Global trends and correlates of covid-19 vaccination hesitancy: Findings from the icare study

The success of large-scale COVID-19 vaccination campaigns is contingent upon people being willing to receive the vaccine. Our study explored COVID-19 vaccine hesitancy and its correlates in eight different countries around the globe. We analyzed convenience sample data collected between March 2020 and January 2021 as part of the iCARE cross-sectional study. Univariate and multivariate statistical analyses were conducted to explore the correlates of vaccine hesitancy. We included 32,028 participants from eight countries, and observed that 27% of the participants exhibited vaccine hesitancy, with increases over time. France reported the highest level of hesitancy (47.3%) and Brazil reported the lowest (9.6%). Women, younger individuals (≤29 years), people living in rural areas, and those with a lower perceived income were more likely to be hesitant. People who previously received an influenza vaccine were 70% less likely to report COVID-19 vaccine hesitancy. We observed that people reporting greater COVID-19 health concerns were less likely to be hesitant, whereas people with higher personal financial concerns were more likely to be hesitant. Our findings indicate that there is substantial vaccine hesitancy in several countries, with cross-national differences in the magnitude and direction of the trend. Vaccination communication initiatives should target hesitant individuals (women, younger adults, people with lower incomes and those living in rural areas), and should highlight the immediate health, social and economic benefits of vaccination across these settings. Country-level analyses are warranted to understand the complex psychological, socio-environmental, and cultural factors associated with vaccine hesitancy

Self-reported adherence to physical activity recommendations compared to the IPAQ interview in patients with hypertension

Glaube R Riegel,1 Giulia B Martins,1 Afonso G Schmidt,1 Marcela P Rodrigues,1 Gerson S Nunes,2 Vicente Correa Jr,1,2 Sandra C Fuchs,1 Flavio D Fuchs,1,2 Paula AB Ribeiro,1,3 Leila B Moreira1,4 1Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; 2Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; 3Cardiology Division, University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada; 4Pharmacology Department, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil Background: Physical activity (PA) is recommended as adjuvant therapy to control blood pressure (BP). The effectiveness of simple recommendations is not clear. We aimed to assess the agreement between self-report of adherence to PA in clinical routine and International Physical Activity Questionnaire (IPAQ) interview and its association with BP control. Methods: A cross-sectional study was conducted with hypertensive outpatients. Adherence to recommendation to PA was assessed by the physician and IPAQ interview. A cutoff of 150 minutes/week was used to classify active or nonactive patients. High sitting time was considered >4 hours/day. A total of 127 individuals (SBP 144.9±24.4 mmHg/DBP 82.0±12.8 mmHg) were included. Results: A total of 69 subjects (54.3%) reported to be active to their physician, whereas 81 (63.8%) were classified as active by IPAQ (6.3% active in leisure time PA). Kappa test was 0.22 (95% CI, 0.06–0.37). The rate of BP control was 45.7%. There was no association with the reported PA assessed by both methods nor with sitting time. Our results demonstrated poor agreement between self-report adherence and IPAQ interview, and neither evaluation was associated with BP control. Conclusion: Our findings underpin evidences that a simple PA recommendation has low association with BP control in clinical settings. Keywords: blood pressure, exercise, treatment adherence, self-report, hypertension, physical activity counselin

Cardiorespiratory Fitness Mediates Cognitive Performance in Chronic Heart Failure Patients and Heart Transplant Recipients.

We compared cognitive profiles in chronic heart failure patients (HF), heart transplant recipients (HT) and healthy controls (HC) and examined the relationship between cardiorespiratory fitness (V˙O <sub>2peak</sub> ), peak cardiac output (CO <sub>peak</sub> ) and cognitive performance. Stable HT patients (n = 11), HF patients (n = 11) and HC (n = 13) (61.5 ± 8.5 years) were recruited. Four cognitive composite scores targeting different cognitive functions were computed from neuropsychological tests: working memory, processing speed, executive functions and verbal memory. Processing speed and executive function scores were higher, which indicates lower performances in HF and HT compared to HC (p < 0.05). V˙O <sub>2peak</sub> and first ventilatory threshold (VT <sub>1</sub> ) were lower in HF and HT vs. HC (p < 0.01). CO <sub>peak</sub> was lower in HF vs. HT and HC (p < 0.01). Processing speed, executive function and verbal memory performances were correlated with V˙O <sub>2peak</sub> , VT <sub>1</sub> and peak cardiac hemodynamics (p < 0.05). Mediation analyses showed that V˙O <sub>2peak</sub> and VT <sub>1</sub> mediated the relationship between group and processing speed and executive function performances in HF and HT. CO <sub>peak</sub> fully mediated executive function and processing speed performances in HF only. V˙O <sub>2peak</sub> and CO <sub>peak</sub> were related to cognitive performance in the entire sample. In addition, V˙O <sub>2peak</sub> and VT <sub>1</sub> fully mediated the relationship between group and executive function and processing speed performances

Obese but Fit: The Benefits of Fitness on Cognition in Obese Older Adults.

Obesity is associated with an accelerated cognitive decline. Aerobic fitness has a protective effect on cognition in older adults, but no study has investigated this effect in obese individuals. The present study aimed to 1) compare cognitive function in lower-fit (LoFit) and higher-fit (HiFit) obese individuals compared with nonobese individuals, and 2) examine the association between exercise variables (including hemodynamic variables) and cognitive function in obese individuals. Fifty-four obese and 16 nonobese individuals performed a maximal cardiopulmonary exercise test (with gas exchange analysis and noninvasive hemodynamic measurement) and cognitive tests assessing short-term and working memory, processing speed, executive function, and long-term verbal memory. Obese individuals were divided into 2 groups according to their median aerobic fitness divided by lean body mass to form a group of LoFit obese (n = 27) and a group of HiFit obese (n = 27) individuals. A total of 14 nonobese individuals and 49 obese individuals were included in the final analysis (HiFit: n = 26, LoFit: n = 23). Compared with LoFit obese, HiFit obese participants had greater performances in executive function (P = 0.002) and short-term memory (P = 0.02). Nonobese and HiFit obese participants showed equivalent performances in all domains of cognition. In obese individuals, aerobic fitness was the only independent predictor for short-term memory (R <sup>2</sup> = 0.24; P < 0.001), working memory (R <sup>2</sup> = 0.16; P = 0.02), processing speed (R <sup>2</sup> = 0.22; P = 0.01), and executive function (R <sup>2</sup> = 0.49; P = 0.003), but not for long-term verbal memory (R <sup>2</sup> = 0.15; P = 0.26). HiFit obese individuals showed greater short-term memory and executive function performances compared with LoFit obese individuals, suggesting that aerobic fitness could help preserve cognitive function despite the presence of obesity