Improve Health Status Research Articles

Quality of life gains in frail and intermediate-fit patients with multiple Myeloma: Findings from the prospective HOVON123 clinical trial

BackgroundFrailty in newly-diagnosed multiple myeloma (NDMM) patients is associated with treatment-related toxicity, which negatively affects health-related quality of life (HRQoL). Currently, data on changes in HRQoL of frail and intermediate-fit MM patients during active treatment and post-treatment follow-up are absent. MethodsThe HOVON123 study (NTR4244) was a phase II trial in which NDMM patients ≥ 75 years were treated with nine dose-adjusted cycles of Melphalan-Prednisone-Bortezomib (MPV). Two HRQoL instruments (EORTC QLQ-C30 and -MY20) were obtained before start of treatment, after 3 and 9 months of treatment and 6 and 12 months after treatment for patients who did not yet start second-line treatment. HRQoL changes and/or differences in frail and intermediate-fit patients (IMWG frailty score) were reported only when both statistically significant (p < 0.005) and clinically relevant (>MID). Results137 frail and 71 intermediate-fit patients were included in the analysis. Compliance was high and comparable in both groups. At baseline, frail patients reported lower global health status, lower physical functioning scores and more fatigue and pain compared to intermediate-fit patients. Both groups improved in global health status and future perspective; polyneuropathy complaints worsened over time. Frail patients improved over time in physical functioning, fatigue and pain. Improvement in global health status occurred earlier than in intermediate-fit patients. ConclusionHRQoL improved during anti-myeloma treatment in both intermediate-fit and frail MM patients. In frail patients, improvement occurred faster and, in more domains, which was retained during follow-up. This implies that physicians should not withhold safe and effective therapies from frail patients in fear of HRQoL deterioration.

Increasing exercise capacity and physical activity in the COPD patient.

Higher levels of exercise capacity and physical activity are desired outcomes in the comprehensive management of the COPD patient. In addition, improvements in exercise capacity and physical activity are instrumental to optimising other important therapeutic goals, such as improved health status, reduced healthcare utilisation and increased survival. Four general approaches towards increasing exercise capacity and physical activity in individuals with COPD will be discussed in this review: 1) pharmacological intervention, especially the administration of long-acting bronchodilators; 2) pulmonary rehabilitation, including exercise training and collaborative self-management; 3) behavioural interventions; and 4) web-based interventions. These are by no means the only approaches, nor are they mutually exclusive: indeed, combining them, as necessary, to meet the needs of the individual respiratory patient may promote optimal outcomes, although further research is necessary in this area.

Curcumin add-on improves quality of life in patients with locally or advanced head and neck cancer receiving nutritional intervention.

e24051 Background: The CurChexia study, NCT04208334, is a phase IIa randomized control trial. The study demonstrates the benefits of adding 4,000 mg of curcumin to the standard nutritional intervention. This addition helps to increase muscle mass and delay the decrease in other body composition parameters. However, clinicians require treatment that maintains or improves the quality of life (QoL) of head and neck cancer patients. In this report, we present the QoL data. Methods: Patients participating in the study were required to complete the EORTC QLQ-C30 version 3.0 questionnaire in the Thai edition. The questionnaire was given at the beginning of the study, at the end of week 4, at the end of the study, or in week 8. The results were scored following the EORTC scoring guidelines and compared between the group that received the curcumin add-on and the standard nutritional intervention (control). The patients needed to complete all sections of the EORTC QLQ-C30, and no data was missing. Results: Ten of the 20 patients were given curcumin, while the others were in the control group. Based on the EORTC QLQ-C30, there was an improvement in the median global health status, but it was not significant between the curcumin and control groups. However, the curcumin group improved all functional status parameters, particularly physical functioning ( p= 0.001) and emotional functioning ( p= 0.023). Regarding symptom scales, curcumin significantly reduced pain symptoms ( p= 0.033) and increased appetite ( p= 0.001) compared to the control group. The other parameters that could have affected QoL did not show significant differences between the two groups. Conclusions: The CurChexia study indicates that curcumin has shown promising results in improving muscle mass, enhancing quality of life, and increasing appetite, thereby establishing its position as a noteworthy phytonutrient. However, it is important to note that further research is necessary to understand the extent of its benefits fully. Clinical trial information: NCT04208334 .

