Impact of cardiovascular risk factor control on long-term cardiovascular and all-cause mortality in the general population

Purpose: In clinical trials, lowering cardiovascular risk factors (CVRFs) reduces cardiovascular (CV) morbidity and mortality. We assessed the impact of controlling CVRFs at baseline on long-term all-cause and CV mortality in the general population.

Methods: Analysis was based on the Third French MONICA population-based survey (1994–1997). Vital status was obtained 18 years after inclusion. Statistical analysis was based on Cox-modelling.

Results: About 3402 participants aged 35–64 were included and 569 (17%) presented with 2 or more uncontrolled CVRFs, 1194 (35%) had one uncontrolled CVRF, 770 (23%) had all CVRFs controlled under treatment (or were former smokers) and 869 (25%) exhibited no CVRF. During the follow-up, 389 deaths occurred (76 were due to CV causes). Considering all-cause mortality, the adjusted hazard ratios (aHR) for subjects with one uncontrolled CVRF and for those with two or more were 1.38 [1.03–1.83] (p?=?0.029) and 1.80 [1.33–2.43](p?aHR was 0.66 [0.44–0.98] (p?=?0.042). Considering CV mortality, aHRs for subjects presenting with one and two or more uncontrolled CVRF were 1.70 [0.84–3.42] (p?=?0.138) and 3.67 [1.85–7.29] (p?Conclusions: Failing to control CVRFs significantly increases long-term all-cause and CV mortality in the French general population.

• Key messages

• Only 30% of patients with cardiovascular risk factors were controlled.

• Failing to control cardiovascular risk factors significantly increased long-term cardiovascular and all-cause mortality.

• A residual risk for all-cause mortality remained even when patients were controlled.

     

Combination of low blood pressure response,low exercise capacity and slow heart rate recovery during an exercise test significantly increases mortality risk

Abstract

Aims: We investigated the combination of low systolic blood pressure (SBP) response, low exercise capacity (EC) and slow heart rate recovery (HRR) during an exercise test in mortality prediction.

Patients and methods: Our population consisted of 3456 patients from the Finnish Cardiovascular Study. A failure of SBP to increase >42?mmHg was defined as a low response. Low EC was defined as <?8 metabolic equivalents. 1-minute HRR ≤18 bpm from maximum was defined as slow HRR.

Results: During a median follow up of 10.0?years, 537 participants died. Reduced SBP response, low EC and slow HRR were independent predictors of all-cause and CV mortality (p?<?.001 for all). Patients with reduced SBP response, low EC and slow HRR had a very high mortality rate of 42.1% during follow up compared to only 4.5% of the patients without any of these risk factors. The hazard ratios for all-cause mortality in patients with one, two or three of the studied risk factors were 3.2, 6.0, and 10.6, respectively (p?<?.001 for all).

Conclusion: The combination of reduced SBP response, low exercise capacity, and reduced HRR in an exercise test is associated with very high mortality and can be used in risk stratification.

• Key messages

• The combination of low blood pressure response, low exercise capacity and slow heart rate recovery in an exercise test is able to identify a group of patients in a very high mortality risk.

• These parameters are easily derived from an exercise test.

• All parameters are commonly available in clinical practice.

     

Limited value of NT-proBNP as a prognostic marker of all-cause mortality in patients with heart failure with preserved and mid-range ejection fraction in primary care: A report from the swedish heart failure register

Abstract

Aim: The prognostic value of natriuretic peptides in the management of heart failure (HF) patients with ejection fraction (EF) <40% is well established, but is less known for those with EF ≥40% managed in primary care (PC). Therefore, the aim of this study is to describe the prognostic significance of plasma NT-proBNP in such patients managed in PC.

Subjects: We included 924 HF patients (48% women) with EF ≥40% and NT-proBNP registered in the Swedish Heart Failure Registry. Follow-up was 1100?±?687?days.

