Predictors of Quitting Smoking in Cardiac Rehabilitation

Ahmad Salman; Patrick Doherty

doi:10.3390/jcm9082612

Predictors of Quitting Smoking in Cardiac Rehabilitation

Journal of Clinical Medicine ◽

10.3390/jcm9082612 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2612

Author(s):

Ahmad Salman ◽

Patrick Doherty

Keyword(s):

Cardiac Rehabilitation ◽

Smoking Status ◽

Binary Logistic Regression ◽

Psychosocial Health ◽

Self Report ◽

Effective Strategies ◽

Patient Demographics ◽

Quitting Smoking ◽

Risk Patients ◽

The Uk

Quitting smoking and participation in cardiac rehabilitation (CR) are effective strategies in reducing morbidity and mortality. However, little is known about the predictors of quitting smoking in those who attend CR. This study aimed to determine the sociodemographic and clinical factors associated with the likelihood of CR attendees who are quitting smoking. Data from the UK National Audit of Cardiac Rehabilitation (NACR) database, between April 2013 and March 2016, were used. Smoking status is categorized as smokers and quitters, assessed by patient self-report. The study used patient demographics, cardiovascular risk factors, comorbidities, and physical and psychosocial health measures. Binary logistic regression was performed to identify the predictors of quitting smoking among CR attendees. Of the 3290 patients who started CR and were entered into the NACR database, 2052 were continued smokers (mean age 58.59 ± 10.49 years, 73.6% men) and 1238 were quitters (mean age 57.63 ± 10.36 years, 75.8% men). The median duration of CR was 9 weeks. Compared to smokers, the quitters were younger, weighed more, were less anxious and depressed, and were more likely to be employed. Single patients had 0.60 times lower odds (95% CI 0.43 to 0.82) of quitting smoking than patients with partners, and low-risk patients had 1.71 times higher odds (95% CI 1.12 to 2.62) of quitting smoking than high-risk patients. Increasing number of comorbidities and depression scores were associated with decreasing likelihood of quitting. This study highlights the routine factors that determine smoking cessation outcomes, which could inform the delivery of CR to better help patients to quit smoking.

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Is Weight Gain Inevitable for Patients Trying to Quit Smoking as Part of Cardiac Rehabilitation?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17228565 ◽

2020 ◽

Vol 17 (22) ◽

pp. 8565

Author(s):

Ahmad Salman ◽

Patrick Doherty

Keyword(s):

Physical Activity ◽

Smoking Cessation ◽

Body Weight ◽

Weight Gain ◽

Cardiac Rehabilitation ◽

Self Report ◽

Routine Practice ◽

Quit Smoking ◽

Quitting Smoking ◽

The Uk

The literature is uncertain about the extent to which those who attend cardiac rehabilitation (CR) gain weight while trying to quit smoking. This study aimed to determine the extent of CR-based smoking cessation provision and whether CR, as delivered in routine practice, is associated with helping patients quit smoking and avoid weight gain. Data from the UK National Audit of Cardiac Rehabilitation database, between April 2013 and March 2016, were used. Smoking status is categorised as smokers and quitters assessed by patient self-report. Outcomes included body weight, blood pressure, depression, and physical activity. A multiple linear regression model was constructed to understand the effect of continuing smoking or quitting smoking on CR outcomes. CR outcome scores were adjusted by the baseline CR score for each characteristic. An e-survey collected information about the smoking cessation support offered to patients attending CR. A total of 2052 smokers (58.59 ± 10.49 years, 73.6% male) and 1238 quitters (57.63 ± 10.36 years, 75.8% male) were analysed. Overall, 92.6% of CR programmes in the United Kingdom (UK) offer smoking cessation support for CR attenders. Quitting smoking during CR was associated with a mean increase in body weight of 0.4 kg, which is much less than seen in systematic reviews. Quitters who attended CR also had better improvements in physical activity status and psychosocial health measures than smokers. As delivered in routine practice, CR programmes in the UK adhere to the guideline recommendations for smoking cessation interventions, help patients quit smoking, and avoid weight gain on completion of CR.

