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Background: COVID-19 survivors who were hospitalised continue to experience long-term multisystemic sequelae and symptoms, impacting their health-related quality of life (HRQoL). The complexity of post-COVID-19 conditions underscores the importance of adopting a multidisciplinary, patient-centric approach to ensure ongoing care. This study aims to assess HRQoL and post-COVID symptoms in a cohort of severe COVID-19 survivors depending on their participation in a multidisciplinary programme. Methods: This prospective study was conducted in a post-COVID clinic staffed by a multidisciplinary team (physical rehabilitator, nutritionist, psychologist, including experts in pulmonary rehabilitation, nutrition, psychology and others). Subjects over 18â years old who were hospitalised due to severe COVID-19 during the acute phase and had attended the post-COVID clinic within the first 3â months following discharge were included. Subjects who were unable or unwilling to provide informed consent to participate in the protocol were excluded. Linear mixed-effect models were employed to examine changes in 12-Item Short-Form Health Survey (SF-12) component scores. The resolution of post-COVID symptom clusters was compared using the Cox model. Results: A total of 730 patients were included, with a mean±sd age of 55.78±15.43â years; 60.55% were male and 90.62% required mechanical ventilation during hospitalisation. Programme attendants demonstrated improved SF-12 physical and mental component scores at 3 and 12â months. A reduction in the prevalence of post-COVID symptoms was observed in both groups, with greater reductions in those attending the programme. Conclusion: Our study showed that patients enrolled on the multidisciplinary programme experienced improvements in fatigue, musculoskeletal, gastrointestinal, neuropsychiatric and respiratory symptoms, along with enhanced SF-12 mental and physical component scores.
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Most COVID-19 survivors report experiencing at least one persistent symptom after recovery, including sympathovagal imbalance. Relaxation techniques based on slow-paced breathing have proven to be beneficial for cardiovascular and respiratory dynamics in healthy subjects and patients with various diseases. Therefore, the present study aimed to explore the cardiorespiratory dynamics by linear and nonlinear analysis of photoplethysmographic and respiratory time series on COVID-19 survivors under a psychophysiological assessment that includes slow-paced breathing. We analyzed photoplethysmographic and respiratory signals of 49 COVID-19 survivors to assess breathing rate variability (BRV), pulse rate variability (PRV), and pulse-respiration quotient (PRQ) during a psychophysiological assessment. Additionally, a comorbidity-based analysis was conducted to evaluate group changes. Our results indicate that all BRV indices significantly differed when performing slow-paced breathing. Nonlinear parameters of PRV were more appropriate for identifying changes in breathing patterns than linear indices. Furthermore, the mean and standard deviation of PRQ exhibited a significant increase while sample and fuzzy entropies decreased during diaphragmatic breathing. Thus, our findings suggest that slow-paced breathing may improve the cardiorespiratory dynamics of COVID-19 survivors in the short term by enhancing cardiorespiratory coupling via increased vagal activity.
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Resumen La falta de adherencia al tratamiento (ADT) en personas con enfermedades crónicas puede fluctuar entre 40 y 75%. Dos tercios de los pacientes con obesidad bajo tratamiento recuperan el peso perdido tras un año, y casi todos a los cinco años, lo que se asocia con la falta de ADT. Esta refiere a un fenómeno multidimensional que supone la acción recíproca de diversos factores, y entre ellos los relativos al paciente. Supuesto que dio paso al surgimiento de los modelos socio-cognitivos de la ADT. El objetivo del presente trabajo fue identificar qué factores de tres diferentes modelos (Teoría de la conducta planeada [TCP], Creencias en salud y el de Wallston) pueden predecir la ADT de pacientes con sobrepeso u obesidad. Participaron 118 adultos, con edad promedio de 52.0 años (DE = 19.0), quienes estaban bajo tratamiento farmacológico y completaron tres cuestionarios, cada uno relativo a los modelos evaluados, y otro más referente a ADT. De los 13 factores, solo uno (Actitudes, del modelo de TCP) mostró capacidad para predecir la ADT (t = 2.75, ß = .26, p < .01). Por tanto, en el caso del sobrepeso u obesidad resulta necesario proponer modelos que reflejen mejor los aspectos que subyacen a la ADT.