Unravelling the complex interplay of factors behind exercise limitations and physical inactivity in COPD.

Exercise limitation and physical inactivity are known treatable traits for people with COPD. Maximising exercise capacity and keeping people physically active improves health status and survival rates among people with COPD. However, managing these two treatable traits can be extremely challenging for clinicians due to the complex intersectionality of factors influencing an individual's capacity, opportunity and motivation to engage in physical activity. This review presents the complex factors influencing exercise capacity ("can do"), levels of physical activity ("do do") and sedentary behaviours amongst people with COPD and provides practical recommendations on how clinicians can address some of these factors in practice. Most importantly, it highlights the importance of referring to pulmonary rehabilitation as a way to improve exercise capacity among people with COPD.

IMPROVEMENT IN QUALITY OF LIFE FOLLOWING PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE FOR MALIGNANT OBSTRUCTIVE JAUNDICE: AN INSTITUTION-BASED OBSERVATIONAL STUDY

Purpose: Long-term prognosis of patients with obstructive jaundice due to malignant biliary disease is very dismal. These patients are treated mainly for palliation of symptomatic jaundice and related complications. To alleviate symptomatic jaundice, three modalities of treatment are generally employed – bilio-enteric bypass, Percutaneous Transhepatic Biliary Drainage (PTBD) and Endoscopic Retrograde Cholangiopancreatography guided stenting. However, minimal data is available comparing the pre-procedure and post-procedure Quality of Life (QOL) of these patients. Aims of the Study: To study the pre-procedure &amp; post-procedure QOL of patients undergoing PTBD. Methodology: We studied patients who underwent PTBD in between January 2017 and June 2021, attending our tertiary-care hospital with malignant obstructive jaundice, with high-up biliary obstruction. An observational study was conducted to compare the QOL before and after procedure using the EORTC-QLQ-30 Symptom Scale Score. Results:The majority (80%) had the diagnosis of carcinoma gallbladder. Maximum number of patients (75%) presented with a pre-procedure bilirubin value of more than 15 mg/dl. These patients showed significant bilirubin decrement by day 7. Follow-up at 1 month and 3 months following PTBD demonstrated significant improvement in global health status, physical status, emotional, cognitive and social QOL score. Some deterioration in the QOL score was noted at 6 months follow-up, which might be related to recurrence or stent blockade. Conclusion: Overall improvement in post-procedure QOL was observed during follow-up analysis of the subjects. The increase in financial burden could be attributed to the maintenance of drainage catheter (wound management bags, treatment of infections) and cost of frequent hospital visits after the procedure.

A single-blinded, randomized, parallel intervention to evaluate genetics and omics-based personalized nutrition in general population via an e-commerce tool: The PREVENTOMICS e-commerce study

BackgroundPersonalized nutrition (PN) has been proposed as a strategy to increase the effectiveness of dietary recommendations and ultimately improve health status. ObjectivesWe aimed to assess whether including omics-based PN in an e-commerce tool improves dietary behavior and metabolic profile in general population. MethodsA 21-wk parallel, single-blinded, randomized intervention involved 193 adults assigned to a control group following Mediterranean diet recommendations (n = 57, completers = 36), PN (n = 70, completers = 45), or personalized plan (PP, n = 68, completers = 53) integrating a behavioral change program with PN recommendations. The intervention used metabolomics, proteomics, and genetic data to assist participants in creating personalized shopping lists in a simulated e-commerce retailer portal. The primary outcome was the Mediterranean diet adherence screener (MEDAS) score; secondary outcomes included biometric and metabolic markers and dietary habits. ResultsVolunteers were categorized with a scoring system based on biomarkers of lipid, carbohydrate metabolism, inflammation, oxidative stress, and microbiota, and dietary recommendations delivered accordingly in the PN and PP groups. The intervention significantly increased MEDAS scores in all volunteers (control—3 points; 95% confidence interval [CI]: 2.2, 3.8; PN—2.7 points; 95% CI: 2.0, 3.3; and PP—2.8 points; 95% CI: 2.1, 3.4; q < 0.001). No significant differences were observed in dietary habits or health parameters between PN and control groups after adjustment for multiple comparisons. Nevertheless, personalized recommendations significantly (false discovery rate < 0.05) and selectively enhanced the scores calculated with biomarkers of carbohydrate metabolism (β: −0.37; 95% CI: −0.56, −0.18), oxidative stress (β: −0.37; 95% CI: −0.60, −0.15), microbiota (β: −0.38; 95% CI: −0.63, −0.15), and inflammation (β: −0.78; 95% CI: −1.24, −0.31) compared with control diet. ConclusionsIntegration of personalized strategies within an e-commerce–like tool did not enhance adherence to Mediterranean diet or improved health markers compared with general recommendations. The metabotyping approach showed promising results and more research is guaranteed to further promote its application in PN.This trial was registered at clinicaltrials.gov as NCT04641559 (https://clinicaltrials.gov/study/NCT04641559?cond=NCT04641559&rank=1).

