No substantial excess all-cause mortality among cardiac implantable electronic device patients during the first COVID‑19 lockdown in the Leiden area

In the Netherlands, the coronavirus disease 2019 (COVID‑19) pandemic has resulted in excess mortality nationwide. Chronic heart disease patients are at risk for a complicated COVID‑19 course. The current study investigates all-cause mortality among cardiac implantable electronic device (CIED) patients during the first peak of the pandemic and compares the data to the statistics for the corresponding period in the two previous years. Data of adult CIED patients undergoing follow-up at the Leiden University Medical Centre were analysed. All-cause mortality between 1 March and 31 May 2020 was evaluated and compared to the data for the same period in 2019 and 2018. At the beginning of the first peak of the pandemic, 3,171 CIED patients (median age 70 years; 68% male; 41% ischaemic aetiology) were alive. Baseline characteristics of the 2019 (n = 3,216) and 2018 (n = 3,169) cohorts were comparable. All-cause mortality during the peak of the pandemic was 1.4% compared to 1.6% and 1.4% in the same period in 2019 and 2018, respectively (p = 0.84). During the first peak of the COVID‑19 pandemic, there was no substantial excess mortality among CIED patients in the Leiden area, despite the fact that this is group at high risk for a complicated course of a COVID‑19 infection. Strict adherence to the preventive measures may have prevented substantial excess mortality in these vulnerable patients.

Short and Long-term Survival Rates following Myocardial Infarction and its Predictive Factors: A Study Using National Registry Data

Background: Coronary artery disease is the most common cause of death worldwide as well as in Iran. The present study was designed to predict short and long-term survival rates after the first episode of myocardial infarction (MI). Methods: The current research is a retrospective cohort study. The data were collected from the Myocardial Infarction Registry of Iran in a 12-month period leading to March 20, 2014. The variables analyzed included smoking status, past medical history of chronic heart disease, hypertension, diabetes, hyperlipidemia, signs and symptoms during an attack, post-MI complications during hospitalization, the occurrence of arrhythmias, the location of MI, and the place of residence. Survival rates and predictive factors were estimated by the Kaplan–Meier method, the log-rank test, and the Cox model. Results: Totally, 21 181 patients with the first MI were studied. There were 15 328 men (72.4%), and the mean age of the study population was 62.10±13.42 years. During a 1-year period following MI, 2479 patients (11.7%) died. Overall, the survival rates at 28 days, 6 months, and 1 year were estimated to be 0.95 (95% CI: 0.95 to 0.96), 0.90 (95% CI: 0.90 to 0.91), and 0.88 (95% CI: 0.88 to 0.89). After the confounding factors were controlled, history of chronic heart disease (p<0.001), hypertension (p<0.001), and diabetes (p<0.001) had a significant relationship with an increased risk of death and history of hyperlipidemia (p<0.001) and inferior wall MI (p<0.001) had a significant relationship with a decreased risk of death. Conclusion: The results of this study provide evidence for health policy-makers and physicians on the link between MI and its predictive factors.

Gender differences in COVID-19 patients: a regional survey among physicians of Internal Medicine Wards

Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has infected millions of individuals around the World. Hypertension (HT), chronic heart disease (CHD), and diabetes mellitus (DM), particularly in the elderly, increase susceptibility to SARS-CoV-2 infection. However, conflicting results [such as coronavirus 2019 (COVID-19) disease vulnerability, case fatality, etc.] have been reported about the response to infection and COVID-19 outcomes in men and women. Therefore, understanding predictors of Intensive Care Unit (ICU) admission might help future planning and management of the disease. We conducted a multicenter survey about COVID-19 involving internists from Internal Medicine Wards. This survey indirectly allowed us to analyze the information of 2400 patients hospitalized in 35 wards of Internal Medicine of the Campania Region between July and October 2020. Our investigation has detected that the infection is more frequent in males, and the number of male patients hospitalized in ICU is also higher than females, with a large proportion of hypertensive patients. Extensive prospective studies are required to confirm this finding and explore the mechanisms for which hypertensive males are exposed to a higher proportion of admission to ICU and higher case fatality rates.