Results: One-, three- and five-year mortality rates were 8.1%, 23.9% and 44.7% in patients with EF 40–50% (HFmrEF) and 7.3%, 23.6% and 37.2% in patients with EF ≥50% (HFpEF) (p?=?0.26). Patients with the highest mean values of NT-proBNP had the highest all-cause mortality but wide standard deviations (SDs). In univariate regression analysis, there was an association only between NT-proBNP quartiles and all-cause mortality. In HFmrEF patients, hazard ratio (HR) was 1.96 (95% CI 1.60–2.39) p?<?0.0001) and in HFpEF patients, HR was 1.72 (95% CI 1.49–1.98) p?<?0.0001). In a multivariate Cox proportional hazard regression analysis, adjusted for age, NYHA class, atrial fibrillation and GFR class, this association remained regarding NT-proBNP quartiles [HR 1.83 (95% CI 1.38–2.44), p?<?0.0001] and [HR 1.48 (95% CI 1.16–1.90), p?=?0.0001], HFmrEF and HFpEF, respectively.

Conclusion: NT-proBNP has a prognostic value in patients with HF and EF ≥40% managed in PC. However, its clinical utility is limited due to high SDs and the fact that it is not independent in this population which is characterized by high age and much comorbidity.

• Key points

• It is uncertain whether NT-proBNP predicts risk in heart failure with preserved ejection fraction (EF?>?40%, HFpEF) managed in primary care.

• We show that high NT-proBNP predicts increased all-cause mortality in HFpEF-patients managed in primary care.

• The clinical use is however limited due to large standard deviations, many co-morbidities and high age.

• Many of these co-morbidities contribute to all-cause mortality and management of these patients should also focus on these co-morbidities.

     

Oxygen uptake at aerobic threshold is inversely associated with fatal cardiovascular and all-cause mortality events

Purpose: We aimed to assess the associations of oxygen uptake at aerobic threshold (VO₂ at AT) with cardiovascular and all-cause mortality.

Design: VO₂ at AT was assessed in 1663 middle-aged men in a cohort study. Hazard ratios (HRs) were calculated for sudden cardiac death (SCD), fatal coronary heart disease (CHD) and cardiovascular disease (CVD) and all-cause mortality.

Results: During a median follow-up of 25.6 years, 138 SCDs, 209 fatal CHDs, 333 fatal CVDs and 719 all-cause mortality events occurred. On adjustment for established risk factors, the HRs (95% CIs) for SCD, fatal CHD, fatal CVD and all-cause mortality were 0.48 (0.28–0.82), 0.48 (0.31–0.74), 0.57 (0.41–0.79) and 0.66 (0.53–0.82), respectively comparing extreme quartiles of VO₂ at AT. On further adjustment for peak VO₂, the HRs were 0.87 (0.48–1.56), 0.83 (0.52–1.34), 0.91 (0.63–1.30) and 0.88 (0.69–1.12), respectively. Addition of VO₂ at AT to a standard CVD mortality risk prediction model was associated with a C-index change of 0.0085 (95% CI: ?0.0002–0.0172; p?=?.05) at 25 years.

Conclusions: VO₂ at AT is inversely associated with cardiovascular and all-cause mortality events, but the associations are partly dependent on peak VO₂. VO₂ at AT may improve the prediction of the long-term risk for CVD mortality.

• KEY MESSAGES

• Oxygen uptake at aerobic threshold (VO₂ at AT), a cardiopulmonary exercise testing parameter, may be a useful prognostic tool for adverse clinical outcomes in the general population.

• In a population-based prospective cohort study of men, VO₂ at AT was inversely associated with cardiovascular and all-cause mortality events and improved the prediction of cardiovascular mortality.

• In populations who cannot achieve maximal VO₂, VO₂ at AT may serve as a useful prognostic tool; however, further studies are warranted.

     

Age at death in cohorts of middle-aged men followed-up until nearly extinction: the European areas of the Seven Countries Study

Abstract

Objectives: To describe age at death (AD) in ten cohorts of middle-aged men followed-up until nearly extinction as a function of personal characteristics measured at baseline.

Material and Methods: Cohorts of men aged 40–59 years in five European countries (Finland, the Netherlands, Italy, Serbia, Greece) were examined and then followed-up for mortality during 45 (3 cohorts) or 50 years (7 cohorts). Multiple linear regression (MLR) models were computed with AD as dependent variable and 35 personal characteristics as independent variables.

