Phase III impact of telerehabilitation in patients with coronary heart disease

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac rehabilitation (CR) in coronary heart disease (CAD) has been shown to improve physical capability and health-related quality of life, reducing morbimortality. However, CR accessibility is still low and patient adherence remains poor. It has been hypothesized that using mobile applications to telemonitor exercise-based CR would increase patient adherence to CR, improving results. Hybrid cardiac telerehabilitation (HCTR) is a new concept that includes center and home interventions.

Objectives

Investigate the effects of HCTR program on improving physical activity, quality of life and reducing cardiovascular risk factors among patients with CAD 1 year after CR phase II.

Materials and methods

Longitudinal retrospective study with patients who attended phase 2 CR program (CRP) at a hospital center between august 2018-november 2020. They were divided in 2 groups: group 1 completed conventional CRP (CCRP), 12 weeks of monitored hospital physical exercise and educational sessions; group 2 participated on HCTR program (CCRP associated to a tele-monitorization platform consisting of a mobile application, MOVIDA.eros, with medical prescription of physical exercise and remote interaction). Group 2 maintained use of MOVIDA.eros on phase 3. Evaluations were performed on T0 – phase 2 onset, T1 – end of phase 2, T2 – 1 year after T1, with registration of age, gender, occupation, body mass index (BMI), exercise stress testing, echocardiogram (evaluation of left ventricular ejection fraction [LVEF]), LDL, HDL cholesterol, triglycerides, NTproBNP levels, and application of EuroQol-5D questionnaire (EQ5D), International Physical Activity Questionnaire – Short Form (IPAQ).

Statistical analysis was completed through software SPSS v28. p-values <0.05 were considered statistically significant.

Results

We analyzed 68 patients, 46 on group 1 and 22 on group 2. Variable analysis revealed similar group characteristics, except for age (p=0.011) and LVEF (p=0.005). There was an association between HCTR adherence and occupation (p=0.002; greater proportion of intellectual professionals on group 2). We observed a significant IPAQ (p=0.018) and EQ-5D index (p=0.034) improvement between T0 to T1 in both groups, but only in group 2 persisted till T2. In exercise stress testing, both groups revealed an increase in METs at T1 and decrease at T2, without significant differences between them. Regarding lipid profile, HbA1c, NTproBNP and BMI, both groups improved from T0 to T1 maintaining it till T2 with no differences between them, however in group 2 HDL cholesterol levels were greater and HbA1c levels were lower than group 1. In both groups, LVEF increased from T0 to T1 and from T1 to T2 in both groups, with faster and higher improvement in group 2.

Conclusions

HCTR outperformed CCRP improving physical activity, patient quality of life, HDL cholesterol and faster improvement of LVEF. These findings encourage the use of a mobile platform in CR.

Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries

AIMS

Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality.

METHODS AND RESULTS

We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients.

CONCLUSION

Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.

Drivers for Teleconsultation Acceptance in Brazil: Patients’ Perspective during the COVID-19 Pandemic

ABSTRACT Context: teleconsultation can be a strategic technological tool for patients to access quality healthcare while dealing with resource challenges within health industry. It can be particularly relevant during and after the COVID-19 pandemic, when the social distancing world had to scramble for new technological solutions to offer quality healthcare services with reduced personal contact. Objective: our research proposes an integrative technology acceptance model to evaluate the drivers of teleconsultation adoption by patients, aligning constructs from the technology acceptance model with other drivers, such as technology readiness, trust, and self-efficacy. Methods: analyses included descriptive statistics and structural equations modeling based on survey’s data from a sample of 415 consumers. Results: results indicate significant relationships between the assessed constructs, with particular relevance on the effects of perceived usefulness, anteceded by trust and technology readiness, on attitude and intention to use teleconsultation. Conclusion: our findings provide helpful insights for health organizations and regulators associated with the diffusion of teleconsultation. The study findings also indicate that the challenging COVID-19 pandemic context may be affecting patients’ intention to adopt teleconsultation.

Influence of microclimate conditions on the cumulative exposure of nursery pigs to swine influenza A viruses

The objective of this study was to investigate the association between environmental temperature and humidity and the presence of antibodies for two specific strains of swine influenza viruses: A/SW/ON/105-56/12/H3N2 (H3N2_D) and A/SW/ON/84/2012/H1N1 (H1N1_P). A cross-sectional study was performed in a commercial farm, and a total of 450 pigs at 10 weeks of age were blood sampled, by sampling 10 pigs per week for 45 weeks corresponding to 45 batches. Exposure of pigs to H3N2_D and H1N1_P virus was assessed by haemagglutination inhibition assay (HI), and a result of ≥1:40 was considered as indication of a positive exposure status for a specific strain. The selection of those two viruses was based on the fact that H1N1 was the dominant virus in Ontario herds, and H3N2 had been previously isolated in this particular farm. Environmental conditions were recorded through a portable device every 5 min and then summarized using descriptive statistics. The association between HI titres and environmental microconditions, in the nursery, was evaluated through random effect linear and logistic regression. The results showed that the prevalence for H1N1_P was high throughout the study (≥70%); however, for H3N2_D, the seroprevalence declined by the end of the study period. Results also showed an association between cumulative exposure to the viruses and temperature and relative humidity (p < .05). These results suggest that microclimate conditions can influence transmission patterns of influenza viruses in swine barns, and that even a herd with relatively simple demographics could have persistent and cocirculation of two different influenza A viruses IAV strains.