The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019

BackgroundThe European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010.MethodsWe used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE).ResultsIn 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for “HIV/AIDS and sexually transmitted diseases” and “transport injuries” (each -19%). “Diabetes and kidney diseases” showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, “mental disorders” showed an increasing age-standardised YLL rate (14.5%).ConclusionsThere was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.

Does photobiomodulation alter mitochondrial dynamics?

Mitochondrial dysfunction is one of the leading causes of disease development. Dysfunctional mitochondria limit energy production, increase reactive oxygen species generation, and trigger apoptotic signals. Photobiomodulation is a noninvasive, nonthermal technique involving the application of monochromatic light with low energy density, inducing non-thermal photochemical effects at the cellular level, and it has been used due to its therapeutic potential. This review focuses on the mitochondrial dynamic's role in various diseases, evaluating the possible therapeutic role of low-power lasers (LPL) and light-emitting diodes (LED). Studies increasingly support that mitochondrial dysfunction is correlated with severe neurodegenerative diseases such as Parkinson's, Huntington's, Alzheimer's, and Charcot-Marie-Tooth diseases. Furthermore, a disturbance in mitofusin activity is also associated with metabolic disorders, including obesity and type 2 diabetes. The effects of PBM on mitochondrial dynamics have been observed in cells using a human fibroblast cell line and invivo models of brain injury, diabetes, spinal cord injury, Alzheimer's disease, and skin injury. Thus, new therapies aiming to improve mitochondrial dynamics are clinically relevant. Several studies have demonstrated that LPL and LED can be important therapies to improve health conditions when there is dysfunction in mitochondrial dynamics.

Factors of Incomplete Inpatient Medical Records Filling at Dr. H. Slamet Martodirdjo Regional General Hospital Pamekasan

Hospitals have an important role in improving health status by providing quality services, including complete medical record data and information. Complete and accurate medical records can be used for health care and patient treatment, evidence in law enforcement, medical discipline and medical ethics, educational and research purposes, basis of payment for health care costs, and health statistical data. This study aimed to identify the factors causing the incomplete filling of inpatient medical records at Dr. H. Slamet Martodirdjo Regional General Hospital Pamekasan. This research applied the descriptive observational method, with data collected through secondary data analysis using document studies and problem exploration using focus group discussions (FGD). The document study was conducted on 80 samples of inpatient medical records, while the FGD was conducted by inviting the head of the planning department, medical records officer, and 8 heads of inpatient wards to find out the causes and solutions for incomplete medical record files. The study results found that the number of incomplete medical records was 76.25%, with the highest percentage of incompleteness due to doctors, pharmacists, and nurses. The main problem causing the incompleteness of medical records was professional caregivers (PPA) who lacked discipline. The solutions obtained were management meetings and evaluations to professional caregivers, constructing policies that regulate reward and punishment systems, monitoring the checklists of medical record completeness, and routine evaluation of medical record files.

Feasibility and acceptability of a home-based virtual group exercise program in global Asian adult population: Baseline characteristics of a cohort study.

