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Jarallah M, Withers TM, Rosewilliam S, Stathi A, Greaves CJ. Methods for assessing exercise fidelity in unsupervised home-based cardiovascular rehabilitation: a scoping review. BMC Sports Sci Med Rehabil 2025; 17:31. [PMID: 40022234 PMCID: PMC11871813 DOI: 10.1186/s13102-025-01069-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 01/29/2025] [Indexed: 03/03/2025]
Abstract
BACKGROUND Home-based cardiac rehabilitation is increasingly popular for patients with cardiovascular diseases. However, this mode of rehabilitation involves unsupervised exercise, making it challenging to assess, correct, and monitor exercise fidelity (the extent to which the patient performs the exercise intended by the intervention provider). This review aimed to identify the range, validity, and acceptability of measures for assessing exercise fidelity in unsupervised, home-based cardiovascular rehabilitation. METHODS We searched PubMed, Embase, CINAHL, Medline, and PsycINFO for studies published between 2000 and 2024 to identify observational studies, trials, and protocols published in English with a home-based cardiovascular rehabilitation intervention and at least one measure of exercise fidelity (e.g., adherence to the intended frequency, intensity, time, type, safety, progression/regression). Two reviewers selected eligible studies and extracted data, including study characteristics, exercise components, adherence definition, adherence measures, and data on measurement validity or acceptability. We conducted a narrative synthesis using a comprehensive definition of exercise fidelity, which evolved as the analysis progressed. RESULTS Forty-six articles describing 41 studies were included. Exercise intensity was the most commonly measured fidelity component (38/41 studies), followed by exercise frequency (32/41 studies). Exercise intensity was mostly assessed by wearable devices (28/41 studies). Frequency of exercise was most commonly assessed subjectively using a self-reported exercise log or diary, but also (objectively) using wearable devices. Exercise quantity was most commonly assessed (in terms of time or duration) by self-reported exercise logs, diaries and wearable devices, or (in terms of steps or distance) mostly by wearable devices (pedometers, other step activity monitors). Safety was only assessed in 12/41 studies. No studies assessed progression or regression of exercise, quality of exercise (accuracy of movement) or the appropriateness of progression or regression. CONCLUSIONS Most studies to date have conceptualised exercise fidelity or adherence narrowly, ignoring important elements of the initial exercise prescription and many have relied on non-validated self-report measures. We present a comprehensive framework for assessing exercise fidelity, which may be useful for designing more robust assessments of exercise fidelity in home-based rehabilitation programmes.
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Affiliation(s)
- Mohammad Jarallah
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Kingdom of Saudi Arabia.
| | - Thomas M Withers
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Sheeba Rosewilliam
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Main LC, Maroni TD, Ojanen T, Drain JR, Nindl B. Soldier performance management: insights from boots on ground research and recommendations for practitioners. BMJ Mil Health 2025:e002742. [PMID: 39793990 DOI: 10.1136/military-2024-002742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 11/29/2024] [Indexed: 01/13/2025]
Abstract
Theoretically, the serial measurement of biomarkers to monitor physiological responses to military training could be used to mitigate musculoskeletal injury risk and better understand the recovery status of personnel. To date, the cost and scalability of these initiatives have impeded their uptake by defence organisations. However, advances in technology are increasing the accessibility of a range of health and performance biomarkers. This paper presents a synthesises of findings from the literature and discussions with informed stakeholders to provide contextually relevant advice for future efforts to monitor military personnel, together with key considerations to ensure actionable outcomes from the data captured. The aim of this review is, therefore, twofold; first, to demonstrate how wearable devices and biomarkers have been used in defence research to assess the context-specific, occupational demands placed on personnel; and second, to discuss their potential to monitor military workloads, optimise training programming and understand soldier adaptation to multi-stressor environments.
