Cardiac rehabilitation availability and characteristics in Latin America and the Caribbean: A global comparison

Background: This study aimed to establish availability and characteristics of cardiac rehabilitation (CR) in Latin America and the Caribbean (LAC), where cardiovascular disease is highly prevalent. Methods: In this cross-sectional sub-analysis focusing on the 35 LAC countries, local cardiovascular societies identified CR programs globally. An online survey was administered to identified programs, assessing capacity and characteristics. CR need was computed relative to ischemic heart disease (IHD) incidence from the Global Burden of Disease study. Results: ≥1 CR program was identified in 24 LAC countries (68.5% availability; median = 3 programs/country). Data were collected in 20/24 countries (83.3%); 139/255 programs responded (54.5%), and compared to responses from 1082 programs in 111 countries. LAC density was 1 CR spot per 24 IHD patients/year (vs 18 globally). Greatest need was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed/year). In 62.8% (vs 37.2% globally P < .001) of CR programs, patients pay out-of-pocket for some or all of CR. CR teams were comprised of a mean of 5.0 ± 2.3 staff (vs 6.0 ± 2.8 globally; P < .001); Social workers, dietitians, kinesiologists, and nurses were significantly less common on CR teams than globally. Median number of core components offered was 8 (vs 9 globally; P < .001). Median dose of CR was 36 sessions (vs 24 globally; P < .001). Only 27 (20.9%) programs offered alternative CR models (vs 31.1% globally; P < .01). Conclusion: In LAC countries, there is very limited CR capacity in relation to need. CR dose is high, but comprehensiveness low, which could be rectified with a more multidisciplinary team.This work was supported by a research grant from York University’s Faculty of Health, Toronto, Canada, and by project number LQ1605 from the National Program of Sustainability II (MEYS CR), Czech Republic

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Comparación de dos métodos para medir la composición corporal de futbolistas profesionales costarricenses

Las características antropométricas y fisiológicas en el fútbol según posición de juego se han estudiado con el objetivo de medir su relevancia en la competición. Sin embargo, la comparación de métodos de composición corporal es poco conocida en jugadores de fútbol costarricense. Propósito: comparar la composición corporal mediante el uso de la absorciometría dual por rayos X (DEXA) y el método de pliegues cutáneos en futbolistas profesionales costarricenses. Métodos: 106 futbolistas con edad promedio de 24.53 ± 4.77 años participaron en el estudio. Resultados: el porcentaje de grasa fue 13.34 ± 4.1 %, el peso magro 62.1 ± 5.5 kg y el contenido mineral óseo fue de 3.6 ± 0.4 g/cm2 obtenido mediante el DEXA y el porcentaje de grasa obtenido por pliegues cutáneos fue 12.58 ± 3.0 %. Al comparar los porcentajes de grasa obtenidos por ambos métodos se registraron diferencias significativas (p = 0,005). Además se encontró diferencias en el peso magro por extremidades, siendo mayor en la lateralidad derecha tanto en extremidades superiores (p = 0.001) como inferiores (p = 0.037). El análisis por posición de juego mostró diferencias a nivel de brazos (p <0.05). Hubo una alta correlación positiva (r = 0.75; p < 0.001) entre el porcentaje de grasa medido por DEXA y por pliegues cutáneos. Conclusión: Al comparar los porcentajes de grasa mediante ambos métodos se registraron diferencias significativas. La grasa corporal obtenida por ambos métodos mostró una alta asociación, por lo tanto ambas técnicas pueden ser utilizadas en esta población

Physical Fitness and its Relationship to Depressive Traits in Older Adults Undertaking Physical Activity

