Determinants of self-reported health status during COVID-19 lockdown among surveyed Ecuadorian population: A cross sectional study

OBJECTIVE

To examine the associations of sociodemographic, socioeconomic, and behavioral factors with depression, anxiety, and self-reported health status during the COVID-19 lockdown in Ecuador. We also assessed the differences in these associations between women and men.

DESIGN, SETTING, AND PARTICIPANTS

We conducted a cross-sectional survey between July to October 2020 to adults who were living in Ecuador between March to October 2020. All data were collected through an online survey. We ran descriptive and bivariate analyses and fitted sex-stratified multivariate logistic regression models to assess the association between explanatory variables and self-reported health status.

RESULTS

1801 women and 1123 men completed the survey. Their median (IQR) age was 34 (27-44) years, most participants had a university education (84%) and a full-time public or private job (63%); 16% of participants had poor health self-perception. Poor self-perceived health was associated with being female, having solely public healthcare system access, perceiving housing conditions as inadequate, living with cohabitants requiring care, perceiving difficulties in coping with work or managing household chores, COVID-19 infection, chronic disease, and depression symptoms were significantly and independently associated with poor self-reported health status. For women, self-employment, having solely public healthcare system access, perceiving housing conditions as inadequate, having cohabitants requiring care, having very high difficulties to cope with household chores, having COVID-19, and having a chronic disease increased the likelihood of having poor self-reported health status. For men, poor or inadequate housing, presence of any chronic disease, and depression increased the likelihood of having poor self-reported health status.

CONCLUSION

Being female, having solely public healthcare system access, perceiving housing conditions as inadequate, living with cohabitants requiring care, perceiving difficulties in coping with work or managing household chores, COVID-19 infection, chronic disease, and depression symptoms were significantly and independently associated with poor self-reported health status in Ecuadorian population.

Differences in the respiratory swings in COPD and ILD candidates for lung transplantation: a critical concern interpreting central pulmonary pressures

Background

In different clinical scenarios (i.e., obesity, COPD, exercise, mechanical ventilation), the swings in intrathoracic pressure are much larger, and end-expiratory (Pee) pressure can be significantly greater than atmospheric pressure. In these scenarios, the intravascular (Piv) pulmonary pressure can overestimate the true transmural (tm) value and it is recommended to read the average of Piv over a few respiratory cycles (Pmrc) [1–3].

Purpose

To analyze the respiratory swings and the effect of esophageal pressure (PES) (as a surrogate of intrathoracic pressure) on the reading of Piv tracings during the RHC at rest in COPD and interstitial lung disease (ILD) candidates for lung transplantation (LTx).

Methods

Thirty-one COPD (15) and ILD (16) candidates for LTx underwent RHC. End-expiratory and mean respiratory cycle measurements were obtained. The respiratory swing was estimated as the difference between maximum-minimum values of Piv. Ten patients (5 COPD/5 ILD) underwent simultaneous RHC and PES (Micro-balloon Esophageal Catheter, LATITUDE) to assess the Ptm (Piv − PES) [4].

Results

Both demographic (11F/20M, 60±7 yrs, 25±4 kg/m2) and hemodynamic data (mPAP 24±9 mmHg, pulmonary arterial occlusion pressure [PAOP] 8.6±4 mmHg, right atrial pressure [RAP] 5.2±3.9 mmHg, pulmonary vascular resistance 3.5±2.6 Wu) did not show significant differences between ILD and COPD except the cardiac index (ILD: 2.8±0.8 vs. COPD: 2.4±0.3 L/min/m2). Intravascular RAPee and PAOPee were higher than mrc values in both groups (Fig 1). However, transmural RAPee and PAOPee were similar to and correlated with (r=0.62 and 0.69, respectively; p<0.05) transmural Pmrc values. PESee values were positive in COPD and ILD (3.0±2.2 vs. 3.3±2.0 mmHg, NS). All ILD had negative PESmrc values and were lower than COPD patients (−1.76±1.7 vs. 0.78±1.6 mmHg, p<0.05). ILD PES swings were higher than COPD (10.9±3.7 vs. 8.3±1.4 mmHg), although it did not reach statistical significance (p=0.08). The lower forced vital capacity (%), the more negative the PESmrc (Fig 2A). ILD pts showed higher transmural to intravascular Pmrc (p<0.05) (Fig 2B).

Conclusion

End-expiratory intravascular RAP and PAOP overestimates the mean respiratory cycle pressures in COPD and ILD candidates for LTx. Averaging pulmonary vascular pressure tracings over the respiratory cycle would be accurate in COPD but could underestimate transmural values in ILD candidates for LTx. The reading of mean respiratory cycle pressure could not be enough to correct the pulmonary pressures measurement error associated with the presence of large swings of intrathoracic pressure.

Funding Acknowledgement

Type of funding sources: None.

Role of echocardiography to avoid misclassification of pulmonary hypertension associated with left heart disease as precapillary pulmonary hypertension

Background

The proportion of patients (pts) diagnosed with pulmonary arterial hypertension (PAH) at a more advanced age and/or with more risk factors for left ventricular diastolic dysfunction is increasing. Therefore, it can be challenging to differentiate PH associated with left heart disease (PH-LHD, PHpost) from other precapillary forms of PH (PHpre).

Purpose

We analyzed the performance of the Opotowsky (OS), D'Alto (DS), and simplified D'Alto (sDS) echocardiographic scores according to the pretest probability (before right heart catheterization – RHC) of PH-LHD in pts with suspected PH submitted to RHC to identify the hemodynamic phenotype.