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Affiliation(s)
- Luana C Main
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - T D Maroni
- Institute of Applied Sciences, University of Chichester, Chichester, UK
| | - T Ojanen
- Finnish Defence Research Agency, Finnish Defence Forces, Järvenpää, Finland
| | - J R Drain
- Defence Science and Technology Group, Melbourne, Victoria, Australia
| | - B Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Bilbrey T, Martin J, Zhou W, Bai C, Vaswani N, Shah R, Chokshi S, Chen X, Bhusri S, Niemi S, Meng H, Lei Z. A Dual-Modality Home-Based Cardiac Rehabilitation Program for Adults With Cardiovascular Disease: Single-Arm Remote Clinical Trial. JMIR Mhealth Uhealth 2024; 12:e59098. [PMID: 39150858 PMCID: PMC11480683 DOI: 10.2196/59098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/20/2024] [Accepted: 08/12/2024] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a safe, effective intervention for individuals with cardiovascular disease (CVD). However, a majority of eligible patients do not complete CR. Growing evidence suggests that home-based cardiac rehabilitation (HBCR) programs are comparable in effectiveness and safety with traditional center-based programs. More research is needed to explore different ways to deliver HBCR programs to patients with CVD. OBJECTIVE We aimed to assess the feasibility and impact of a digital HBCR program (RecoveryPlus.Health) that integrates both telehealth and mHealth modalities on functional exercise capacity, resting heart rate, and quality of life among adults with CVD. METHODS This 12-week prospective, single-arm remote clinical trial used a within-subject design. We recruited adults with CVD (aged ≥40 years) from the community with a CR-eligible diagnosis (stable angina pectoris, myocardial infarction, and heart failure) between May and August 2023. All enrolled patients referred to the RPH clinic in Roanoke, Texas, were included. The care team provided guideline-concordant CR services to study participants via two modalities: (1) a synchronous telehealth exercise training through videoconferencing; and (2) an asynchronous mobile health (mHealth) coaching app (RPH app). Baseline intake survey, electronic health record, and app log data were used to extract individual characteristics, care processes, and platform engagement data. Feasibility was measured by program completion rate and CR service use. Efficacy was measured by changes in the 6-minute walk test, resting heart rate, and quality of life (12-Item Short-Form Health Survey) before and after the 12-week program. Paired t tests were used to examine pre- and postintervention changes in the outcome variables. RESULTS In total, 162 met the inclusion criteria and 75 (46.3%) consented and were enrolled (mean age 64, SD 10.30 years; male: n=37, 49%; White: n=46, 61%). Heart failure was the most common diagnosis (37/75, 49%). In total, 62/75 (83%) participants completed the 12-week study and used the telehealth modality with 9.63 (SD 3.33) sessions completed, and 59/75 (79%) used the mHealth modality with 10.97 (SD 11.70) sessions completed. Post intervention, 50/62 (81%) participants' performance in the 6-minute walk test had improved, with an average improvement of 40 (SD 63.39) m (95% CI 25.6-57.1). The average 12-Item Short-Form Health Survey's physical and mental summary scores improved by 2.7 (SD 6.47) points (95% CI 1.1-4.3) and 2.2 (SD 9.09) points (95% CI 0.1-4.5), respectively. There were no changes in resting heart rate and no exercise-related adverse events were reported. CONCLUSIONS The RecoveryPlus.Health digital HBCR program showed feasibility and efficacy in a group of nationally recruited patients with CVD. The findings add to the evidence that a telehealth and mHealth dual-modality HBCR program may be a promising approach to overcome some of the main barriers to improving CR access in the United States. TRIAL REGISTRATION ClinicalTrials.gov NCT05804500; https://clinicaltrials.gov/search?cond=NCT05804500.
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Affiliation(s)
- Tim Bilbrey
- RecoveryPlus.Health, Inc, New York, NY, United States
| | - Jenny Martin
- RecoveryPlus.Health, Inc, New York, NY, United States
| | - Wen Zhou
- RecoveryPlus.Health, Inc, New York, NY, United States
| | - Changhao Bai
- RecoveryPlus.Health, Inc, New York, NY, United States
| | - Nitin Vaswani
- Node.Health Foundation, Wilmington, DE, United States
| | - Rishab Shah
- Node.Health Foundation, Wilmington, DE, United States
| | - Sara Chokshi
- Node.Health Foundation, Wilmington, DE, United States
| | - Xi Chen
- RecoveryPlus.Health, Inc, New York, NY, United States
| | - Satjit Bhusri
- Upper East Side Cardiology PLLC, New York, NY, United States
| | - Samantha Niemi
- McCormick School of Engineering, Northwestern University, Chicago, IL, United States
| | - Hongdao Meng
- School of Aging Studies, University of South Florida, Tampa, FL, United States
| | - Zhen Lei
- RecoveryPlus.Health, Inc, New York, NY, United States
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Meredith SJ, Shepherd AI, Saynor ZL, Scott A, Gorczynski P, Perissiou M, Horne M, McNarry MA, Mackintosh KA, Witcher CSG. Device-based 24-hour movement behaviours in adult phase III cardiac rehabilitation service-users during the COVID-19 pandemic: a mixed-methods prospective observational study. Disabil Rehabil 2024:1-12. [PMID: 39257350 DOI: 10.1080/09638288.2024.2397086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/12/2024]
Abstract
PURPOSE To examine changes in device-based 24-hour movement behaviours (MB), and facilitators and barriers to physical activity (PA) and exercise, during remotely-delivered cardiac rehabilitation (RDCR). MATERIALS AND METHODS This prospective observational study used wrist-worn GENEActiv accelerometers to assess MB of 10 service-users (63 ± 10 years) at the start, middle, and end of three-months of RDCR. Barriers and facilitators to PA and exercise were explored through self-report diaries and analysed using content analysis. RESULTS At start, service-users were sedentary for 12.6 ± 0.7 h · day-1 and accumulated most PA at a light-intensity (133.52 ± 28.57 min · day-1) - neither changed significantly during RDCR. Sleep efficiency significantly reduced from start (88.80 ± 4.2%) to the end (86.1 ± 4.76%) of CR, with values meeting health-based recommendations (≥85%). Barriers to RDCR exercise included exertional discomfort and cardiac symptoms, and reduced confidence when exercising alone. Setting meaningful PA goals, self-monitoring health targets, and having social support, facilitated PA and exercise during RDCR. CONCLUSIONS Our RDCR programme failed to elicit significant changes in MB or sleep. To increase the likelihood of successful RDCR, it is important to promote a variety of exercise and PA options, target sedentary time, and apply theory to RDCR design, delivery, and support strategies.
