Changes in self-care maintenance during quarantine in patients with heart failure

Background

Patients with heart failure (HF) experience challenges in self-care that contribute to poor quality of life and high health care utilization. The COVID-19 pandemic required HF patients, especially living in countries with strict lockdowns and quarantines, to change their lifestyle including health promoting behaviors.

Purpose

To assess changes in self-care maintenance in patients with HF changed during quarantine compared to before quarantine. We hypothesized that the self-care maintenance behavior physical activity was most effected during quarantine.

Method

This is a cross-sectional survey study. From the medical chart, patients' disease severity (NYHA-class), ejection fraction and comorbidities were collected. Self-care maintenance was assessed using subscale Self-Care of Heart Failure Index 6.2. The total score ranges from 0–100, where 70 or higher is seen as having good self-care maintenance. With all the questions in the self-care maintenance scale a question was added: Did this change due to the COVID-19 pandemic? Patients could answer yes or no. When patients answered yes, they were asked the elaborate. Patients self-reported physical activity, before and during the pandemic, using the International Physical Activity Questionnaire (short form). Descriptive analyses were used for self-care maintenance, content analysis was applied for the qualitative data. Paired sample t-test were performed to assess the change in the total physical activity.

Results

In total, 120 patients with HF were included in this study (mean age was 79±13, 39% female, 78% NYHA-class I/II). Patients had a mean self-care maintenance of 32 (±6). No participant had good self-care maintenance (score of 70 or higher). Patients were non-adherent to regular physical activity (77%, n=92), keeping weight down (74%, n=89) and weighing themselves (66%, n=79) during quarantine (Figure). Behaviors which changed the most included keeping medical appointments (81%) and regular exercise (82%). Significantly higher levels of physically active was noticed before quarantine (776 Mets-minutes) compared to during quarantine (106 Mets-minutes) (p<0.01). The change in self-care maintenance was explained by change in motivation and self-confidence. Because of the pandemic and the quarantine, patients reported not being able to rely on health care and their usual social support system. Patients tried to create new habits when trying to maintain their self-care.

Conclusion

Patients with HF reported experiencing low self-care maintenance during quarantine due to not being able to go to medical appointments and decrease in physical activity. Public health policies during crisis events such as a pandemic should strive to provide support in coping with these changes and offer alternative ways of maintaining their self-care maintenance, especially with physical activity.

Funding Acknowledgement

Type of funding sources: None.

Interests and preferences towards technology-based cardiac rehabilitation in men and women with coronary artery disease

Funding Acknowledgements

Type of funding sources: None.

Introduction

Several studies have demonstrated the effectiveness of telemedicine programmes in patients with coronary artery disease (CAD). However, the development of these programmes is driven from a technical point of view and does not usually take into account the needs and expectations of patients. Thus, we found a need to study the interests and preferences towards technology-based cardiac rehabilitation (CR) in patients with CAD.

Purpose

The aim of this study was to compare the interests and preferences towards technology-based CR in men and women with CAD.

Method

A cross-sectional study was conducted. A total of 70 subjects with CAD (84.28% male) were included. Participants' interests and preferences were measured using the Technology Usage Questionnaire, which includes items on digital health and technology usage.

Results

On the one hand, men showed a greater interest in receiving CR counselling via mobile phone (p=0.022), would sign up for a free technology-based CR programme (p=0.034) and would like to receive less than 1-2 messages a week (p=0.010). On the other hand, women showed greater interest in receiving information about the different components included in the CR programme (receiving healthy meal/recipe ideas (p=0.002), reminders to take medication (p=0.039) and showed greater interest in meeting other people with heart disease (p=0.034). No differences were found by gender in type of communication that participants would like to receive through their mobile phone (p=0.154) or through the Internet (p=0.648), interest in receiving treatment through the Internet (p=0.454), interest in receiving an exercise-based CR program using virtual reality (p=0.810), nor usefulness of a virtual CR session (p=0.801).

Conclusions

In subjects with CAD, gender appears to be a determinant of interest. Men showed a greater interest in receiving CR counselling via mobile phone, would sign up for a technology-based CR programme and would like to receive fewer notifications. Women were more interested in receiving information about different components of the CR programme.

Physical activity and technology usage performed by patients with coronary artery disease: a gender approach

Funding Acknowledgements

Type of funding sources: None.

