Women's Preferences for Cardiac Rehabilitation: Do Home-Based and Women Only Programs Better Meet Their Needs?

Background: Although cardiac rehabilitation (CR) is effective, women report programs do not meet their needs. The objectives of the study were to describe women’s: (1) adherence to CR allocation, (2) satisfaction by model attended, and (3) CR preferences. Design & Methods: Female patients were randomized to mixed-sex, women-only, or home-based CR. Patients were recruited from six hospitals. Consenting participants were asked to complete a survey. Eligible patients were randomized. Participants were mailed a follow-up survey. Results: Overall 169 (18.6%) patients were randomized, of which 116 (68.6%) were retained. Forty-five (26.6%) participants did not receive the allocated model. Satisfaction was high (mean=4.23±1.16/5; p=0.85), but women-only participants felt more comfortable in their workout attire (p=0.003), and perceived the environment as less competitive (p=0.02). Patients preferred mixed-sex (n=44, 41.9%) and women-only (n=44, 41.9%) CR, over home-based (n=17, 16.2%). Conclusion: Females were highly satisfied regardless of CR model attended, but preferred supervised programs most

Initial study on Hand Grip Asymmetry in Lebanese Adults: An Advanced Model Integrating Maximal and Explosive Strength

This study introduces a refined model of hand grip asymmetry tailored to the Lebanese population, incorporating both maximal strength (Fmax) and explosive strength (RFDmax). Unlike previous models that primarily focused on maximal strength, this dual-parameter approach provides a more comprehensive assessment of hand grip asymmetry, offering insights into functional health and injury risk. Given the absence of prior data on this population, the model establishes baseline asymmetry thresholds to support clinical evaluations and performance assessments. A total of 393 healthy adults (241 males, 152 females) from various Lebanese regions underwent hand grip assessments measuring Fmax and RFDmax for both the dominant (DH) and non-dominant hands (NDH). Asymmetry levels were computed separately for handgrip strength and handgrip explosive strength, and participants were classified into four asymmetry groups: low (0–10%), moderate (10.1–20%), high (20.1–30%), and very high (>30%) based on asymmetry percentage thresholds. Results indicated that males demonstrated approximately 44% greater hand grip strength (Fmax) and 47% higher RFDmax than females across both hands (p < 0.001). A dominant hand advantage was observed, with a 6.9% higher Fmax in males and a 7.9% difference in females (p < 0.001). While overall asymmetry did not differ significantly between genders, females exhibited slightly higher asymmetry in RFDmax. Notably, explosive strength asymmetry was more pronounced than maximal strength asymmetry, suggesting it may serve as a stronger indicator of neuromuscular control and injury risk. This model serves as a key reference for understanding hand grip asymmetry in the Lebanese population, establishing normative benchmarks that may aid in health risk identification and functional assessments. Future research should explore age-related trends and cross-population comparisons to further evaluate the impact of hand grip asymmetry on performance and health outcomes

Shingrix Revaccination and Vaccination in Vulnerable Populations

Herpes zoster, also known as shingles, is a painful cutaneous eruption that develops following the reactivation of the varicella zoster virus (VZV), the same virus that causes chickenpox.1 About 1 in 3 people in the United States will develop shingles, with an estimated 1 million cases occurring annually. Anyone with a history of chickenpox is at risk for shingles, but the risk increases with age and in patients who are immunocompromised.