Results: Out of 7047 men, 6798 (96.5%) died in 45–50 years. Average AD was 74.4 (median 75) years. Only five variables were significant in all the five countries when tested by MLR. By pooling together all countries and selecting variables by a stepwise technique, 20 were significant (p?<?.05): age at entry examination, being married, being a never smoker or an ex-smoker (versus current smokers), forced expiratory volume, high socio-economic status, arm circumference, subscapular skinfold, having moderate or vigorous physical activity (all with a positive relationship with AD); father early mortality, laterality/linearity index, high systolic blood pressure, high serum cholesterol, having a major cardiovascular disease, diabetes or chronic bronchitis (these with a negative relationship), while body mass index, subdivided into four classes, showed a parabolic relationship (versus a reference class). Each factor was associated with a difference of months or a few years to AD, while their combinations were associated with several years of greater or smaller AD.

Conclusions: The availability of a relatively small number of risk factors measured in middle-aged men allows making rough estimates of AD as related to all-cause mortality during a follow-up of 50 years. AD is also a valuable metrics to describe past health in nearly extinct populations.

• Key messages

• We aimed at studying the age at death (AD) of middle-aged men of the European cohorts of the Seven Countries Study, followed-up 45–50 years until nearly extinction, as a function of personal characteristics measured at baseline.

• Multiple linear regression (MLR) models were computed with AD as dependent variable and 35 personal characteristics or risk factors as independent variables and only five were significant in all individual countries, whereas pooling together all countries, 20 variables were significant as selected by stepwise MLR.

• Each factor was associated with differences of months or a few years to AD, while their combinations were associated with several years of greater or smaller AD.

• AD is a valuable metrics to describe past health in nearly extinct populations: it might also be used to communicate years of life gained by preventive measures on modifiable variables.

     

Applicability,validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions

Purpose: To verify the applicability, reproducibility and validity of the SCIM III patients with non-traumatic spinal cord injury.

Method: The cross-sectional study included 30 patients (66% females; 41.5?±?14.7 yo) with non-traumatic spinal cord injury of any etiology. Subjects were subjected by computerized gait analysis and answered the Brazilian versions of SCIM III (0–100 points) and FIM? (18–126 points) by two raters (A and B) at the same day and 1 week later (A).

Results: The intraclass correlation coefficient for the use of SCIM III indicated appropriated intra- and inter-evaluator reproducibility (ICC?=?0.9). Correlation between the SCIM III and the motor FIM? was appropriate (r?=?0.6; p?=?0.0). SCIM III subscales and FIM? domains correlated strongly for self-care (r?=?0.8; p?≤?0.001), moderately for transfers (r?=?0.6; p?=?0.0005) and locomotion (r?=?0.6; p?=?0.0006). SCIM III mobility subscale positively correlated with the cadence (r?=?0.8; p?≤?0.01), gait speed (r?=?0.7; p?≤?0.01) and step length (r?=?0.6; p?≤?0.01).

Conclusions: SCIM III is a reproducible functional assessment instrument and capable of evaluating the level of independence of the individual with non-traumatic spinal cord injury. The SCIM III is more sensitive than the MIF? for non-traumatic spastic paraplegic patients with higher levels of independence, particularly if they can walk independently. Linear gait parameters correlated with its mobility subscale.

• Implications for Rehabilitation

• Applicability, validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions.

• There are not many studies focused on patients with non-traumatic spinal cord lesion.

• Disability varies in severity, but frequently contributes to limitations in the activities of daily living (ADL) and participation.

• We do not find in the literature studies that assess the functionality of these individuals as comprehensive as ours.

     

How the probability of presentation to a primary care clinician correlates with cancer survival rates: a European survey using vignettes

Objective: European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates.

Design: Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates.

Setting: A total of 14 countries.

Subjects: Consensus groups of PCPs.

Main outcome measures: Probability of initial presentation to a PCP for four clinical vignettes.

Results: There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r =??0.16, 95% CI??0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r?=??0.57, 95% CI??0.83 to??0.12; ovary: r?=??0.13, 95% CI??0.57 to 0.38; breast r?=?0.14, 95% CI??0.36 to 0.58; bowel: r?=?0.20, 95% CI??0.31 to 0.62).

Conclusions: There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a “PCP-as-gatekeeper” system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival.

• KEY POINTS

• European cancer survival rates vary widely, and health system factors may account for some of these differences.

• The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP.

• The degree to which PCPs act as gatekeepers varies considerably from country to country.

• There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.

     

Level of agreement between physical activity levels measured by ActiHeart and the International Physical Activity Questionnaire in persons with intellectual disability

Purpose: The purpose of this study was to determine the level of agreement between objective physical activity (PA) (ActiHeart^®) and subjective proxy-respondent International Physical Activity Questionnaire-short version (IPAQ-S) data in adults with intellectual disabilities (IDs).

