POST EVENT-CARDIOVASCULAR RISK PERCEPTION SURVEY: VALIDITY AND RELIABILITY IN CARDIAC PATIENTS POST HEART EVENT.

Background: Cardiac risk perception in patients who had a heart event is unknown. Purpose: Evaluate the validity and reliability of the Post Event-Cardiovascular Risk Perception Survey (PE-CRPS). Methods: This is a descriptive, cross-sectional study with a convenient sample of 251 patients who experienced a heart event. Descriptive and exploratory factor analyses was used to analyze the data. Results: Nine of ten items with an oblique (direct oblimin) rotation resulted in two factors extracted, which explained 54% of the variance. The two factors represented perception of medical history variable and a stress/family history variable. Cronbach's α reliability analyses indicated both factors were reliable; strongly related with a correlation of .69 and .81. Conclusion: Cardiovascular risk perception explained by two factors.

Exercise Adherence in Older and Middle-Aged Adults With Coronary Artery Disease Before and During COVID-19.

BACKGROUND: Regular exercise is advised for individuals given a diagnosis of cardiovascular disease. COVID-19 presented challenges to exercise adherence. OBJECTIVE: The objective of this study was to determine long-term exercise adherence and whether individuals with cardiovascular disease adhered to American Heart Association/American College of Cardiology Foundation guidelines before and during the COVID-19 pandemic. METHODS: This is an observational cross-sectional study in which men (73%) and women discharged from a multiwide hospital system after an acute coronary event were enrolled. Participants completed 3 questionnaires, including the Exercise Adherence Rating Scale. RESULTS: Five hundred eighty-two individuals (mean [SD] age, 67 [9.8] years) completed the survey. Fifty-three percent of participants met minimum exercise guidelines during COVID-19. Exercise days per week decreased significantly during COVID-19 in women (P = .013) but not significant for men (P = .301). Categorized by age, the decrease was significant for middle-aged women (P = .002), not older women (P = .336). Men exercised more minutes per session (P = .034), and had greater exercise adherence (P = .003) and greater exercise intensity (P < .001). Overall, women participated less in cardiac rehabilitation (P = .046) and reported the greatest disparity in exercise adherence and intensity. CONCLUSION: Exercise after an acute event is beneficial, and the percentage of individuals meeting recommended guidelines should be higher considering the relationship between exercise and the possibility of future cardiac events. On the basis of the many physical and mental benefits of maintaining exercise, healthcare practitioners are encouraged to screen all patients for exercise adherence with a major emphasis on educating women and older adults.

Comparison of Lean Mass in Women With and Without Heart Disease.

PURPOSE: This proof-of-concept study compared lean mass (LM) between women with heart disease (HD) and without HD. METHODS: Fifty-six community-dwelling women were pair-matched by age. Heart disease was defined using criteria from the US Behavioral Risk Factor Surveillance System. Body composition was measured using multifrequency bioelectrical impedance analysis. Relative LM was calculated against height (kg/m2) as the lean mass index (LMI). Sarcopenia was defined as an LMI <15.0 kg/m2. Strength was measured with a handgrip dynamometer, arm curl test, and chair stand test. RESULTS: Those with HD had significantly less absolute (38.2 ± 0.8 vs 43.5 ± 1.0 kg; P < .001) and relative (15.3 ± 0.3 vs 16.2 ± 0.3 kg/m2, P = .015) LM compared with those without HD. Body mass was significantly greater for those without HD (76.1 ± 2.1 vs 68.4 ± 2.1 kg; P = .013) and there were no differences in fat mass. Upper body strength was significantly less and lower body strength was diminished but not significantly different in those with HD compared to those without HD (handgrip: P = .016; arm curl: P < .001; chair stand: P = .066). CONCLUSIONS: In this group of community-dwelling women, those who reported a diagnosis of HD had significantly less LM than those without HD. Although neither group was classified as sarcopenic, women with HD were at greater risk due to lower relative LM. Based on our findings, during cardiac rehabilitation clinicians should counsel women regarding resistance exercise for maintenance of LM in addition to strength.

Matrix-Bound Growth Factors are Released upon Cartilage Compression by an Aggrecan-Dependent Sodium Flux that is Lost in Osteoarthritis.

