of geographical aggregation, and “built environment”, reflecting proximity to the city centre, with nevertheless no meaningful associations with the outcome of interest. The SED index captured a stepwise decrease in physical (-1.39 95%CI -2.06, -0.72) and mental health (-1.26 95% -1.98, -0.54) scores across quartiles of postcodes with increasing disadvantage, of similar clinically significant effect size by gender. Associations attenuated slightly but remained significant after adjusting for person-based indicators of social position, with some weak evidence of cross-level interactions for physical, but not mental, health.

Conclusions
The composite index, tapping on educational, economic, material, occupational and social disadvantage, allowed the exploration of socioeconomic disadvantage patterning at a small-area level in the city of Limassol and documented the social gradient in health-related quality of life among a late working-life sample of residents.

Key messages
First-time depiction of the geographical patterning of socioeconomic disadvantage across the small geographical level of postcodes in the city of Limassol, Cyprus. Social gradient in physical and mental health in men and women across the continuum of socioeconomic disadvantage over and above person-based indicators of social position.
Clinician responses to cannabis use during pregnancy and lactation: a systematic review and integrative mixed-methods research synthesis
Authors: Panday Janelle , Taneja Shipra , Popoola Anuoluwa , Pack Rachael , Greyson Devon , McDonald Sarah D , Black Morgan , Murray-Davis Beth , Darling Elizabeth , Vanstone Meredith 
Published: October 2021

Abstract

Background
Perinatal cannabis use is increasing, and clinician counselling is an important aspect of reducing the potential harm of cannabis use during pregnancy and lactation. To understand current counselling practices, we conducted a systematic review and integrative mixed-methods synthesis to determine “how do perinatal clinicians respond to pregnant and lactating patients who use cannabis?”

Methods
We searched 6 databases up until 2021-05-31. Eligible studies described the attitudes, perceptions, or beliefs of perinatal clinician about cannabis use during pregnancy or lactation. Eligible clinicians were those whose practice particularly focusses on pregnant and postpartum patients. The search was not limited by study design, geography, or year. We used a convergent integrative analysis method to extract relevant findings for inductive analysis.

Results
Thirteen studies were included; describing perspectives of 1,366 clinicians in 4 countries. We found no unified approach to screening and counselling. Clinicians often cited insufficient evidence around the effects of perinatal cannabis use and lacked confidence in counselling about use. At times, this meant clinicians did not address cannabis use with patients. Most counselled for cessation and there was little recognition of the varied reasons that patients might use cannabis, and an over-reliance on counselling focussed on the legal implications of use.

Conclusion
Current approaches to responding to cannabis use might result in inadequate counselling. Counselling may be improved through increased education and training, which would facilitate conversations to mitigate the potential harm of perinatal cannabis use while recognizing the benefits patients perceive.
Diameter, height and volume increment single tree models for improved Sitka spruce in Great Britain
Authors: Manso Rubén , Davidson Rachael , McLean J Paul 
Published: October 2021

Abstract
The British forestry sector lacks reliable dynamic growth models for stands of improved Sitka spruce, the most important commercial forest type in Great Britain. The aim of this study is to fill this gap by trialling a new modelling framework and to lay the foundations of a future dynamic growth simulator for that forest type. First, we present single tree diameter and height increment models that are climate sensitive and include explicit competition effects. The predictions from the increment models are pooled to project diameter and height at a given age. These projections are then used as inputs to an integrated taper model from which stochastic tree volume predictions are obtained. Retrospective data from over 1400 trees collected in two extensive genetic trials in Scotland and Wales were used for the purposes of this study. Diameter increment and height increment predictions were highly accurate and diameter and height projections proved consistent. The predicted volume at the time of harvesting also exhibited a high degree of accuracy, which shows the robustness of our approach. Further data will be needed in the future to recalibrate the present models and extend their range of validity to the whole of Great Britain.