Method: Fifty-eight participants wore ActiHeart^® monitors for seven consecutive days. Caregivers of each participant completed the IPAQ-S on behalf of the participant. Total PA, time spent in light, moderate, and vigorous activity as well as time spent being sedentary were assessed by the IPAQ-S and the ActiHeart^®. Results were compared by means of correlation analyses. The level of agreement was presented with Bland–Altman plots.

Results: Objective PA (ActiHeart^®) was higher (225.57?±?91.96?min/week) than IPAQ-S PA reported by care-givers (177.06?±?309.17?min/week). Weak significant correlations were observed between the ActiHeart^® and IPAQ-S instruments for sedentary behavior (r?=?0.31; p?=?0.04); no significant correlations for light (r=??0.04; p?=?0.8), moderate (r=??0.07; p?=?0.63), or vigorous PA (r=??0.2; p?=?0.18) were found. Limited agreement between objectively determine PA (ActiHeart^®) and IPAQ-S was found.

Conclusion: IPAQ-S is inaccurate when determining PA in persons with ID as it significantly underestimates the true levels of PA in this cohort.

• Implications for Rehabilitation

• Persons with intellectual disability (ID) report insufficient physical activity for health benefits.

• Physical activity is often determined by means of subjective proxy reporting.

• Objective physical activity measurements by means of combined heart rate and accelerometer are necessary to determine accurate levels of physical activity in persons with ID.

• Exercise interventions should be based on objective physical activity measurements.

     

Trans-fatty acids and cardiovascular risk: does origin matter?

Several studies have aimed to unravel the contribution of different types of dietary fatty acids to human health and disease. Investigations have consistently shown that high consumption of industrially produced trans-fatty acids from partially hydrogenated vegetable oils is harmful to human health, in particular cardiovascular health. Therefore, the U.S. Food and Drug Administration announced that partially hydrogenated oils are no longer ‘generally recognized as safe’, and trans-fatty acids are not permitted in the U.S. food supply. On the other hand, recent studies analyzing the association between circulating trans-fatty acids and disease have revealed that some ruminant-specific trans-fatty acids are associated with a reduction in incidence of disease. In this special report, we highlight recent findings and point out perspectives for future studies on this topic.     

Reliability and validity of the Finnish version of the Lower Extremity Functional Scale (LEFS)

Purpose: The present study aimed to assess the psychometric properties of the Finnish version of the Lower Extremity Functional Scale (LEFS) among foot and ankle patients.

Methods: The LEFS was translated and cross-culturally adapted to Finnish. We assessed the test–retest reliability, internal consistency, floor-ceiling effect, construct validity and criterion validity in patients who underwent surgery due to musculoskeletal pathology of the foot and ankle (N?=?166).

Results: The test–retest reliability was high (ICC = 0.93, 95% CI: 0.91–0.95). The standard error of measurement was 4.1 points. The Finnish LEFS showed high internal consistency (Cronbach’s α?=?0.96). A slight ceiling effect occurred as 17% achieved the maximum score. The LEFS correlation was strong with the 15D Mobility dimension (r?=?0.74) and overall HRQoL (r?=?0.66), pain during foot and ankle activity (r=??0.69) and stiffness (r=??0.62). LEFS correlated moderately with foot and ankle pain at rest (r=??0.50) and with physical activity (r?=?0.46).

Conclusions: The Finnish version of the LEFS showed reliability and validity comparable to those of the original version. This study indicates that the Finnish version of the LEFS serves both clinical and scientific purposes in assessing lower-limb function.

• Implications for Rehabilitation

• The Finnish version of the Lower Extremity Functional Scale (LEFS) is a reliable and valid tool for assessing lower-extremity musculoskeletal disability in Finnish-speaking population.

• Investigation of the psychometric properties of the Finnish version of the LEFS showed validity and reliability comparable to those of the original English version.

• The Finnish LEFS is easy to complete and suitable for clinical, rehabilitation and research purposes.

     

Sex after amputation: the relationships between sexual functioning,body image,mood and anxiety in persons with a lower limb amputation

Aim: The study examined the relationships between psychological variables and sexual functioning in persons with lower limb amputations.

