Effects of a PRECEDE-PROCEED Model-Based Intervention on Fatigue in Patients With Coronary Heart Disease: A Randomized Controlled Trial

Objective:This research aimed to determine how a 12-week PRECEDE-PROCEED model-based intervention affected fatigue in patients with coronary heart disease.Methods:This cluster randomized controlled trial recruited participants diagnosed with coronary heart disease at 2 community health centers in China. Participants in the control group (n = 36) received routine health education, whereas those in the intervention group (n = 38) were given a 12-week PRECEDE-PROCEED model-based intervention and routine health education. The intervention consisted of 6 training sessions on coronary heart disease, fatigue, fatigue management, self-management skills and social support. A primary outcome (fatigue) and 4 secondary outcomes (knowledge of fatigue, self-management, quality of life and body mass index) were assessed using the Fatigue Scale-14, Fatigue Cognitive Questionnaire for Patients with Coronary Heart Disease, Coronary Artery Disease Self-Management Scale, Chinese Cardiovascular Questionnaire of Quality of Life, and electronic weighing scale, respectively. Data were collected 3 times over 12 weeks.Results:Compared with the control group, the intervention group showed a statistically significant improvement in the level of fatigue (8.72 vs 7.06, P < .001), knowledge of fatigue (P < .001), self-management skills (P < .001), and quality of life (P < .001). However, there was no significant difference in body mass index between the 2 groups (P = .504).Conclusions:The findings suggest that a well-designed intervention based on the PRECEDE-PROCEED model could alleviate fatigue symptoms and increase knowledge of fatigue, self-management skills and quality of life in patients with coronary heart disease

Effect of ApoB/ApoA1 ratio on the all-cause mortality of patients with pulmonary embolism

Objective To investigate the effect of ApoB/ApoA1 ratio on the all-cause mortality of patients with pulmonary embolism at admission. Methods One hundred and seventy-seven patients with hemodynamically stable pulmonary embolism were retrospectively collected. The time of admission was the start of follow up， June 30， 2022 was the end of follow up， and all-cause death was the outcome. The best cut-off value of ApoB/ApoA1 to predict all-cause death was calculated according to the receiver operating characteristic （ROC） curve. All patients were assigned into high ratio group （ApoB/ApoA1 ≥0.8） and low ratio group （ApoB/ApoA1 <0.8）. The effect of ApoB/ApoA1 ratio on the prognosis of pulmonary embolism patients was analyzed by univariate and multifactorial Cox regression models， and Kaplan-Meier analysis and Log-rank test was used to compare the survival. Results During the follow-up period， 43 patients died with a mortality of 24.3%. The best cut-off of ApoB/ApoA1 was 0.8 according to ROC and the area under the curve （AUC） was 0.805 （95% CI=0.738-0.872）. There were 39 deaths and 4 deaths in high ratio group and low ratio group， respectively， with a mortality of 52.0% and 3.9%， respectively. Univariate Cox proportional hazards regression model analysis showed that age， hazards stratification， D-Dimer， MPV/D-Dimer， blood urea nitrogen （BUN） and ApoB/ApoA1 were significant for the prognosis of pulmonary embolism patients （P < 0.05）. Multivariate Cox proportional hazards regression model analysis showed that age （P = 0.005）， ApoB/ApoA1 ratio （P < 0.001） and BUN （P < 0.001） were independent factors of the prognosis of pulmonary embolism patients. Log-rank test indicated that survival rate in high ratio group was significantly lower than that in low ratio group （χ2=58.166， P <0.001）. Conclusion A higher ApoB/ApoA1 ratio at admission is related to the higher risk of death in pulmonary embolism patients， and is an effective factor to predict all-cause mortality in pulmonary embolism patients

Retinal microvascular abnormalities predict clinical outcomes in patients with heart failure

Background: Narrower retinal arterioles and wider retinal venules have been associated with the incidence of heart failure (HF). However, whether they are predictive of the prognosis of heart failure (HF) is unclear. We aimed to explore the role of retinal vessel calibers in predicting long-term clinical outcomes of HF. Methods: This is a prospective, single-center, observational study that surveyed patients in a tertiary referral hospital for the treatment of HF. Retinal vessel caliber was graded using retinal photography. The primary endpoint was the composite endpoint of HF rehospitalization and mortality at 12 months. Results: There were 55 patients with chronic HF included in the final analysis. At 12 months, the cumulative incidence of the primary endpoint, HF rehospitalization, and mortality tended to be higher with the widening of the central retinal venular equivalent (CRVE) (p for non-linearity = 0.059) and was significantly increased when CRVE reached a cut-off value (283 μm) (p = 0.011) following adjustment for age, sex, etiology of HF, and diabetes. No association between the central retinal arteriolar equivalent (CRAE) and arteriolar-to-venular caliber ratio (AVR) was found with the clinical outcome in both univariable and multivariable Cox regression. CRAE, CRVE, and AVR had no relationship with the concentration of the N-terminal pro-B-type natriuretic peptide. In addition, CRVE was not associated with cardiac diastolic and systolic function. Conclusions: When the retinal venular caliber widens to a certain point, the composite incidence of HF rehospitalization and mortality significantly increase, suggesting retinal vessel caliber imaging may provide insight into the development of HF