To determine the potential influence of a home-based virtual group exercise on people's long-term overall health consequences in global Asian population. We recruited 1021 participants from more than 7 regions across the globe including Taiwan, Malaysia, Singapore, Hong Kong, United States, Canada, Europe, and other regions. All the participants attended the virtual group Qigong exercise 60-minute bi-weekly with instructors for 6 months from June 2022 to December 2022. The physical, mental, and social well-being and other variables were measured via online questionnaires. The majority were 51 to 65 (50.6%) years old, female (90.2%), married (68.5%), and came from Taiwan (48.9%). Older adults had higher scores on measures of overall health and exercise adherence, and lower scores on measures of sleep quality and depressive symptoms compared with younger counterparts (P < .05). Most of them (95.3%) acknowledged that the improvement of health status was their motivating factor for exercise. Eighty nine percent of the participants believed that social media played an important role in this exercise program. This study will suggest such approach has great potential to reduce health disparities and can be implemented to underserved population who has limited recourses to join in-person exercise program.

Semaglutide and NT-proBNP in Obesity-Related HFpEF: Insights From the STEP-HFpEF Program

BackgroundThe glucagon-like peptide-1 receptor agonist, semaglutide, improved health status and reduced body weight in patients with obesity-related heart failure (HF) with preserved ejection fraction (HFpEF) in the STEP-HFpEF (Semaglutide Treatment Effect in People with Obesity and HFpEF) program. Whether benefits were due to mechanical unloading or effects on HF pathobiology is uncertain. ObjectivesThis study sought to determine if semaglutide 2.4 mg reduced N-terminal pro–B-type natriuretic peptide (NT-proBNP) in patients with obesity-related HFpEF and compare treatment responses by baseline NT-proBNP. MethodsThis was a prespecified secondary analysis of pooled data from 2 double-blind, placebo-controlled, randomized trials (STEP-HFpEF [Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity] and STEP-HFpEF DM [Research Study to Look at How Well Semaglutide Works in People Living With Heart Failure, Obesity and Type 2 Diabetes]) testing effects of semaglutide in patients with obesity-related HFpEF. The main outcomes were change in NT-proBNP at 52 weeks and change in the dual primary endpoints of Kansas City Cardiomyopathy Questionnaire Clinical Summary Score and body weight by baseline NT-proBNP. ResultsIn total, 1,145 patients were randomized. Semaglutide compared with placebo reduced NT-proBNP at 52 weeks (estimated treatment ratio: 0.82; 95% CI: 0.74-0.91; P = 0.0002). Improvements in health status were more pronounced in those with higher vs lower baseline NT-proBNP (estimated difference: tertile 1: 4.5 points, 95% CI: 0.8–8.2; tertile 2: 6.2 points, 95% CI: 2.4-10.0; tertile 3: 11.9 points, 95% CI: 8.1-15.7; P interaction = 0.02; baseline NT-proBNP as a continuous variable: P interaction = 0.004). Reductions in body weight were consistent across baseline NT-proBNP levels (P interaction = 0.21). ConclusionsIn patients with obesity-related HFpEF, semaglutide reduced NT-proBNP. Participants with higher baseline NT-proBNP had a similar degree of weight loss but experienced larger reductions in HF-related symptoms and physical limitations with semaglutide than those with lower NT-proBNP.

Sirtfood intake in relation to the 10-year risk of major adverse cardiovascular events: a population-based cohort study