Background

Recent studies show that cardiac telerehabilitation, including exercise and lifestyle modification, is effective in reducing cardiovascular risk factors in patients with coronary artery disease (CAD). Thus, physical activity and technology usage of patients with CAD are important key points in order to create technology-based cardiac rehabilitation programs to improve physical patients´ condition and reduce cardiovascular risk.

Purpose

The aim of this study was to compare the physical activity and the technological usage of women and men with CAD.

Methods

A cross-sectional study in patients with CAD was performed. Sociodemographic data, physical activity (measured with the International Physical Activity Questionnaire, IPAQ) and the technology usage (measured with the Technology use subscale of the Technology Usage Questionnaire) were collected. Descriptive and inferential analyzes were performed to explore the differences between men and women with CAD.

Results

A total of 70 participants were included (84.28% men, mean age=59±8.54 years). Regarding the IPAQ, men significantly reported higher walking time (99.31±95.22 METS vs. 33.28±37.42 METS, p=0.001, respectively) and higher total physical activity (4164.91±4164.91 METS vs. 1390.68±1609.05 METS, p&lt;0.001, respectively) than women. In relation to technology usage, the entire sample used a mobile phone, whilst there were no significant gender differences in the functions/applications used (phone calls, text messages, camera, receive videos/photos, internet searches, apps, instant messages, social media, games) (p=0.068). Although the majority of the participants (85.71%) had regular access to internet, men used their phone more frequently than women (81.10% vs. 37.50%, p=0.005, respectively). Comparison by gender showed no significant differences in the type of device used for internet searches (computer, tablet, mobile phone) (p=0.169), familiarization with technology-based physical activity games (p=0.801), use of heart rate monitors (p=0.193), preference to monitor heart rate when exercising (p=0.664), nor use of other devices to monitor physical activity (pedometer, etc.) (p=0.193).

Conclusion

Based on the results obtained, we conclude that men with CAD were more physical active and used the Internet more often than women, whilst there were no differences by gender in the rest of variables. Assessment of physical activity and technology usage should be implemented in patients with CAD, in order to adapt and improve the design of technology-based telerehabilitation programs

Evaluation of specific humoral immune response in pigs vaccinated with cell culture adapted classical swine fever vaccine

Aim:

To determine an efficient vaccination schedule on the basis of the humoral immune response of cell culture adapted live classical swine fever virus (CSFV) vaccinated pigs and maternally derived antibody (MDA) in piglets of vaccinated sows.

Materials and Methods:

A cell culture adapted live CSFV vaccine was subjected to different vaccination schedule in the present study. Serum samples were collected before vaccination (day 0) and 7, 14, 28, 42, 56, 180, 194, 208, 270, 284 and 298 days after vaccination and were analyzed by liquid phase blocking enzyme-linked immunosorbent assay. Moreover, MDA titre was detected in the serum of piglets at 21 and 42 days of age after farrowing of the vaccinated sows.

Results:

On 28 days after vaccination, serum samples of 83.33% vaccinated pigs showed the desirable level of antibody titer (log₁₀ 1.50 at 1:32 dilution), whereas 100% animals showed log₁₀ 1.50 at 1:32 dilution after 42 days of vaccination. Animals received a booster dose at 28 and 180 days post vaccination showed stable high-level antibody titre till the end of the study period. Further, piglets born from pigs vaccinated 1 month after conception showed the desirable level of MDA up to 42 days of age.

Conclusion:

CSF causes major losses in pig industry. Lapinised vaccines against CSFV are used routinely in endemic countries. In the present study, a cell culture adapted live attenuated vaccine has been evaluated. Based on the level of humoral immune response of vaccinated pigs and MDA titer in piglets born from immunized sows, it may be concluded that the more effective vaccination schedule for prevention of CSF is primary vaccination at 2 months of age followed by booster vaccination at 28 and 180 days post primary vaccination and at 1 month of gestation.

Accessory sulcus of the liver - an incidental laparotomy finding

The diaphragmatic surface of the liver is normally smooth but may be grooved occasionally. Such grooves could be 'cough furrows' or due to a 'corset liver'. Accessory sulci have also been described and may confuse the inexperienced surgeon. We describe one such case of an accessory sulcus found incidentally at laparotomy.