Cardiac rehabilitation: a comprehensive review

Cardiac rehabilitation (CR) is a commonly used treatment for men and women with cardiovascular disease. To date, no single study has conclusively demonstrated a comprehensive benefit of CR. Numerous individual studies, however, have demonstrated beneficial effects such as improved risk-factor profile, slower disease progression, decreased morbidity, and decreased mortality. This paper will review the evidence for the use of CR and discuss the implications and limitations of these studies. The safety, relevance to special populations, challenges, and future directions of CR will also be reviewed

Predictors of Metabolic Syndrome in Participants of a Cardiac Rehabilitation Program

Metabolic syndrome increases the risk of all-cause mortality, cardiovascular mortality and cardiovascular events in patients with cardiovascular disease (CVD). This study assessed the predictors of metabolic syndrome, both its incidence and resolution in a cohort of cardiac rehabilitation program graduates. Methods. A total of 154 and 80 participants without and with metabolic syndrome respectively were followed for 48 months. Anthropometric measurements, metabolic risk factors, and quality of life were assessed at baseline and at 48 months. Logistic regression models were used to assess the predictors of metabolic syndrome onset and resolution. Results. Increasing waist circumference (OR 1.175, P ≤ 0.001) was an independent predictor for incident metabolic syndrome (R2 for model = 0.46). Increasing waist circumference (OR 1.234, P ≤ 0.001), decreasing HDL-C (OR 0.027, P = 0.005), and increasing triglycerides (OR 3.005, P = 0.003) were predictors of metabolic syndrome resolution. Conclusion. Patients with CVD that further develop metabolic syndrome are particularly susceptible for the cascade of cardiovascular events and mortality. Increasing waist circumference confers a higher risk for future onset of metabolic syndrome in this group of patients. They will require closer follow-up and should be targeted for further prevention strategies after cardiac rehabilitation program completion

Internet-Based Support for Cardiovascular Disease Management

With significant declines in cardiovascular disease (CVD) mortality, attention has shifted to patient management. Programs designed to manage CVD require the involvement of health professionals for comanagement and patients' self-management. However, these programs are commonly limited to large urban centers, resulting in limited access for rural patients. The use of telehealth potentially overcomes geographical barriers and can improve access to care for patients. The current research explores how an Internet-based platform might facilitate collaboration among healthcare providers comanaging patients and enhance behavioural change in patients. Forty-eight participants were interviewed including: (a) patients (n = 12), (b) physicians (n = 11), (c) nurses (n = 13), and (d) allied health professionals (n = 10). The results were organized and analyzed in three central themes: (1) role of technology for CVD management, (2) challenges to technology adoption, and (3) incentives for technology adoption. Health care providers and patients supported future implementation of Internet-based technology support for CVD management

Determinants of changes in dietary patterns among Chinese immigrants: a cross-sectional analysis

Background: Chinese individuals who have immigrated to a Western country initially tend to have a lower risk ofcardiovascular disease (CVD) compared to people who are already living there. Some studies have found, however,that CVD risk increases over time in immigrants and that immigration to a western country is associated withchanges in dietary patterns. This could have unfavourable effects on the risk of CVD. There is limited knowledge onthe food patterns, awareness and knowledge about healthy nutrition among Chinese immigrants. The objective forthis study is to explore changes in food patterns, and levels of awareness and knowledge of healthy nutrition bylength of residence among Chinese immigrants to Canada.Methods: 120 Chinese individuals born in China but currently living in Canada completed an assessment on sociodemographiccharacteristics, changes in dietary patterns and variables of awareness and knowledge about healthyfoods. With ordinal logistic regression the associations between the quartiles of length of residence and dietarypatterns, variables of awareness and knowledge about healthy foods were explored, adjusting for age, sex,education and body mass index.Results: More than 50% of the participants reported increasing consumption of fruits and vegetables, decreasingthe use of deep-frying after immigration. Increased awareness and knowledge about healthy foods was reportedby more than 50% of the participants. Ordinal regression indicated that Chinese immigrants who lived in Canadathe longest, compared to Chinese immigrants who lived in Canada the shortest, consumed significant greaterportion sizes (OR: 9.9; 95% CI: 3.11 - 31.15), dined out more frequently (OR: 15.8; 95% CI: 5.0 - 49.85), and consumedconvenience foods more often (OR: 3.5; 95% CI: 1.23 - 10.01).Conclusions: Chinese immigrants reported some favourable changes in their dietary intake and greater awarenessand more knowledge about healthy foods after immigration. However, an increase in portion size, an increasedfrequency of dining out and an increased consumption of convenience foods could indicate some unfavourablechanges. These results suggest that health promotion strategies should build on the observed benefits ofimproved nutritional knowledge and target areas of portion size and convenience eating