Methylation of the Vitamin D Receptor (VDR) Gene, Together with Genetic Variation, Race, and Environment Influence the Signaling Efficacy of the Toll-Like Receptor 2/1-VDR Pathway

BackgroundThe disparity in prevalence of infectious diseases across the globe is common knowledge. Vitamin D receptor (VDR)-mediated toll-like receptor (TLR) 2/1 signaling produces antimicrobial peptides, which is critical as a first line of defense in innate immunity. Numerous studies disclosed the independent role of genetic polymorphisms in this pathway, vitamin D status or season and more recently epigenetics, as factors contributing to infectious disease predisposition. Few studies address the interaction between environment, genetics, and epigenetics. Here, we hypothesized that VDR-mediated TLR2/1 signaling is influenced by a combination of environment, epigenetics and genetics, collectively influencing differential innate immunity.MethodsHealthy Black and White South Africans (n = 100) donated blood, while ultraviolet index (UVI) was recorded for the duration of the study. LC-MS/MS supported 25(OH)D3 quantification. Monocyte/macrophage cultures, supplemented with/without 1,25(OH)2D3, were activated with the TLR2/1 elicitor, Pam3CSK4. VDR, cathelicidin antimicrobial peptide, hCAP-18, and 25-hydroxyvitamin D3-24-hydroxylase expression were quantified by RT-qPCR or flow cytometry. Pyrosequencing facilitated VDR methylation analysis and single-nucleotide polymorphism (SNP) genotyping in regions pinpointed through a bioinformatics workflow.ResultsSeason interacted with race showing 25(OH)D3 deficiency in Blacks. UVI correlated with 25(OH)D3 and VDR methylation, likely influencing race differences in the latter. Regarding the TLR2/1 pathway, race differences in SNP genotype distribution were confirmed and functional analysis of VDR-mediated signaling showed interaction between race, season, and 25(OH)D3 status. Multivariate OPLS-DA mirrored several interactions between UVI, 25(OH)D3 status, DNA sequence, and methylation variants. Methylation of the third cytosine-phosphate-guanine dinucleotide (CpG) in the promoter CpG island (CGI) 1062, CGI 1062 CpG 3, significantly discriminated a 5.7-fold above average mean in VDR protein level upon TLR2/1 elicitation, the variation of which was further influenced by 25(OH)D3 status and the VDR SNP TaqI.ConclusionRegulation of VDR-mediated TLR2/1 signaling is multifactorial, involving interaction between environment [UVI and consequent 25(OH)D3 status], epigenetics (VDR methylation at key regulatory sites), and genetics (TLR1, TIRAP, and VDR SNPs)

Home Blood Pressure Monitoring to Improve Hypertension Control: A Narrative Review of International Guideline Recommendations

Home blood pressure monitoring (HBPM) is a convenient way to assess out-of-office blood pressure control and is recommended by numerous international guidelines to aid clinicians in the diagnosis and management of essential hypertension. Although available guidelines recommend the use of HBPM in patients receiving antihypertensive medication, their specific recommendations regarding optimal monitoring schedule, duration, and clinician interpretation of home blood pressure readings may differ among guidelines. Purpose: The purpose of this article is to review available international hypertension guideline recommendations related to the use of HBPM to improve hypertension control among patients receiving antihypertensive therapy. We also briefly highlight clinical trials that have shown improved blood pressure control using HBPM to intensify antihypertensive therapy and provide a practical guide for implementing HBPM to improve hypertension control. Results: Eleven international guidelines were identified and reviewed. In total, recommendations relating to which HBPM to use, number of measurements per day, and how to interpret home blood pressure values were largely in agreement among available guidelines. Conclusion: Clinicians recommending HBPM to their patients with hypertension should utilise a standardised HBPM protocol, based on available guideline recommendations

Internação domiciliária de idosos e as implicações bioéticas nas autogestões da saúde suplementar