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Affiliation(s)
- S J Meredith
- Academic Geriatric Medicine and National Institute of Health Research Collaboration for Leadership in Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - A I Shepherd
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Z L Saynor
- School of Health Sciences, University of Southampton, Southampton, UK
| | - A Scott
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - P Gorczynski
- School of Human Sciences, University of Greenwich, London, UK
| | - M Perissiou
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - M Horne
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - M A McNarry
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Department of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - K A Mackintosh
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Department of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - C S G Witcher
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
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Alshahrani NS, Hartley A, Howard J, Hajhosseiny R, Khawaja S, Seligman H, Akbari T, Alharbi BA, Bassett P, Al-Lamee R, Francis D, Kaura A, Kelshiker MA, Peters NS, Khamis R. Randomized Trial of Remote Assessment of Patients After an Acute Coronary Syndrome. J Am Coll Cardiol 2024; 83:2250-2259. [PMID: 38588928 DOI: 10.1016/j.jacc.2024.03.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Telemedicine programs can provide remote diagnostic information to aid clinical decisions that could optimize care and reduce unplanned readmissions post-acute coronary syndrome (ACS). OBJECTIVES TELE-ACS (Remote Acute Assessment of Patients With High Cardiovascular Risk Post-Acute Coronary Syndrome) is a randomized controlled trial that aims to compare a telemedicine-based approach vs standard care in patients following ACS. METHODS Patients were suitable for inclusion with at least 1 cardiovascular risk factor and presenting with ACS and were randomized (1:1) before discharge. The primary outcome was time to first readmission at 6 months. Secondary outcomes included emergency department (ED) visits, major adverse cardiovascular events, and patient-reported symptoms. The primary analysis was performed according to intention to treat. RESULTS A total of 337 patients were randomized from January 2022 to April 2023, with a 3.6% drop-out rate. The mean age was 58.1 years. There was a reduced rate of readmission over 6 months (HR: 0.24; 95% CI: 0.13-0.44; P < 0.001) and ED attendance (HR: 0.59; 95% CI: 0.40-0.89) in the telemedicine arm, and fewer unplanned coronary revascularizations (3% in telemedicine arm vs 9% in standard therapy arm). The occurrence of chest pain (9% vs 24%), breathlessness (21% vs 39%), and dizziness (6% vs 18%) at 6 months was lower in the telemedicine group. CONCLUSIONS The TELE-ACS study has shown that a telemedicine-based approach for the management of patients following ACS was associated with a reduction in hospital readmission, ED visits, unplanned coronary revascularization, and patient-reported symptoms. (Telemedicine in High-Risk Cardiovascular Patients Post-ACS [TELE-ACS]; NCT05015634).
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Affiliation(s)
- Nasser S Alshahrani
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; King Khalid University, Abha, Saudi Arabia
| | - Adam Hartley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - James Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Reza Hajhosseiny
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Saud Khawaja
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Henry Seligman
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Tamim Akbari
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Badr A Alharbi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; King Khalid University, Abha, Saudi Arabia
| | - Paul Bassett
- Statsconsultancy Ltd, Amersham, Buckinghamshire, United Kingdom
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Darrel Francis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Amit Kaura
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mihir A Kelshiker
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ramzi Khamis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom.
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Lin S, Wang M, Jing C, Zhang S, Chen J, Liu R. The influence of AI on the economic growth of different regions in China. Sci Rep 2024; 14:9169. [PMID: 38649432 PMCID: PMC11035668 DOI: 10.1038/s41598-024-59968-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
High-quality development plays a crucial role in China's economic progress in the new era. It represents a new concept of advancement and mirrors the increasing aspirations of the populace for an improved standard of living. In this context, the role of artificial intelligence (AI) in promoting sustainable development cannot be overemphasized. This paper explores how AI technologies can drive the transition to a green, low-carbon and circular economy. We have established an index system to measure the development level of the artificial intelligence industry and the high-quality development of the economy, which is relevant to the current state of the artificial intelligence industry and the advancement of the economy. Panel data from 2008 to 2017 has been utilized for this purpose. Global principal component analysis method and entropy value method are employed in the evaluation. Through in-depth analysis of the application of artificial intelligence and environmental protection in various provinces and cities, we clarify that artificial intelligence promotes innovation, saves resources, and is conducive to the development of green economy in the new era.
