Chronic Disease Population Research Articles

Association between lung function and sleep disorder symptoms in a community-based multi-site case-finding study.

Obstructive airway disease is associated with sleep disturbances. We aimed to assess the relationship between lung function and sleep disorder symptoms using cross-sectionally collected data between March 2017 and August 2021 from the Undiagnosed Chronic Obstructive Pulmonary Disease and Asthma Population study, a prospective community-based multi-site case-finding study. Undiagnosed Chronic Obstructive Pulmonary Disease and Asthma Population study participants with respiratory symptoms but without diagnosed lung disease who completed spirometry and the Global Sleep Assessment Questionnaire were included. We conducted multivariate linear regression models for forced expiratory volume in 1 s, forced vital capacity and forced expiratory volume in 1 s/forced vital capacity by Global Sleep Assessment Questionnaire responses adjusted for confounders. The same models were employed to examine respiratory symptoms, as reported on the St George's Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test, by Global Sleep Assessment Questionnaire responses. Logistic regression models were used to assess the association of undiagnosed obstructive airway disease with sleep symptoms. Amongst 2093 adults included in the study, 48.3% were female and the median age was 63 years (interquartile range 53-72). Two-hundred and five (9.79%) subjects met spirometry criteria for undiagnosed chronic obstructive pulmonary disease, and 191 (9.13%) for undiagnosed asthma. There were no significant associations between spirometry measures and sleep symptoms (p > 0.5), controlling for age, sex, body mass index, smoking and comorbidities. Those with undiagnosed asthma were more likely to report insomnia "at least sometimes" versus "never" (odds ratio 2.58, 95% confidence interval: 1.27-6.19, p = 0.02). Respiratory symptoms were associated with sleep symptoms, with significant (p < 0.05) increases in St George's Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test scores in those reporting most sleep symptoms. Overall, we found an association between undiagnosed asthma and insomnia, and between respiratory and sleep disorder symptoms.

Impact of post-COVID-19 changes in outpatient chronic patients’ healthcare-seeking behaviors on medical utilization and health outcomes

IntroductionThis study comprehensively investigates the changes in healthcare utilization among chronic patients with regular outpatient visits to hospitals after the occurrence of Covid-19. The research examines whether patients altered their originally regular medical attendance frequencies due to the pandemic and explores potential negative impacts on the health conditions of those irregular attendees post-pandemic.MethodsData for this study were sourced from a database at a medical center in Taiwan. The subjects were chronic patients with regular hospital outpatient visits before the Covid-19 outbreak. The study tracked medical utilization patterns from 2017 to 2022 for different patient characteristics and outpatient behaviors, employing statistical methods such as Repeated Measures ANOVA and Generalized Estimating Equation to analyze changes in healthcare utilization and health status during the post-pandemic period.ResultsThe results reveal that, compared to the regular group, chronic patients with irregular outpatient visits during the post-pandemic period exhibited a decrease of 5.85 annual outpatient visits, a reduction of NT$20,290.1 in annual medical expenses, and a significantly higher abnormality rate in average biochemical test results by 0.9%.ConclusionsThe findings contribute to understanding the impact of the Covid-19 pandemic on healthcare utilization and health conditions among outpatient chronic disease populations. In response to the new medical landscape in the post-pandemic era, proactive suggestions are made, including providing telemedicine outpatient services and referral-based medical care to meet the needs of the target population, ensuring a continuous and reassuring healthcare model for chronic patients, and mitigating the operational impacts of public health emergencies on hospitals.

The iPeer2Peer mentorship program for adolescent thoracic transplant recipients: An implementation-effectiveness evaluation