El propósito de esta investigación fue determinar la relación entre la aptitud física y los niveles depresivos en las personas adultas mayores que participan en programas de actividad física en el área de San Ramón, Alajuela. Un total de 138 personas mayores con edades entre los 60 y 86 años (67.94 ± 5.26 años), fueron medidas en los componentes de la aptitud física mediante la prueba  “Senior Fitness Test” (SFT) y los niveles de depresión mediante la Escala de Depresión Geriátrica de “Yesavage” (GDS, “Geriatric Depression Scale” por sus siglas en Inglés). Los resultados sugieren que el 97,8 % de las personas analizadas se ubicó dentro de los parámetros normales y excelentes de aptitud física, mientras tanto, el 86,2 % se encontró en la etapa normal de la depresión. Por su parte, la depresión geriátrica correlacionó negativamente con la aptitud física en las variables: fuerza muscular y resistencia corporal de la parte baja del cuerpo, resistencia de la fuerza muscular del brazo, la agilidad y equilibrio dinámico, y flexibilidad parte baja del cuerpo (p &lt;0,05). Se concluye que a mayor nivel de aptitud física menor son los rasgos depresivos en personas adultas mayores.The purpose of this study was to determine the relationship between physical fitness and levels of depression in older persons involved in physical activity programs in San Ramon, Alajuela. A total of 138 older adults aged 60 to 86 years (67.94 ± 5.26) were assessed on the physical fitness using the SFT and levels of depression were measured using the GDS. Results suggest that about 97.8% of persons tested were within normal parameters and excellent on their physical fitness. Additionally, 86.2% of the cohort was found in a normal stage of depression. In addition, geriatric depression was negatively correlated with physical fitness on variables such as lower body muscle strength and endurance, arm muscle strength endurance, physical agility and dynamic balance, and lower body flexibility (p&lt;0.05).  It is concluded that higher levels of physical fitness are associated with lower depression status in older adults

Determinación de las características antropométricas y consumo máximo de oxígeno del ciclista élite costarricense según especialidad y tipo de prueba

The purpose of this study was to determine anthropometric characteristics and the maximum consumption of oxygen (VO2max) of professional Costa Rican cyclists. A total of 22 cyclists participated with an average age of 24.7 ± 3.7 years, a body weight of 64.5 ± 2.7 kg, height of 1.73 ± 0.02 m and competition experience of 10 ± 2.3 years. The following were the variables used: weight, height, body fat percentage and VO2max, which was measured directly. Data obtained was analyzed through descriptive statistics (averages and standard deviation), t-student for independent groups and one-way ANOVA with Tukey post hoc. No significant statistical differences were recorded in the following variables: weight (t(20)=0.24; p=.82), height (t(20)=1.37; p=.19), body fat percentage (t(20)=0.90; p=.38) and VO2max (t(20)=0.03; p=.98) among the cyclists that only do road cycling and those who do both road and MTB, depending on the type of race. On the analysis by area of expertise, significant differences were detected only in body weight (F(2,21)=4.95; p=.02) showing that time trialists are significantly heavier than climbers. Conclusion: anthropometric and cardiorespiratory characteristics by type of race and area of expertise of Costa Rican cyclists are similar, except for body weight, which was significantly greater in time trialists than climbers.El propósito de este estudio fue determinar las características antropométricas y el consumo máximo de oxígeno (VO2máx) de ciclistas élite costarricenses. Participaron un total de 22 ciclistas con un promedio de edad de 24.7 ± 3.7 años, un peso corporal de 64.5 ± 2.7 kg, estatura de 1.73 ± 0.02 m y una experiencia en competencias de 10 ± 2.3 años. Se obtuvieron las siguientes variables: peso, estatura y porcentaje de grasa corporal y VO2máx, el cual se midió forma directa. Los datos obtenidos se analizaron mediante estadística descriptiva (promedios y desviaciones estándar), t student para grupos independientes y ANOVA de una vía con post hoc de Tukey. No se registraron diferencias estadísticamente significativas en las variables peso (t(20)=0.24; p=.82), estatura (t(20)=1.37; p=.19), porcentaje de grasa corporal (t(20)=0.90; p=.38) y VO2máx (t(20)=0.03; p=.98) entre los ciclistas que practican solamente ruta y aquellos que practican ruta y MTB de manera conjunta según el tipo de prueba. En el análisis por especialidad, se detectó diferencias significativas únicamente en el caso del peso corporal (F(2,21) = 4.95; p=.02), mostrando que los contrarrelojistas son significativamente más pesados que los escaladores. Conclusión: las características antropométricas y cardiorrespiratorias según el tipo de prueba y especialidad de los ciclistas costarricenses son similares, con excepción del peso corporal, que fue significativamente mayor en los contrarrelojistas que los escaladores