Articular cartilage is a dense extracellular matrix-rich tissue that degrades following chronic mechanical stress, resulting in osteoarthritis (OA). The tissue has low intrinsic repair especially in aged and osteoarthritic joints. Here, we describe three pro-regenerative factors; fibroblast growth factor 2 (FGF2), connective tissue growth factor, bound to transforming growth factor-beta (CTGF-TGFß), and hepatoma-derived growth factor (HDGF), that are rapidly released from the pericellular matrix (PCM) of articular cartilage upon mechanical injury. All three growth factors bound heparan sulfate, and were displaced by exogenous NaCl. We hypothesised that sodium, sequestered within the aggrecan-rich matrix, was freed by injurious compression, thereby enhancing the bioavailability of pericellular growth factors. Indeed, growth factor release was abrogated when cartilage aggrecan was depleted by IL-1 treatment, and in severely damaged human osteoarthritic cartilage. A flux in free matrix sodium upon mechanical compression of cartilage was visualised by 23Na -MRI just below the articular surface. This corresponded to a region of reduced tissue stiffness, measured by scanning acoustic microscopy and second harmonic generation microscopy, and where Smad2/3 was phosphorylated upon cyclic compression. Our results describe a novel intrinsic repair mechanism, controlled by matrix stiffness and mediated by the free sodium concentration, in which heparan sulfate-bound growth factors are released from cartilage upon injurious load. They identify aggrecan as a depot for sequestered sodium, explaining why osteoarthritic tissue loses its ability to repair. Treatments that restore matrix sodium to allow appropriate release of growth factors upon load are predicted to enable intrinsic cartilage repair in OA. SIGNIFICANCE STATEMENT: Osteoarthritis is the most prevalent musculoskeletal disease, affecting 250 million people worldwide.1 We identify a novel intrinsic repair response in cartilage, mediated by aggrecan-dependent sodium flux, and dependent upon matrix stiffness, which results in the release of a cocktail of pro-regenerative growth factors after injury. Loss of aggrecan in late-stage osteoarthritis prevents growth factor release and likely contributes to disease progression. Treatments that restore matrix sodium in osteoarthritis may recover the intrinsic repair response to improve disease outcome.

"Would You Rather Jump Out of a Perfectly Good Airplane or Develop Cardiovascular Disease?" Validity and Reliability of the Cardiovascular Risk Perception Survey Among Military Personnel.

BACKGROUND AND PURPOSE: Cardiovascular disease (CVD) is a major cause of death in the United States. The military are viewed as fit, ready to fight and that jumping out of perfectly good airplane or going to war is a greater risk than CVD. The purpose of this study was to determine reliability and validity of the Cardiovascular Risk Perception Survey (CRPS). METHODS: A cross-sectional descriptive design was performed, supported by the Health Belief Model. Internal consistency reliability (Cronbach's alpha) and validity (principal component analysis) were examined. RESULTS: Fifty-five participants were included in this study. Construct validity of the CRPS was supported by principal component analysis; indicating one scale that measured cardiovascular risk perception. The Cronbach's alpha is reported .865. CONCLUSION: Initial psychometric testing of the CRPS provides evidence for construct validity and internal consistency reliability.

Validity of a Single Activity Question for Clinical Assessment of Older Women.

Physical activity is an important part of clinical assessment. However, objective measurement can be expensive and burdensome. The current study validated a single activity question for use in clinical assessment. Ninety-seven older women (mean age = 73.7 years, SE = 0.7) completed an activity questionnaire and measurement of anthropometrics, body composition, and strength. Activity level was reported as not active, somewhat active, active, and very active. Activity level was significantly related to hours of light, moderate, and vigorous activity; body mass index (BMI); waist circumference; percent fat and lean mass; and strength (p < 0.05). When activity levels were collapsed into two groups (not active + somewhat active, and active + very active), women in the high activity group (n = 48) were significantly (p < 0.05) more active, had healthier BMI and waist circumference values, less fat and more lean mass, and were stronger than women in the low activity group (n = 49). A single activity question is valid for use in clinical assessment. [Journal of Gerontological Nursing, 46(12), 15-22.].

Contrasting responses to salinity and future ocean acidification in arctic populations of the amphipod Gammarus setosus.

Climate change is leading to alterations in salinity and carbonate chemistry in arctic/sub-arctic marine ecosystems. We examined three nominal populations of the circumpolar arctic/subarctic amphipod, Gammarus setosus, along a salinity gradient in the Kongsfjorden-Krossfjorden area of Svalbard. Field and laboratory experiments assessed physiological (haemolymph osmolality and gill Na+/K+-ATPase activity, NKA) and energetic responses (metabolic rates, MO2, and Cellular Energy Allocation, CEA). In the field, all populations had similar osmregulatory capacities and MO2, but lower-salinity populations had lower CEA. Reduced salinity (S = 23) and elevated pCO2 (~1000 µatm) in the laboratory for one month increased gill NKA activities and reduced CEA in all populations, but increased MO2 in the higher-salinity population. Elevated pCO2 did not interact with salinity and had no effect on NKA activities or CEA, but reduced MO2 in all populations. Reduced CEA in lower-rather than higher-salinity populations may have longer term effects on other energy demanding processes (growth and reproduction).

