The impact of COVID-19 on the lives of Canadians with and without non-communicable chronic diseases: results from the iCARE Study.

BACKGROUND: The COVID-19 pandemic and its prevention policies have taken a toll on Canadians, and certain subgroups may have been disproportionately affected, including those with non-communicable diseases (NCDs; e.g., heart and lung disease) due to their risk of COVID-19 complications and women due to excess domestic workload associated with traditional caregiver roles during the pandemic. AIMS/OBJECTIVES: We investigated the impacts of COVID-19 on mental health, lifestyle habits, and access to healthcare among Canadians with NCDs compared to those without, and the extent to which women with NCDs were disproportionately affected. METHODS: As part of the iCARE study ( www.icarestudy.com ), data from eight cross-sectional Canadian representative samples (total n = 24,028) was collected via online surveys between June 4, 2020 to February 2, 2022 and analyzed using general linear models. RESULTS: A total of 45.6% (n = 10,570) of survey respondents indicated having at least one physician-diagnosed NCD, the most common of which were hypertension (24.3%), chronic lung disease (13.3%) and diabetes (12.0%). In fully adjusted models, those with NCDs were 1.18-1.24 times more likely to report feeling lonely, irritable/frustrated, and angry 'to a great extent' compared to those without (p's < 0.001). Similarly, those with NCDs were 1.22-1.24 times more likely to report worse eating and drinking habits and cancelling medical appointments/avoiding the emergency department compared to those without (p's < 0.001). Moreover, although there were no sex differences in access to medical care, women with NCDs were more likely to report feeling anxious and depressed, and report drinking less alcohol, compared to men with NCDs (p's < 0.01). CONCLUSION: Results suggest that people with NCDs in general and women in general have been disproportionately more impacted by the pandemic, and that women with NCDs have suffered greater psychological distress (i.e., feeling anxious, depressed) compared to men, and men with NCDs reported having increased their alcohol consumption more since the start of COVID-19 compared to women. Findings point to potential intervention targets among people with NCDs (e.g., prioritizing access to medical care during a pandemic, increasing social support for this population and mental health support).

Aerobic Exercise Prescription in Cardiac Rehabilitation Based on Heart Rate from Talk Test Stages and 6-Minute Walk Test. / Prescrição de Exercício Aeróbio na Reabilitação Cardíaca Baseada na Frequência Cardíaca dos Estágios do Teste da Fala e do Teste de Caminhada de 6 Minutos.

BACKGROUND: Although the Talk Test (TT) is a reliable and low-cost test, its use for aerobic exercise prescription is still limited. OBJECTIVE: To analyze the heart rate (HR) in the stages of the TT and at the peak of the 6-minute walk test (6MWT) as a parameter to prescribe aerobic exercise compared with HR at the first and second ventilatory thresholds (VT1 and VT2) of cardiopulmonary exercise test (CPET). METHODS: Individuals with cardiovascular disease attended three assessment days: 1) anamnesis and CPET; 2) 6MWT; and 3) TT. One-way repeated measures ANOVA or Friedman's test were used to compare HR at VT1 and VT2 with HR at TT stages: last positive (TT+), first equivocal (TT±), and negative (TT-), and at the peak of the 6MWT. Pearson's or Spearman's test assessed correlations between HR at VTs, TT stages, and 6MWT. Statistical significance was set at 5%. RESULTS: The study included 22 cardiac patients (13 men, 61 ± 8 years). HR at VT1 was similar to HR at TT+ (p = 0.987) and TT± (p = 0.154), and moderately correlated with TT+ (r = 0.479, p = 0.024). HR at VT2 was similar to TT- (p = 0.383), with a strong correlation (r = 0.757, p < 0.001). HR at the peak of the 6MWT was significantly different from HR at TT+, TT±, and VT1 (p = 0.001, p = 0.005, and p < 0.001, respectively) but similar to TT- (p = 0.68). CONCLUSIONS: HR at TT+ and TT- reflect HR at VT1 and VT2, respectively, differently from 6MWT, which was similar only to VT2. TT may be an objective test to assist aerobic exercise prescription in cardiac rehabilitation.