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Widespread gaps in the quality of care for primary biliary cholangitis in UK

Frontline Gastroenterology ◽

10.1136/flgastro-2020-101713 ◽

2021 ◽

pp. flgastro-2020-101713

Author(s):

Mathuri Sivakumar ◽

Akash Gandhi ◽

Eathar Shakweh ◽

Yu Meng Li ◽

Niloufar Safinia ◽

...

Keyword(s):

Quality Of Care ◽

Medical Records ◽

Clinical Symptoms ◽

Primary Biliary Cholangitis ◽

Cholestatic Liver Disease ◽

Patient Demographics ◽

Risk Patients ◽

Wide Scale ◽

The Uk

ObjectivePrimary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The European Association for the Study of the Liver (EASL) in 2017. We report on the first national, pilot audit that assesses the quality of care and adherence to guidelines.DesignData were collected from 11 National Health Service hospitals in England, Wales and Scotland between 2017 and 2020. Data on patient demographics, ursodeoxycholic acid (UDCA) dosing and key guideline recommendations were captured from medical records. Results from each hospital were evaluated for target achievement and underwent χ2 analysis for variation in performance between trusts.Results790 patients’ medical records were reviewed. The data demonstrated that the majority of hospitals did not meet all of the recommended EASL standards. Standards with the lowest likelihood of being met were identified as optimal UDCA dosing, assessment of bone density and assessment of clinical symptoms (pruritus and fatigue). Significant variations in meeting these three standards were observed across UK, in addition to assessment of biochemical response to UDCA (all p<0.0001) and assessment of transplant eligibility in high-risk patients (p=0.0297).ConclusionOur findings identify a broad-based deficiency in ‘real-world’ PBC care, suggesting the need for an intervention to improve guideline adherence, ultimately improving patient outcomes. We developed the PBC Review tool and recommend its incorporation into clinical practice. As the first audit of its kind, it will be used to inform a future wide-scale reaudit.

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Re-assessing the Validity of the Opioid Risk Tool in a Tertiary Academic Pain Management Center Population

Pain Medicine ◽

10.1093/pm/pnx332 ◽

2018 ◽

Vol 19 (7) ◽

pp. 1382-1395 ◽

Cited By ~ 5

Author(s):

Meredith R Clark ◽

Robert W Hurley ◽

Meredith C B Adams

Keyword(s):

Pain Management ◽

Smoking Status ◽

Low Risk ◽

The Self ◽

Self Report ◽

Drug Misuse ◽

Aberrant Behavior ◽

Cross Sectional ◽

Risk Patients ◽

Aberrant Behaviors

AbstractObjectiveTo analyze the validity of the Opioid Risk Tool (ORT) in a large. diverse population.DesignA cross-sectional descriptive study.SettingAcademic tertiary pain management center.SubjectsA total of 225 consecutive new patients, aged 18 years or older.MethodsData collection included demographics, ORT scores, aberrant behaviors, pain intensity scores, opioid type and dose, smoking status, employment, and marital status.ResultsIn this population, we were not able to replicate the findings of the initial ORT study. Self-report was no better than chance in predicting those who would have an opioid aberrant behavior. The ORT risk variables did not predict aberrant behaviors in either gender group. There was significant disparity in the scores between self-reported ORT and the ORT supplemented with medical record data (enhanced ORT). Using the enhanced ORT, high-risk patients were 2.5 times more likely to have an aberrant behavior than the low-risk group. The only risk variable associated with aberrant behavior was personal history of prescription drug misuse.ConclusionsThe self-report ORT was not a valid test for the prediction of future aberrant behaviors in this academic pain management population. The original risk categories (low, medium, high) were not supported in the either the self-reported version or the enhanced version; however, the enhanced data were able to differentiate between high- and low-risk patients. Unfortunately, without technological automation, the enhanced ORT suffers from practical limitations. The self-report ORT may not be a valid tool in current pain populations; however, modification into a binary (high/low) score system needs further study.