BackgroundAn increase in self-management skills for adolescent thoracic transplant recipients may improve health outcomes and facilitate a successful transition to adulthood. The iPeer2Peer© program is an online peer mentorship program that has been successfully implemented as a self-management intervention in multiple chronic disease populations. This study aimed to determine the implementation and effectiveness outcomes of the iPeer2Peer program for adolescent thoracic transplant recipients. MethodsA type III, hybrid implementation-effectiveness pilot study that comprised a quasi-experimental single-arm pre-post design was used to evaluate the iPeer2Peer program. Participant mentees, ages 12 to 17, were recruited from two large Canadian transplant centres. Peer mentors, ages 18 to 25, were thoracic transplant recipients who had successfully transitioned to adult care and self-manage their condition. A mixed methods approach for data collection was used, including interviews, focus groups, and standardized questionnaires. ResultsTwenty mentees (median 15.0 years, IQR 3.3 years; 65% female) completed the iPeer2Peer program with nine young adult mentors (median 21.0 years, IQR 3.0 years; 78% female). Implementation outcomes indicated that the iPeer2Peer intervention was perceived as feasible, adoptable, acceptable, and appropriate for adolescent thoracic transplant recipients. Significant findings were noted in mentees for increased self-management and a decrease in overall depression and anxiety symptoms. ConclusionsThe successful implementation of the pilot iPeer2Peer program offers support to evaluate the scalability, sustainability, and cost-effectiveness of the program for adolescents with chronic illness, specifically thoracic transplant recipients. Changes to the iPeer2Peer program that facilitate a flexible delivery may help implementation and acceptance.

Controlling nutritional status score in the prediction of cardiovascular disease prevalence, all-cause and cardiovascular mortality in chronic obstructive pulmonary disease population: NHANES 1999–2018

BackgroundMalnutrition is prevalent in chronic obstructive pulmonary disease (COPD) and associated with adverse outcomes, while COPD is intricately linked to cardiovascular disease (CVD), sharing common risk factors. The controlling nutritional status (CONUT) score, a promising tool for assessing malnutrition, warrants investigation into its predictive ability for cardiovascular disease prevalence and mortality in COPD patients.MethodsBased on the National Health and Nutrition Examination Survey (NHANES), this study analyzed 1501 adult COPD patients from 1999 to 2018. The endpoints were CVD prevalence, mortality related to CVD, and overall mortality. We evaluated the correlation of the CONUT score with each outcome using logistic regression and Cox regression models. The prognostic evaluation of patients was conducted using Kaplan-Meier curves in accordance with the CONUT score. We formed the receiver operating characteristic (ROC) curves for evaluating the CONUT score's discriminative capability.ResultsThe prevalence of malnutrition was 21.31% in COPD populations. Logistic analyses suggested a distinct connection between the CONUT score and CVD prevalence (OR:1.86, 95%CI:1.28-2.70) in individuals with COPD. The CONUT score demonstrated a significant correlation with a heightened risk of CVD mortality (HR: 1.86, 95%CI: 1.27-2.74) and overall mortality (HR: 1.50, 95%CI: 1.18-1.91). The prognostic outcomes might be effectively discriminated by the CONUT score, as seen by the Kaplan-Meier curves.ConclusionsIn summary, the CONUT score provides an uncomplicated and readily attainable marker for forecasting CVD prevalence, total mortality, and mortality from CVD among COPD patients.

Clinical Decision Support Systems in Adults with Chronic Respiratory Disease: A Systematic Review

Background: A sub-optimal uptake of clinical guidelines is reported across healthcare settings in many chronic respiratory disease populations. Clinical decision support systems (CDSS) are systems which analyse and present data so that users can make decisions more easily and are suggested as part of the solution to poor adoption of guidelines. Aims: The aim of this review was to describe the literature on CDSS in chronic respiratory disease management, their function and the features that may impact their effectiveness. Methods: The electronic databases PubMed, MEDLINE, EMBASE, Web of Science, the trial registries Cochrane Central Register of Controlled Trials, EU Clinical Trial Register, ClinicalTrials.gov and World Health Organisation (WHO) trial registry were searched with the aid of a medical librarian. All searches began from September 2019 to March 2021. Data from relevant studies were extracted independently by 2 review authors using Covidence software and Microsoft Excel. Study quality was assessed. CDSS description and indication, function and the theory underpinning the CDSS (e.g., guidelines, expert opinion, etc.) were themed and summarised. The presence or absence of the important CDSS features were recorded i.e., (i) computer-based decision support, (ii) automatic provision of decision support as part of clinician workflow, (iiii) provision of decision support at the time and location of decisionmaking and (iv) provision of recommendations rather than just assessments. Results: Of the 2647 articles screened, 27 papers or abstracts (n = 22 full text and n = 5 abstracts) describing 26 studies met all inclusion and exclusion criteria. The 26 studies evaluated asthma care (n = 16), COPD care (n = 9) and both asthma and COPD care (n = )]. The highest level of evidence was generated by RCTs (n = 7). The 26 studies described 24 different CDSS. Most were based solely or in part on clinical and best practice guidelines. Whilst most CDSS had multiple functions, which were wide ranging, medicines management was the most prevalent function. Most systems had 3 out of 4 of the specific system features that have been correlated with improvements in clinical practice. Generally, in both controlled studies and in other study designs, patient and process outcome measures were commonly reported with performance outcomes measures less commonly reported. Fewer positive effects were reported in the higher quality studies (i.e. controlled studies). The success rate of the CDSS was higher in those studies that had 3 out of the 4 important CDSS features. Conclusion: Many CDSS in adults with asthma and COPD improve patient, process and performance outcomes.