Detection of Mycoplasma pulmonis in laboratory rats and technicians

Five species of mycoplasma are associated with several rat diseases. Mycoplasma pulmonis is the most important and most studied, possibly causing disease in rats and undermining the validity of laboratory experiments. M. pulmonis was isolated in 144/240 laboratory rats and identified by PCR in 155/240. This species was also detected in 12 human individuals (technicians of a laboratory animal house hold) in contact with these rats. The results were confirmed by sequencing of DNA products. Mycoplasma species are host specific; however, M. pulmonis was identified in humans, suggesting a case of unspecific colonization. Statistical analysis shows a greater risk for M. pulmonis colonizing individuals who are exposed to infected rats in animal facilities than individuals who do not. The detection of M. pulmonis in humans indicates a new status for this mollicute mycoplasmas in animal-holding facilities.

Use of a polymerase chain reaction for detection of Mycoplasma dispar in the nasal mucus of calves

A polymerase chain reaction (PCR) assay was developed for the detection of Mycoplasma dispar in nasal mucus samples collected from calves. The target DNA sequence was the 16S rRNA gene, and the fragment was selected within a region of high polymorphism. The specificity and detection limit of the method were determined. This method was then used for the detection of M. dispar in nasal swabs collected from 301 calves, including 155 clinical samples from animals showing signs of respiratory disease and 146 samples from healthy animals. PCR with generic primers was applied to the detection of Mollicutes, followed by the detection of M. dispar. Mollicutes were detected in 52.05% of clinical samples from healthy animals and in 90.96% of samples from sick animals. Mycoplasma dispar was detected in 6.16% of healthy animals and in 34.84% of sick animals. The PCR assay was useful in verifying the presence of M. dispar in calves and may be a useful tool in monitoring this mycoplasma in cattle herds.

Drinking water as an iron carrier to control anemia in preschool children in a day-care center

OBJECTIVE

Several foods have been used as iron (Fe) carriers to fight widespread global Fe deficiency and anemia. This paper describes the longitudinal effect of Fe-fortified drinking water given to a group of Brazilian preschool children.

DESIGN

The experimental design included 31 preschool children who attended a day-care institution. Hemoglobin and serum ferritin were the blood parameters used to check the Fe status. Fe++ sulfate (20 mg Fe/L) was added daily to their drinking water container and measurements were obtained before the addition, 4 and 8 months later.

RESULTS

The number of Fe-deficient children decreased drastically after they started drinking the Fe-enriched water. Mean hemoglobin values increased from 10.6 to 13.7 g/dL and serum ferritin from 13.7 to 25.6 micrograms/L. There were no problems related to the salt addition or to the children drinking the Fe-enriched water.

CONCLUSION

Fe-enriched drinking water was shown to be a practical alternative to supply Fe to children attending a day-care institution.

[Dupuytren's disease. Analysis of a 10 year caseload]

The authors present an analysis concerning patients operated on for Dupuytren contracture over the past ten years. One hundred and ten patients (94 males and 16 females) were reviewed. At the time of surgery the average was 52 years old. The 125 hands (292 fingers) were rated 3,136, according to the simplified Tubiana's score. In 82.7% of the patients, selective regional fasciectomy was applied. In the long term, recurrence appeared in 58 hands (96 fingers); 74.1% being in the first five years. 48 of them were graded Stage Nodular, 28 Stage 1, 16 Stage 2, 4 Stage 3. Some factors seem to be of a bad prognosis regarding recurrence: ectopic localisations, age (under 55 years old), alcoholism, diabetes mellitus, epilepsy, and family history. Results after operative procedure were satisfactory. The hands were rated 1,316 and the Coefficient of Amelioration was above 0.75 in more than 50%.

Prevalence of nits and lice in samples of cut hair from floors of barbershops and beauty parlors in Belo Horizonte, Minas Gerais State, Brazil

A louse survey based on samples of cut hair collected from floors of barbershops and beauty parlors was conducted in Belo Horizonte, Minas Gerais State, Brazil, from October 1984 to April 1985, as an alternative way to determine the prevalence of pediculosis capitis in the population. Of 475 samples examined for nits, nymphs, or adults of Pediculus capitis, 140 were infested (29.5%). A total of 58 lice and 3,553 nits were found in 33,632.9 g of hair collected, giving a ratio of 0.10 nit/g. Almost 29% of the nits were viable and capable of being transmitted after hatching. There was significant difference among the infestation rates by socioeconomic levels, and samples from barbershops with male customers were the most infested. Based upon the number of haircuts in each sample, we estimated that 5 or 6% of the population might be infested by this species.