Suburbanisation of Oral Cavity Cancers: Evidence From a Geographically-Explicit Observational Study of Incidence Trends in British Columbia, Canada, 1981–2010

Background Recent studies have demonstrated an elevated risk of oral cavity cancers (OCC) among socioeconomically deprived populations, whose increasing presence in suburban neighbourhoods poses unique challenges for equitable health service delivery. The majority of studies to date have utilised aspatial methods to identify OCC. In this study, we use high-resolution geographical analyses to identify spatio-temporal trends in OCC incidence, emphasising the value of geospatial methods for public health research. Methods Using province-wide population incidence data from the British Columbia Cancer Registry (1981–2009, N  = 5473), we classify OCC cases by census-derived neighbourhood types to differentiate between urban, suburban, and rural residents at the time of diagnosis. We map geographical concentrations by decade and contrast trends in age-adjusted incidence rates, comparing the results to an index of socioeconomic deprivation. Results Suburban cases were found to comprise a growing proportion of OCC incidence. In effect, OCC concentrations have dispersed from dense urban cores to suburban neighbourhoods in recent decades. Significantly higher age-adjusted oral cancer incidence rates are observed in suburban neighbourhoods from 2006 to 2009, accompanied by rising socioeconomic deprivation in those areas. New suburban concentrations of incidence were found in neighbourhoods with a high proportion of persons aged 65+ and/or born in India, China, or Taiwan. Conclusions While the aging of suburban populations provides some explanation of these trends, we highlight the role of the suburbanisation of socioeconomically deprived and Asia-born populations, known to have higher rates of risk behaviours such as tobacco, alcohol, and betel/areca consumption. Specifically, betel/areca consumption among Asia-born populations is suspected to be a primary driver of the observed geographical shift in incidence from urban cores to suburban neighbourhoods. We suggest that such geographically-informed findings are complementary to potential and existing place-specific cancer control policy and targeting prevention efforts for high-risk sub-populations, and call for the supplementation of epidemiological studies with high-resolution mapping and geospatial analysis

Ethnic-Specific Differences in Vitamin D Status Is Associated with Adiposity

BackgroundLow circulating 25 hydroxyvitamin D [25(OH)D] concentrations are common in obesity (BMI ≥30 kg/m2) and a negative relationship with body fat distribution has recently been reported. Ethnic-specific differences in body fat distribution have been described with South Asians are reported to have greater visceral adipose tissue (VAT), which could influence circulating 25(OH)D concentrations. The objective of this study is to investigate the relationship between plasma 25(OH)D, adiposity, and body fat distribution in Europeans and South Asians.Methods/Principal Findings187 Europeans and 192 South Asians were assessed for demographics, anthropometrics, and plasma 25(OH)D concentrations. Subcutaneous adipose tissue (SAT) and VAT were quantified by CT scan, and percent body fat by DEXA. Data were assessed by general linear models. South Asians had lower (P<0.001) plasma 25(OH)D concentrations and higher VAT (P = 0.04) than Europeans. Plasma 25(OH)D concentrations were negatively (P<0.05) associated with BMI, waist circumference, percent body fat, total adipose tissue, VAT, and SAT in unadjusted models and negatively (P<0.05) associated with VAT, SAT, and percent body fat after adjusting for BMI, ethnicity, age, and season of blood collection in males and females. When percent body fat, VAT, and SAT were included in the same model, only VAT remained negatively (P<0.05) associated with plasma 25(OH)D concentrations. Ethnicity remained significant in all models (P<0.001).ConclusionCompared to other adipose tissue compartments, VAT may have a distinct role in determining plasma 25(OH)D concentrations, which may account for the lower levels in South Asians