Method: Sixty-five participants (n?=?49 males, n?=?16 females) with lower limb amputations completed a battery of self-report questionnaires regarding their current psychological well-being and their current sexual activity. Measures included the anxiety items on the Hospital Anxiety and Depression Scale, the Beck Depression Inventory – Second Edition, Body Image Quality of Life Inventory, Body Exposure Self-Consciousness during Intimate Situations and the Golombok-Rust Inventory of Sexual Satisfaction.

Results: Half of all participants with lower limb amputations were not currently sexually active. Approximately 60% of those who were sexually active scored within the clinical range for overall sexual dysfunction. Overall levels of sexual dysfunction were associated with significantly higher levels of anxiety (r?=?0.40, p?r?=?0.41, p?r?=?0.56, p?Conclusions: Psychological challenges following limb loss are strongly associated with levels of sexual dysfunction. The study highlights the need for psychological and psychosexual assessment and intervention following limb loss to enhance sexual functioning and overall quality of life.

• Implications for Rehabilitation

• Only half of the participants with a lower limb amputation were sexually active. Over 60% of those who were sexually active reported clinical levels of sexual dysfunction. One third of the entire sample scored within the clinical range for depression and for anxiety.

• Depression, anxiety and body image issues were significantly associated with sexual dysfunction in the current sample of individuals with lower limb amputation.

• There is a need for psychosexual assessment following limb loss to ensure that appropriate and timely interventions are made available. Interventions that target the psychological factors related to sexual dysfunction are likely to improve overall quality of life for these individuals

     

Potentially severe drug–drug interactions among older people and associations in assisted living facilities in Finland: a cross-sectional study

Objective: This study aims to assess potentially severe class D drug–drug interactions (DDDIs) in residents 65 years or older in assisted living facilities with the use of a Swedish and Finnish drug–drug interaction database (SFINX).

Design: A cross-sectional study of residents in assisted living facilities in Helsinki, Finland.

Setting: A total of 1327 residents were assessed in this study. Drugs were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and DDDIs were coded according to the SFINX.

Main outcome measures: Prevalence of DDDIs, associated factors and 3-year mortality among residents.

Results: Of the participants (mean age was 82.7 years, 78.3% were females), 5.9% (N?=?78) are at risk for DDDIs, with a total of 86 interactions. Participants with DDDIs had been prescribed a higher number of drugs (10.8 (SD 3.8) vs. 7.9 (SD 3.7), p?p?=?0.030). The most frequent DDDIs were related to the concomitant use of potassium with amiloride (N?=?12) or spironolactone (N?=?12). Carbamazepine (N?=?13) and methotrexate (N?=?9) treatments were also frequently linked to DDDIs. During the follow-up, no differences in mortality emerged between the participants exposed to DDDIs and the participants not exposed to DDDIs.

Conclusions: Of the residents in assisted living, 5.9% were exposed to DDDIs associated with the use of a higher number of drugs. Physicians should be trained to find safer alternatives to drugs associated with DDDIs.

• KEY POINTS

• Potentially severe, class D drug–drug interactions (DDDIs) have been defined in the SFINX database as clinically relevant drug interactions that should be avoided.

• ???Of the residents in assisted living, 5.9% were exposed to DDDIs that were associated with the use of a higher number of drugs.

• ???The most frequent DDDIs were related to the concomitant use of potassium with amiloride or spironolactone. Carbamazepine and methotrexate were also linked to DDDIs.

• ???No difference in mortality was observed between residents exposed to DDDIs and residents not exposed to DDDIs.

     

High hospital readmission rates for patients aged ≥65 years associated with low socioeconomic status in a Swedish region: a cross-sectional study in primary care

Objective: There is a presumption that hospital readmission rates amongst persons aged ≥65 years are mainly dependent on the quality of care. In this study, our primary aim was to explore the association between 30-day hospital readmission for patients aged ≥65 years and socioeconomic characteristics of the studied population. A secondary aim was to explore the association between self-reported lack of strategies for working with older patients at primary health care centres and early readmission.

Design: A cross-sectional ecological study and an online questionnaire sent to the heads of the primary health care centres. We performed correlation and regression analyses.

Setting and subjects: Register data of 283,063 patients in 29 primary health care centres in the Region Örebro County (Sweden) in 2014.

Main outcome measure: Thirty-day hospital readmission rates for patients aged ≥65 years. Covariates were socioeconomic characteristics among patients registered at the primary health care centre and eldercare workload.