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Affiliation(s)
- Shuang Lin
- School of Economics and Management, Civil Aviation Flight University of China, Deyang, 618307, China
| | - Minke Wang
- School of Airport Engineering, Civil Aviation Flight University of China, Deyang, 618307, China.
| | - Chongyi Jing
- School of Economics and Management, Civil Aviation Flight University of China, Deyang, 618307, China
| | - Shengda Zhang
- School of Economics and Management, Civil Aviation Flight University of China, Deyang, 618307, China
| | - Jiuhao Chen
- School of Economics and Management, Civil Aviation Flight University of China, Deyang, 618307, China
| | - Rui Liu
- Department of Administration, Chengdu University of TCM, Chengdu, 611137, China
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Shi W, Green H, Sikhosana N, Fernandez R. Effectiveness of Telehealth Cardiac Rehabilitation Programs on Health Outcomes of Patients With Coronary Heart Diseases: An Umbrella Review. J Cardiopulm Rehabil Prev 2024; 44:15-25. [PMID: 37335820 DOI: 10.1097/hcr.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
PURPOSE The aim of this study was to conduct an umbrella review summarizing the evidence from existing systematic reviews of telehealth cardiac rehabilitation (CR) on health outcomes of patients with coronary heart disease (CHD). REVIEW METHODS An umbrella review of systematic reviews was undertaken in accordance with the PRISMA and JBI guidelines. A systematic search was conducted in Medline, APA PsycINFO, Embase, CINAHL, Web of Science, Cochrane database of systematic reviews, JBI evidence synthesis, Epistemonikos, and PROSPERO, searching for systematic reviews published from 1990 to current and was limited to the language source of English and Chinese. Outcomes of interest were health behaviors and modifiable CHD risk factors, psychosocial outcomes, and other secondary outcomes. Study quality was appraised using the JBI checklist for systematic reviews. A narrative analysis was conducted, and meta-analysis results were synthesized. SUMMARY From 1301 identified reviews, 13 systematic reviews (10 meta-analyses) comprised 132 primary studies conducted in 28 countries. All the included reviews have high quality, with scores ranging 73-100%. Findings to the health outcomes remained inconclusive, except solid evidence was found in the significant improvement in physical activity (PA) levels and behaviors from telehealth interventions, exercise capacity from mobile health (m-health) only and web-based only interventions, and medication adherence from m-health interventions. Telehealth CR programs, work adjunct or in addition to traditional CR and standard care, are effective in improving health behaviors and modifiable CHD risk factors, particularly in PA. In addition, it does not increase the incidence in terms of mortality, adverse events, hospital readmission, and revascularization.
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Affiliation(s)
- Wendan Shi
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, New South Wales, Australia (Ms Shi, Dr Green, Mr Sikhosana, and Dr Fernandez); Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia (Ms Shi); Faculty of Medicine and Health, University of Newcastle, Callaghan, New South Wales, Australia (Mr Sikhosana and Dr Fernandez); and School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, and Centre for Evidence based Initiatives in Health Care: A JBI Centre for Excellence, Wollongong, New South Wales, Australia (Dr Green)
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Poot CC, Meijer E, Fokkema M, Chavannes NH, Osborne RH, Kayser L. Translation, cultural adaptation and validity assessment of the Dutch version of the eHealth Literacy Questionnaire: a mixed-method approach. BMC Public Health 2023; 23:1006. [PMID: 37254148 DOI: 10.1186/s12889-023-15869-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The digitalization of healthcare requires users to have sufficient competence in using digital health technologies. In the Netherlands, as well as in other countries, there is a need for a comprehensive, person-centered assessment of eHealth literacy to understand and address eHealth literacy related needs, to improve equitable uptake and use of digital health technologies. OBJECTIVE We aimed to translate and culturally adapt the original eHealth Literacy Questionnaire (eHLQ) to Dutch and to collect initial validity evidence. METHODS The eHLQ was translated using a systematic approach with forward translation, an item intent matrix, back translation, and consensus meetings with the developer. A validity-driven and multi-study approach was used to collect validity evidence on 1) test content, 2) response processes and 3) internal structure. Cognitive interviews (n = 14) were held to assess test content and response processes (Study 1). A pre-final eHLQ version was completed by 1650 people participating in an eHealth study (Study 2). A seven-factor Confirmatory Factor Analysis (CFA) model was fitted to the data to assess the internal structure of the eHLQ. Invariance testing was performed across gender, age, education and current diagnosis. RESULTS Cognitive interviews showed some problems in wording, phrasing and resonance with individual's world views. CFA demonstrated an equivalent internal structure to the hypothesized (original) eHLQ with acceptable fit indices. All items loaded substantially on their corresponding latent factors (range 0.51-0.81). The model was partially metric invariant across all subgroups. Comparison of scores between groups showed that people who were younger, higher educated and who had a current diagnosis generally scored higher across domains, however effect sizes were small. Data from both studies were triangulated, resulting in minor refinements to eight items and recommendations on use, score interpretation and reporting. CONCLUSION The Dutch version of the eHLQ showed strong properties for assessing eHealth literacy in the Dutch context. While ongoing collection of validity evidence is recommended, the evidence presented indicate that the eHLQ can be used by researchers, eHealth developers and policy makers to identify eHealth literacy needs and inform the development of eHealth interventions to ensure that people with limited digital access and skills are not left behind.