Release of Perfluoroalkyl Substances From Melting Glacier of the Tibetan Plateau: Insights Into the Impact of Global Warming on the Cycling of Emerging Pollutants

The Tibetan Plateau (TP) has encountered rapid warming, with more than 50% of lakes expanding and 80% of glaciers retreating. Melting glaciers are known as a secondary source of pollutants, but the dynamics and release features of water‐soluble emerging chemicals have not been studied in the TP. Glacial ice and snow, meltwater runoff, rain, and lake water were collected in Nam Co basin, in the central TP. The total concentrations of perfluoroalkyl acids (PFAAs) were 1,413 pg/L for glacial ice, followed by 1,277 pg/L for meltwater runoff, 980 pg/L for lake water, and 616 pg/L for rain. Perfluorobutanoic acid is dominant in runoff and glacial ice, while lake water contained high proportions of perfluorobutane sulfonate and perfluorooctane sulfonate. During the melting season, meltwater runoff generally had greater PFAAs concentrations, and the PFAAs release fluxes were strongly related to the glacial melt intensity. Due to the direct input of PFAAs by melted glaciers, south shore of Lake Nam Co contained higher PFAAs concentrations. The estimated input fluxes of PFAAs to the lake by rain and glacial and nonglacial runoff were 1,425, 1,342, and 2,192 mg/day, respectively. Taken together, these evidences suggest that melting glaciers are sources of PFAAs, while the lake is the receptor. Given the continuity of glacial melt and high concentrations of water‐soluble emerging pollutants in glacier, the melting process will increase the risks of emerging pollutants to freshwater sources and should be of great concern.Post-print / Final draf

A home-based exercise program for children with congenital heart disease following interventional cardiac catheterization: study protocol for a randomized controlled trial

BACKGROUND: Cardiac catheterization has opened an innovative treatment field for cardiac disease; this treatment is becoming the most popular approach for pediatric congenital heart disease (CHD) and has led to a significant growth in the number of children with cardiac catheterization. Unfortunately, based on evidence, it has been demonstrated that the majority of children with CHD are at an increased risk of “non-cardiac” problems. Effective exercise therapy could improve their functional status significantly. As studies identifying the efficacy of exercise therapy are rare in this field, the aims of this study are to (1) identify the efficacy of a home-based exercise program to improve the motor function of children with CHD with cardiac catheterization, (2) reduce parental anxiety and parenting burden, and (3) improve the quality of life for parents whose children are diagnosed with CHD with cardiac catheterization through the program. METHODS/DESIGN: A total of 300 children who will perform a cardiac catheterization will be randomly assigned to two groups: a home-based intervention group and a control group. The home-based intervention group will carry out a home-based exercise program, and the control group will receive only home-based exercise education. Assessments will be undertaken before catheterization and at 1, 3, and 6 months after catheterization. Motor ability quotients will be assessed as the primary outcomes. The modified Ross score, cardiac function, speed of sound at the tibia, functional independence of the children, anxiety, quality of life, and caregiver burden of their parents or the main caregivers will be the secondary outcome measurements. DISCUSSION: The proposed prospective randomized controlled trial will evaluate the efficiency of a home-based exercise program for children with CHD with cardiac catheterization. We anticipate that the home-based exercise program may represent a valuable and efficient intervention for children with CHD and their families. TRIAL REGISTRATION: http://www.chictr.org.cn/ on: ChiCTR-IOR-16007762. Registered on 13 January 2016. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-016-1773-7) contains supplementary material, which is available to authorized users

Maternal physical activity levels in early pregnancy and the risk of spinal deformity among preschoolers at age 4: findings from the Shanghai birth cohort study

ObjectiveTo study the impact of maternal physical activity levels before and after birth on the risk of spinal deformity in preschool children.MethodsA cohort study of 760 preschoolers and their mothers tracked maternal physical activity levels during the prenatal period and the two years postnatally, as well as for two years after the child's birth, using standardized questionnaires at 6, 12, and 24 months. The risk of spinal deformity was assessed by the angle of trunk rotation (ATR) at the thoracic (T5), thoracic-lumbar (T12), and lumbar (L4) segments of the spine, with max values noted. An adjusted logistic regression model was used to explore the relationships between prenatal and postnatal physical activity levels and the risk of spinal deformity in preschoolers.ResultsIn 98 children (12.9%), ATRs were 3 or above, and 3 had ATRs of 5 at age 4. The duration of physical activity during early pregnancy (min/week) indicated a moderate risk of spinal deformity (with an ATR between 3 and 5) in children at age 4 (OR: 0.986, 95% CI: 0.976–1.001, P = 0.084). Exercising outdoors <1 h/day during 0–6 months reduced spinal deformity risk (3 ≤ ATRs < 5) compared to >1 h (OR = 0.525, 95% CI 0.301–0.917, p = 0.024). The risen risk of high ATR with long outdoor time was more significant when maternal blood calcium levels were low (OR=0.302, 95% CI 0.134–0.682; p = 0.004).ConclusionLong outdoor times (>1 h/day) in infants under 6 months may be associated with changes in trunk rotation angle or postural stress. Exercise during early pregnancy may relate to good spine development in children. Further studies are needed on physical activity's role in scoliosis prevention