Results: Early hospital readmission was found to be associated with low socioeconomic status of the studied population: proportion foreign-born (r?=?0.74; p?r?=?0.73; p?r?=?0.74; p?r?=?0.51; p?r?=??0.40; p?=?0.03). The proportion of unemployed alone could explain up to 71.4% of the variability in hospital readmission (p?Conclusion: Primary health care centres localized in neighbourhoods with low socioeconomic status had higher rates of hospital readmission for patients aged ≥65. Interventions aimed at reducing hospital readmissions for older patients should also consider socioeconomic disparities.

• Key Points

• In Sweden, hospital readmission within 30 days among patients aged ≥65 has been used as a measure of quality of primary care for the elderly.

• However, in our study, elderly 30-day readmission was associated with low neighbourhood socioeconomic status.

• A simple survey in one Swedish region showed that the primary health care centres that lacked active strategies for working with aged patients did not have higher hospital readmission rates than those that reported having strategies.

• Interventions aimed at reducing elderly hospital readmissions should therefore also consider the socioeconomic disparities in the elderly.

     

Self-efficacy is an independent predictor for postoperative six-minute walk distance after elective open repair of abdominal aortic aneurysm

Objectives: Open surgery is performed to treat abdominal aortic aneurysm (AAA), although the subsequent surgical stress leads to worse physical status. Preoperative self-efficacy has been reported to predict postoperative physical status after orthopedic surgery; however, it has not been sufficiently investigated in patients undergoing abdominal surgery. The purpose of the present study is to investigate the correlation between preoperative self-efficacy and postoperative six-minute walk distance (6MWD) in open AAA surgery.

Methods: Seventy patients who underwent open AAA surgery were included. Functional exercise capacity was measured using preoperative and 1 week postoperative 6MWD. Self-efficacy was preoperatively measured using self-efficacy for physical activity (SEPA). The correlations of postoperative 6MWD with age, height, BMI, preoperative 6MWD, SEPA, Hospital Anxiety and Depression Scale (HADS) score, operative time, and blood loss were investigated using multivariate analysis.

Results: Single regression analysis showed that postoperative 6MWD was significantly correlated with age (r?=??0.553, p?≤?0.001), height (r?=?0.292, p?=?0.014), Charlson’s comorbidity index (r?=??0.268, p?=?0.025), preoperative 6MWD (r?=?0.572, p?≤?0.001), SEPA (r?=?0.586, p?≤?0.001), and HADS-depression (r?=??0.296, p?=?0.013). Multiple regression analysis showed that age (p?=?0.002), preoperative 6MWD (p?=?0.013), and SEPA (p?=?0.043) score were significantly correlated with postoperative 6MWD.

Conclusions: Self-efficacy was an independent predictor for postoperative 6MWD after elective open AAA surgery. This suggests the importance of assessing not only physical status but also psychological factors such as self-efficacy.

• Implications for Rehabilitation

• Preoperative self-efficacy has been limited to reports after orthopedic surgery.

• We showed that preoperative self-efficacy predicted postoperative 6MWD after AAA surgery.

• Treatment to improve self-efficacy might be useful in patients receiving AAA surgery in rehabilitation.

     

Cross-cultural adaptation,reliability, and validation of the Korean version of the identification functional ankle instability (IdFAI)

Abstract

Purpose: To cross-culturally adapt the Identification Functional Ankle Instability for use with Korean-speaking participants.

Methods: The English version of the IdFAI was cross-culturally adapted into Korean based on the guidelines. The psychometric properties in the Korean version of the IdFAI were measured for test-retest reliability, internal consistency, criterion-related validity, discriminative validity, and measurement error 181 native Korean-speakers.

Results: Intra-class correlation coefficients (ICC_2,1) between the English and Korean versions of the IdFAI for test–retest reliability was 0.98 (standard error of measurement?=?1.41). The Cronbach’s alpha coefficient was 0.89 for the Korean versions of IdFAI. The Korean versions of the IdFAI had a strong correlation with the SF-36 (r_s?=??0.69, p?<?.001) and the Korean version of the Cumberland Ankle Instability Tool (r_s?=??0.65, p?<?.001). The cutoff score of >10 was the optimal cutoff score to distinguish between the group memberships. The minimally detectable change of the Korean versions of the IdFAI score was 3.91.