Clinical and laboratory findings and PCR results in severe and non-severe COVID19 patients based on CURB-65 and WHO severity indices

Background The importance of clinicolaboratory characteristics of COVID-19 made us report our findings in the Alborz province according to the latest National Guideline for the diagnosis and treatment of COVID-19 in outpatients and inpatients (trial five versions, 25 March 2020) of Iran by emphasizing rRT-PCR results, clinical features, comorbidities, and other laboratory findings in patients according to the severity of the disease. Methods In this study, 202 patients were included, primarily of whom 164 had fulfilled the inclusion criteria. This cross-sectional, two-center study that involved 164 symptomatic adults hospitalized with the diagnosis of COVID-19 between March 5 and April 5, 2020, was performed to analyze the frequency of rRT-PCR results, distribution of comorbidities, and initial clinicolaboratory data in severe and non-severe cases, comparing the compatibility of two methods for categorizing the severity of the disease. Results According to our findings, 111 patients were rRT-PCR positive (67.6%), and 53 were rRT-PCR negative (32.4%), indicating no significant difference between severity groups that were not related to the date of symptoms' onset before admission. Based on the National Guideline, among vital signs and symptoms, mean oxygen saturation and frequency of nausea showed a significant difference between the two groups (P < 0.05); however, no significant difference was observed in comorbidities. In CURB-65 groups, among vital signs and comorbidities, mean oxygen saturation, diabetes, hypertension (HTN), hyperlipidemia, chronic heart disease (CHD), and asthma showed a significant difference between the two groups (P < 0.05), but no significant difference was seen in symptoms. Conclusion In this study, rRT-PCR results of hospitalized patients with COVID-19 were not related to severity categories. From initial clinical characteristics, decreased oxygen saturation appears to be a more common abnormality in severe and non-severe categories. National Guideline indices seem to be more comprehensive to categorize patients in severity groups than CURB-65, and there was compatibility just in non-severe groups of National Guideline and CURB-65 categories.

Penyuluhan Kesehatan Berpengaruh Terhadap Pengetahuan Keluarga Tentang Stunting

Stunting is one of the national health problems caused by multidimensional factors. Stunting children have an increased risk of suffering from repeated infections that can lead to death such as diarrhea, pneumonia, smallpox, and an increased risk of chronic heart disease in childhood. The purpose of the activity was to increase the knowledge or behavior of the community about stunting in Betteng village, Pamboang sub-district. The target of the activity was the community in the working area of ​​the Pamboang Public Health Center. This counseling emphasized more on the method of delivering information about stunting, especially in the causes, prevention, and control which were carried out in the form of explanations for families who have stunting children. In conclusion, health education affects changes in knowledge about stunting. Therefore, it is recommended to carry out health education activities if public knowledge is to be increased. ABSTRAK Kejadian Stunting merupakan salah satu permasalah kesehatan secara nasional yang diakibatkan oleh faktor multidimensi. Anak stunting meningkat resiko untuk menderita infeksi berulang yang dapat mengakibatkan kematian seperti diare, pneumonia dan cacar serta meningkatkan resiko mengalami penyakit jantung kronik di usia anak. Tujuan kegiatan pengabdian masyarakat untuk mengetahui pengaruh penyuluhan kesehatan terhadap stunting. Untuk itu perlu diperlukan pengetahuan yang baik oleh semua pihak. Metode kegiatan pengabdian kepada masyarakat Metode kuantitatif dengan pre-eksperimental dengan menggunakan suatu rancangan One Group Pre test and Post test design dengan memberikan penyuluhan kepada para petugas kesehatan tentang stunting terkait penyebab dan upaya penanggulangannya. Hasil pengukurannya menunjukkan bahwa pada pengukuran sebelum dengan pengukuran setelah intervensi memiliki nilai p = 0,084. Dengan nilai α ( 0,05 ) > nilai p value ( 0,084 ) sehingga ada perbedaan pengetahuan sebelum dan sesudah intervensi atau ada pengaruh intervensi penyuluhan penguatan keluarga dalam pengendalian stunting. Kesimpulannya bahwa penyuluhan kesehatan berpengaruh terhadap perubahan pengetahuan tetang stunting. Sehingga direkomendasikan melakukan kegiatan penyuluhan kesehatan jika ingin meningkatkan pengetahuan masyarakat.

Patient values: A foundation for eHealth design and evaluation in BENEFIT for all (Preprint)

BACKGROUND eHealth interventions are developed to support and facilitate patients with lifestyle changes and (self) care tasks after being diagnosed with a chronic heart disease. Creating long lasting effects in lifestyle change and health outcomes with eHealth interventions is challenging and requires good understanding of patient values. OBJECTIVE This study aims to identify which values of cardiac patients should be considered when designing a technological lifestyle platform. METHODS A mixed-method design was applied, combining data from usability testing with an additional online survey study, to validate the outcomes of the usability tests. RESULTS Eleven relevant patient values were identified, including the need for security, support, not wanting to feel anxious, tailoring of treatment, and personalized, accessible care. The validation survey shows that all values but one (Value 9: To have extrinsic motivation to accomplish goals or activities (related to health/lifestyle)) were regarded as important/very important. A rating of very unimportant or unimportant was given by less than 2% of the respondents (0.5%¬¬–1.6%) to all values except but one (Value 9). CONCLUSIONS There is a remarkably high consensus among patients regarding the identified values reflecting goals and themes central to patients in their lives, while living with or managing their cardiovascular disease. The identified values can serve as a starting point for future research to translate and integrate these values into the design of the eHealth technology. This may call for prioritization of values, as not all values can be met equally.

