Patophysiologic and gender differences regarding exercise responses in decompensated heart failure patients

Heart Failure patients often present impairment on their functional capacity. Exercise training is the key component of cardiac rehabilitation and must be early implemented. Knowing the characteristics that lead a patient to be a good responder to an exercise intervention would be useful to identify the ones that could benefit from this same intervention. Purpose: Identify the characteristics of good responses to an aerobic exercise training in decompensated heart failure (HF) patients and understand if there are gender differences. Methods: Cross sectional study with 76 inpatients who performed an aerobic exercise training program (AET). Functional capacity was evaluated at admission and discharge using three different tools: the London Chest of Activity of Daily Living (LCADL) scale, the Barthel Index (BI) and the 6-minute walking test (6MWT). Multivariate linear regression was performed by gender to understand which variables lead a patient to have better performance. Since it is known that men and women have different responses to exercise training, the results and analysis of the data collected were performed by gender. Results: Seventy-six patients (52 men) were included. The mean age was 67 ± 10 years, 15.8% were New York Heart Association (NYHA) class IV and 76.3% had reduced ejection fraction. The major etiology of HF was ischemic disease (35.5%). Six predictive equations were obtained, one for each functional capacity (FC) tool divided by gender. NYHA class III patients do not differ from class IV in terms of FC at discharge. However, HFreduced ejection fraction patients presented higher 6MWT distance (309,6m vs 231m) and lower LCADL score (11 vs 15) compared to non-reduced. Gender analysis showed that women had an average of 4 days longer in-hospital stay and a considerable difference in the 6MWT. At admission women walked 15 meters less than man and at discharge 69 meters less, presenting also lower score at BI and higher at LCADL. However, only the discharge 6MWT distance presents a statistical significant difference (69 meters; p = 0.01). Traditionally women are more sedentary and present less fitness level than men. The linear regression model shows that gender is a independent variable that contributes to the change in the 6MWT - favouring men. Conclusions: The AET program appears to be more effective in younger patients, with low FC at admission and who are less impaired. Those with left systolic ventricular function apparently interfered with progression during the program. Gender influences the performance of patients undergoing exercise training. Men present higher FC at discharge but the predictive models are stronger for women. These results are consistent with the idea that gender plays an important role in determine the performance of patients in exercise training programs.info:eu-repo/semantics/publishedVersio

Pathophysiologic and gender differences regarding exercise responses in decompensated Heart Failure patients

Introduction: Heart Failure patients often present impairment on their functional capacity. Exercise training is the key component of cardiac rehabilitation and must be early implemented. Knowing the characteristics that lead a patient to be a good responder to an exercise intervention would be useful to identify the ones that could benefit from this same intervention. Purpose: Identify the characteristics of good responses to an aerobic exercise training in decompensated heart failure (HF) patients and understand if there are gender differences. Methods: Cross sectional study with 76 inpatients who performed an aerobic exercise training program (AET). Functional capacity was evaluated at admission and discharge using three different tools: the London Chest of Activity of Daily Living (LCADL) scale, the Barthel Index (BI) and the 6-minute walking test (6MWT). Multivariate linear regression was performed by gender to understand which variables lead a patient to have better performance. Since it is known that men and women have different responses to exercise training, the results and analysis of the data collected were performed by gender. Results: Seventy-six patients (52 men) were included. The mean age was 67 ± 10 years, 15.8% were New York Heart Association (NYHA) class IV and 76.3% had reduced ejection fraction. The major etiology of HF was ischemic disease (35.5%). Six predictive equations were obtained, one for each functional capacity (FC) tool divided by gender. NYHA class III patients do not differ from class IV in terms of FC at discharge. However, HFreduced ejection fraction patients presented higher 6MWT distance (309,6m vs 231m) and lower LCADL score (11 vs 15) compared to non-reduced. Gender analysis showed that women had an average of 4 days longer in-hospital stay and a considerable difference in the 6MWT. At admission women walked 15 meters less than man and at discharge 69 meters less, presenting also lower score at BI and higher at LCADL. However, only the discharge 6MWT distance presents a statistical significant difference (69 meters; p = 0.01). Traditionally women are more sedentary and present less fitness level than men. The linear regression model shows that gender is a independent variable that contributes to the change in the 6MWT - favouring men. Conclusions: The AET program appears to be more effective in younger patients, with low FC at admission and who are less impaired. Those with left systolic ventricular function apparently interfered with progression during the program. Gender influences the performance of patients undergoing exercise training. Men present higher FC at discharge but the predictive models are stronger for women. These results are consistent with the idea that gender plays an important role in determine the performance of patients in exercise training programs.info:eu-repo/semantics/publishedVersio