Conclusion: The Korean versions of the IdFAI have shown to be an excellent, reliable, and valid instrument. The Korean versions of the IdFAI can be utilized to assess the presence of Chronic Ankle Instability by researchers and clinicians working among Korean-speaking populations.

• Implications for rehabilitation

• The high recurrence rate of sprains may result into Chronic Ankle Instability (CAI).

• The Identification of Functional Ankle Instability Tool (IdFAI) has been validated and recommended to identify patients with Chronic Ankle Instability (CAI).

• The Korean version of the Identification of Functional Ankle Instability Tool (IdFAI) may be also recommend to researchers and clinicians for assessing the presence of Chronic Ankle Instability (CAI) in Korean-speaking population.

     

The construct validity of the Dutch version of the activity card sort

Purpose: Establishing construct validity of the ACS-NL in individuals with Parkinson’s disease (PD).

Method: Discriminative validity was established in 191 community-dwelling individuals with PD using an extreme groups design (Hoehn and Yahr stages 1 and 3). Convergent validity was determined by relating the performance scores of the ACS-NL to the scores of the Canadian Occupational Performance Measure (COPM) and the Parkinson’s Disease Questionnaire (PDQ-39) scores, and relating ACS-NL satisfaction scores to the COPM scores and to the Utrecht Scale for Evaluation of Rehabilitation Participation (USER-P).

Results: The ACS-NL discriminated between individuals with PD with H&;Y stages 1 and 3 (U?=?524.5, Z?=??5.453). ACS-NL performance scores correlated weakly with COPM scores (r?=?(0).19) and moderately with PDQ-39 scores (r?=?0.44–0.55). The ACS-NL satisfaction scores correlated weakly with COPM scores (r?= 0.23), and moderately with USER-P scores (r?≥?0.40).

Conclusions: This study contributed to the validation of the ACS-NL. The assessment enhances the possibility of monitoring participation in activities in individuals with PD.

• Implications for Rehabilitation

• The ACS-NL appears to hold good potential for use in the assessment of participation in activities in individuals with PD.

• The ACS-NL has added value parallel to administration of other instruments measuring participation (COPM) and quality of life (PDQ-39).

• This study demonstrates the capacity of the ACS to measure a unique construct of participation and helps to improve the psychometric properties and administration of the ACS-NL in practice.

     

Awareness of hypertension and depressive symptoms: a cross-sectional study in a primary care population

Objective: To investigate the association of hypertension awareness and depressive symptoms, and to analyse factors predisposing aware hypertensives to depressive symptoms.

Design: Cross-sectional study in a primary care population.

Setting: Cardiovascular risk factor survey in two semi-rural towns in Finland.

Subjects: Two thousand six hundred seventy-six middle-aged risk persons without an established cardiovascular or renal disease or type 2 diabetes.

Main outcome measures: Depressive symptoms, previous and new diagnosis of hypertension.

Results: Hypertension was diagnosed in 47.9% of the subjects, of whom 34.5% (442/1 282) had previously undetected hypertension. Depressive symptoms were reported by 14% of the subjects previously aware of their hypertension, and by 9% of both unaware hypertensives and normotensive subjects. In the logistic regression analysis, both the normotensive (OR 0.62, 95% CI 0.45–0.86) (p?=?0.0038) and the unaware hypertensive subjects (OR 0.54, 95% CI 0.35–0.84) (p?=?0.0067) had lower risk for depressive symptoms than the previously diagnosed hypertensives. Among these aware hypertensives, female gender (OR 3.61, 95% CI 2.06–6.32), harmful alcohol use (OR 2.55, 95% CI 1.40–4.64) and obesity (OR 2.50, 95% CI 1.01–6.21) predicted depressive symptoms. Non-smoking (OR 0.57, 95% Cl 0.33–0.99) and moderate leisure-time physical activity compared to low (OR 0.53, 95% CI 0.33–0.84) seemed to buffer against depressive symptoms.

Conclusion: Depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension. Many modifiable, lifestyle associated factors may contribute to the association of hypertension and depressive symptoms.

• Key Points

• Hypertension and depressive symptoms are known to form a toxic combination contributing even to all-cause mortality.

• Comorbidities or the labelling effect of the diagnosis of hypertension can confound their association.

• Our study shows that depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension.

• Many modifiable, lifestyle-associated factors may contribute to the association of hypertension and depressive symptoms.