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Forced migration and psychosocial health: meaning-making through autobiographical narratives in the UK

MIGRATION LETTERS ◽

10.33182/ml.v7i1.182 ◽

2014 ◽

Vol 7 (1) ◽

pp. 79-90 ◽

Cited By ~ 1

Author(s):

Maria Psoinos

Keyword(s):

Social Context ◽

Meaning Making ◽

Forced Migration ◽

Psychosocial Health ◽

Autobiographical Narratives ◽

Narrative Interviews ◽

Negative Stereotypes ◽

The Third ◽

The Uk ◽

Autobiographical Narrative

This paper explores how refugees in the UK perceive the relation between their experience of migration and their psychosocial health. Autobiographical narrative interviews were carried out with fifteen refugees residing in the UK. The findings reveal a contrast between the negative stereotypes concerning refugees’ psychosocial health and the participants’ own perceptions. Two of the three emerging narratives suggest a more balanced view of refugees’ psychosocial health, since- in contrast to the stereotypes- most participants did not perceive this through the lens of ‘vulnerability’. The third narrative revealed that a hostile social context can negatively shape refugees’ perceptions of their psychosocial health. This runs counter to the stereotype of refugees as being exclusively responsible for their ‘passiveness’ and therefore for the problems they face.

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Relaksasi Benson Untuk Durasi Tidur Pasien Penyakit Jantung Koroner

Jurnal Endurance ◽

10.22216/jen.v3i3.2788 ◽

2018 ◽

Vol 3 (3) ◽

pp. 556

Author(s):

Mulyanti Roberto Muliantino ◽

Tuti Herawati ◽

Masfuri Masfuri

Keyword(s):

Cardiac Rehabilitation ◽

Sleep Duration ◽

Intervention Group ◽

Self Report ◽

Pharmacological Intervention ◽

Control Group ◽

P Value ◽

Short Sleep Duration ◽

Short Sleep ◽

Coronary Arterial Disease

Coronary Arterial Disease (CAD) is one of cardiovaskular disease that remain leading cause death and disability. Short sleep duration is the major symptoms in patients with CAD, during recovery period after cardiac events and during cardiac rehabilitation. Benson’s relaxation is one of relaxation as modalities therapy to increase sleep duration, however few studies related to this technique in planned intervention. This study was to measured the effectiveness of Benson’s relaxation in short sleep duration of CAD patients during cardiac rehabilitation. It was a quasi experimental pretest posttest control group design. This study included 29 respondens in Dr.M.Djamil Hospital were assigned to intervention group which receiving Benson’s relaxation technique (n=15) and control group with routine care (n=14). Benson’s relaxation technique was administered for 5 days 2 times a day, each 20 minutes to intervention group. Short sleep duration was measured using sleep diary (self report). The result indicated significant increasing in mean of sleep duration before and after Benson’s relaxation in intervention group (p value < 0,001). The study concluded that Benson’s relaxation technique is an effective non-pharmacological intervention to increase sleep duration in CAD patients. Penyakit jantung koroner menjadi masalah kardiovaskular yang mengakibatkan angka mortalitas yang tinggi. Durasi tidur pendek termasuk salah satu keluhan utama pasien penyakit jantung koroner pada masa recovery setelah serangan dan menjalani rehabilitasi fase 2. Relaksasi Benson merupakan teknik relaksasi sebagai terapi modalitas untuk mengurangi keluhan durasi tidur pendek, namum belum banyak penelitian terkait intervensi ini. Penelitian ini bertujuan untuk mengidentifikasi pengaruh relaksasi Benson terhadap durasi tidur pasien penyakit jantung koroner yang menjalani rehabilitasi fase 2. Penelitian ini menggunakan desain Quasi Eksperimen dengan pendekatan control group pretest posttest design pada 29 responden di RSUP. Dr.M.Djamil Padang yang dibagi dalam dua kelompok (kelompok intervensi dan kelompok kontrol). Hasil penelitian menunjukan ada perbedaan rerata durasi tidur yang signifikan antara sebelum dan setelah dilakukan intervensi relaksasi Benson pada kelompok intervensi (p value < 0,001). Simpulan hasil penelitian ini dapat menjadi salah satu terapi modalitas bagi perawat untuk mengatasi masalah durasi tidur pendek pada pasien penyakit jantung koroner.