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Affiliation(s)
- Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
- National eHealth Living Lab (NeLL), Leiden University Medical Centre, The Netherlands, Leiden, The Netherlands.
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- National eHealth Living Lab (NeLL), Leiden University Medical Centre, The Netherlands, Leiden, The Netherlands
| | - Marjolein Fokkema
- Methodology and Statistics Research Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- National eHealth Living Lab (NeLL), Leiden University Medical Centre, The Netherlands, Leiden, The Netherlands
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Batalik L, Filakova K, Sladeckova M, Dosbaba F, Su J, Pepera G. The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: a systematic review. Eur J Phys Rehabil Med 2023; 59:248-258. [PMID: 36692413 PMCID: PMC10167703 DOI: 10.23736/s1973-9087.23.07773-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/28/2023] [Accepted: 01/09/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Alternatives such as remotely delivered therapy in the home environment or telehealth represent an opportunity to increase overall cardiac rehabilitation (CR) utilization. Implementing alternatives into regular practice is the next step in development; however, the cost aspect is essential for policymakers. Limited economic budgets lead to cost-effectiveness analyses before implementation. They are appropriate in cases where there is evidence that the compared intervention provides a similar health benefit to usual care. This systematic review aimed to compare the cost-effectiveness of exercise-based telehealth CR interventions compared to standard exercise-based CR. EVIDENCE ACQUISITION PubMed and Web of Science databases were systematically searched up to August 2022 to identify randomized controlled trials assessing patients undergoing telehealth CR. The intervention was compared to standard CR protocols. The primary intent was to identify the cost-effectiveness. Interventions that met the criteria were home-based telehealth CR interventions delivered by information and communications technology (telephone, computer, internet, or videoconferencing) and included the results of an economic evaluation, comparing interventions in terms of cost-effectiveness, utility, costs and benefits, or cost-minimization analysis. The systematic review protocol was registered in the PROSPERO Registry (CRD42022322531). EVIDENCE SYNTHESIS Out of 1525 identified studies, 67 articles were assessed for eligibility, and, at the end of the screening process, 12 studies were included in the present systematic review. Most studies (92%) included in this systematic review found strong evidence that exercise-based telehealth CR is cost-effective. Compared to CBCR, there were no major differences, except for three studies evaluating a significant difference in average cost per patient and intervention costs in favor of telehealth CR. CONCLUSIONS Telehealth CR based on exercise is as cost-effective as CBCR interventions. Funding telehealth CR by third-party payers may promote patient participation to increase overall CR utilization. High-quality research is needed to identify the most cost-effective design.
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Affiliation(s)
- Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic -
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic -
| | - Katerina Filakova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Michaela Sladeckova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurology, University Hospital of Brno, Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Jingjing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Garyfallia Pepera
- School of Health Sciences, Department of Physiotherapy, Clinical Exercise Physiology and Rehabilitation Laboratory, University of Thessaly, Lamia, Greece
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Wang X, Xu L, Lee G, Song A, Shao J, Chen D, Zhang H, Chen H. Development of an integrated cardiac rehabilitation program to improve the adaptation level of patients after acute myocardial infarction. Front Public Health 2023; 11:1121563. [PMID: 37139361 PMCID: PMC10150700 DOI: 10.3389/fpubh.2023.1121563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Background Individual's adaptation following acute myocardial infarction (AMI) and low attendance of whole-course cardiac rehabilitation (CR) are significant issues. For optimal health post AMI, an integrated CR program aiming at individual's adaptive behaviors is imperative for improving the CR efficiency and patients' outcomes. This study aims to develop theory-guided interventions to increase CR attendance and adaptation level of patients post-AMI. Methods This study was conducted in a tertiary hospital from July 2021 to September 2022 in Shanghai China. Guided by the theory of adaptation to chronic illness (ACI theory), the study followed the Intervention mapping (IM) framework to develop the interventions for CR program. Four phases included: (1) needs assessment of patients and facilitators using a cross-sectional study and semi-structured, in-depth interviews, (2) identification of implementation outcomes and performance objectives, (3) selection of theoretical methods to explain the mechanism of patients' adaptive behaviors and to use for behavior change, and (4) development of implementation protocol from the results of the previous phases. Results A total of 226 AMI patient-caregivers paired samples were eligible for the data analysis, 30 AMI patients participated in the qualitative inquiry, 16 experts in the CR field evaluated the implementation protocol, and 8 AMI patients commented on the practical interventions. Following the IM framework, an integrated cardiac rehabilitation program using mHealth strategies was developed for AMI patients to facilitate CR attendance and completion, to improve their adaptation level and health outcomes. Conclusion Using the IM framework and ACI theory, an integrated CR program was developed to help guide the behavior change and improve adaptation among AMI patients. The preliminary findings suggest that further intervention in enhancing the combination of three-stage CR is required. A feasibility study will be conducted to assess the acceptability and effectiveness of this generated CR intervention.