Abstract The lack of adherence to treatment (ADT) in people with chronic diseases range from 40 to 75%. Two thirds of the patients with obesity under treatment recover the weight lost after one year, and almost all of them after five years, which is associated with the lack of ADT. Adherence refers to a multidimensional phenomenon that involves the reciprocal action of several factors, including those related to the patient. Assumption that triggered the first socio-cognitive models of ADT. The aim of the present work was to identify which factors of three different models (Theory of the planned behavior [TPB], Beliefs in health, and the one of Wallston) can predict the ADT of patients with overweight or obesity. A total of 118 adults participated, with an average age of 52.0 years (SD = 19.0), who were under pharmacological treatment and completed three questionnaires, each one related to the models evaluated, and another one related to ADT. Of the 13 factors, only one (attitudes, from the TPB model) showed ability to predict ADT (t = 2.75, ß = .26, p < .01). Therefore, for overweight and obesity it is necessary to propose models that can reflect better the differences that underlie the ADT.
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BACKGROUND & AIMS: The deterioration of pulmonary function has been associated with increased levels of systemic inflammation that can be stimulated by consumption of saturated fatty acids and trans fats. We hypothesized that fatty acids intake impact on pulmonary function. However, evidence about the impact of different types of fatty acids on pulmonary function in patients with chronic obstructive pulmonary disease (COPD) is limited and heterogeneous. The aim of this study was to evaluate the association between intake of fatty acids and pulmonary function in patients with COPD. METHODS: Cross sectional study of patients diagnosed with COPD. The relationship between consumption of fatty acids and the FEV1/FVC ratio obtained by spirometry was assessed. Patients with exacerbations during the prior 2 months, diagnosis of asthma or administration of a dietary supplement were excluded. RESULTS: A simple linear regression showed that for each gram of carbohydrates and total l fatty acids intake, the FEV1/FVC ratio decreased -0.03 ml (ß: -0.03, 95% CI -0.06 to -0.01, p = 0.008) and -0.009 ml (ß: -0.00, 95% CI -0.02 to 0.00, p = 0.031) respectively. Pentadecanoic acid (C15:0) was associated with an increase of 0.47 ml in the FEV1/FVC ratio for each milligram intake (ß: 0.47, 95% CI 0.04 to 0.91, p = 0.031). Subsequently, when adjusted for calories intake, an increase of 0.53 ml was observed in the FEV1/FVC for each milligram of C15:0 fatty acid intake (ß:0.53, 95% CI 0.09 to 0.97, p = 0.018). CONCLUSION: A positive association was observed between pentadecanoic acid and the FEV1/FVC ratio with a beneficial effect on patients with COPD.
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Grasas de la Dieta , Ácidos Grasos/metabolismo , Volumen Espiratorio Forzado/fisiología , Pulmón/metabolismo , Enfermedad Pulmonar Obstructiva Crónica/metabolismo , Capacidad Vital/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Asma , Estudios Transversales , Carbohidratos de la Dieta , Suplementos Dietéticos , Ácidos Grasos/clasificación , Ácidos Grasos/uso terapéutico , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/dietoterapia , EspirometríaRESUMEN
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory condition characterized by complex lesions of the lungs and other organs as well as a progressive obstruction of the airway. In COPD patients, heart failure (HF) is associated with worse conditions such as inflammation, arterial stiffness, and increased risk mortality. However, the association of HF, COPD, and stroke are unclear; the examination of the role of HF, especially right HF, about increased risk of stroke in COPD patients has not been studied. We aimed to determine if right HF is a risk factor for stroke in patients with COPD. MATERIALS AND METHODS: A case-control study of patients with COPD was carried out. The cases were defined as COPD patients with ischemic stroke and control COPD patients without stroke. RESULTS: A total of 162 patients with COPD were analyzed: COPD with stroke (n = 35) and COPD alone (n = 127). COPD patients with right HF were at a greater risk of stroke compared with patients without right HF (odds ratio 3.03, 95% confidence interval 1.13-10.12, p = .044) adjusted for confounding factors. CONCLUSIONS: Right HF is an independent risk factor for stroke, probably because of cerebrovascular stasis secondary to congestion of the superior vena cava.