FUNDAMENTO: Embora o Teste da Fala (TF) seja um teste confiável e de baixo custo, seu uso para prescrição de exercício aeróbio ainda é limitado. OBJETIVO: Analisar a frequência cardíaca (FC) dos estágios do TF e no pico do teste de caminhada de 6 minutos (TC6min) como parâmetro para a prescrição de exercício aeróbio comparando com a FC no primeiro e segundo limiares ventilatórios (LV1 e LV2) do teste cardiopulmonar de exercício (TCPE). MÉTODOS: Pacientes com doença cardiovascular compareceram a 3 dias de avaliação: 1) anamnese e TCPE; 2) TC6min; e 3) TF. Foram usados ANOVA unidirecional de medidas repetidas ou teste de Friedman para comparar a FC no LV1 e LV2 com a FC nos estágios do TF: último positivo (TF+), primeiro equívoco (TF±) e negativo (TF−) e no pico do TC6min. O teste de Pearson ou Spearman avaliou se há correlação entre FC em LVs, estágios do TF e TC6min. A significância estatística foi fixada em 5%. RESULTADOS: O estudo incluiu 22 pacientes cardíacos (13 homens, 61 ± 8 anos). A FC no LV1 foi semelhante à FC no TF+ (p = 0,987) e TF± (p = 0,154), e moderadamente correlacionada com o TF+ (r = 0,479, p = 0,024). A FC no LV2 foi semelhante ao TF− (p = 0,383), com forte correlação (r = 0,757, p < 0,001). A FC no pico do TC6min foi significativamente diferente da FC no TF+, TF± e LV1 (p = 0,001, p = 0,005 e p < 0,001, respectivamente), mas semelhante ao TF− (p = 0,68). CONCLUSÕES: A FC no TF+ e TF− reflete a FC no LV1 e LV2, respectivamente, diferentemente do TC6min, que foi semelhante apenas ao LV2. O TF pode ser um teste objetivo para auxiliar a prescrição de exercício aeróbio na reabilitação cardíaca.

Long-term effectiveness of COVID-19 vaccines against infections, hospitalisations, and mortality in adults: findings from a rapid living systematic evidence synthesis and meta-analysis up to December, 2022.

BACKGROUND: Synthesising evidence on the long-term vaccine effectiveness of COVID-19 vaccines (BNT162b2 [Pfizer-BioNTech], mRNA-1273 [Moderna], ChAdOx1 nCoV-19 [AZD1222; Oxford-AstraZeneca], and Ad26.COV2.S [Janssen]) against infections, hospitalisations, and mortality is crucial to making evidence-based pandemic policy decisions. METHODS: In this rapid living systematic evidence synthesis and meta-analysis, we searched EMBASE and the US National Institutes of Health's iSearch COVID-19 Portfolio, supplemented by manual searches of COVID-19-specific sources, until Dec 1, 2022, for studies that reported vaccine effectiveness immediately and at least 112 days after a primary vaccine series or at least 84 days after a booster dose. Single reviewers assessed titles, abstracts, and full-text articles, and extracted data, with a second reviewer verifying included studies. The primary outcomes were vaccine effectiveness against SARS-CoV-2 infections, hospitalisations, and mortality, which were assessed using three-level meta-analytic models. This study is registered with the National Collaborating Centre for Methods and Tools, review 473. FINDINGS: We screened 16 696 records at the title and abstract level, appraised 832 (5·0%) full texts, and initially included 73 (0·4%) studies. Of these, we excluded five (7%) studies because of critical risk of bias, leaving 68 (93%) studies that were extracted for analysis. For infections caused by any SARS-CoV-2 strain, vaccine effectiveness for the primary series reduced from 83% (95% CI 80-86) at baseline (14-42 days) to 62% (53-69) by 112-139 days. Vaccine effectiveness at baseline was 92% (88-94) for hospitalisations and 91% (85-95) for mortality, and reduced to 79% (65-87) at 224-251 days for hospitalisations and 86% (73-93) at 168-195 days for mortality. Estimated vaccine effectiveness was lower for the omicron variant for infections, hospitalisations, and mortality at baseline compared with that of other variants, but subsequent reductions occurred at a similar rate across variants. For booster doses, which covered mostly omicron studies, vaccine effectiveness at baseline was 70% (56-80) against infections and 89% (82-93) against hospitalisations, and reduced to 43% (14-62) against infections and 71% (51-83) against hospitalisations at 112 days or later. Not enough studies were available to report on booster vaccine effectiveness against mortality. INTERPRETATION: Our analyses indicate that vaccine effectiveness generally decreases over time against SARS-CoV-2 infections, hospitalisations, and mortality. The baseline vaccine effectiveness levels for the omicron variant were notably lower than for other variants. Therefore, other preventive measures (eg, face-mask wearing and physical distancing) might be necessary to manage the pandemic in the long term. FUNDING: Canadian Institutes of Health Research and the Public Health Agency of Canada.