• When treating hypertensive patients, consideration of depressive symptoms is important in order to promote favorable lifestyle and control of hypertension.

     

Significance of perioperative goal-directed hemodynamic approach in preventing postoperative complications in patients after cardiac surgery: a meta-analysis and systematic review

Purpose: Goal-directed hemodynamic therapy (GDT) is used to prevent hypoperfusion resulting from surgery. The objective of this study was to analyze the efficacy and importance of perioperative GDT.

Methods: PUBMED, MEDLINE, CENTRAL, and Google Scholar databases were searched until 17 June 2016 using the search terms: cardiac output, cardiac surgical procedures, hemodynamics, goal-directed therapy, and intraoperative. Randomized-controlled trials with pre-emptive hemodynamic intervention for cardiac surgical population versus standard hemodynamic therapy were included.

Results: Nine studies were included with a total of 1148 patients. The overall analysis revealed no significant difference in the all-cause mortality (pooled peto OR =0.58, 95%CI =0.27–1.525, p?=?0.164), duration of mechanical ventilation (pooled difference in mean=??1.48, 95%CI=??3.24 to 0.28, p?=?0.099), or length of intensive care unit (ICU) stay (pooled difference in mean=??9.10, 95%CI=??20.14 to 1.93, p?=?0.106) between patients in the GDT and control groups. Patients in the GDP group were associated with shorter hospital stay than those in the control group (pooled difference in mean=??1.52, 95%CI=??2.31 to ?0.73, p?Conclusion: GDT reduces the length of hospital stay compared with the standard of care. Further studies are necessary to continually assess the benefit of GDT following major surgery.

• Key Messages

• The results of this analysis revealed no significant difference between cardiac surgery patients receiving goal-directed hemodynamic therapy (GDT) or conventional fluid therapy in terms of the all-cause mortality, duration of mechanical intervention, and length of ICU-stay.

• The length of hospital stay was significantly reduced in patients treated with GDT compare to conventional fluid therapy.

• GDT may have limited benefit in reducing mortality; however, the association to shorter length of hospital stay may suggest that better hemodynamic balance can facilitate postoperative recovery.

     

Brazilian Portuguese version of the Revised Fibromyalgia Impact Questionnaire (FIQR-Br): cross-cultural validation,reliability, and construct and structural validation

Purpose: This study aimed to culturally adapt and validate the Revised Fibromyalgia Impact Questionnaire (FIQR) to Brazilian Portuguese, by the use of analysis of internal consistency, reliability, and construct and structural validity.

Method: A total of 100 female patients with fibromyalgia participated in the validation process of the Brazilian Portuguese version of the FIQR (FIQR-Br).The intraclass correlation coefficient (ICC) was used for statistical analysis of reliability (test–retest), Cronbach’s alpha for internal consistency, Pearson’s rank correlation for construct validity, and confirmatory factor analysis (CFA) for structural validity.

Results: It was verified excellent levels of reliability, with ICC greater than 0.75 for all questions and domains of the FIQR-Br. For internal consistency, alpha values greater than 0.70 for the items and domains of the questionnaire were observed. Moderate (0.40?r?r?>?0.70) correlations were observed for the scores of domains and total score between the FIQR-Br and FIQ-Br. The structure of the three domains of the FIQR-Br was confirmed by CFA.

Conclusions: The results of this study suggest that that the FIQR-Br is a reliable and valid instrument for assessing fibromyalgia-related impact, and supports its use in clinical settings and research. The structure of the three domains of the FIQR-Br was also confirmed.

• Implications for Rehabilitation

• Fibromyalgia is a chronic musculoskeletal disorder characterized by widespread and diffuse pain, fatigue, sleep disturbances, and depression. The disease significantly impairs patients’ quality of life and can be highly disabling.

• To be used in multicenter research efforts, the Revised Fibromyalgia Impact Questionnaire (FIQR) must be cross-culturally validated and psychometrically tested. This paper will make available a new version of the FIQR-Br since another version already exists, but there are concerns about its measurement properties.

• The availability of an instrument adapted to and validated for Brazilian Portuguese may make it possible to reliably verify the effects of rehabilitation programs on disability from fibromyalgia.

• The FIQR-Br showed results comparable with other versions of the FIQR in other languages, thereby enabling comparison of effects of rehabilitation interventions on disability from fibromyalgia conducted in Brazil with results of studies carried out in other parts of the world.