Methods

37 consecutive stable pts (3/2018–3/2020) with a tricuspid regurgitation peak velocity >2.8 m/s were prospectively included (21F, 49±17 yrs). Blinded transthoracic echocardiography was performed within 2 hours of RHC. We assessed OS (−2 to 2 points) and DS/sDS (0 to 34/7 points). We estimated cardiac index (thermodilution) and hemodynamic parameters using standard formulas. If PA occlusion pressure (PAOP) cannot properly be measured at end-expiration, we assessed left ventricular end-diastolic pressure (LVEDP). PH was defined as a mean PA pressure (mPAP) ≥25 mmHg. PAOP/LVEDP >15 mmHg defined PHpost. If the PAOP/LVEDP was between 13–15 mmHg in an I pt, a volume challenge was done. We categorized pts according to the pretest probability of PH-LHD proposed in the 6th WSPH based on the combination of 7 noninvasive variables (age, presence of CV comorbidities, presence of current or paroxysmal atrial fibrillation, prior cardiac intervention, presence of structural LHD, presence of left bundle branch/LV hypertrophy or RV strain in ECG, presence of left atrial dilatation/grade >2 mitral flow in Echo). The individual average probability was calculated by assigning a score of 1, 2, and 3 for each variable (1 = low (L), 2 = intermediate (I), and 3 = high (H) probability) rounding the average of the sum of values allocated for each variable to the nearest integer. Nonparametric ROC plots assessed the performance of echo-scores.

Results

All pts had PH. 19 pts showed PHpost, 10/19 with PVR >3Wu (Combined PHpost). All scores were lower in PHpost compared to PHpre pts (p<0.05) (Table 1). ROC area was >0.9 with a similar Youden index (0.83) among the three scores (p<0.05) (Figure 1). 17 PHpost with H pts were correctly identified by all scores (94–100%). In 15 PHpre with L pts OS performed better than DS/sDS (93 vs. 80%). In 3 PHpre and 2 PHpost with I pts, DS/sDS performed better than OS (100 vs. 80%).

Conclusion

The use of simple echo-scores could facilitate the screening of the hemodynamic phenotype in pts with PH, regardless of the pretest probability of PH-LHD. D'Alto scores might have some advantage compared to OS to classify the intermediate pretest probability of PH pts correctly.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Centro Cardiovascular Universitario. Hospital de Clínicas. Facultad de Medicina. Universidad de la República Table 1. Echo & Hemodynamic DataFigure 1. ROC curves of Echo scores

Persistent organochlorine pesticide levels in bovine fat from Mexico

Organochlorine pesticides have been used in Mexico in agriculture as a seed dresser, in sanitation, in malaria control programmes and in livestock to combat ectoparasites. The pesticides applied drift to areas where cattle graze and plants grow. Because of their chemical stability, they accumulate in the lipid-rich tissues of the body. In the body, they circulate throughout all compartments and accumulate in adipose fat. The aim was to monitor the organochlorine pesticide levels in bovine muscle fat and kidney fat from cows living in an endemic malaria zone, where the environmental contamination can be suspected as being higher. Two hundred samples (100 muscle fat, 100 kidney fat) were analysed by gas chromatography. From the pesticides, only hexachlorobenzene (HCB), beta-hexachlorocyclohexane (HCH), gamma-HCH, pp'-1.1.1-trichloro-2,2-bis(4-chlorophenyl)ethane (DDT), op'-DDT and pp'-DDE, were detected frequently and at levels above the detection limits. The HCB mean level was low at 0.009 mg kg(-1) on a fat basis. From the HCH isomers, beta-HCH mean concentration was 0.039 mg kg(-1) and gamma-HCH was 0.025 mg kg(-1) on a fat basis. Among DDTs, pp'-DDT was the major constituent (0.032 mg kg(-1) on a fat basis) followed by pp'-DDE (0.025 mg kg(-1) on a fat basis) and op'-DDT (0.023 mg kg(-1) on a fat basis). The DDT total (sigma DDT) level was 0.067 mg kg(-1) on a fat basis. Comparing the previous study (1994) and the present one (2002-03), organochlorine pesticide levels were decreased. HCB decreased 3.7 times from 0.033 to 0.009 mg kg(-1) on a fat basis; beta-HCH decreased 3.8 times from 0.149 to 0.039 mg kg(-1) on a fat basis; pp'-DDE did not reveal a significant difference at 0.026 versus 0.025 mg kg(-1) on a fat basis. However, pp'-DDT decreased substantially, 6.7 times from 0.215 to 0.032 mg kg(-1) on a fat basis. The DDT total decreased 3.5 times from 0.236 to 0.067 mg kg(-1) on a fat basis. The tendency for reduced concentrations in organochlorine pesticide levels in Mexican cows is caused by their substitution with pyrethroids used in agriculture and by the Mexican Ministry of Health in sanitary programmes.

[Cognitive stimulation workshops in old age: preliminary experience]

OBJECTIVE

To test the utility of cognitive stimulation in a group of healthy older people.

DESIGN

A pilot study in 11 healthy women from Conchali council. All of them were evaluated before and after stimulation using Minimental State Examination of Folstein (MM), Memory Wechsler Scale (MW) and Geriatric Depression Scale (GDS).

PARTICIPANTS

Were selected from a group of regularly participants in center for seniors, aged 60 years or more (mean 66.6 years old), able to read and write (mean scholarship 5.3 years).

INTERVENTION

16 workshop of 90 minutes, twice a week during 2 months. They had motivation pantomime plays, memory activities and so on.

RESULTS

Wilcoxon signed rank pre and post workshop for MM was -2.633 (p = 0.008), for MW was -2.938 (p = 0.003) and for GDS was -2.943 (p = 0.03).

CONCLUSIONS

Cognitive stimulation could be useful in older people. It is necessary to increase the sample.