Results of a hybrid cardiovascular rehabilitation program (in-hospital plus home) in patients with low income

Background

One of the main problems facing cardiovascular rehabilitation (CR) is patient care and adherence. However, due to the low level of economic income of the patients who are cared for in our center, the possibility of going to CR in a conventional way is very difficult since they do not have the necessary resources to cover transportation, cost of the sessions, among others.

It has been shown that the greater the number of sessions attended by the patient, the greater the reduction in cardiovascular risk, however the role of a hybrid program with a decreased number of face-to-face sessions has not been established.

Purpose

Present the results of a hybrid training program (in-hospital plus home) in a low-income population. Education through supervised sessions plus home physical training in a patient with bases for exercise can improve their adherence with better results.

Methods

A cohort of patients with heart disease who were referred to the Cardiovascular Rehabilitation program between May 2017 and February 2019 was included. The socioeconomic level was classified into 6 strata according to occupation, income, housing, economic dependents, place of origin and family health status. After risk stratification, the patients participated in a hybrid program that consisted of 6 in-hospital sessions, once a week, in which the training to be carried out at home was prescribed by means of a triptych. An exercise test was performed before and after completing the program, as well as psychological and nutritional intervention. Statistical analysis was performed using SPSS 21.0 software. All p values less than 0.05 were considered significant.

Results

In the study period, of the total number of patients discharged for heart disease from the hospital, 61% were referred to cardiovascular rehabilitation, of which only 45% (n=39) completed the program, the reasons for dropping out were multiple and the lowest socioeconomic level (1) was the most frequent (figure 1). The main referral diagnosis was ischemic heart disease in 82%. The majority of patients were men, 95%. A significant improvement was observed in load METs, maximum heart rate, heart rate recovery (figure 2).

Conclusion

The implementation of a hybrid cardiovascular rehabilitation program (in-hospital + home) was associated with an improvement in the exercise test parameters of patients who successfully completed the program.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

Two Indigenous Berberis Species From Spain Were Confirmed as Alternate Hosts of the Yellow Rust Fungus Puccinia striiformis f. sp. tritici

Puccinia striiformis f. sp. tritici, which causes yellow (or stripe) rust on wheat, is a macrocyclic and heteroecious fungus. In this study, we investigated whether Berberis vulgaris subsp. seroi and B. vulgaris subsp. australis, which are indigenous in Spain, may serve as alternate hosts for P. striiformis f. sp. tritici. Wheat leaves bearing telia of an isolate of P. striiformis f. sp. tritici were harvested and used to inoculate plants of both barberry subspecies. Pycnia were observed on the adaxial side of the leaves from 10 days after inoculation (dai). Following successful fertilization, aecia were observed on the abaxial side of the leaves from 16 dai. At 27 dai, barberry leaves bearing aecia were detached and used to inoculate susceptible wheat seedlings of cultivar Morocco. Uredinia were observed on wheat seedlings from 12 days after aeciospore exposure. Eighty-three single lesions were recovered from individual wheat leaves, of which 43 were genotyped using 19 P. striiformis f. sp. tritici simple sequence repeat markers (SSR). In total, 19 multilocus genotypes (MLGs) were identified among the 43 progeny isolates. The SSR genotyping confirmed that all 43 isolates were derived from the parental isolate. Seven heterozygous SSR markers showed segregation among the progenies, whereas none of the 12 homozygous markers resulted in segregation. These results demonstrated that B. vulgaris subspp. seroi and australis can serve as alternate hosts for P. striiformis f. sp. tritici, which may result in novel virulence combinations that can have a detrimental impact on wheat production. Although P. striiformis f. sp. tritici has not been detected on these barberry species in nature, this study highlights the importance of rust surveillance in barberry areas where suitable conditions for completion of the sexual life cycle may be present.