Systematic Review of Interventions Designed to Maintain or Increase Physical Activity Post-Cardiac Rehabilitation Phase II.

BACKGROUND: Cardiovascular disease (CVD) continues to be the No. 1 cause of death in the United States and globally, and individuals with a history of a cardiac event are at increased risk for a repeat event. Physical inactivity creates health problems for individuals with chronic heart disease. Evidence shows that physical activity (PA), as a central component of cardiac rehabilitation phase II (CRII), decreases hospital readmission and mortality. Yet, individual adherence to PA tends to decline several months following CRII completion. OBJECTIVE: The purpose of this review was to evaluate current literature for interventions designed to assist individuals diagnosed with myocardial infarction (MI), coronary artery bypass graft (CABG), coronary artery disease (CAD), and percutaneous coronary intervention (PCI) to maintain or increase PA post-CRII. METHODS: A systematic search of 5 electronic databases including hand-searched articles between 2000 and 2019. Key Medical Subject Headings (MeSH) search terms included cardiac rehabilitation, intervention, exercise or PA, outcomes, compliance, adherence, or maintenance. Only interventions implemented following CRII program completion were included for review. RESULTS: Based on the inclusion criteria, the search yielded 19 randomized control trials retained for descriptive analysis. Interventions were categorized into 3 domains. The intervention designs varied widely in terms of duration of the intervention and the length of time to outcome measurement. Most interventions were short-term with only 2 studies offering a long-term intervention of greater than 1 year. Interventions using a theoretical approach most often included a cognitive-behavioral model. CONCLUSIONS: Interventions offered shortly after completion of CRII may help cardiac patients maintain PA and reduce the risk of experiencing additional cardiac events; however, more quality research is needed. Additional research to examine PA maintenance in older adults (70 years and older) would be valuable based on the increase in average lifespan. Studies with larger and more diverse samples, and less variation in methods and outcomes would greatly increase the ability to conduct a high-quality meta-analysis.

Physical activity-related quality of life in breast cancer survivors compared to healthy women.

OBJECTIVE: To evaluate physical activity-related quality of life (PAQOL) in breast cancer survivors compared to healthy women. METHODS: Physical activity level was measured as not active, somewhat active, active or very active. Intensity was reported as hours per week of light, moderate and vigorous activity. Physical activity-related quality of life was measured with the Vitality Plus Scale, a self-report instrument developed and validated to measure exercise-related health benefits. RESULTS: Compared to healthy women (n = 23), breast cancer survivors (n = 23) were older (57.0 ± 2.3 vs. 49.0 ± 1.1 years; p < .01) and reported more light activity (4.1 ± 0.6 vs. 2.4 ± 0.5 hr/week; p < .05), but no differences in PAQOL. However, when grouped by physical activity level there were no differences in age, but inactive women (n = 30) had higher body mass index (29.3 ± 1.0 vs. 25.1 ± 1.1 kg/m2 ; p < .05) and reported less moderate (1.3 ± 0.4 vs. 3.6 ± 0.8 hr/week; p < .05) and vigorous (0.2 ± 0.1 vs. 1.9 ± 0.5 hr/week; p < .01) activity than active women (n = 16). Furthermore, active women reported higher overall PAQOL, greater energy levels and quicker sleep onset than inactive women (p < .05). CONCLUSIONS: In these women, moderate and vigorous physical activity and PAQOL were not influenced by breast cancer survivorship. Despite diagnosis, active women who engaged in greater amounts of moderate and vigorous activity reported better PAQOL than inactive women.

Ageing significantly impacts the biomechanical function and structural composition of skin.

Skin ageing is a complex process involving the additive effects of skin's interaction with its external environment, predominantly chronic sun exposure, upon a background of time-dependent intrinsic ageing. Here, using non-invasive cutometry and ballistometry, we explore the consequences of ageing on the biomechanical function of skin in otherwise healthy White Northern European volunteers. Intrinsic skin ageing caused biomechanical decline; skin loses both resilience (P < 0.01) and elasticity (P < 0.001), which is characterised histologically by modest effacement of rete ridges (P < 0.05) and disorganisation of papillary dermal elastic fibres. At photoexposed sites, biomechanical testing identified significant loss of biomechanical function-particularly in the aged cohort. Photoaged forearm displayed severe loss of resilience (P < 0.001) and elasticity (P < 0.001); furthermore with repetitive testing, fatigue (P < 0.001), hysteresis (P < 0.001) and viscous "creep" (P < 0.001) were exacerbated. Histologically, both young and aged forearm displayed flattening of rete ridges and disruption to the arrangement of elastic fibres. We conclude that maintenance of skin architecture is inherently associated with optimal biomechanical properties. Modest perturbations to skin architecture-as exemplified by intrinsic ageing-result in moderate functional decline. Chronic sun exposure causes fundamental changes to the clinical and histological appearance of skin, and these are reflected by an extreme alteration in biomechanical function.