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Affiliation(s)
- Xiyi Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
- *Correspondence: Xiyi Wang,
| | - Li Xu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
- Department of Nursing, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Geraldine Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Antai Song
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Shao
- School of Nursing, Zhejiang University School of Medicine, Zhejiang, China
| | - Dandan Chen
- School of Nursing, Zhejiang University School of Medicine, Zhejiang, China
| | - Hui Zhang
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Hanfen Chen
- Department of Nursing, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ventura F, Sousa P, Dixe MA, Ferreira P, Martinho R, Dias SS, Morais J, Gonçalves LM. A Clinical Decision Support System for Remote Monitoring of Cardiovascular Disease Patients: A Clinical Study Protocol. Front Public Health 2022; 10:859890. [PMID: 35615041 PMCID: PMC9124932 DOI: 10.3389/fpubh.2022.859890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/29/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction Cardiovascular diseases (CVD) are the leading cause of death globally, taking an estimated 17. 9 million lives each year. Cardiac rehabilitation is shown to reduce mortality and hospital readmissions, while improving physical fitness and quality of life. Despite the recommendations and proven benefits, acceptance and adherence remain low. Mobile health (mHealth) solutions may contribute to more personalized and tailored patient recommendations according to their specific needs. This study protocol aims to assess the effectiveness of a user-friendly, comprehensive Clinical Decision Support System (CDSS) for remote patient monitoring of CVD patients, primarily on the reduction of recurrent cardiovascular events. Methods and Analysis The study will follow a multicenter randomized controlled design involving two cardiology units in the Center Region of Portugal. Prospective CVD patients will be approached by the healthcare staff at each unit and checked for eligibility according to the predefined inclusion/exclusion criteria. The CDSS will suggest a monitoring plan for the patient, will advise the mHealth tools (apps and wearables) adapted to patient needs, and will collect data. The clinical study will start in January 2023. Discussion The success of the mHeart.4U intervention will be a step toward the use of technological interfaces as an integrating part of CR programs. Ethics and Dissemination The study will undergo ethical revision by the Ethics Board of the two hospital units where the study will unfold. The study was registered in ClinicalTrials.gov on 18th January 2022 with the number NCT05196802. The study findings will be published in international peer-reviewed scientific journals and encounters and in a user-friendly manner to the society.
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Affiliation(s)
- Filipa Ventura
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Pedro Sousa
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Center for Innovative Care and Health Technology (ciTechcare), School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
| | - Maria Anjos Dixe
- Center for Innovative Care and Health Technology (ciTechcare), School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
| | - Paulo Ferreira
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Ricardo Martinho
- School of Technology and Management, Polytechnic of Leiria, Leiria, Portugal
- CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Sara Simões Dias
- Center for Innovative Care and Health Technology (ciTechcare), School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
| | - João Morais
- Center for Innovative Care and Health Technology (ciTechcare), School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
- Cardiology Division, Leiria Hospital Center, Leiria, Portugal
| | - Lino M. Gonçalves
- Cardiology Department, Coimbra University Hospital Centre, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Affiliation(s)
- Amitabh C Pandey
- Scripps Research Translational Institute, Scripps Research La Jolla, CA 92037, USA; Division of Cardiology, Scripps Clinic, La Jolla, CA
| | - Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Eric J Topol
- Scripps Research Translational Institute, Scripps Research La Jolla, CA 92037, USA; Division of Cardiology, Scripps Clinic, La Jolla, CA.
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Taralunga DD, Florea BC. A Blockchain-Enabled Framework for mHealth Systems. SENSORS (BASEL, SWITZERLAND) 2021; 21:2828. [PMID: 33923842 PMCID: PMC8073055 DOI: 10.3390/s21082828] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/29/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022]
Abstract
Presently modern technology makes a significant contribution to the transition from traditional healthcare to smart healthcare systems. Mobile health (mHealth) uses advances in wearable sensors, telecommunications and the Internet of Things (IoT) to propose a new healthcare concept centered on the patient. Patients' real-time remote continuous health monitoring, remote diagnosis, treatment, and therapy is possible in an mHealth system. However, major limitations include the transparency, security, and privacy of health data. One possible solution to this is the use of blockchain technologies, which have found numerous applications in the healthcare domain mainly due to theirs features such as decentralization (no central authority is needed), immutability, traceability, and transparency. We propose an mHealth system that uses a private blockchain based on the Ethereum platform, where wearable sensors can communicate with a smart device (a smartphone or smart tablet) that uses a peer-to-peer hypermedia protocol, the InterPlanetary File System (IPFS), for the distributed storage of health-related data. Smart contracts are used to create data queries, to access patient data by healthcare providers, to record diagnostic, treatment, and therapy, and to send alerts to patients and medical professionals.