Social context of HIV risk behaviours among male-to-female transgenders of colour

To explore the social context of drug use and sexual behaviours that put male-to-female (MTF) transgenders at risk for HIV, focus groups were conducted consisting of African American, Latina and Asian and Pacific Islander MTF transgenders (N = 48) who reside or work in San Francisco, California. Participants were likely to report having unprotected sex with primary partners to signify love and emotional connection, as well as to receive gender validation from their partners. In contrast, viewing sex work with customers as a business encouraged intentious to use condoms. Safer sex intentions with customers were frequently undermined by urgent financial needs, which stemmed from transphobia, employment discrimination and costly procedures associated with gender transition. Participants reported using drugs as a way to cope with or escape life stresses associated with relationships, sex work, transphobia and financial hardship. Interventions with at-risk MTF transgenders should address the interpersonal and social context of unsafe sex and drug use, particularly the unique roles of relationship issues with male partners, stigma, discrimination and community norms regarding sex work and drug use.

Experimental electron temperature gradient dependence of heavy impurity transport in fusion devices

The turbulent impurity (nickel) transport dependence on the normalized electron temperature gradient has been analyzed in sawtooth-free electron cyclotron wave heated Tore Supra plasmas. In the core, our experimental analysis shows that the lower R/L((T)(e)), the lower the nickel diffusion coefficient. The latter decreases until the instability threshold is reached. The experimental threshold is in agreement with the one computed by a gyrokinetic model. Further out, R/L((T)(e)) plays no role in the impurity diffusion. This set of experimental results is consistent with a quasilinear gyrokinetic analysis.

Comparative performance of carbon isotope discrimination and canopy temperature depression as predictors of genotype differences in durum wheat yield in Spain

The relationships between carbon isotope discrimination (Δ) in mature kernels, canopy temperature depression (CTD) during anthesis and grain filling, 1000-kernel weight (TKW), total carbon content of mature kernels, and yield were studied in durum wheat (Triticum turgidum L. var. durum) grown in Spain (western Mediterranean basin). Twenty-five durum wheat genotypes were grown in 2 regions (NE and SE Spain) and under 2 water regimes (rainfed v. support irrigation) from 1997 to 1999 (i.e. a total of 12 trials). Principal component analysis placed yield and Δ on the same axis. Pearson’s correlation and stepwise analysis confirmed that Δ was the trait that best assessed genotype differences in yield within trials, and was followed, at a considerable distance, by TKW. Our results also demonstrated the extremely poor performance of CTD throughout the wide range of growing conditions in this study.

Photosynthetic and developmental traits associated with genotypic differences in durum wheat yield across the Mediterranean basin

The relationships between various morphophysiological traits and yield were studied in durum wheat (Triticum durum Desf.) grown in Mediterranean conditions. Two sets of 22 genotypes were used. One was developed for semi-humid environments (TA-genotypes) and was cultivated in 22 trials around the Mediterranean basin with a mean yield across genotypes and environments of 4925 kg/ha. The other set was developed for drier conditions (CA-genotypes) and was cultivated in 15 trials, with a mean yield of 3501 kg/ha. Morphophysiological traits for each set were evaluated in 2 trials with contrasting water regimes conducted in north-eastern Spain: Lleida-rainfed (LR) and Lleida-irrigation (LI). Two kinds of traits were evaluated: developmental traits, including early vigour, plant height, and phenology (days from planting to heading and to maturity); and traits related to photosynthetic performance such as canopy temperature and chlorophyll content of the flag leaf, both measured during grain filling, and carbon isotope discrimination of mature grains. All the traits, measured in both Lleida trials, were related to the mean yield of the same genotypes across all the sites where they were cultivated. Yield measured at either of the 2 environments at Lleida was a much poorer predictor of genotype differences in mean yield than most of the traits. Nevertheless, the kind of environment where the morphophysiological traits were evaluated affected the performance of these traits as yield predictors. The combination of significant traits measured in the better environment (LI) explained 71% and 55% of genotype variability in yield within TA- and CA-genotypes, respectively, but only 56% and 27% when they were evaluated at LR. On the other hand, growing conditions of the yield trials was the main factor determining the best combination of traits. For TA-genotypes, larger yields were associated with shorter plants and higher carbon isotope discrimination (Δ) of grains, and to a lesser extent with higher early vigour and lower canopy temperature, whereas phenological traits made no contribution to explaining genotype differences in yield. For the CA-genotypes, higher yields were related to an earlier heading date or alternatively to a higher chlorophyll content during grain filling. A higher Δ in mature kernels also seems to be a positive trait.