Factors Associated with Contraceptive Use among Jordanian Muslim Women: Implications for Health and Social Policy

The objectives of this quantitative study were to identify factors associated with contraceptive use by Jordanian Muslim women; to estimate factors that predict the variance in contraceptive use; and recommend appropriate health and social policies to enhance quality of life of Jordanian women. A cross -sectional design was used to collect data from 487 married non-pregnant women aged 18 to 49 years who resided in three southern governorates in Jordan using a structured interview guide. Results showed that 63.2% of women used some form of contraceptive method; IUD was the most frequently used method (44.2%). The percentage of women exposed to violence was 5% and 9.2% for physical and verbal abuse respectively. Findings also showed that there was a significant relationship between psychological wellbeing of women and contraceptive use. Furthermore, no relationship between women’s perceived religious stance towards contraceptives and their use. Predictors of contraceptive use were: women aged 40-45 years explained 23.3% of the variance in contraceptive use; and the woman’s approval of contraceptive use for birth spacing explained 21.4% of the variance in contraceptive use. The Islamic stance towards contraceptive use was not significant in these women; however further studies are needed to confirm these findings as well as the generalizability to Muslim women in other countries. The study findings have implications for health and social policies relevant to family planning services in order to enhance and increase the use of contraceptives to reduce the TFR in Jordan. Furthermore, health care providers, social and economical policy makers need to integrate women’s cultural views and contraceptive use in strategies and policies beyond health to improve women’s quality of life and build on the global consensus for women and children to achieve the Millennium Development goals

Self-blame Attributions of Patients: a Systematic Review Study

Introduction: Psychological aspects are important issues in patients that will have significant effects on disease progression. A new and important psychological concern is self-blame. This review was performed with the aim of systematic review on studies around patient’s self-blame.Methods: This is a systematic review using international databases including PubMed (since 1950), Scopus (since 2004), Web of Sciences (since 1900), and ProQuest (since 1938) and Iranian databases including SID (since 2004) and Magiran (since 2001). Mesh terms including “patient,” “regret,” and “guilt” and non-Mesh terms including “self-blame attribution,” “characterological self-blame,” “behavioral self-blame,” and “blame” were used in Iranian and international databases with OR and AND operators.Results: The review yielded 59 articles; 15 articles were included in the present study. The ages of patients ranged from 29-68.4 years. Most of studies (86.6%) had cross-sectional design and use characterological self-blame and behavioral self-blame variables for assessing self-blame attributions. The results showed that in most studies, a significant relationship among self-blame and psychological distress, anxiety, and depression were reported.Conclusion: A significant relation was reported between self-blaming and the degree of distress, anxiety, and depression in patients in most of the studies

Development and validation of the care challenge scale in family caregivers of people with Alzheimer's disease