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Affiliation(s)
- Dragos Daniel Taralunga
- Faculty of Electronics, Telecommunications and Information Technology, Politehnica University of Bucharest, 060042 Bucharest, Romania;
- Faculty of Medical Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania
| | - Bogdan Cristian Florea
- Faculty of Electronics, Telecommunications and Information Technology, Politehnica University of Bucharest, 060042 Bucharest, Romania;
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Liu JY, Xu KK, Zhu GL, Zhang QQ, Li XM. Effects of smartphone-based interventions and monitoring on bipolar disorder: A systematic review and meta-analysis. World J Psychiatry 2020; 10:272-285. [PMID: 33269223 PMCID: PMC7672788 DOI: 10.5498/wjp.v10.i11.272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently, there has been a range of studies about smartphone-based interventions and monitoring for reducing symptoms of bipolar disorder (BD). However, their efficacy for BD remains unclear.
AIM To compare the effect of smartphone-based interventions and monitoring with control methods in treating patients with BD.
METHODS A systematic literature search was performed on PubMed, Embase, Clinical trials, psycINFO, Web of Science, and Cochrane Library. Randomized clinical trials (RCTs) or single-group trials in which smartphone-based interventions and monitoring were compared with control methods or baseline in patients with symptoms of BD were included. Data were synthesized using a random-effects or a fixed-effects model to analyze the effects of psychological interventions and monitoring delivered via smartphone on psychiatric symptoms in patients with BD. The primary outcome measures were set for mania and depression symptoms. Subgroups were created to explore which aspects of smartphone interventions are relevant to the greater or lesser efficacy of treating symptoms.
RESULTS We identified ten articles, including seven RCTs (985 participants) and three single-group trials (169 participants). Analysis of the between-group study showed that smartphone-based interventions were effective in reducing manic [g = -0.19, 95% confidence interval (CI): -0.33 to -0.04, P = 0.01] and depressive (g = -0.28, 95%CI: -0.55 to -0.01, P < 0.05) symptoms. In within-group analysis, smartphone-based interventions significantly reduced manic (g = 0.17, 95%CI: 0.04 to 0.30, P < 0.01) and depressive (g = 0.48, 95%CI: 0.18 to 0.78) symptoms compared to the baseline. Nevertheless, smartphone-based monitoring systems significantly reduced manic (g = 0.27, 95%CI: 0.02 to 0.51, P < 0.05) but not depressive symptoms. Subgroup analysis indicated that the interventions with psychoeducation had positive effects on depressive (g = -0.62, 95%CI: -0.81 to -0.43, P < 0.01) and manic (g = -0.24, 95%CI: -0.43 to -0.06, P = 0.01) symptoms compared to the controlled conditions, while the interventions without psychoeducation did not (P > 0.05). The contacts between therapists and patients that contributed to the implementation of psychological therapy reduced depression symptoms (g = -0.47, 95%CI: -0.75 to -0.18, P = 0.01).
CONCLUSION Smartphone-based interventions and monitoring have a significant positive impact on depressive and manic symptoms of BD patients in between-group and within-group analysis.
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Affiliation(s)
- Jia-Yuan Liu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
- Department of Anesthesia, First Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Kang-Kang Xu
- Department of Clinical Medicine, Second Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Guang-Lin Zhu
- Department of Clinical Medicine, Second Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Qi-Qi Zhang
- Department of Clinical Medicine, First Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Xiao-Ming Li
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
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Gao L, Maddison R, Rawstorn J, Ball K, Oldenburg B, Chow C, McNaughton S, Lamb K, Amerena J, Nadurata V, Neil C, Cameron S, Moodie M. Economic evaluation protocol for a multicentre randomised controlled trial to compare Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) versus usual care cardiac rehabilitation among people with coronary heart disease. BMJ Open 2020; 10:e038178. [PMID: 32847918 PMCID: PMC7451486 DOI: 10.1136/bmjopen-2020-038178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION It is important to ascertain the cost-effectiveness of alternative services to traditional cardiac rehabilitation while the economic credentials of the Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) programme among people with coronary heart disease (CHD) are unknown. This economic protocol outlines the methods for undertaking a trial-based economic evaluation of SCRAM in the real-world setting in Australia. METHODS AND ANALYSIS The within-trial economic evaluation will be undertaken alongside a randomised controlled trial (RCT) designed to determine the effectiveness of SCRAM in comparison with the usual care cardiac rehabilitation (UC) alone in people with CHD. Pathway analysis will be performed to identify all the costs related to the delivery of SCRAM and UC. Both a healthcare system and a limited societal perspective will be adopted to gauge all costs associated with health resource utilisation and productivity loss. Healthcare resource use over the 6-month participation period will be extracted from administrative databases (ie, Pharmaceutical Benefits Scheme and Medical Benefits Schedule). Productivity loss will be measured by absenteeism from work (valued by human capital approach). The primary outcomes for the economic evaluation are maximal oxygen uptake (VO2max, mL/kg/min, primary RCT outcome) and quality-adjusted life years estimated from health-related quality of life as assessed by the Assessment of Quality of Life-8D instrument. The incremental cost-effectiveness ratio will be calculated using the differences in costs and benefits (ie, primary and secondary outcomes) between the two randomised groups from both perspectives with no discounting. All costs will be valued in Australian dollars for year 2020. ETHICS AND DISSEMINATION The study protocol has been approved under Australia's National Mutual Acceptance agreement by the Melbourne Health Human Research Ethics Committee (HREC/18/MH/119). It is anticipated that SCRAM is a cost-effective cardiac telerehabilitation programme for people with CHD from both a healthcare and a limited societal perspective in Australia. The evaluation will provide evidence to underpin national scale-up of the programme to a wider population. The results of the economic analysis will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12618001458224).