Association of Job Stress and Hypertension among Nurses in Imo State, Nigeria

Hypertension is one of the major public health problems and it is prevalent all over the world. Raised blood pressure (BP) is a major risk factor for chronic heart disease, stroke and coronary heart disease. This study was a descriptive and correlation study carried out to investigate the association of job stress and hypertension among nurses in Imo state, Nigeria. A well-structured questionnaire was used to interview the subjects and obtain data for the study. All subjects used for this study gave an informed consent to be part of the study. Data analysis was performed using SPSS Statistics version 23. Bivariate (unadjusted) discriminant analysis method was used to assess the correlation of hypertension with job stress. Results showed that significant correlation was found between hypertension and job stress (Wilks’s Lambda=0.965, F=13.85, p <0.0001), a significant proportion (34.3%) of the hypertensive nurses stated that they feel stressful working on night compared with 19.0% who are non-hypertensive. But the corresponding mean score (2.6) remained the same for both groups. Up to 21.8% of the non-hypertensive nurses compared with 32.1% of the hypertensive nurses reported that most of the times they deprive themselves from sleeping just to perform work task. The mean score showed variations for two groups with higher score for the non-hypertensive among those that find it stressful to engage in a non-nursing task while on duty (non-hypertensive 2.6, hypertensive 2.3). The score was rather higher in the hypertensive (3.0) than the non-hypertensive (2.5) among those who responded that the task they handle make them feel fatigued. In conclusion, there was a correlation between job stress and hypertension. It was recommended that stress intervention programmes be introduced to encourage nurses to manage stress in the workplace. Keywords: Hypertension, High Blood Pressure, Job stress, Nurses, Cardiovascular disease.

Retrospective Study of the Upsurge of Enterovirus D68 Clade D1 among Adults (2014–2018)

Enterovirus D68 (EV-D68) has emerged as an agent of epidemic respiratory illness and acute flaccid myelitis in the paediatric population but data are lacking in adult patients. We performed a 4.5-year single-centre retrospective study of all patients who tested positive for EV-D68 and analysed full-length EV-D68 genomes of the predominant clades B3 and D1. Between 1 June 2014, and 31 December 2018, 73 of the 11,365 patients investigated for respiratory pathogens tested positive for EV-D68, of whom 20 (27%) were adults (median age 53.7 years [IQR 34.0–65.7]) and 53 (73%) were children (median age 1.9 years [IQR 0.2–4.0]). The proportion of adults increased from 12% in 2014 to 48% in 2018 (p = 0.01). All adults had an underlying comorbidity factor, including chronic lung disease in 12 (60%), diabetes mellitus in six (30%), and chronic heart disease in five (25%). Clade D1 infected a higher proportion of adults than clades B3 and B2 (p = 0.001). Clade D1 was more divergent than clade B3: 5 of 19 amino acid changes in the capsid proteins were located in putative antigenic sites. Adult patients with underlying conditions are more likely to present with severe complications associated with EV-D68, notably the emergent clade D1.

Prevalence and Factors Associated With Atrial Fibrillation in Elderly Patients With Obstructive Sleep Apnea

Purpose: This study sought to identify the prevalence and factors associated with atrial fibrillation (AF) in elderly patients with obstructive sleep apnea (OSA) in China. Methods: Between January 2015 and October 2017, we recruited 1285 elderly patients with OSA who underwent overnight polysomnography at sleep centers of multiple hospitals. They were assessed using 12-lead ECG or 24-hour dynamic ECG, and their baseline demographics, clinical characteristics, sleep parameters, and medical history were determined. Binary logistic regression analysis was used to investigate the factors related to AF in these elderly patients. Results: The clinician classified 122 (9.5%) patients as having AF. The prevalence of AF significantly increased with age (p＜0.05) but did not significantly differ between the mild, moderate, and severe OSA groups. Additionally, the prevalence of paroxysmal AF was 7.2% among the overall study population, and it increased with OSA severity or advanced age (p＜0.05). Persistent AF was noted in 2.3% participants, and the prevalence also increased with age. The logistic regression analysis showed that age (OR=1.054, 95%CI: 1.027-1.018, p＜0.001) , history of drinking (OR=1.752, 95%CI: 1.070-2.867, p＜0.05), chronic heart disease (OR=1.778, 95%CI: 1.156-2.736, p＜0.01), diabetes mellitus (OR=1.792, 95%CI: 1.183-2.713, p＜0.01), and cardiac dysfunction (OR=2.373, 95%CI=1.298-4.337, p＜0.01) were relevant to AF among participants with OSA.Conclusion: The prevalence of AF is significantly common in elderly patients with OSA. Age, history of drinking, chronic heart disease, diabetes mellitus, and cardiac dysfunction are independently related to AF in these patients.