BackgroundAlzheimer's disease (AD) is a progressive and debilitating disorder that strongly affects people with AD and their families. The changes in signs of the disease and its treatment lead to many challenges in people with AD that affect the performance and the ability of caregivers, their social life, and physical, emotional, and psychological aspects of caregivers' health. Therefore, this study was designed to develop and validate the Care Challenge Scale (CCS) for family caregivers of people with AD in the care context of Iran.MethodThis is a cross-sectional study, and the primary scale was based on 14 semi-structured interviews with family caregivers of Iranian people with AD. In the next phase, the psychometric features were assessed, including the face validity (qualitative and quantitative), content validity (qualitative and quantitative), item analysis, structural validity (exploratory and confirmatory factors), and construct validity (convergent and discriminant validity). Finally, the reliability was assessed using internal consistency (Cronbach's alpha, McDonald's omega coefficient, and the average inter-item correlation), stability (intraclass correlation coefficient), and absolute reliability.ResultsTotally, 435 Iranian family caregivers filled out online questionnaires, with a mean age of 50.26(±13.24) years. Based on the results of the qualitative phase, an item pool was generated with 389 items, and after deleting overlapping and unrelated items, the CCS with 14 items was created. The results of the quantitative phase showed that the CCS consists of two factors with 10 items each, which are named effective role-play challenge and lack of social-financial support, and they explained 42.23% of the total variance. Furthermore, the results of confirmatory factor analysis showed a good fitness of the scale structure model, and it had convergent and discriminant validity. The reliability indexes showed this scale has internal consistency and stability.ConclusionThe most care challenge among Iranian family caregivers of people with AD is effective role-play challenges and lack of social-financial support. The scale as designed has good validity, internal consistency, and stability that can be used by therapists, nurses, and researchers for the assessment of the challenges of this population

Psychometric evaluation of the Connor-Davidson Resilience Scale among Iranian population

Background The resilience construct is considered a personal trait composed of multiple aspects. Connor–Davidson Resilience Scale is a standard tool composed of fve factors and 25 items. This study aimed to determine the psychometric properties of this scale. Methods In this cross-sectional study, after the scale translation, the factorial structural validity was assessed via the confrmatory factor analysis with 70 180 samples. Internal consistency, composite reliability, convergent validity were assessed by calculating Cronbach’s alpha, composite reliability, maximum reliability, and Average Variance Extracted. The discriminant validity was assessed using Heterotrait-monotrait ratio of correlations matrix and also, measure invariance was evaluated. Results The original fve-factor model had good model ft indices but due to low factor loading of item 2 and 20, the model was modifed. The Cronbach’s alpha and composite reliability for four factors were above 0.7 (except for factor 5). The convergent validity for all fve factors were achieved. Between factors 1 with 2 and 4, 2 with 3 and 4 discriminant validity was not established (correlations>0.9) and the results suggested that there might be a secondorder latent construct behind these factors. Therefore, a second-order assessment was performed. The results of the second-order latent construct assessment showed a good goodness-of ft and strong measurement invariance for both men and women. Conclusion The 23-item version of Connor-Davidson Resilience Scale is a reliable and valid scale to measure resilience as a complex construct in the Iran contextinfo:eu-repo/semantics/publishedVersio

Accuracy of peak VO2 assessments in career firefighters

Abstract Background Sudden cardiac death is the leading cause of on-duty death in United States firefighters. Accurately assessing cardiopulmonary capacity is critical to preventing, or reducing, cardiovascular events in this population. Methods A total of 83 male firefighters performed Wellness-Fitness Initiative (WFI) maximal exercise treadmill tests and direct peak VO2 assessments to volitional fatigue. Of the 83, 63 completed WFI sub-maximal exercise treadmill tests for comparison to directly measured peak VO2 and historical estimations. Results Maximal heart rates were overestimated by the traditional 220-age equation by about 5 beats per minute (p < .001). Peak VO2 was overestimated by the WFI maximal exercise treadmill and the historical WFI sub-maximal estimation by ~ 1MET and ~ 2 METs, respectively (p < 0.001). The revised 2008 WFI sub-maximal treadmill estimation was found to accurately estimate peak VO2 when compared to directly measured peak VO2. Conclusion Accurate assessment of cardiopulmonary capacity is critical in determining appropriate duty assignments, and identification of potential cardiovascular problems, for firefighters. Estimation of cardiopulmonary fitness improves using the revised 2008 WFI sub-maximal equation

The effects of early rehabilitation on functional exercise tolerance in decompensated heart failure patients: results of a multicenter randomized controlled trial (ERIC-HF study)