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Insuficiencia Cardíaca/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Accidente Cerebrovascular/epidemiología , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Bases de Datos Factuales , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Modelos Logísticos , Pulmón/fisiopatología , Masculino , México/epidemiología , Análisis Multivariante , Oportunidad Relativa , Prevalencia , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Volumen Sistólico , Función Ventricular DerechaRESUMEN
Objetivo. Examinar la asociación entre autoeficacia y sobrecarga percibida del cuidador de pacientes con insuficiencia cardíaca. Diseño. Estudio exploratorio y correlacional de corte transversal. Emplazamiento. Ámbito comunitario. Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas'. Participantes. 109 cuidadores de pacientes con insuficiencia cardíaca. Mediciones Principales. Se realizó una evaluación psicológica, en la que se aplicaron los siguientes instrumentos: Escala de Carga Zarit y la Escala de Autoeficacia Percibida en Cuidadores Primarios Informales de Enfermos Crónicos. Resultados. El 49,5% (95%IC: 82,12-89,16) de la muestra reportó un nivel de autoeficacia bajo. El 27,5% (95%IC: 20,04-22,75) presentó sobrecarga leve y el 25,7% (95%IC: 37,71-47,78) sobrecarga intensa. Los resultados del análisis revelan una relación inversamente proporcional entre las variables del estudio (rs=-0,592, p<0,05), Eliminar lo siguiente: esto quiere decir que a mayor sobrecarga menor autoeficacia percibida y viceversa. Conclusiones. La sobrecarga es una de las consecuencias negativas más reportadas. Al estar relacionada con la autoeficacia percibida, este hallazgo podría ser considerado en el diseño de programas de intervención para reducir la carga del cuidador (AU)
Objective. To examine the association between perceived self-efficacy and burden in caregivers of patients with heart failure. Design. Cross-sectional exploratoy and correlational study. Location. Community level. Instituto Nacional de Enfermedades Respiratorias (National Institute of Respiratory Diseases) 'Ismael Cosío Villegas'. Participants. 109 caregivers of patients with heart failure. Main measures. A psychological evaluation was performed in which the following instruments were applied: the Zarit Burden Scale and Scale of Perceived Self-Efficacy in Informal Primary Caregivers of the Chronically Sick. Results. 49.5% (95% CI: 82.12-89.16) of the sample reported a low level of self-efficacy. 27.5% (95% CI: 20.04-22.75) had low burden and 25.7% (95% CI: 37.71-47.78) intense burden. The results of the analysis revealed an inverse relationship between the study variables (r = -0.592), so that the higher the perceived self-efficacy the lower the burden, and viceversa. Conclusions. The burden is one of the most commonly reported negative consequences. Since it is related to the perceived self-efficacy, this finding could be taken into account when designing intervention programs that reduce caregiver burden (AU)
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Cuidadores/psicología , Cuidadores/estadística & datos numéricos , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/enfermería , Insuficiencia Cardíaca/prevención & control , Autoeficacia , Estudios Transversales/métodos , Estudios Transversales , Salud Mental/normas , Salud Mental/tendenciasRESUMEN
BACKGROUND: Cachexia is a common complication in patients with advanced heart failure (HF) associated with inflammatory response activation. Atrial fibrillation (AF) is the most frequent arrhythmia (26%), probably both exacerbate the cardiac cachexia (CC). OBJECTIVES: Evaluate the association of cardiac cachexia and atrial fibrillation in heart failure patients. MATERIAL AND METHODS: In a case control study, CC was diagnosed by electrical bioimpedance with vectorial analysis (BIVA). Subjects with congenital heart disease, cancer, HIV, drug use and other causes than HF were excluded. RESULTS: Of the 359 subjects analyzed (men: 52.9%) median age 65years (55-74). Those with CC were older [72 (61-67)] vs. without [62 (52-70) years old, p<0.01]. During follow-up 47.8% of subjects developed CC and 17.27% AF, this was significantly more frequent in cachectic patients CC (23% vs 12.11%, OR: 2.17, 95% CI: 1.19-4.01, p=0.006). Subjects, with AF had lower left ventricular ejection fraction (25.49±12.96 vs. 32.01±15.02, p=0.08), lower posterior wall thickness (10.03±2.12 vs. 11.00±2.47, p=0.007), larger diameter of the left atrium (49.87±9.84 vs. 42.66±7.56, p<0.001), and a higher prevalence of CC (85.42% vs. 69.77%, p=0.028). The 50.58% of was in NYHA class I. In NYHA III, 22.95% were in AF vs. 12.10% with not AF (p=0.027). CONCLUSION: The frequent coexistence of CC and AF as HF complications indicate greater severity of HF, regardless of its type of HF.