Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions

Cardiac rehabilitation (CR) services improve various clinical outcomes in patients with cardiovascular disease, but such services are underutilized, particularly in women. The aim of this study was to identify evidence-based barriers and solutions for CR participation in women. A literature search was carried out using PubMed, EMBASE, Cochrane, OVID/Medline, and CINAHL to identify studies that have assessed barriers and/or solutions to CR participation. Titles and abstracts were screened, and then the full-text of articles that met study criteria were reviewed. We identified 24 studies that studied barriers to CR participation in women and 31 studies that assessed the impact of various interventions to improve CR referral, enrollment, and/or completion of CR in women. Patient-level barriers included lower education level, multiple comorbid conditions, non-English native language, lack of social support, and high burden of family responsibilities. We found support for the use of automatic referral and assisted enrollment to improve CR participation. A small number of studies suggest that incentive-based strategies, as well as home-based programs, may contribute to improving CR attendance and completion rates. A systematic approach to CR referral, including automatic CR referral, may help overcome barriers to CR referral in women and should be implemented in clinical practice. However, more studies are needed to help identify the best methods to improve CR attendance and completion of CR rates in women.     

A new SNP in a negative regulatory region of the CYP19A1 gene is associated with lumbar spine BMD in postmenopausal women

Osteoporosis is a common disease of bone possessing a strong genetic component. Cytochrome P450 aromatase, which is encoded by the CYP19A1 gene, converts androgens to estradiol. Considerable evidence suggests that extragonadal estrogens play an important role in determining bone mineral density (BMD) in postmenopausal women, and, among them, those synthesized in bone cells may also be important for the determination of bone phenotype. Therefore, CYP19A1 is an excellent candidate gene for osteoporosis. Since a region upstream of exon I.3, including exon I.6, was identified as containing repressor elements of promoter pII, we conducted a search for SNPs in this region of CYP19A1. Two SNPs [Aro1(rs4775936) and Aro2] located in exon I.6 and promoter I.6, respectively, were identified and their association with BMD analyzed in a cohort of 256 Spanish postmenopausal women. Aro1(rs4775936), but not Aro2, was associated with lumbar spine BMD (P = 0.029). Homozygotes AA (16% of the women) exhibited significantly higher lumbar spine BMD, compared with GG or GA individuals. Therefore, this study describes the Aro1 polymorphism which lies within a regulatory region and which may be a functional polymorphism, partially responsible for the bone phenotype it is associated with.     

Fever and abdominal pain. A case of familial mediterranean fever

Familial mediterranean fever (FMF) is an hereditary disease transmitted in an autosomal recessive way and characterized by recurrent and brief episodes of fever and pain secondary to serositis. The pain is usually located in abdomen simulating an acute abdomen, and in thorax in the form of pleuritic pain. The most severe complication of the FMF is the development of amyloidosis being the main cause of death. This illness affects an specific ethnic group of the mediterranean area, but the prevalence in our area is low. We present the case of a 30 years old man with recurrent thoracic and abdominal pain, whose final diagnostic was FMF. Insisting on the difficulty that it was recognize this proper illness.     

Diabetes team consultation: impact on length of stay of diabetic patients admitted to a short-stay unit

OBJECTIVE: To assess the impact of endocrinology team consultation on hospital stay and clinical outcomes of diabetic patients admitted with a primary non-diabetes-related diagnosis in a short stay unit (SSU). METHODS: Patients admitted to the SSU between 2001 and 2005. Between 2001 and 2003 there was no endocrinology team consultation available and the management of hyperglycemia was handled by the SSU team alone. From 2003 until 2005 an endocrinology team was in charge of diabetes care. We compared in both periods: prevalence of diabetes, length of hospital stay, mortality, early readmissions and number of patients requiring conventional hospitalization. RESULTS: In period 2001-2003, 1023 patients were admitted, among which 212 were diabetic (20.7%). Over the years 2003-2005, 892 patients were hospitalized, 223 were diabetic (25%). Clinical characteristics of diabetic patients from both periods were comparable, but glycaemia at admission was higher on the second period (217 mg/dl versus 198 mg/dl). The length of stay of diabetic patients in the second period decreased from 5.49 to 4.90 days. There were no significant differences in mortality (1.4% versus 0.4%) or in early re-admissions among the two periods. CONCLUSIONS: The intervention of a diabetes team diminished the average length of stay of diabetic patients.