Perfil de calidad de vida, sobrepeso-obesidad y comportamiento sedentario en niños (as) escolares y jóvenes de secundaria guanacastecos

The purpose of this study was to identify the quality of life profile, overweight-obesity and sedentary behavior in a group of elementary and high school children of Guanacaste. 635 students participated in the study. The participants completed a protocol by which they were anthropometrically evaluated, and also filled up a questionnaire related to sedentary behavior and quality of life. In general, the findings reflected a prevalence of overweight and obesity of 13, 9%. The most important sedentary activities were, in descending order, the small screen (watching TV, video games, computer), and certain social and cultural activities. The self-reported quality of life index was within acceptable limits but not exceeding 80 points on a scale of 1-100. There was no significant relationship between the rate of the overall quality of life, overweight, obesity and some sedentary behaviors, although some anthropometric parameters like percentage of body fat and body weight showed significant correlation with sedentary behavior and specific aspects belonging to quality of life. The study provides valuable information to health authorities, directors of educational institutions and parents about key issues related to child development.Recibido 02 de agosto de 2010 • Aceptado 31 de agosto de 2010 • Corregido 14 de octubre de 2010   El propósito de este estudio fue identificar el perfil de calidad de vida, sobrepeso-obesidad y comportamiento sedentario en un grupo de escolares y colegiales de la provincia de Guanacaste. Se contó con la participación de 635 estudiantes. Los (as) niños (as) y jóvenes participantes en el estudio cumplieron con un protocolo mediante el cual se les evaluó antropométricamente, también, completaron cuestionarios relacionados con el comportamiento sedentario y calidad de vida. En general, los resultados registrados mostraron una prevalencia del sobrepeso-obesidad del 13,9 %. Las actividades sedentarias más importantes fueron, en orden descendente, la pantalla chica (ver televisión, videojuegos, computadora), las actividades sociales y las culturales. El auto-reporte de calidad de vida mostró valores aceptables, aunque no superiores a 80 puntos en escala de 1 a 100. No se registraron relaciones significativas entre índice de calidad de vida global, sobrepeso-obesidad y comportamientos sedentarios, aunque algunos parámetros antropométricos como el porcentaje de grasa y el peso corporal mostraron correlaciones significativas con el comportamiento sedentario y con dominios específicos del constructo calidad de vida. El estudio brinda información valiosa en relación con aspectos centrales en el desarrollo del niño (a) o joven, no solo para autoridades en salud, sino también, para los directores (as) de centros educativos y, por supuesto, para padres y madres de familia

Cardiac function in critically ill patients with severe COVID: A prospective cross-sectional study in mechanically ventilated patients

Purpose: To evaluate cardiac function in mechanically ventilated patients with COVID-19. Materials and methods: Prospective, cross-sectional multicenter study in four university-affiliated hospitals in Chile. All consecutive patients with COVID-19 ARDS requiring mechanical ventilation admitted between April and July 2020 were included. We performed systematic transthoracic echocardiography assessing right and left ventricular function within 24 h of intubation. Results: 140 patients aged 57 ± 11, 29% female were included. Cardiac output was 5.1 L/min [IQR 4.5–6.2] and 86% of the patients required norepinephrine. ICU mortality was 29% (40 patients). Fifty-four patients (39%) exhibited right ventricle dilation out of whom 20 patients (14%) exhibited acute cor pulmonale (ACP). Eight out of the twenty patients with ACP exhibited pulmonary embolism (40%). Thirteen patients (9%) exhibited left ventricular systolic dysfunction (ejection fraction <45%). In the multivariate analysis acute cor pulmonale and PaO2/FiO2 ratio were independent predictors of ICU mortality. Conclusions: Right ventricular dilation is highly prevalent in mechanically ventilated patients with COVID-19 ARDS. Acute cor pulmonale was associated with reduced pulmonary function and, in only 40% of patients, with co-existing pulmonary embolism. Acute cor pulmonale is an independent risk factor for ICU mortality