A calculation of capitation-based payment standardto chronic disease cases in primary care settings

BackgroundOutpatient medical care payment play a pivotal role in the reform of medical insurance payment methods. With ongoing reforms in China, a variety of payment strategies, including capitation and the ambulatory patient groups (APG) point method, are being progressively implemented. ObjectiveThis study aims to identify appropriate capitation calculation methods for chronic diseases in Beijing and to provide recommendations for implementing capitation payments reforms in the city. MethodsWe focused on four prevalent chronic diseases—hypertension, diabetes, coronary heart disease, and stroke—and analyzed basic medical data and public health funding in Beijing's districts C and H as case studies. This research was aimed at developing a capitation calculation method tailored to these locales, determining payment standards for major chronic diseases in primary care clinics, and thus supporting the advancement of capitation reform for outpatient chronic diseases. ResultsUsing medical insurance data and public health funding data from 2017 to 2019, a top-down allocation was employed to determine the capitation payment standards in district H: 4,693.11 Yuan for hypertension, 6,597.70 Yuan for diabetes, 5,644.46 Yuan for coronary heart disease, and 6,437.78 Yuan for stroke. A bottom-up costing approach was used in district C, resulting in payment standards of 4,884.18 Yuan for hypertension, 5,960.63 Yuan for diabetes, 3,733.93 Yuan for coronary heart disease, and 3,886.66 Yuan for stroke. ConclusionThe outpatient costs associated with different chronic disease populations vary considerably. In view of maintaining equity in medical insurance and the fairness of capitation fees, it is imperative to apply risk adjustments to the benchmark capitation fee. Personalized services should be tailored to the diverse types and severities of chronic diseases. It is also crucial to provide customized basic medical and public health services to various chronic disease patients as part of the capitation payment reform for outpatient services. Additionally, enhancing the capabilities of community health services in managing chronic diseases, improving contracting percentages, and establishing effective incentive and evaluation mechanisms for general practitioners are essential for equitable distribution of surplus from capitation payments.

Modeling chronic disease risk across equity factors using a population-based prediction model: the Chronic Disease Population Risk Tool (CDPoRT)

BackgroundPredicting chronic disease incidence at a population level can help inform overall future chronic disease burden and opportunities for prevention. This study aimed to estimate the future burden of chronic...

Education, employment, and income among people living with cystic fibrosis across three decades – A matched cohort study using Danish health registries

BackgroundPast and ongoing advancements in cystic fibrosis (CF) care warrant long-term analysis of the societal impact of the condition. This study aims to evaluate changes in key socioeconomic factors across three decades among people living with CF (pwCF), compared with both the general population and an early-onset chronic disease population. MethodsThis nationwide, registry-based, matched cohort study included all pwCF ≥ 18 years in Denmark in the years 1990, 2000, 2010, and 2018. Each person living with CF was matched to five individuals in the general population and five individuals living with type 1 diabetes or juvenile arthritis based on age, sex, and municipality. ResultsThe Danish adult CF population increased nearly fourfold from 88 in 1990 to 331 in 2018, and mean age increased by ten years. The educational level of pwCF was similar to the two comparator cohorts, while pwCF were less often in employment and more often permanently outside the labor force. Personal and household income levels of the CF cohort were higher than those of the comparator cohorts. ConclusionsThe disadvantage in employment for pwCF remained, but, over time, the societal profiles of the one-year CF cohorts increasingly converged with those of the comparator cohorts, indicative of improved clinical management, extended life expectancy, and the supportive role of the Danish welfare system in reducing health inequalities. Further research should be done to evaluate the effects of the newly introduced modulator therapies on employment, considering the broader societal impact and impact on quality of life.