Prescrição de Exercício Aeróbio na Reabilitação Cardíaca Baseada na Frequência Cardíaca dos Estágios do Teste da Fala e do Teste de Caminhada de 6 Minutos / Aerobic Exercise Prescription in Cardiac Rehabilitation Based on Heart Rate from Talk Test Stages and 6-Minute Walk Test

Resumo Fundamento Embora o Teste da Fala (TF) seja um teste confiável e de baixo custo, seu uso para prescrição de exercício aeróbio ainda é limitado. Objetivo Analisar a frequência cardíaca (FC) dos estágios do TF e no pico do teste de caminhada de 6 minutos (TC6min) como parâmetro para a prescrição de exercício aeróbio comparando com a FC no primeiro e segundo limiares ventilatórios (LV1 e LV2) do teste cardiopulmonar de exercício (TCPE). Métodos Pacientes com doença cardiovascular compareceram a 3 dias de avaliação: 1) anamnese e TCPE; 2) TC6min; e 3) TF. Foram usados ANOVA unidirecional de medidas repetidas ou teste de Friedman para comparar a FC no LV1 e LV2 com a FC nos estágios do TF: último positivo (TF+), primeiro equívoco (TF±) e negativo (TF−) e no pico do TC6min. O teste de Pearson ou Spearman avaliou se há correlação entre FC em LVs, estágios do TF e TC6min. A significância estatística foi fixada em 5%. Resultados O estudo incluiu 22 pacientes cardíacos (13 homens, 61 ± 8 anos). A FC no LV1 foi semelhante à FC no TF+ (p = 0,987) e TF± (p = 0,154), e moderadamente correlacionada com o TF+ (r = 0,479, p = 0,024). A FC no LV2 foi semelhante ao TF− (p = 0,383), com forte correlação (r = 0,757, p < 0,001). A FC no pico do TC6min foi significativamente diferente da FC no TF+, TF± e LV1 (p = 0,001, p = 0,005 e p < 0,001, respectivamente), mas semelhante ao TF− (p = 0,68). Conclusões A FC no TF+ e TF− reflete a FC no LV1 e LV2, respectivamente, diferentemente do TC6min, que foi semelhante apenas ao LV2. O TF pode ser um teste objetivo para auxiliar a prescrição de exercício aeróbio na reabilitação cardíaca.

Abstract Background Although the Talk Test (TT) is a reliable and low-cost test, its use for aerobic exercise prescription is still limited. Objective To analyze the heart rate (HR) in the stages of the TT and at the peak of the 6-minute walk test (6MWT) as a parameter to prescribe aerobic exercise compared with HR at the first and second ventilatory thresholds (VT1 and VT2) of cardiopulmonary exercise test (CPET). Methods Individuals with cardiovascular disease attended three assessment days: 1) anamnesis and CPET; 2) 6MWT; and 3) TT. One-way repeated measures ANOVA or Friedman's test were used to compare HR at VT1 and VT2 with HR at TT stages: last positive (TT+), first equivocal (TT±), and negative (TT−), and at the peak of the 6MWT. Pearson's or Spearman's test assessed correlations between HR at VTs, TT stages, and 6MWT. Statistical significance was set at 5%. Results The study included 22 cardiac patients (13 men, 61 ± 8 years). HR at VT1 was similar to HR at TT+ (p = 0.987) and TT± (p = 0.154), and moderately correlated with TT+ (r = 0.479, p = 0.024). HR at VT2 was similar to TT− (p = 0.383), with a strong correlation (r = 0.757, p < 0.001). HR at the peak of the 6MWT was significantly different from HR at TT+, TT±, and VT1 (p = 0.001, p = 0.005, and p < 0.001, respectively) but similar to TT− (p = 0.68). Conclusions HR at TT+ and TT− reflect HR at VT1 and VT2, respectively, differently from 6MWT, which was similar only to VT2. TT may be an objective test to assist aerobic exercise prescription in cardiac rehabilitation.