BackgroundSirtuins have an important role in the regulation of metabolic and biological processess. Thus, we hypothesized that foods that could activate sirtuins, known as “sirtfood”, may improve health status. So, this study was aimed at investigating the association between the amount of sirtfood intake and the risk of major adverse cardiovascular events (MACE).MethodsIn this cohort study, 2918 adults who had no history of MACE at the start of the study (2006–2008) participated and were followed up on until 2018. The amount of sirtfoods intake (servings per week) was computed using a validated food frequency questionnaire. Each patient’s medical records were evaluated to detect MACE. The Cox proportional hazards model was applied to assess the association between the amount of sirtfood intake and the risk of MACE.ResultsThe median duration of the study was 10.6 years. The hazard ratio (HR) for the risk of MACE was 0.70 for the second (95% CI: 0.50, 0.98) and 0.60 (95% CI: 0.42, 0.86) for the third tertile of sirtfoods intake compared with the first tertile. This association was nonlinear, and sirtfoods consumption of more than five servings per week did not result in a lower risk of MACE. In addition, there was a significant interaction between age (P-interaction < 0.001) and sirtfoods intake in relation to MACE occurrence. When assessing sirtfood components, compared with the lowest intake, the highest amount of soy (HR: 0.74, 95% CI: 0.56, 0.99) and parsley (HR: 0.62, 95% CI: 0.47, 0.83) intake was related to a lower risk of MACE.ConclusionOur results indicated an inverse association between a higher amount of sirtfood intake and a lower risk of MACE incidents. This association was nonlinear, and having more than five servings of sirtfood per week did not reduce the risk of MACE any further.

The effectiveness of a self-reported questionnaire on masticatory function in health examinations.

Periodontal diseases have been reported to be lifestyle-related and associated with metabolic syndrome (MetS). The introduction of dental checkups in a health checkup program may create a synergistic effect and aid the prevention of MetS. In Japan, a chewing function questionnaire has now been introduced into the national health checkup program. The purpose of this study was to investigate whether the questionnaire reflects dental and oral conditions and whether it helps improve general and oral health. A total of 6599 subjects who underwent health checkups or guidance specified by the National Health Insurance of Japan for two consecutive years were included. A single comprehensive question to evaluate masticatory function was asked. Medical and dental examinations and insurance data were collected and used for analysis. In terms of masticatory function during chewing, 82.3% of subjects experienced no problems, 17.3% experienced some difficulty, and 0.4% experienced severe problems. There was a significant relationship between the questionnaire response and dental examinations results for several items of examination. The overall dental consultation rate after health screening was 42.3%. Improvement in periodontal disease was achieved in those who reported some problems with chewing function. Improvement in blood pressure was also observed in those who reported some problem with chewing function and subsequently had a dental consultation. The results of this study indicate that questionnaires on masticatory function reflect the status of dental and oral health. In addition, the results suggested that questionnaire results are potentially linked to improvement in dental and oral health status, and improvement in MetS.

234 Evaluation of a phytogenic blend on post-weaning growth performance, health, and sera metabolite responses during the initial 56 d feedlot receiving period in newly weaned steers

Abstract The objective of this study was to determine if a blend of capsicum oleoresin, clove essential oil, and garlic essential oil (CCG; Fytera Advance - Selko USA, Indianapolis IN) influences measures of cattle performance during the initial 56-d feedlot receiving phase. Newly weaned Charolais × Angus steers [n = 256; initial shrunk body weight (BW) = 273 ± 26 kg) were used in 56-d receiving phase experiment. Steers were transported 513 km to the Ruminant Nutrition Center in Brookings, SD on the day of weaning. Steers were individually weighed and allotted to 1 of 32 pens (n = 8 steers; 8 pens/treatment) in a randomized complete block design and randomly assigned to 1 of 4 treatments: control diet with no test product (CON); CCG at 125 mg/steer daily (CCG1); CCG at 250 mg/steer daily (CCG2); or CCG at 500 mg/steer daily (CCG3). Steers were fed twice daily, and bunks were managed using a slick bunk system from d 14 to 56; feed deliveries during the first 14 d were managed by feedlot personnel to adapt cattle to a targeted dry matter intake (DMI). The basal diet provided: 13.8% CP, 1.74 Mcal/kg NEm, and 1.07 Mcal/kg NEg. Monensin sodium was fed to all steers at a rate of 25 g/907 kg (DM basis). Steers were individually weighed on d -1, 1, 14, 35, and 56. Daily dry matter intake (DMI) was influenced by dietary treatment (quadratic effect; P = 0.01) in which steers that were fed with CON or CCG3 had greater DMI than those subjected to CCG1 and CCG2 dietary regimens. However, CCG supplementation did not result in improvements in average daily gain nor gain to feed ratio (P ≥ 0.15). A tendency for a treatment × day interaction was noted for sera non-esterified fatty acids (NEFA; P = 0.06), on d 14, steers from CCG3 had greater NEFA compared with CON and steers from CCG1 and CCG2 were intermediate (P ≤ 0.05). Dietary treatment influenced (P = 0.04) circulating concentrations of ceruloplasmin (CPL), where steers from CCG2 and CCG3 resulted in decreased circulating concentrations of CPL compared with CON and CCG1, indicating less inflammation. In conclusion, steers supplemented CCG3 had greater DMI and decreased ceruloplasmin suggesting an overall improvement in health status. Steers from CCG3 had increased NEFA on d 14, which could imply a catabolic state; However, sera NEFA decreased over time compared with the other treatments. More research is necessary to determine the consistency of the performance responses and better understand the correct dosage of CCG fed to newly weaned beef calves.