Feasibility and performance of the chronic obstructive pulmonary disease population screener and chronic obstructive pulmonary disease screening questionnaire in a Chinese physical examination center.

Chronic obstructive pulmonary disease (COPD) affects up to 13% of the Chinese population, though it is under diagnosed throughout China. Screening among asymptomatic individual as part of routine health checks in China can facilitate early diagnosis and intervention to prevent disease progress. The COPD Population Screener (COPD-PS) or COPD Screening Questionnaire (COPD-SQ) has yet to be applied in Chinese physical examination centers (PECs) for COPD screening, and their feasibility and effectiveness should be clarified before full-scale implementation. This study is the first to apply the COPD-PS and COPD-SQ in a public hospital PEC in China to assess their feasibility and effectiveness and to identify their optimal cutoff values. People aged ≥40 years who attended the Second Affiliated Hospital of Shantou University PECs from September 2021 to December 2022 were asked to complete the COPD-PS and COPD-SQ and to undergo spirometry. The optimal cutoff values of the two questionnaires at the maximal Youden index were found, and the sensitivity and specificity were calculated. Data from 198 participants were analyzed; mean [standard deviation (SD)] age of patients was 63.52 (10.94) years. Twenty-five participants (12.63%) were diagnosed with COPD. The number of COPD patients classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1 to 4 were 8, 12, 4, and 1, respectively. The area under the curves (AUCs) of the COPD-PS and COPD-SQ were 0.730 and 0.738, respectively. The optimal COPD-PS cutoff value of 4 points corresponded to a sensitivity of 72.00% and a specificity of 60.10%. The COPD-SQ optimal cutoff value of 15 points corresponded to a sensitivity of 76.00% and a specificity of 63.60%. Applying the COPD-PS and COPD-SQ in Chinese PECs is feasible, cost-effective and effective. COPD-PS and COPD-SQ can facilitate the early diagnosis of COPD, and whether they can improve the participants' quality of life would benefit a further study. It is recommended that the COPD-PS or COPD-SQ questionnaires be added to the screening of the physical examination program in PECs as part of health checks for people over 40 years old.

The Use of Gamification in the Self-Management of Patients With Chronic Diseases: Scoping Review.

Chronic disease self-management is a public health issue of worldwide concern, and gamification is an emerging strategy to improve patients' participation in chronic disease self-management. Some studies have summarized designs for the gamification of chronic disease self-management from the perspective of eHealth technology, but they have not mentioned differences in design methods, functions, and evaluation methods of gamified designs for self-management in different chronic diseases. This scoping review aims to synthesize the characteristics of realization forms, functions, and evaluation methods in chronic disease self-management gamification to improve self-management among the chronic disease population. We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. As of January 7, 2023, we systematically searched 9 databases for relevant studies from January 2012 to December 2022. Related data were extracted based on the research questions. We calculated the frequencies, charted the quantitative data, and coded the extracted material for qualitative content analysis. We retrieved 16,221 records, of which 70 (0.43%) met the eligibility criteria. In the included research, the target populations for gamified designs for self-management of chronic diseases included patients with stroke, cancer, diabetes, chronic obstructive pulmonary disease, coronary heart disease, obesity, and hypertension. Almost all studies mentioned technical support for gamification (68/70, 97%), mainly in the form of active video games (58/70, 83%); however, less than half of the studies mentioned the theoretical basis for gamification (31/70, 44%). There were 37 concepts or theories relevant to gamification design, most of which were in the field of psychology or were cross-disciplinary (n=33, 89%). Gamification for the self-management of chronic diseases has been widely recognized, including for promoting physical exercise and rehabilitation training (48/99, 48%), increasing initiative for symptom management (18/99, 18%), providing psychological support (14/99, 14%), improving cognitive function (12/99, 12%), and improving medication adherence (7/99, 7%). A total of 39 studies mentioned the gamification effect; however, we did not find a unified evaluation standard. This scoping review focuses on gamification designs for chronic disease self-management and summarizes the realization forms and functions of gamification in self-management for different patient populations. With practice in a gamified internet-based environment, patients can not only master the knowledge and skills of self-management in fascinating scenarios but also benefit from gaming experience and make better health-related decisions in real life. It is worth noting that a comprehensive evaluation of the users as well as a personalized and targeted intervention should be developed before gamification.