Frailty influences the vascular responsiveness of elderly individuals with chronic heart failure.

INTRODUCTION: Frailty is highly prevalent in heart failure (HF) patients. HF is associated with oxidative stress and chronic inflammation, which impair oxygen use by skeletal muscles. Little is known about the influence of frailty on vascular responsiveness and tissue oxygenation. OBJECTIVE: Analyze the influence of frailty on vascular responsiveness and muscle oxygenation in elderly individuals with and without HF. METHODS: Individuals aged ≥60 years, with or without HF, were evaluated for frailty (phenotype). Near-infrared spectroscopy (NIRS) was used to assess muscle oxygenation at rest (oxygen saturation - StO2 and deoxyhemoglobin) and during handgrip exercise (minimum StO2 and maximum deoxyhemoglobin), and oxygenation variables. STATISTICAL ANALYSIS: Results were grouped according to the frailty phenotype: non-frail, pre-frail, and frail. Shapiro-Wilk test was used to assess normality. Data were compared using a two-way analysis of variance (ANOVA). Bonferroni post hoc test was applied to determine the influence of frailty or HF on NIRS variables. SPSS software was used in the analyses; p < 0.05 was considered significant. RESULTS: 55 elderly participants (61.8% female; 70.4 ± 7.2 years old; 28 HF patients) participated in the study. 32.7% (n = 18) were classified as non-frail, 43.3% (n = 24) as pre-frail, and 23.6% (n = 13) as frail. The analysis of vascular responsiveness (n = 52) identified an influence (p < 0.05) of frailty on the reperfusion rate (slope 2 and ∆StO2 of nadir-peak) and desaturation during occlusion (area under the curve of StO2) in HF patients. There was no influence of frailty or HF on muscle oxygenation at rest and during exercise (n = 54; p > 0.05). CONCLUSION: The coexistence of frailty and HF seems to impair vascular responsiveness, as frail elderly participants with HF presented lower reperfusion rates and higher desaturation levels during the arterial occlusion test. However, the presence of frailty or HF alone had no influence on muscle oxygenation at rest or during exercise.

Application and Measurement Properties of the Talk Test in Cardiopulmonary Patients: A Systematic Review.

Background: The talk test (TT) evaluates the exercise intensity by measuring speech comfort level during aerobic exercise. There are several application protocols available to assess individuals with cardiopulmonary diseases. However, the measurement properties of the TT were not systematically reviewed yet. Methods: A systematic review was developed, registered (CRD420181068930), and reported according to PRISMA Statement. Randomized clinical trials, cross-sectional studies, or series cases were identified through multiple databases and were selected if they presented concomitant speech provocation and an exercise test. Included studies were evaluated based on methodological quality (adapted New Castle-Ottawa Scale), descriptive quality (STROBE Statement), and risk of bias (COSMIN bias risk scale). Results: Ten studies were included. Seven studies presented moderate to high quality and the majority presented good scores according to the STROBE statement. Four hundred and fourteen subjects performed the TT, the majority being patients with coronary artery disease. The test validity was supported by the included studies. Talk Test reliability was considered satisfactory, although only one study presented an adequate reliability analysis. The studies found a correlation between the last positive stage of the TT with the first ventilatory threshold. Workload, oxygen uptake, and heart rate in the last positive stage of the TT were not different from the same parameters related to the first ventilatory threshold. Conclusions: The evidence indicates that the TT is suitable as an alternative tool for the assessment and prescription of exercise in individuals with cardiovascular diseases. The stage when the individual is still able to speak comfortably is suggested as the intensity for aerobic exercise prescription. As there is still no well-defined and fully explored TT protocol, caution is required when interpreting the TT results.

Pulmonary and muscle profile in pneumosepsis: A temporal analysis of inflammatory markers.