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699 Sleep Health Traits and COVID-19: Mortality Risk from the UK Biobank

SLEEP ◽

10.1093/sleep/zsab072.697 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A273-A273

Author(s):

Xi Zheng ◽

Ma Cherrysse Ulsa ◽

Peng Li ◽

Lei Gao ◽

Kun Hu

Keyword(s):

Risk Factors ◽

Sleep Apnea ◽

Sleep Duration ◽

Sex Education ◽

Mortality Risk ◽

Self Report ◽

Severe Illness ◽

Uk Biobank ◽

Sleep Health ◽

The Uk

Abstract Introduction While there is emerging evidence for acute sleep disruption in the aftermath of coronavirus disease 2019 (COVID-19), it is unknown whether sleep traits contribute to mortality risk. In this study, we tested whether earlier-life sleep duration, chronotype, insomnia, napping or sleep apnea were associated with increased 30-day COVID-19 mortality. Methods We included 34,711 participants from the UK Biobank, who presented for COVID-19 testing between March and October 2020 (mean age at diagnosis: 69.4±8.3; range 50.2–84.6). Self-reported sleep duration (less than 6h/6-9h/more than 9h), chronotype (“morning”/”intermediate”/”evening”), daytime dozing (often/rarely), insomnia (often/rarely), napping (often/rarely) and presence of sleep apnea (ICD-10 or self-report) were obtained between 2006 and 2010. Multivariate logistic regression models were used to adjust for age, sex, education, socioeconomic status, and relevant risk factors (BMI, hypertension, diabetes, respiratory diseases, smoking, and alcohol). Results The mean time between sleep measures and COVID-19 testing was 11.6±0.9 years. Overall, 5,066 (14.6%) were positive. In those who were positive, 355 (7.0%) died within 30 days (median = 8) after diagnosis. Long sleepers (>9h vs. 6-9h) [20/103 (19.4%) vs. 300/4,573 (6.6%); OR 2.09, 95% 1.19–3.64, p=0.009), often daytime dozers (OR 1.68, 95% 1.04–2.72, p=0.03), and nappers (OR 1.52, 95% 1.04–2.23, p=0.03) were at greater odds of mortality. Prior diagnosis of sleep apnea also saw a two-fold increased odds (OR 2.07, 95% CI: 1.25–3.44 p=0.005). No associations were seen for short sleepers, chronotype or insomnia with COVID-19 mortality. Conclusion Data across all current waves of infection show that prior sleep traits/disturbances, in particular long sleep duration, daytime dozing, napping and sleep apnea, are associated with increased 30-day mortality after COVID-19, independent of health-related risk factors. While sleep health traits may reflect unmeasured poor health, further work is warranted to examine the exact underlying mechanisms, and to test whether sleep health optimization offers resilience to severe illness from COVID-19. Support (if any) NIH [T32GM007592 and R03AG067985 to L.G. RF1AG059867, RF1AG064312, to K.H.], the BrightFocus Foundation A2020886S to P.L. and the Foundation of Anesthesia Education and Research MRTG-02-15-2020 to L.G.

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Hybrid cardiac rehabilitation program as a potential enhancer of adherence to cardiac rehabilitation in smoking patients with coronary heart disease - a retrospective single-centre analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.347 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

M Cabral ◽

R Santos ◽

F Januario ◽

A Antunes ◽

R Fonseca-Pinto

Keyword(s):