Sleep disturbances and progression of mobility disability: Longitudinal findings from the Nurses’ Health Study

ObjectiveTo examine longitudinal associations between self-reported sleep disturbances and mobility disability progression among women, including subgroups with multiple sclerosis (MS), diabetes, and osteoarthritis (OA). MethodsProspective cohort study using data from Nurses’ Health Study long-form questionnaires (2008, 2012, 2014, 2016). Logistic regression was used to quantify associations between sleep-related variables at baseline and subsequent increase in mobility disability. ResultsOf 70,303 women (mean age 73), 392 had MS, 7,302 had diabetes, and 24,099 had OA. Between 2008–2016, mobility disability increased by 16.9 % overall, 27.8 % in the MS subgroup, 27.0 % in the diabetes subgroup, and 23.7 % in the OA subgroup. Known/suspected obstructive sleep apnea was significantly associated with an increase in mobility disability between 2008 and 2016, overall (OR:1.4, 95 %CI:1.2,1.5), and in the diabetes (OR:1.5, 95 %CI:1.2,1.9) and OA subgroups (OR:1.2, 95 %CI:1.0,1.4), but not in the MS subgroup (OR:2.3, 95 %CI:0.6,8.9); however, across 2012–2016, this association was significant for MS (OR:4.0, 95 %CI:1.0,16.1). Suboptimal sleep duration was significantly associated with increased odds of mobility disability progression overall, but not in disease subgroups. Perception of adequate sleep was associated with lower odds of mobility disability progression overall (OR:0.82, 95 %CI:0.78,0.87) and for the OA subgroup (OR:0.83, 95 %CI:0.76,0.91). Excessive daytime sleepiness was associated with mobility disability progression overall (OR:1.2, 95 %CI:1.1,1.4) and for the OA subgroup (OR:1.2, 95 %CI:1.0,1.4). ConclusionsPrevalent sleep disturbances could increase disability progression among women. Chronic disease populations may be uniquely vulnerable. Informed by these data, future research could offer new insight into sleep-based strategies to ameliorate mobility decline.

Effect of a Medication Adherence Mobile Phone App on Medically Underserved Patients with Chronic Illness: Preliminary Efficacy Study.

Medication adherence is vital in the treatment of patients with chronic illness who require long-term medication therapies to maintain optimal health. Medication adherence, a complex and widespread problem, has been difficult to solve. Additionally, lower-income, medically underserved communities have been found to have higher rates of inadequate adherence to oral medications. Even so, this population has been underrepresented in studies using mobile medication adherence app interventions. Federally qualified health centers provide care for medically underserved populations, defined as communities and populations where there is a demonstrable unmet need for health services. These centers have been reporting an increase in a more complex chronic disease population. Including medically underserved individuals in mobile health studies provides opportunities to support this disproportionately affected group, work toward reducing health disparities in access to health care, and understand barriers to mobile health uptake. The aim of this preliminary efficacy study was to evaluate the effects and feasibility of a commercially available medication adherence app, Medisafe, in a medically underserved adult population with various chronic illnesses seeking care in a federally qualified health center. Participants in this single-arm pre-post intervention preliminary efficacy study (N=10) completed a baseline survey, used the app for 2 weeks, and completed an end-of-study survey. The primary outcome measures were medication adherence and medication self-efficacy. Feedback on the use of the app was also gathered. A statistically significant median increase of 8 points on the self-efficacy for adherence to medications scale was observed (P=.03, Cohen d=0.69). Though not significant, the adherence to refills and medications scale demonstrated a median change of 2.5 points in the direction of increased medication adherence (P=.21, Cohen d=0.41). Feedback about the app was positive. Use of the Medisafe app is a viable option to improve medication self-efficacy and medication adherence in medically underserved patients in an outpatient setting with a variety of chronic illnesses.