The Effectiveness of EduMind for Mental Health Promotion Among Youths.

Introduction The global surge in mental health issues, particularly among the youth, is evident. Despite the proliferation of digital mental health services, their adoption remains limited, hindered by various barriers. To address this issue, an evidence-based, validated digital mental health intervention is necessary. Although much research has explored the effectiveness of such interventions, there was limited evidence supporting those within the youth population. The objective of this research is to assess the effects of aninterventional module on depression, anxiety, and stress symptoms among youths. Methods The EduMind online mental health intervention contents were developed from a needs assessment and a scoping review of effective psychotherapies, achieving a high content validation index (CVI) of 0.96. The contents were integrated into a web application to assess its effectiveness among the target population which consisted of university students of a local institution. A quasi-experimental study compared the intervention group (n=264) to a waitlist-control group (n=200), evaluating changes in mental health status with the Depression, Anxiety and Stress Scale 21 (DASS-21) questionnaire using analysis of covariance (ANCOVA) to analyse mean differences. Results Participants in the intervention group indicated a significant decrease (p< 0.001) in depression, anxiety, and stress. The pre-test and post-test mean scores in the intervention group were 15.81 and 8.97 for depression, 11.46 and 7.02 for anxiety and 14.64 and 6.33 for stress, respectively. In the control group, there was no significant difference between the pre-test and post-test mean scores for depression. However, there was a slight significant reduction for anxiety with pre- and post-test scores of13.31 and 12.95. Stress mean scores exhibited a slight increase, rising from 13.55 to 14.24. The final phase revealed significant improvements in mental health status between groups, with significant effect sizes for stress (ƞp2= 0.57, p < 0.001), depression (ƞp2= 0.71, p < 0.001), and anxiety (ƞp2= 0.27, p < 0.001). Conclusion The findings contribute to the advancement of technology-assisted health services, facilitating greater uptake among the population.This study utilized a comprehensive module development framework and demonstrated the effectiveness of the expert-guided mental health intervention module.Furthermore, the study suggests potential integration with the National Strategic Plan for Mental Health 2020-2025 and the National Mental Health Policy, proposing the web application as a potential compulsory student screening tool administered by universities. The information gathered by this application could inform future research directions, propelling technological-assisted mental health services to new heights.

In HFpEF with obesity, semaglutide improved health status and weight loss at 52 wk, regardless of initial health status.

Kosiborod MN, Verma S, Borlaug BA, et al; STEP-HFpEF Trial Committees and Investigators. Effects of semaglutide on symptoms, function, and quality of life in patients with heart failure with preserved ejection fraction and obesity: a prespecified analysis of the STEP-HFpEF trial. Circulation. 2024;149:204-216. 37952180.

Exploring the relationship between anemia in pregnancy and infant mortality: a narrative review

Anemia is a multivariate and highly prevalent health concern among the worldwide population. However, owing to the socioeconomic conditions of Pakistan and physiological changes that take place during pregnancy, an exceptionally high percentage of pregnant Pakistani females suffer from anemia with the most common cause being iron deficiency. Unsurprisingly, many complications for both mother and child have been recorded in association with this issue, such as postpartum hemorrhage, low birthweight, stunted development, and still birth. Given the situation, it is imperative to strengthen operational measures while introducing more effective strategies to improve health status among pregnant women.