Mental Health ◽

Cardiac Rehabilitation ◽

Smoking Status ◽

Rehabilitation Program ◽

Anxiety And Depression ◽

Cardiac Rehabilitation Program ◽

Phase 2 ◽

Significant Difference ◽

Group 2 ◽

Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Cardiac rehabilitation (CR) has well known beneficial effects on physical capacity, health-related quality of life, morbidity and mortality following an acute cardiac event. It is also known that smoking status is a powerful predictor of recurrent cardiovascular disease events. However, it has been noted that smoker patients may be less likely to access or complete CR. The aim of this study was to determine the levels of anxiety and depression and its improvement, depending on the smoking status of patients with coronary artery disease (CAD) on phase 2 of the Cardiac Rehabilitation Program (CRP). Additionally, we intend to investigate the mental health impact on smoker patients" group in conventional CR versus telemonitored CR. A retrospective study was conducted and patients in CRP between 2017 and 2020 were included. Patient selection and information collection were obtained through medical records. The outcomes of anxiety and depression were evaluated through the Hospital Anxiety and Depression Scale (HADS). Patients were divided into two groups: group 1 for non-smokers or ex-smokers and group 2 for smokers. For group 2 patients, a sub-analysis was performed for patients following the conventional CR versus the telemonitored CR, with the use of MOVIDA mobile application. Variables were analysed in the beginning (T0) and in the end (T1) of phase 2, around 3 months after. Group comparisons tests and statistical analysis were performed using SPSS software v25.0. A p-value less than 0.05 is statistically significant. We analysed 107 patients, which 93 of these were assiduous and 69 concluded the phase 2 of CRP: 39 patients in group 1 and 30 patients in group 2. Two groups have similar baseline characteristics, except for the higher presence of diabetes (p = 0.02) in group 1. It was noted an improvement in both anxiety and depression items for group 1 (p < 0.01 for both), but only for anxiety item for group 2 (p = 0.03). In subgroup analysis, we observed no improvement for smoking patients following the conventional CR for both anxiety and depression items (p = 0.60 and p = 0.71, respectably) versus a significant difference in telemonitored CR patients (p = 0.02 and p = 0.04). We hypothesise that, when compared to conventional CR, cardiac telemonitored exercise using modern communication methods may result in an improved mental health state among smoking patients, which can lead to a better adherence for CRP. Further studies including more patients and phase 3 of CRP are needed to confirm these results.

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Machine Learning Prediction of Biomarkers from SNPs and of Disease Risk from Biomarkers in the UK Biobank

Genes ◽

10.3390/genes12070991 ◽

2021 ◽

Vol 12 (7) ◽

pp. 991

Author(s):

Erik Widen ◽

Timothy G. Raben ◽

Louis Lello ◽

Stephen D. H. Hsu

Keyword(s):

Disease Risk ◽

Smoking Status ◽

Glycated Haemoglobin ◽

European Ancestry ◽

Risk Scores ◽

Common Disease ◽

Atherosclerotic Cardiovascular Disease ◽

Uk Biobank ◽

Lipoprotein A ◽

The Uk

We use UK Biobank data to train predictors for 65 blood and urine markers such as HDL, LDL, lipoprotein A, glycated haemoglobin, etc. from SNP genotype. For example, our Polygenic Score (PGS) predictor correlates ∼0.76 with lipoprotein A level, which is highly heritable and an independent risk factor for heart disease. This may be the most accurate genomic prediction of a quantitative trait that has yet been produced (specifically, for European ancestry groups). We also train predictors of common disease risk using blood and urine biomarkers alone (no DNA information); we call these predictors biomarker risk scores, BMRS. Individuals who are at high risk (e.g., odds ratio of >5× population average) can be identified for conditions such as coronary artery disease (AUC∼0.75), diabetes (AUC∼0.95), hypertension, liver and kidney problems, and cancer using biomarkers alone. Our atherosclerotic cardiovascular disease (ASCVD) predictor uses ∼10 biomarkers and performs in UKB evaluation as well as or better than the American College of Cardiology ASCVD Risk Estimator, which uses quite different inputs (age, diagnostic history, BMI, smoking status, statin usage, etc.). We compare polygenic risk scores (risk conditional on genotype: PRS) for common diseases to the risk predictors which result from the concatenation of learned functions BMRS and PGS, i.e., applying the BMRS predictors to the PGS output.