Feasibility and user-experience of a virtual environment for social connection and education after stroke: A pilot study

ObjectivesTo evaluate the feasibility and usability of stroke survivor participation in an 8-week virtual environment intervention that provides opportunities for social support exchanges, social network interactions, and recovery education. Materials and methodsA single-group, pre- and post-test measure design was used. Descriptive statistics were used to examine enrollment and retention rates, proportion of questionnaires completed, and virtual environment process data (e.g., number of log-ins) and usability scores. Changes in pre- and post-intervention questionnaire (e.g., usability, social support, depression, anxiety, loneliness, and self-efficacy) scores were explored using Wilcoxon signed-rank tests and paired t-test. ResultsFifteen (65 %) of the eligible stroke survivors enrolled (60 % white, 27 % black), 12 (80 %) had an ischemic stroke, ages ranged from 33 to 74 years (mean 44 years), and mean months since stroke was 33 ± 23. Retention and questionnaire completion rates were both 93 % (n = 14). Survivors logged into the virtual environment a total of 122 times, logged an average of 49 min/log-in, and 12 (80 %) attended support groups and social activities. Median usability score indicated lower than average usability. Improvement trends in social support, loneliness, and depressive symptoms were found, but significant changes in mean questionnaire scores were not found. ConclusionsOverall, the results suggest that using a virtual environment to foster social support exchanges, social network interactions, and recovery education after stroke is feasible. Similar to other chronic disease populations, stroke survivor adoption of a virtual environment likely requires ongoing technical assistance, repetition of instructions, and opportunities for practice to reinforce engagement. Trial registrationNCT05487144.

Efficacy and safety of pharmacological intervention for smoking cessation in smokers with diseases: A systematic review and network meta-analysis.

To investigate the most effective and best-tolerated drugs for treating diseased smokers. Eight databases were searched for randomized controlled trials (RCTs) involving different pharmacological interventions for smoking cessation in disease patients (January 2023). Network meta-analysis was performed using STATA 15.1 software. The Cochrane Risk of Bias Tool assessed the risk of bias, and confidence in evidence was assessed using CINeMA. A total of 60 RCTs involving 13,009 patients of 12 disease categories were included. All trials reported 13 interventions, resulting in 78 comparisons. Network meta-analysis showed that varenicline (OR=2.30, 95% CI (1.77, 3.00)) and bupropion (OR=1.65, 95% CI (1.29, 2.11)) showed favorable abstinence effects compared to placebo in the cardiovascular disease population. Nicotine replacement therapy (NRT) had better withdrawal advantages than placebo (OR=11.18, 95% CI (2.25, 55.54)) in the chronic obstructive pulmonary disease (COPD) population. Some combination treatments showed better results than monotherapy, such as bupropion + NRT was superior to bupropion (OR=8.45, 95% CI (1.84, 38.89)) and NRT (OR=4.98, 95% CI (1.25, 19.78)) in mental illness population. The final surface under the cumulative ranking curve indicated that bupropion + NRT achieved the best smoking cessation effect. Overall confidence in the evidence was low. In a comparison of drugs, the results showed that bupropion + NRT had the best safety. Most interventions show the benefit of quitting smoking compared with placebo, including monotherapy and combination therapy. Moreover, varenicline or bupropion combined with NRT is superior to some monotherapies.

A pilot study to assess the feasibility of a remotely monitored high-intensity interval training program prior to allogeneic hematopoietic stem cell transplantation.

Although allogeneic hematopoietic stem cell transplantation (HCT) can be a curative therapy for hematologic disorders, it is associated with treatment-related complications and losses in cardiorespiratory fitness and physical function. High-intensity interval training (HIIT) may be a practical way to rapidly improve cardiorespiratory fitness and physical function in the weeks prior to HCT. The primary aim of this study was to assess the feasibility of implementing a pre-HCT home-based HIIT intervention. The secondary aim was to evaluate pre to post changes in cardiorespiratory fitness and physical function following the intervention. This was a single-arm pilot study with patients who were scheduled to undergo allogeneic HCT within six months. Patients were instructed to complete three 30-minute home-based HIIT sessions/week between the time of study enrollment and sign-off for HCT. Sessions consisted of a 5-minute warm-up, 10 high and low intervals performed for one minute each, and a 5-minute cool-down. Prescribed target heart rates (HR) for the high- and low-intensity intervals were 80-90% and 50-60% of HR reserve, respectively. Heart rates during HIIT were captured via an Apple Watch and were remotely monitored. Feasibility was assessed via retention, session adherence, and adherence to prescribed interval number and intensities. Paired t-tests were used to compare changes in fitness (VO2peak) and physical function [Short Physical Performance Battery (SPPB), 30-second sit to stand, and six-minute walk test (6MWT)] between baseline and sign-off. Pearson correlations were used to determine the relationship between intervention length and changes in cardiorespiratory fitness or functional measures. Thirteen patients (58.8±11.6 years) participated in the study, and nine (69.2%) recorded their training sessions throughout the study. Median session adherence for those nine participants was 100% (IQR: 87-107). Adherence to intervals was 92% and participants met or exceeded prescribed high-intensity HR on 68.8±34.8% of intervals. VO2peak improved from baseline to sign-off (14.6±3.1 mL/kg/min to 17.9±3.3 mL/kg/min; p<0.001). 30-second sit to stand and SPPB chair stand scores significantly improved in adherent participants. Improvements in 30-second sit to stand (13.8±1.5 to 18.3±3.3 seconds) and 6MWT (514.4±43.2 to 564.6±19.3) exceeded minimal clinically important improvements established in other chronic disease populations, representing the minimum improvement considered meaningful to patients. Findings demonstrate that implementing a pre-HCT home-based remotely monitored HIIT program is feasible and may provide benefits to cardiorespiratory fitness and physical function.