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Bioética, 2013.Com a elevação da perspectiva de vida ao nascer e o envelhecimento da população brasileira, a Internação Domiciliária (ID), ressurge na modernidade para atendimento da consequente elevação da demanda de idosos que requerem cuidados prolongados. Juntamente com este reordenamento da assistência, advêm novos conflitos éticos no âmbito do domicílio. Este estudo foi realizado em um plano de saúde na modalidade de autogestão, a qual não tem finalidade lucrativa, e as pessoas beneficiárias são empregados ativos e aposentados de uma empresa. Os conflitos se dão de formas variadas, principalmente em relação à elegibilidade de idosos, ainda autônomos, os quais a família não apresenta possibilidades em realizar seus cuidados. A substituição dos cuidados familiares por cuidados profissionais torna os conflitos potencializados quando mesclados com questões sociais. O contexto destes conflitos permite pensar nos problemas interpessoais pela bioética clínica e na esfera da saúde pública por meio da bioética social. Este trabalho foi realizado por meio de estudo de caso exploratório, utilizando como procedimentos metodológicos a observação e entrevistas com os atores envolvidos (idoso, familiares, profissionais de saúde e gestores). Foram selecionados dois casos, o primeiro caso tendo o idoso com elegibilidade clínica para concessão de serviço de ID e o segundo caso de um idoso sem elegibilidade para tal serviço. Os resultados do estudo identificaram conflitos semelhantes nos dois casos, porém com intensidades diferentes em conformidade ao contexto. Pode-se especificar que os conflitos de maior intensidade são relativos a não elegibilidade clínica de idosos autônomos, conflitos relativos à anulação da autonomia do idoso pelos cuidadores familiares e profissionais, conflitos relativos à ausência de acolhimento do solicitante do serviço de ID junto ao plano de saúde, conflitos relativos à amplitude dos serviços oferecidos na ID que poderiam abarcar maior número de procedimentos de saúde realizados no domicílio, conflitos quanto a disponibilização de materiais e medicamentos que passam a ser utilizados pela família do idoso, conflitos relativos ao financiamento do serviço de ID pelo plano de saúde pelos altos custos, dentre outros. A análise dos resultados viabilizou por meio da identificação dos conflitos para possíveis vias para prevenção ou solução dos conflitos, como é próprio à ética aplicada, e indicar novos itinerários investigativos para futuras pesquisas de maior extensão. ______________________________________________________________________________ ABSTRACTWith the increase in life expectancy at birth and aging of the Brazilian population, the domiciliary hospitalization, resurfaces in modernity to serve the consequent increase in demand for seniors who require long term care. Along with this reordering of assistance, come new ethical conflicts within the household. This study was conducted in a health plan in the form of self-management, which is not for profit and the beneficiary people, are active and retired employees of a firm. Conflicts occur in various ways, especially regarding the eligibility of seniors, yet autonomous, which families has no possibilities to undertake their care. The replacement of family care by professional care exacerbate the conflicts allows to thinking the interpersonal problems by clinical bioethics and in the sphere of public health though social bioethics. This work was carried out through exploratory case study, using as instruments observation and interviews with the actors involved (elderly, family, health professionals and managers). We selected two cases, the first case having the elderly clinical eligibility for domiciliary hospitalization concession service and the second case, an elderly without eligibility for such service. The results of the stud identified similar conflicts in both cases, but with different intensities according to the context. You can specify that the most intense conflicts are related to non clinical eligibility for autonomous seniors, conflicts concerning the annulment of the autonomy of the elderly by family caregivers and professional conflicts concerning the absence of the host requesting the domiciliary hospitalization service with the plan health, conflicts regarding the breadth of services offered in the domiciliary hospitalization that could encompass a greater number of health procedures performed at home, conflicts about the availability of supplies and medicines that are being used by the family of the elderly, conflicts regarding the financing of domiciliary hospitalization service by the health plan because of high costs, among others. The results made possible through the identification of conflicts suggest possible ways for prevention or resolution of conflicts, as befits the applied ethics, and indicate new itineraries for future investigative research greatest extension

Dosisabhängiger Einfluss von Combretastatin A-4 auf das Wachstum humaner, aortaler, glatter Muskelzellen