In sepsis, greater understanding of the inflammatory mechanism involved would provide insights into the condition and into its extension to the muscular apparatus in critically ill patients. Therefore, this study evaluates the inflammatory profile of pneumosepsis induced by Klebsiella pneumoniae (K.p.) in lungs and skeletal muscles during the first 72 h. Male BALB/c mice were divided into 4 groups, submitted to intratracheal inoculation of K.p. at a concentration of 2 × 108 (PS) or PBS, and assessed after 24 (PS24), 48 (PS48) and 72 (PS72) hours. The Maximum Physical Capacity Test (MPCT) was performed before and after induction. Pulmonary inflammation was assessed by total cell number, nitric oxide levels (NOx), IL-1ß and TNF-α levels in bronchoalveolar lavage fluid (BALF); inflammation and muscle trophism were evaluated by the levels of TNF-α, IL-6, TGF-ß and BDNF by ELISA and NF-κB by western blotting in muscle tissue. Cells and colony forming units (CFU) were also analyzed in blood samples. The PS groups showed an increase in total cells in the BALF (p < 0.05), as well in the number of granulocytes in the blood (p < 0.05) and a decrease in performance in the MPCT (p < 0.05). NOx levels showed significant increase in PS72, when compared to Control group (p = 0.03). The PS24 showed a significant increase lung in TNF-α levels (p < 0.001) and in CFU (p = 0.013). We observed an increase in muscular IL-6 and nuclear NF-κB levels in PS24 group, when compared to PS48 and Control groups (p < 0.05). Nevertheless, mild signs of injury in the skeletal muscle tissue does not support the idea of an early muscular injury in this experimental model, suggesting that the low performance of the animals during the MPCT may be related to lung inflammation.

Questionnaires Designed to Assess Knowledge of Heart Failure Patients: A Systematic Review.

BACKGROUND: The objectives of this systematic review were (1) to describe the psychometric properties of questionnaires designed to assess knowledge of heart failure (HF) patients and (2) to identify the most applicable questionnaire to assess knowledge of HF patients. METHODS: A literature search of electronic databases was conducted from database inception to March 2014. Eligible articles included studies describing the development and psychometric testing of questionnaires designed to assess HF patients' knowledge. Outcomes were based on the quality criteria for measurement properties of health status questionnaires. Articles were considered for inclusion by 2 authors independently. RESULTS: Overall, 12 articles were included, of which 4 (33.33%) were considered "good" quality. Twelve original English-language instruments were identified. Content validity was described in 10 studies and presented positive ratings in all of them (83.33%); internal consistency in 10 studies and positive ratings in 5 (41.66%); construct validity in 5 and positive ratings in 4 (33.33%); responsiveness in 3 and positive ratings in 2 (16.66%); and reproducibility and floor effects in 1 with positive ratings. Based on our criteria, the Atlanta HF Knowledge Test was identified as the most applicable questionnaire to assess knowledge of HF patients. CONCLUSION: Psychometric properties of questionnaires assessing HF patients' knowledge are poorly described in the literature. Although we identified the Atlanta HF Knowledge Test as the most promising instrument, it has methodological limitations. We recommend the researchers to use the questionnaire that best serves their research question and context.

Knowledge and exercise behavior maintenance in cardiac rehabilitation patients receiving educational interventions.

OBJECTIVES: To test whether a theoretically-based education curriculum results in more sustained knowledge, higher scores on Health Action Process Approach (HAPA) constructs, and greater exercise behavior 6 months post-cardiac rehabilitation (CR) when compared to traditional CR education. BACKGROUND: Patient education is a core component of CR. No research has examined whether this education results in sustained improvements post-program. METHODS: In this quasi-experimental study, participants exposed to the traditional vs HAPA-based education completed surveys pre, post-CR, and 6 months post-discharge assessing knowledge, HAPA constructs, and exercise. RESULTS: Ninety-three participants completed the final survey. Knowledge increases post-CR were sustained 6 months post-program, with no differences by curriculum. Many improvements in HAPA constructs observed post-CR were sustained, except for some decay in self-efficacy. Minutes of exercise per week were significantly greater in participants exposed to the HAPA-based curriculum 6 months post-program. CONCLUSIONS: HAPA-based education in CR has sustained effects on exercise.