Evaluation of the Impact of a Public Bicycle Share Program on Population Bicycling in Vancouver, BC

Public bicycle share programs have been implemented in cities around the world to encourage bicycling. However, there are limited evaluations of the impact of these programs on bicycling at the population level. This study examined the impact of a public bicycle share program on bicycling amongst residents of Vancouver, BC. Using an online panel, we surveyed a population-based sample of Vancouver residents three times: prior to the implementation of the public bicycle share program (T0, October 2015, n=1111); in the early phase of implementation (T1, October 2016, n=995); and one-year post implementation (T2, October 2017, n=966). We used difference in differences estimation to assess whether there was an increase in bicycling amongst those living and/or working in close proximity (≤500 m) to Vancouver\u27s Mobi by Shaw Go public bicycle share program, compared to those living and working outside this area. Results suggest that only living or only working inside the bicycle share service area was not associated with increases in bicycling at T1 or T2 relative to those outside the service area. Both living and working inside the bicycle share service area was associated with increases in bicycling at T1 (OR: 2.26, 95% CI: 1.07, 4.80), however not at T2 (OR: 1.37, 95% CI: 0.67, 2.83). These findings indicate that the implementation of a public bicycle share program may have a greater effect on bicycling for residents who both live and work within the service area, although this effect may not be sustained over time.&nbsp

A Direct Assessment of “Obesogenic” Built Environments: Challenges and Recommendations

This paper outlines the challenges faced during direct built environment (BE) assessments of 42 Canadian communities of various income and urbanization levels. In addition, we recommend options for overcoming such challenges during BE community assessments. Direct BE assessments were performed utilizing two distinct audit methods: (1) modified version of Irvine-Minnesota Inventory in which a paper version of an audit tool was used to assess BE features and (2) a Physical Activity and Nutrition Features audit tool, where the presence and positions of all environmental features of interest were recorded using a Global-Positioning-System (GPS) unit. This paper responds to the call for the need of creators and users of environmental audit tools to share experiences regarding the usability of tools for BE assessments. The outlined BE assessment challenges plus recommendations for overcoming them can help improve and refine the existing audit tools and aid researchers in future assessments of the BE

Environmental Profile of a Community’s Health (EPOCH): An Ecometric Assessment of Measures of the Community Environment Based on Individual Perception

Background Public health research has turned towards examining upstream, community-level determinants of cardiovascular disease risk factors. Objective measures of the environment, such as those derived from direct observation, and perception-based measures by residents have both been associated with health behaviours. However, current methods are generally limited to objective measures, often derived from administrative data, and few instruments have been evaluated for use in rural areas or in low-income countries. We evaluate the reliability of a quantitative tool designed to capture perceptions of community tobacco, nutrition, and social environments obtained from interviews with residents in communities in 5 countries. Methodology/ Principal Findings Thirteen measures of the community environment were developed from responses to questionnaire items from 2,360 individuals residing in 84 urban and rural communities in 5 countries (China, India, Brazil, Colombia, and Canada) in the Environmental Profile of a Community’s Health (EPOCH) study. Reliability and other properties of the community-level measures were assessed using multilevel models. High reliability (>0.80) was demonstrated for all community-level measures at the mean number of survey respondents per community (n = 28 respondents). Questionnaire items included in each scale were found to represent a common latent factor at the community level in multilevel factor analysis models. Conclusions/ Significance Reliable measures which represent aspects of communities potentially related to cardiovascular disease (CVD)/risk factors can be obtained using feasible sample sizes. The EPOCH instrument is suitable for use in different settings to explore upstream determinants of CVD/risk factors