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Association between socioeconomic status and self-reported, tested and diagnosed COVID-19 status during the first wave in the Northern Netherlands: a general population-based cohort from 49 474 adults

BMJ Open ◽

10.1136/bmjopen-2020-048020 ◽

2021 ◽

Vol 11 (3) ◽

pp. e048020

Author(s):

Yinjie Zhu ◽

Ming-Jie Duan ◽

Hermien H. Dijk ◽

Roel D. Freriks ◽

Louise H. Dekker ◽

...

Keyword(s):

Socioeconomic Status ◽

General Population ◽

Low Income ◽

Smoking Status ◽

Sleep Time ◽

Population Based ◽

Lifestyle Factors ◽

Self Report ◽

Low Education ◽

Tv Watching

ObjectivesStudies in clinical settings showed a potential relationship between socioeconomic status (SES) and lifestyle factors with COVID-19, but it is still unknown whether this holds in the general population. In this study, we investigated the associations of SES with self-reported, tested and diagnosed COVID-19 status in the general population.Design, setting, participants and outcome measuresParticipants were 49 474 men and women (46±12 years) residing in the Northern Netherlands from the Lifelines cohort study. SES indicators and lifestyle factors (i.e., smoking status, physical activity, alcohol intake, diet quality, sleep time and TV watching time) were assessed by questionnaire from the Lifelines Biobank. Self-reported, tested and diagnosed COVID-19 status was obtained from the Lifelines COVID-19 questionnaire.ResultsThere were 4711 participants who self-reported having had a COVID-19 infection, 2883 participants tested for COVID-19, and 123 positive cases were diagnosed in this study population. After adjustment for age, sex, lifestyle factors, body mass index and ethnicity, we found that participants with low education or low income were less likely to self-report a COVID-19 infection (OR [95% CI]: low education 0.78 [0.71 to 0.86]; low income 0.86 [0.79 to 0.93]) and be tested for COVID-19 (OR [95% CI]: low education 0.58 [0.52 to 0.66]; low income 0.86 [0.78 to 0.95]) compared with high education or high income groups, respectively.ConclusionOur findings suggest that the low SES group was the most vulnerable population to self-reported and tested COVID-19 status in the general population.

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Hair Cortisol Concentrations Are Associated with Dental Anxiety during Pregnancy

Dentistry Journal ◽

10.3390/dj9040042 ◽

2021 ◽

Vol 9 (4) ◽

pp. 42

Author(s):

Hilja Viitaniemi ◽

Auli Suominen ◽

Linnea Karlsson ◽

Paula Mustonen ◽

Susanna Kortesluoma ◽

...

Keyword(s):

Hair Sample ◽

Psychological Symptoms ◽

Smoking Status ◽

Dental Anxiety ◽

Binary Logistic Regression ◽

Birth Cohort Study ◽

Hair Cortisol ◽

Binary Logistic Regression Model ◽

Gestational Week ◽

Independent Association

Dental anxiety (DA) and hair cortisol concentrations (HCC) are associated with psychological symptoms and vary during pregnancy. We aimed to examine the association between HCC and DA at two points of pregnancy. Participants were pregnant mothers (n = 533) drawn from the FinnBrain Birth Cohort Study donating a hair sample at gestational week (gwk) 24 (n = 442) and/or at delivery (n = 176) and completed questionnaires on DA. Two groups, HCC1 and HCC2, treated as separate in the analyses, were formed according to the hair sample donation time i.e., gwk24 and delivery. 85 subjects were included in both groups. MDAS, EPDS, and SCL-90 were used to measure DA, depressive and anxiety symptoms, respectively, at gwk14 for the HCC1 group and gwk34 for the HCC2 group. The association between DA and HCC was studied with a binary logistic regression model, adjusted for anxiety and depressive symptoms, age, BMI, and smoking status. Individuals with high DA had lower HCC levels at gwk24 (OR = 0.548; 95% CI = 0.35–0.86; p = 0.009), but the association was not statistically significant at the delivery (OR = 0.611; 95% CI = 0.28–1.33; p = 0.216). The independent association between HCC and DA in pregnant women suggests that long-term cortisol levels could play a role in the endogenous etiology of DA. Further studies are however, needed.

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