Construção e Validação do Questionário de Conhecimentos para Pacientes com Insuficiência Cardíaca / Construction and Validation of a Questionnaire about Heart Failure Patients' Knowledge of Their Disease

Fundamento: A ausência de instrumentos capazes de mensurar o nível de conhecimento de pacientes com insuficiência cardíaca sobre sua própria síndrome, participantes de programas de reabilitação, demonstra a carência de recomendações específicas a respeito da quantidade ou do conteúdo de informações necessárias. Objetivo: Construir e validar um questionário para avaliar o conhecimento sobre sua condição de pacientes portadores de insuficiência cardíaca participantes de programas de reabilitação cardíaca. Métodos: O instrumento foi construído com base no questionário de conhecimento para doença coronariana e aplicado em 96 pacientes com insuficiência cardíaca, com média de idade de 60,22 ± 11,6 anos, 64% homens. A reprodutibilidade foi obtida por meio do coeficiente de correlação intraclasse, utilizando-se as situações do método de teste-reteste. A consistência interna foi obtida pelo alfa de Cronbach e a validade do construto, pela análise fatorial exploratória. Resultados: A versão final do instrumento apresentou 19 questões dispostas em dez áreas de importância para a educação do paciente. O instrumento proposto apresentou um índice de clareza de 8,94 ± 0,83. O valor do coeficiente de correlação intraclasse foi de 0,856 e do alfa de Cronbach, 0,749. A análise fatorial revelou cinco fatores associados às áreas de conhecimento. Quando os escores finais foram comparados com as características da população, verificou-se que baixa escolaridade e baixa renda estão significativamente associadas a baixos escores de conhecimento. Conclusão: O instrumento possui índice de clareza satisfatório e de validade adequado, podendo ser utilizado ...

Background: The lack of tools to measure heart failure patients' knowledge about their syndrome when participating in rehabilitation programs demonstrates the need for specific recommendations regarding the amount or content of information required. Objectives: To develop and validate a questionnaire to assess heart failure patients' knowledge about their syndrome when participating in cardiac rehabilitation programs. Methods: The tool was developed based on the Coronary Artery Disease Education Questionnaire and applied to 96 patients with heart failure, with a mean age of 60.22 ± 11.6 years, 64% being men. Reproducibility was obtained via the intraclass correlation coefficient, using the test-retest method. Internal consistency was assessed by use of Cronbach's alpha, and construct validity, by use of exploratory factor analysis. Results: The final version of the tool had 19 questions arranged in ten areas of importance for patient education. The proposed questionnaire had a clarity index of 8.94 ± 0.83. The intraclass correlation coefficient was 0.856, and Cronbach's alpha, 0.749. Factor analysis revealed five factors associated with the knowledge areas. Comparing the final scores with the characteristics of the population evidenced that low educational level and low income are significantly associated with low levels of knowledge. Conclusion: The instrument has satisfactory clarity and validity indices, and can be used to assess the heart failure patients' knowledge about their syndrome when participating in cardiac rehabilitation programs. .

Construction and validation of a questionnaire about heart failure patients' knowledge of their disease.

BACKGROUND: The lack of tools to measure heart failure patients' knowledge about their syndrome when participating in rehabilitation programs demonstrates the need for specific recommendations regarding the amount or content of information required. OBJECTIVES: To develop and validate a questionnaire to assess heart failure patients' knowledge about their syndrome when participating in cardiac rehabilitation programs. METHODS: The tool was developed based on the Coronary Artery Disease Education Questionnaire and applied to 96 patients with heart failure, with a mean age of 60.22 ± 11.6 years, 64% being men. Reproducibility was obtained via the intraclass correlation coefficient, using the test-retest method. Internal consistency was assessed by use of Cronbach's alpha, and construct validity, by use of exploratory factor analysis. RESULTS: The final version of the tool had 19 questions arranged in ten areas of importance for patient education. The proposed questionnaire had a clarity index of 8.94 ± 0.83. The intraclass correlation coefficient was 0.856, and Cronbach's alpha, 0.749. Factor analysis revealed five factors associated with the knowledge areas. Comparing the final scores with the characteristics of the population evidenced that low educational level and low income are significantly associated with low levels of knowledge. CONCLUSION: The instrument has satisfactory clarity and validity indices, and can be used to assess the heart failure patients' knowledge about their syndrome when participating in cardiac rehabilitation programs.