Dosisabhängiger Einfluss von Combretastatin A-4 auf das Wachstum humaner, aortaler, glatter Muskelzellen Thema der Dissertation ist der dosisabhängige Einfluss von Combretastatin A-4 (CA-4) auf das Wachstum humaner, aortaler, glatter Muskelzellen (HASMC). Die HASMCs spielen eine besondere Rolle beim Restenosemechanismus, insbesondere nach stattgehabter percutaner transluminaler Angioplastie (PTA). CA-4 gehört zur Stoffgruppe der Combretastatine, die den Tubulin-bindenden Stoffen zugerechnet werden. Combretastatine zeigen eine strukturelle Ähnlichkeit mit Colchizin, verfügen jedoch über eine höhere Affinität zu den Colchizinbindungsstellen auf dem Tubulin als Colchizin selbst. Sie inhibieren die Mikrotubulusaktivität und verhindern somit ein Zellwachstum sowie eine Zellvermehrung. Zur Untersuchung der wachstumshemmenden Wirkung des CA-4 wurden u.a. als methodische Mittel die Proliferationskinetik (PK), der Koloniebildungstest (KOBI = klonogene Aktivität) und die Durchflußzytometrie verwendet. In der Proliferationskinetik wurden die HASMCs in einer Untersuchungsgruppe einmalig (Einfach-Behandlung) und in einer anderen Untersuchungsgruppe kontinuierlich (Dauer-Behandlung) nach entsprechenden Medienwechseln (MW) - jeweils alle 4 Tage und erneuter Zugabe von CA-4 - anbehandelt. Hierbei zeigte sich im Vergleich zur Kontrolle (unbehandelt) für die geringste Dosis (0.5x10-9 M, s. Abb. 3, Tab. 5 und 6) sowohl in der Einfach-Behandlung als auch Dauer-Behandlung nahezu keine inhibierenden Effekte auf das Proliferationsverhalten der HASMCs. Deutlicher erkennbar wirkte sich der inhibierende Effekt ab einer Dosis von 2.5x10-9 M (Abb. 3, Tab. 5 und 6) aus. Hier zeigte sich bereits eine merkliche Abnahme des Proliferationsverhaltens der Zellen mit flacherem Wachstumsanstieg und demzufolge niedrigeren Zellzahlen im Vergleich zur Kontrollgruppe in beiden Behandlungsformen. Der Übergang in ein Plateau, das „steady-state“ (Zellproliferation = Zelluntergang), wurde auf einem niedrigerem Zellzahlenniveau (s. Tab. 5 und 6) in beiden Behandlungsformen erreicht. Die Zellen mit der Höchstdosis 5x10-9 M (s. Abb. 3, Tab. 5 und 6) erfuhren eine erhebliche Hemmung der Proliferation. Die „Einfach-behandelten“ Zellen, zeigten nach den regelmäßigen Stopptagen mit MW, eine langsame Erholungstendenz, wenngleich auf deutlich niedrigerem Niveau. In der Gruppe der „Dauer-behandelten“ Zellen trat ein kompletter Wachstumsstopp ein (s. Tab 6) mit geradem Kurvenverlauf auf Höhe des Ausgangswert Tag 0. Der Kurvenverlauf in der Einfach-Behandlung nimmt hingegen einen erheblich flacheren, exponentiellen Verlauf (s. Abb. 3, 5x10-9 M) an mit Übergang in eine Plateauphase. Aus den Ergebnissen sowie der Erstellung des Proliferationsmodells (s. Formel, Kap. 2.5.2) läßt sich zudem eine dosisabhängige Abnahme der Zellzahl pro 1 M des CA-4 Agens ableiten. Für beide Behandlungsarten bedeutet dies pro 1 M des CA-4 Agens, Abnahme der Zellzahl um 319.000 Zellen. Bei der Auswertung des KOBI (untersucht die Vermehrungsfähigkeit der Zellen) wies die behandelte Zellgruppe mit 5x10-10 M CA-4 (s. Abb. 4 und 5, grüne Kurve) einen nahezu identischen Kurvenverlauf zur Kontrollgruppe auf, welches sich auch in den gemittelten KOBI-Zahlen (s. Tab. 7 und 8) beider Behandlungsgruppen (Einfach- und Dauer-Behandlung) widerspiegelte. Die mit 2.5x10-9 M CA-4 „Einfach-behandelte“ Zellgruppe zeichnete