How stiff is skin?

The measurement of the mechanical properties of skin (such as stiffness, extensibility and strength) is a key step in characterisation of both dermal ageing and disease mechanisms and in the assessment of tissue-engineered skin replacements. However, the biomechanical terminology and plethora of mathematical analysis approaches can be daunting to those outside the field. As a consequence, mechanical studies are often inaccessible to a significant proportion of the intended audience. Furthermore, devices for the measurement of skin function in vivo generate relative values rather than formal mechanical measures, therefore limiting the ability to compare studies. In this viewpoint essay, we discuss key biomechanical concepts and the influence of technical and biological factors (including the nature of the testing apparatus, length scale, donor age and anatomical site) on measured mechanical properties such as stiffness. Having discussed the current state-of-the-art in macro-mechanical and micromechanical measuring techniques and in mathematical and computational modelling methods, we then make suggestions as to how these approaches, in combination with 3D X-ray imaging and mechanics methods, may be adopted into a single strategy to characterise the mechanical behaviour of skin.

Predicting Long-Term Mortality, Morbidity, and Survival Outcomes Following a Cardiac Event: A Cardiac Rehabilitation Study.

BACKGROUND: Cardiac rehabilitation (CR) has been shown to decrease mortality and morbidity but estimations vary. While there is significant literature supporting short-term benefits, there is not a similarly body of research as to long-term (LT) benefits. Low participation rates in CR are due to several causes and evidence demonstrating positive LT outcomes could be a catalyst to increased participation rates. OBJECTIVE: To predict LT mortality, readmission, and survival benefits associated with CR participation in a nationally certified program. METHODS: Investigators collected mortality and hospital readmission data in a retrospective study to examine a cohort of cardiac patients following a myocardial infarction (MI), MI/percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) up to 14 years ago. Hospital electronic medical record (EMR; n = 207) were used to measure hospital readmission outcome and State Health Department records (n = 361) for mortality and survival outcomes. Participation in CR, age, gender prior history of cardiac event, and diagnosis were used to predict readmission, mortality, and survival. RESULTS: Approximately half (52.1%) the sample participated in CR. Participants included 72% males, average age 68 years (38-91 years), and were predominantly Non-Hispanic white. CR participants attended an average of 20 sessions. CR group differed in diagnoses MI (58.5%), CABG (57.4%) and in prior history of heart disease (25.4%) from the non-cardiac rehabilitation (NCR) group (83.2%, 25.4%, 42.2%, respectively) (P < .05). After controlling for the covariates in logistic regression analyses, the CR group independently predicted lower all-cause mortality (odds ratio, OR = 0.22, 95% CI 0.12 to 0.39) and decreased hospital readmissions (OR = 0.48, 95% CI 0.24 to 0.96). After controlling for the covariates in survival analysis, the CR group significantly contributed to decreased likelihood of death hazard (hazard ratio = 0.36, 95% CI 0.24 to 0.54). Median survivor time for the participants was 5.91 years, SD = 3.81 years. CONCLUSIONS: Participation in CR for middle age and elderly patients is associated with increased survival, a marked decrease in all-cause mortality, and a decrease in cardiovascular-related hospital readmission. A referral to a nationally certified outpatient CR program prior to hospital discharge and early enrollment may improve LT outcomes.

Mentoring for new graduates.

The School of Veterinary Medicine in Dublin (UCD) has introduced an alumni mentoring programme for new veterinary and veterinary nursing graduates. Helen Graham, clinical education support manager, explains how it works.

Individual and population-level responses to ocean acidification.

Ocean acidification is predicted to have detrimental effects on many marine organisms and ecological processes. Despite growing evidence for direct impacts on specific species, few studies have simultaneously considered the effects of ocean acidification on individuals (e.g. consequences for energy budgets and resource partitioning) and population level demographic processes. Here we show that ocean acidification increases energetic demands on gastropods resulting in altered energy allocation, i.e. reduced shell size but increased body mass. When scaled up to the population level, long-term exposure to ocean acidification altered population demography, with evidence of a reduction in the proportion of females in the population and genetic signatures of increased variance in reproductive success among individuals. Such increased variance enhances levels of short-term genetic drift which is predicted to inhibit adaptation. Our study indicates that even against a background of high gene flow, ocean acidification is driving individual- and population-level changes that will impact eco-evolutionary trajectories.