Edukasi, Pendampingan, dan Pemberdayaan Keluarga yang Menjalani Isolasi Mandiri COVID 19 dalam Upaya Peningkatan Status Kesehatan Keluarga

The beginning of 2020 was the beginning of the COVID-19 outbreak in the world; until 2021, more and more COVID-19 cases occurred in Indonesia, and more and more positive cases in the community resulted in hospitals not being able to accept patients for treatment in hospitals, so people who experienced moderate symptoms, mild and without symptoms can self-isolate in their respective homes. As of February 28, 2021, there were 2112 positive cases in Tegal City. During self-isolation, the patient needs family support; the family has a vital role in improving health status, so education, assistance, and empowerment are needed for families; education is provided through booklet media, as well as the provision of masks, hand sanitizers, hand soap, disinfectant spray and digital thermometer to families who are self-isolating. This activity aims to increase knowledge, attitudes, and behavior about COVID-19 to improve health status and prevent the spread of COVID-19 in the community, especially families.

Alzheimer's Disease in Lebanon: Exploring Genetic and Environmental Risk Factors-A Comprehensive Review.

Alzheimer's disease (AD) is a neurodegenerative condition that displays a high prevalence in Lebanon causing a local burden in healthcare and socio-economic sectors. Unfortunately, the lack of prevalence studies and clinical trials in Lebanon minimizes the improvement of AD patient health status. In this review, we include over 155 articles to cover the different aspects of AD ranging from mechanisms to possible treatment and management tools. We highlight some important modifiable and non-modifiable risk factors of the disease including genetics, age, cardiovascular diseases, smoking, etc. Finally, we propose a hypothetical genetic synergy model between APOE4 and TREM2 genes which constitutes a potential early diagnostic tool that helps in reducing the risk of AD based on preventative measures decades before cognitive decline. The studies on AD in Lebanon and the Middle East are scarce. This review points out the importance of genetic mapping in the understanding of disease pathology which is crucial for the emergence of novel diagnostic tools. Hence, we establish a rigid basis for further research to identify the most influential genetic and environmental risk factors for the purpose of using more specific diagnostic tools and possibly adopting a local management protocol.

The iATTEND Trial: A Trial Comparing Hybrid Versus Standard Cardiac Rehabilitation

The improving ATTENDance (iATTEND) to cardiac rehabilitation (CR) trial tested the hypotheses that hybrid cardiac rehabilitation (HYCR = combination of virtual and in-facility CR sessions) would result in greater attendance compared to traditional, facility-based only CR (FBCR) and yield equivalent improvements in exercise capacity and health status. Patients were randomized to HYCR (n=142) or FBCR (n=140), stratified by sex and race. Attendance was assessed as number of CR sessions completed within 6 mo (primary end-point) and % patients completing 36 CR sessions. Other end-points (tested for equivalency) included exercise capacity and self-reported health status. HYCR patients completed 1 to 12 sessions in-facility, with the balance completed virtually using synchronized, two-way audiovisual technology. Neither total number of CR sessions completed within 6 mo (29±12 vs 28±12 visits, adjusted P= 0.94) nor % of patients completing 36 sessions (59±4% vs 51±4%, adjusted P=0.32) were significantly different between HYCR and FBCR, respectively. The between group changes for exercise capacity (peak oxygen uptake, 6-minute walk distance) and health status were equivalent. Regarding safety, no sessions required physician involvement, there was 1 major adverse event after a virtual session, and no falls requiring medical attention. In conclusion, although we rejected our primary hypothesis that attendance would be greater with HYCR versus FBCR, we showed that FBCR and HYCR resulted in similar patient attendance patterns and equivalent improvements in exercise capacity and health status. HYCR that incorporates virtually supervised exercise should be considered an acceptable alternative to FBCR.NCT identifier: 03646760; The Improving ATTENDance to Cardiac Rehabilitation Trial - Full Text View - ClinicalTrials.gov; https://classic.clinicaltrials.gov/ct2/show/NCT03646760