sich zu Beginn durch einen leicht herabgesetzten Kurvenbeginn (s. Abb. 4, blaue Kurve 2.5) aus im Sinne einer reduzierten klonogenen Aktivität. Mit regelmäßigem MW näherte sich die 2.5x10-9 M Kurve der Kontrollgruppenkurve allmählich an, wobei erst gegen Ende der Beobachtungsperiode das Niveau der klonogenen Fähigkeit der Kontrollgruppe erreicht wird. Dieser Effekt lässt sich auch an den absoluten KOBI-Zahlen (s. Tab. 7) beobachten. Der beobachtete Effekt in der Einfach-Behandlung mit 2.5x10-9 M CA-4 beruht auf das Auswaschen der Substanz durch die regelmäßig durchgeführten MWs. Demzufolge stellt sich eine langsame Erholung der klonogenen Aktivität ein. In der Dauer-behandelten Gruppe mit 2.5x10-9 M CA-4 setzt sich jedoch der supprimierende Effekt weiter fort. Unter der Behandlung mit 5x10-9 M CA-4 fällt bereits nach dem ersten Behandlungstag (Tag 4) sowohl für die Einfach- als auch Dauer-Behandlung (s. Tab. 4 und 5) eine komplette Aufhebung der klonogene Aktivität auf. Während bei der Einfach-Behandlung bereits nach einmaligem MW ein Wiedereinsetzen der klonogenen Aktivität zu verzeichnen war, hielt unter der Dauer-Behandlung die vollständige Suppression an. Um den Wirkmechanismus des Zytostatikums CA-4 in der Proliferationsphase genauer zu betrachten, erfolgte die Untersuchung des Zellzyklusses mit Hilfe der Durchflusszytometrie (s. 2.7 Zellzyklusanalyse). Während die meisten Zellen, sowohl der Kontroll-HASMCs, als auch der behandelten Zellgruppen (Einfach/Dauer: 0.5x10-9 M bzw. 2.5x10-9 M CA-4) sich am Anfang der Beobachtung in der G1-Phase befanden, stellte sich im weiteren Beobachtungsverlauf eine zunehmende Phasenverschiebung zugunsten der G2/M-Phase (s. Tab 10) ein. Im Gegensatz dazu befanden sich bereits zu Beginn der Beobachtungsphase, die mit 5x10-9 M CA-4 behandelten Zellen (s. Tab. 10), mehrheitlich in der G2/M-Phase. In beiden Behandlungsgruppen kam es zu einem verzögerten Shift der Phasenverschiebung in Richtung G1-Phase. So fanden sich mehrheitlich erst am 6. Beobachtungstag der „Einfach-behandelten“ Zellen (s. Tab. 10) in der G1-Phase, wohingegen die Phasenverschiebung in der „Dauer-behandelten“ Zellgruppe erst am 14. Tag zu verzeichnen war. Während jedoch mit der Phasenverschiebung in der „Einfach-behandelten“ Zellgruppe auch mehr Zellen, im Zuge des Substratwechsels und der daraus resultierenden langsamen Erholung, in die S-Phase übergingen, fand sich bei den „Dauer-behandelten“ Zellen (s. Tab. 10) kein vermehrter Übergang in die S-Phase. Die gewonnenen Daten belegen einen konzentrationsabhängigen Einfluss des CA-4 auf den Wachstumsverlauf der HASMCs. Unter der mittleren Behandlungsdosis (2.5x10-9 M) mit CA-4 ist bereits eine merkliche Reduktion der PK sowie der klonogenen Aktivität zu erkennen, welche sich unter der Einfach-Behandlung langsam auf Kontrollniveau erholt, jedoch unter der Dauer-Behandlung sich stetig auf einem etwas niedrigerem Niveau einpegelt. Unter der Höchstdosis (5x10-9 M) zeigt sich bei „einmaliger Behandlung“ nach anfänglicher kompletter Suppression und anschließend regelmäßig durchgeführten MWs eine stark verlangsamte Erholung sowohl der PK als auch der klonogenen Aktivität. Wohingegen unter der Dauer-Behandlung ein vollständiger Stopp der Proliferationsfähigkeit sowie klonogenen Aktivität zu verzeichnen ist. Die Inhibierung der Zellen durch das CA-4 findet hierbei in der G2/M-Phase statt