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Affiliation(s)
- Lan Gao
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Jonathan Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Brian Oldenburg
- Nossal Institute for Global Health, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Clara Chow
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah McNaughton
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Karen Lamb
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Amerena
- Cardiac Services, Barwon Health, Geelong, Victoria, Australia
- Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Voltaire Nadurata
- Department of Cardiology, Bendigo Health, Bendigo, Victoria, Australia
| | - Christopher Neil
- Western Clinical School, The University of Melbourne, Saint Albans, Victoria, Australia
| | - Stuart Cameron
- Applied Artificial Intelligence Institute, Deakin University, Burwood, Victoria, Australia
| | - Marj Moodie
- School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
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Huang H, Wang Y, Wang X, Lei Y. Association of CYP4F2 and CTRP9 polymorphisms and serum selenium levels with coronary artery disease. Medicine (Baltimore) 2020; 99:e20494. [PMID: 32481463 DOI: 10.1097/md.0000000000020494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aims to explore the interaction between serum selenium level and CYP4F2 and CTRP9 gene polymorphisms in the development of coronary artery disease (CAD).A total of 200 cases of CAD were selected from the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Hubei, China, and 200 healthy subjects cases were served as controls. The polymorphism of CYP4F2 and CTRP9 gene was detected by Sanger sequencing, and the serum selenium level was measured by hydride generation atomic fluorescence spectrometry.The serum selenium level in the CAD group was significantly lower than that in the control group. The risk of CAD was decreased in the patients carrying the AA genotype in CYP4F2 rs3093135, while the frequency of the CC genotype of CTRP9 rs9553238 in CAD patients was higher than that in control subjects. Low serum selenium level and CTRP9 rs9553238 CC genotype play a positive role in the occurrence of CAD.The serum selenium level is negatively correlated with CAD. The polymorphism of the CYP4F2 rs3093135 and CTRP9 rs9553238 was significantly related to the susceptibility of CAD, and there is a synergistic effect between the serum selenium level and the CTRP9 rs9553238 CC genotype, which significantly increases the risk of CAD.
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Affiliation(s)
- Hao Huang
- Cardiovascular Disease Center, Central Hospital of Enshi Autonomous Prefecture, Enshi, China
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Saadi A, Kanmanthareddy A, Anantha-Narayanan M, Hardy K, Williams M, Alla VM. Access to smart devices and utilization of online health resources among older cardiac rehabilitation participants. World J Cardiol 2020; 12:203-209. [PMID: 32547714 PMCID: PMC7283998 DOI: 10.4330/wjc.v12.i5.203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/29/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Newer models of cardiac rehabilitation (CR) delivery are promising but depend upon patient participation and ability to use technological media including Internet and smart devices.
AIM To explore the availability of smart devices, current utilization and proficiency of use among older CR program attendees.
METHODS Study participants were enrolled from four CR programs in Omaha, Nebraska United States and completed a questionnaire of 28 items.
RESULTS Of 376 participants approached, 169 responded (45%). Mean age was 71.1 (SD ± 10) years. Demographics were 73.5% males, 89.7% Caucasians, 52% with college degree and 56.9%, with income of 40K$ or more. Smart device ownership was 84.5%; desktop computer was the most preferred device. Average Internet use was 1.9 h/d (SD ± 1.7); 54.3% of participants indicating for general usage but only 18.4% pursued health-related purposes. Utilization of other health information modalities was low, 29.8% used mobile health applications and 12.5% used wearable devices. Of all participants, 72% reported no barriers to using Internet. Education and income were associated positively with measures of utilization and with less perceived barriers.
CONCLUSION Among an older group of subjects attending CR, most have access to smart devices and do not perceive significant barriers to Internet use. Nonetheless, there was low utilization of health-related resources suggesting a need for targeted education in this patient population.
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Affiliation(s)
- Abdulghani Saadi
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE 68124, United States
- CHI, Creighton University Medical Center, Omaha, NE 68124, United States
| | - Arun Kanmanthareddy
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE 68124, United States
- CHI, Creighton University Medical Center, Omaha, NE 68124, United States
| | | | - Karen Hardy
- CHI, Creighton University Medical Center, Omaha, NE 68124, United States
| | - Mark Williams
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE 68124, United States
| | - Venkata M Alla
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE 68124, United States
- CHI, Creighton University Medical Center, Omaha, NE 68124, United States
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