To analyze (1) the effect of an aerobic training program on functional exercise tolerance in decompensated heart failure (DHF) patients; (2) to assess the effects of an aerobic training program on functional independence; and (3) dyspnea during activities of daily living. Design A randomized controlled clinical trial with follow-up at discharge. Settings Eight hospitals. Recruitment took place between 9/ 2017 and 3/2019. Group Assignments Patients with DHF who were admitted to the hospital, were randomly assigned to usual rehabilitation care guideline recommended (control group) or aerobic training program (exercise group). Main outcome Functional exercise tolerance was measured with a 6-min walking test at discharge. Results In total 257 patients with DHF were included, with a mean age of 67 ± 11 years, 84% (n = 205) had a reduced ejection fraction and the hospital stay was 16 ± 10 days. At discharge, patients in the intervention group walked further compared to the control group (278 ± 117m vs 219 ± 115m, p < 0.01) and this difference stayed significant after correcting for confounders (p < 0.01). A significant difference was found favoring the exercise group in functional independence (96 ± 7 vs 93 ± 12, p = 0.02) and dyspnea associated to ADL (13 ± 5 vs 17 ± 7, p < 0.01) and these differences persisted after correcting for baseline values and confounders (functional independence p < 0.01; dyspnea associated with ADL p = 0.02). Conclusion The ERIC-HF program is safe, feasible, and effective in increasing functional exercise tolerance and functional independence in hospitalized patients admitted due to DHF.info:eu-repo/semantics/publishedVersio

The relationship among positive body image, body esteem, and eating attitude in Iranian population

Background and aimThe correlation between eating attitudes, positive body image, and body esteem is a pivotal area of research that has garnered substantial attention in recent years, given its implications for both mental and physical well-being. The objective of this study was to examine the interplay between positive body image, body esteem, and eating attitudes within an Iranian population.Materials and methodsThis study employed a cross-sectional study design and was conducted in the year 2022. A convenience sample of 752 participants residing in Tehran, Iran, was included in the study. The data collection tools were comprised of a demographic registration form, the Adolescence/Adults Scale (PBIAS), the Eating Attitudes Test (EAT), and the Body Esteem Scale (BES) as measurement instruments.ResultsMean age of participants was 26.36 (SD = 8.49). Significant relationships were found among positive body image (B = − 0.095, β = −0.150, p &lt; 0.001), and body esteem (B = 0.175, β = 0.149, p &lt; 0.001) with eating attitudes.ConclusionThese findings suggest that individuals with positive body image and high body esteem may have healthier eating attitudes, while those with negative body image and low body esteem may be more likely to have unhealthy eating attitudes

A validity and reliability evaluation of fear of progression questionnaire in Iranian breast cancer patients: A methodological study.

BACKGROUND AND AIMS: Recognizing the ability to adapt coping mechanisms in response to the unique issues present in various Iranian societies underscores the importance of considering culture and religion when interacting with diverse groups of individuals. The objective of this study was to assess the reliability and validity of the fear of progression questionnaire-short form (FoP-Q-SF) in Iranian breast cancer patients. METHODS: In this methodological cross-sectional research design, 400 Iranian breast cancer patients completed the FoP-Q-SF in 2023. We assessed the characteristics, content, and both exploratory and confirmatory construct validity of the measures. To evaluate the reliability and construct validity of the FoP-Q-SF, we calculated Cronbachs α, McDonalds omega, and the Intraclass Correlation Coefficient. RESULTS: The average age of the patients was 49.18 (standard deviation = 16.14) years. The results of exploratory factor analysis revealed that a single-factor structure, specifically the self-efficacy scale, accounted for 65.045% of the total variance. The findings from the confirmatory factor analysis indicated a satisfactory model fit. The reliability analysis indicated that the internal consistency and stability of the measures were acceptable. CONCLUSION: The short Persian version of the FoP-Q-SF exhibits satisfactory validity and reliability. Thus, we recommend using this questionnaire to assess the fear of disease progression among breast cancer patients in Iran