Modelos de estrutura de covariância para dados longitudinais considerando o plano amostral complexo

In this monograph statistical methods are studied with the support of computational tools with the aim of analysing panel data from the British Household Panel Survey (BHPS). Statistical inference procedures for parameters of mixed models are evaluated considering different longitudinal covariance structures. Comparisons between estimation methods that consider the complex sampling design and those which ignore it are carried out through a simulation study and the behavior of estimators which are based upon adjustment functions is assessed. The following estimation methods are considered: maximum likelihood, maximum pseudo-likelihood and generalized least squares. The performance of the estimators is also evaluated for scenarios which consider data being generated from different probability distributions, including both symmetrical and asymmetrical distributions.Nesta monografia são estudados métodos estatísticos com o apoio de ferramentas computacionais para o estudo de dados do tipo painel oriundos da pesquisa British Househould Panel Survey (BHPS). Procedimentos de inferência estatística para parâmetros de modelos de efeitos mistos são avaliados considerando diferentes estruturas longitudinais de covariância. Comparações entre métodos de estimação que consideram o plano amostral complexo e aqueles que o ignoram são realizadas através de um estudo de simulação e o comportamento de estimadores que tem como base funções de ajuste é avaliado. São considerados os seguintes métodos de estimação pontual: máxima verossimilhança, máxima pseudo verossimilhança e mínimos quadrados generalizados. O desempenho dos estimadores também é avaliado considerando cenários em que os dados são gerados a partir de diferentes distribuições de probabilidade, incluindo tanto distribuições simétricas quanto assimétricas

The syntheses and NMR studies of hexadeca- and octaneopentoxyphthalocyanines

The syntheses of 3,6-dineopentoxyphthalonitrile and 3,4,5,6-tetraneopentoxyphthalonitrile are described. Condensation of these phthalonitriles with nickel chloride in N,N-dimethylaminoethanol yielded 1,4,8,11,15,18,22,25-octaneopentoxyphthalocyaninato nickel(II) (3) and 1,2,3,4,8,9,10,11,15,16,17,18,22,23,24,25-hexadecaneopentoxyphthalocyaninato nickel(II) (7). The 1H NMR spectra of these phthalocyanines and the related 2,3,9,10,16,17,23,24-octaneopentoxyphthalocyaninato nickel(II) (8) at temperatures from 205 to 330 K in toluene-d8 exhibited various degrees of restriction of rotation of the neopentoxy groups. Compound 7 exhibited a single atropisomer at 235 K.Key words: neopentoxy substituted phthalocyanines, variable temperature NMR, restricted rotation. </jats:p

Pharmacogenomic Considerations in Opioid Therapy

Opioids are among the most common medications used in the treatment of pain, and they carry many serious risks if used inappropriately. Pharmacogenomic considerations can impact a patient’s treatment plan for chronic pain, as CYP polymorphisms may interfere with nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, and opioids. In particular, CYP2D6 polymorphisms may play a considerable part in the safety and efficacy of codeine, hydrocodone, and tramadol, as outlined in the Clinical Pharmacogenetic Implementation Consortium (CPIC) guideline on opioids. Based on current research, the CPIC recently updated its guidance on opioid use and interactions with CYP2D6, OPRM1, and COMT polymorphisms. Greater pharmacist understanding of CYP polymorphisms can lead to safer opioid prescribing and better outcomes for patients receiving pain management