Exercise Training Recommendations for Adults With and Without Chronic Disease to Improve Endothelial Health

The endothelium is the innermost layer of the blood vessels and is responsible for the production of chemicals that are used to regulate arterial diameter in response to changes in blood flow. Dysfunction of the endothelium is a key precursor for cardiovascular disease. However, exercise training may mitigate this dysfunction and promote endothelial health. Therefore, this infographic illustrates findings from an umbrella review (review of reviews; 10.1007/s40279-023-01837-w) that investigated the impact of any exercise training intervention (intervention) on adults with or without chronic disease (population), with, or without a comparator group (comparison), on endothelial function (outcome) using evidence from 27 reviews, including 19 meta-analyses (5464 unique participants). Overall, the included reviews provided evidence that the type of training to optimally improve endothelial function may vary based on disease condition. Specifically, the evidence suggests that healthy adults benefitted most from high intensity aerobic training and/or more frequent low-moderate resistance training. In addition, adults with type 2 diabetes benefitted most from low-intensity resistance or low-moderate aerobic exercise training, whereas those with cardiovascular conditions (i.e., heart transplant patients, peripheral artery disease, heart failure, hypertension, and cerebrovascular disease) should consider engaging in higher-intensity aerobic training to improve endothelial function, although may still need to consult a healthcare provider. Exercise training also improves endothelial function in other chronic conditions including cancer and autoimmune rheumatic disease, but the evidence is insufficient to provide specific guidelines. Although insufficient data exists to determine specific intervention characteristics (i.e., frequency, intensity, type, time), this information provides a high level of evidence to support exercise training, including aerobic, resistance, and combined training as effective strategies to improve endothelial-dependent vasodilatory function in adults. These findings should help guide the design of specific exercise programs or recommendations.

Frailty phenotype in chronic obstructive pulmonary disease patients: prevalence and relation to disease severity

Frailty is considered a high risk for falls, disability, hospitalization, and mortality in geriatric and certain chronic-disease populations. So, this study was planned to determine the prevalence of frailty phenotype in Chronic obstructive pulmonary disease (COPD) patients. Methods. 70 stable COPD patients were included in this study. Age, comorbidities (The FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale, BODE index, and modified Medical Research Council dyspnea score (mMRC) were recorded. In addition, each patient performed the Six-minute walk test (6-MWT) and underwent a pulmonary function test. Results. Frailty was detected in 37.3% of studied patients. However, 43.1% were classified as pre-frail. The presence of frailty was not significantly associated with the age of studied patients (p = 0.7). Comorbidities were significantly associated with frailty (p = 0.009). Also, the BODE index was significantly higher among patients with frailty (p &lt; 0.001). Frailty was significantly associated with forced expiratory volume in 1 second, residual lung volume/Total Lung Capacity, and GOLD (Global Initiative for Chronic Obstructive Lung Disease) classification of COPD (p = 0.001; p = 0.003; p = 0.003 respectively). Frailty was significantly associated with 6-MWD and Borg scale difference (Lowest 6-MWD, highest Borg scale difference were detected in frail patients (p = 0.008; p = 0.001). Conclusion. Frailty is frequent among COPD patients. The presence of frailty is related to disease severity and functional impairment. Evaluation of frailty should be considered as a part of COPD assessment in clinical practice.

People With Cancer Experience Worse Psychosocial and Financial Consequences of COVID-19 Compared With Other Chronic Disease Populations: Findings From the International COVID-19 Awareness and Response Evaluation Survey Study

PURPOSE The COVID-19 pandemic is likely to have profound psychosocial impacts across the globe. In this analysis of the International COVID-19 Awareness and Response Evaluation (iCARE) survey study, we comparatively investigated the psychosocial effects of COVID-19 on individuals with cancer and people with other chronic illness. METHODS iCARE study respondents were divided into two groups on the basis of self-reported health status: (1) active/current cancer (with or without any other chronic condition: heart disease, lung disease, hypertension, diabetes, severe obesity, immunity disease, and depressive or anxiety disorder); and (2) other chronic condition, but not cancer. Linear regressions were conducted to evaluate the associations between health status and outcomes. RESULTS Worldwide, 18,154 iCARE study respondents (mean age, 50.8 years) from 175 countries were included in the analysis. Among them, 3.8% (n = 677) identified as having active/current cancer and 96.2% (n = 17,477) identified as having other chronic condition. Multivariate analyses showed significant associations between having cancer and declined mental (β = .364; P &lt; .0001) and physical (β = .317; P &lt; .0001) health since the start of the COVID-19 pandemic, relative to those with other chronic illness. Moreover, individuals with cancer demonstrated a higher likelihood of reporting maladaptive coping mechanisms such as increased alcohol use (β = .457; P &lt; .0001) and financial hardships such as not paying rent/mortgage (β = .476; P &lt; .0001), compared with people with other chronic illness. CONCLUSION Individuals with cancer worldwide tended to have worse psychosocial and financial challenges during the COVID-19 pandemic, compared with other chronic disease populations. Clinicians need to be aware of the importance of attending to the specific mental health needs of individuals with cancer during and after COVID-19–related restrictions.

Defining and Promoting Pediatric Pulmonary Health: Assessing Lung Function and Structure.

Lifelong respiratory health is rooted in the structural and functional development of the respiratory system in early life. Exposures and interventions antenatally through childhood can influence lung development into young adulthood, the life stage with the highest achievable lung function. Because early respiratory health sets the stage for adult lung function trajectories and risk of developing chronic obstructive pulmonary disease, understanding how to promote lung health in children will have far reaching personal and population benefits. To achieve this, it is critical to have accurate and precise measures of structural and functional lung development that track throughout life stages. From this foundation, evaluation of environmental, genetic, metabolic, and immune mechanisms involved in healthy lung development can be investigated. These goals require the involvement of general pediatricians, pediatric subspecialists, patients, and researchers to design and implement studies that are broadly generalizable and applicable to otherwise healthy and chronic disease populations. This National Institutes of Health workshop report details the key gaps and opportunities regarding lung function and structure.

Estimating the Health and Economic Impact of Improved Management in Prevalent Chronic Obstructive Pulmonary Disease Populations in England, Germany, Canada, and Japan: A Modelling Study.

COPD is a leading cause of morbidity and mortality globally. Management is complex and costly. Although international quality standards for diagnosis and management exist, opportunities remain to improve outcomes, especially in reducing avoidable hospitalisations. To estimate the potential health and economic impact of improved adherence to guideline-recommended care for prevalent, on-treatment COPD populations in four high-income settings. A disease simulation model was developed to evaluate the impact of theoretical improvements to COPD management, comparing outcomes for usual care and policy scenarios for interventions that reduce avoidable hospitalisations: 1) increased attendance (50% vs 31-38%) of early follow-up review after severe exacerbation hospitalisation; 2) increased access (30% vs 5-10%) to an integrated disease management (IDM) programme that provides guideline adherent care. For cohorts of 100,000 patients, Policy 1 yielded additional life years (England: 523; Germany: 759; Canada: 1316; Japan: 512) and lifetime cost savings (-£2.89 million; -€6.58 million; -$40.08 million; -¥735.58 million). For Policy 2, additional life years (2299; 3619; 3656) and higher lifetime total costs (£38.15 million; €35.58 million; ¥1091.53 million) were estimated in England, Germany and Japan, and additional life years (4299) and cost savings (-$20.52 million) in Canada. Scenarios found that the cost impact depended on the modelled intervention effect size. Interventions that reduce avoidable hospitalisations are estimated to improve survival and may generate cost savings. This study provides evidence on the theoretical impact of policies to improve COPD care and highlights priority areas for further research to support evidence-based policy decisions.