Lown Institute

Restriction measures during the COVID-19 pandemic may have reduced opportunities to engage in physical activity. This study explored the changes in self-reported physical activity level (PAL), risk factors, and estimated cardiorespiratory fitness (eCRF) among south American adults by comparing data reflecting the pre-pandemic period to data collected during the survey. We conducted a cross-sectional online survey between July 2021 through March 2022 using validated questionnaires (e.g., GPAQ and WHO-STEPS) on a convenience sample of 1,934 adults (68.7% women) from Argentina (n = 484), Brazil (n = 405), Chile (n = 279), Colombia (n = 343) and Uruguay (n = 423). We compared self-reported PAL, risk factors, and eCRF before the pandemic period and at the time of the survey (mean 842days from the first reported case in each country). Data were presented as medians (interquartile range [IQR]) or means (95% confidence interval [CI]) for continuous variables and percentages for categorical ones. Paired data analyses were conducted using paired t-tests, Wilcoxon Signed Rank test, and McNamar's tests, as applicable. We observed a decrease in PAL at work (median, 0 METs/min/week and interquartile range, [0-240] vs. 0 METs/min/week [0-30]; p = 0.032) and active transportation domains (0 METs/min/week [0-693] vs. 0 METs/min/week [0-594]; p = 0.008). In addition, the median sedentary time on weekdays increased by 60min/day (360 [240-540] vs 420 [240-600]; p < 0.001). We also observed an increase in the proportion of participants with hypertension (12.9 vs. 16.5%), diabetes (6.8 vs. 9.8%), dyslipidemia (18.9 to 24%), depression symptoms (14.4 to 15.4%) and obesity (15.4 to 18.2%) compared with pre-pandemic levels (all p-values < 0.05). The eCRF was significantly lower at the survey time compared with pre-pandemic levels (mean difference, -1.17mL/min/kg (or 3.34%): 95% CI, -1.03 to -1.30) even after adjusting for age (-0.50mL/min/kg (or 1.45%): 95% CI -0.37 to -0.64). Across five countries in South America, social restriction policies to control the COVID-19 pandemic may have reduced physical activity and estimated cardiorespiratory fitness with no recovery until the survey time.

Abstract We examined the construction of media reporting on the Meiwes “cannibal” case where two consensual adults gratified fantasies resulting in the death, dismemberment and partial consumption of one. We found the media imposed a traditional but ill‐fitting predator–prey frame, contributing to omissions relating to sexuality and death, the utilization of cultural “Othering” and the presence of the defenses of intellectualization and humor; thus distracting us against anxiety from our own mortality. This study suggests the relationship between the British media and public in crime reporting is not passive but reciprocal: the media creates but also responds to public fantasies/desires.

Patient decision aids enable patients to be better informed about the potential benefits and harms of their healthcare options. Certification of patient decision aids at the national level in the United States is a critical step towards responsible governance-primarily as a quality measure that increases patients' safety, as mandated in the U.S. Patient Protection and Affordable Care Act (PPACA). Certification would provide a verification process to identify conflicts of interest that may otherwise bias the scientific evidence presented in decision aids. Certification also benefits clinicians who may otherwise face malpractice claims based on harm to patients caused by possible reliance on patient decision aids that are inaccurate, incomplete, or presented in a manner that biases the patient's decision. Existing work by the International Patient Decision Aid Standards Collaboration could guide the establishment of a certification process within the U.S. This article argues for national certification of patient decision aids and discusses how that may be achieved.

Global Heart is the official and primary publication of the World Heart Federation, offering a platform for the dissemination of knowledge on research, developments, trends, solutions and public health programmes in the area of cardiovascular disease. Global Heart welcomes research results, points of view and educational material on the prevention, treatment and control of cardiovascular disease with a special focus on low and middle-income countries which are facing the brunt of epidemiological transition.Global Heart strongly encourages authors to adhere to CONSORT, STROBE, STARD, and PRISMA guidelines for reporting of clinical trials, observational studies, diagnostic test accuracy papers, and systematic reviews or meta-analyses. Authors are required for submission to download and complete the appropriate Equator Network checklist: http://www.equator-network.org/.

Coronary heart disease is the leading cause of death in Americans. Despite increased interest in end-of-life care, data regarding the use of do-not-resuscitate (DNR) orders in acutely ill cardiac patients remain extremely limited. The objectives of this study were to describe use of DNR orders, treatment approaches, and hospital outcomes in patients with acute myocardial infarction. The study sample consisted of 4621 residents hospitalized with acute myocardial infarction at all metropolitan Worcester, Mass, area hospitals in five 1-year periods from 1991 to 1999. Significant increases in the use of DNR orders were observed during the study decade (from 16% in 1991 to 25% in 1999). The elderly, women, and patients with previous diabetes mellitus or stroke were more likely to have DNR orders. Patients with DNR orders were significantly less likely to be treated with effective cardiac medications, even if the DNR order occurred late in the hospital stay. Less than 1% of patients were noted to have DNR orders before hospital admission. Patients with DNR orders were significantly more likely to die during hospitalization than patients without DNR orders (44% vs 5%). The results of this community-wide study suggest increased use of DNR orders in patients hospitalized with acute myocardial infarction during the past decade. Use of certain cardiac therapies and hospital outcomes are different between patients with and without DNR orders. Further efforts are needed to characterize the use of DNR orders in patients with acute coronary disease.

Going back to the ‘archaic past and to obsolete ancestors’ [1] provides insight not only where we came from but where we might be heading. Indeed history matters in medicine as it does in everyday life. It is now 40 years since the introduction of DC defibrillation and cardioversion [2,3]. Like the proverbial pebble cast in the water, the ripple effects of these technologies extend beyond the horizon of early prediction. Among the more important consequences were: stimulating the development of coronary care units, facilitating the emergence of coronary bypass and other heart operations, focusing attention on the still formidable out-of-hospital problem of sudden cardiac death, advancing the field of clinical electrophysiology and contributing to implantable devices to protect against death from malignant arrhythmias. Most important are the countless lives saved with this straightforward medical advance. From time immemorial, drugs, potions and herbs were the mainstay in treating arrhythmias of the heart. This therapeutic approach presented formidable limitations. In the individual patient the effective dose of the drug was unknown. A tedious biological titration was required to avoid serious or even life threatening toxic reactions. When the arrhythmia was ventricular tachycardia, the route for administering drugs was necessarily intravenous, thereby maximizing the likelihood of adverse reactions. When drugs were given orally, the required incremental dosing consumed hours and at times days. Even with the most scrupulous monitoring, toxic reactions were nearly unavoidable. Looking back it is remarkable how the clinical topography has changed since the introduction of DC defibrillation and cardioversion. One example may be illustrative. Levine, during 33 years of clinical practice, observed only 137 episodes in 107 cases of paroxysmal ventricular tachycardia [4]. This represents approximately three patients annually; it may be far less, since all wide complex tachycardias were designated as ventricular. In contrast during …

Misuse of medications is a major cause of morbidity and mortality. Few studies have examined the frequency of, and factors associated with, discrepancies between what doctors prescribe and what patients take in actual practice. Patients' medication bottles and their reported use of medications were compared with physicians' records of outpatients seen between November 1997 and February 1998 in a private practice affiliated with an academic medical center in Boston, Mass. Three hundred twelve patients from the practices of 5 cardiologists and 2 internists who were returning for their routine follow-up visits were included. The presence of discrepancies based on comparing medication bottles with medical records. Discrepancies were present in 239 patients (76%). The 545 discrepancies in these patients were the result of patients taking medications that were not recorded (n = 278 [51%]); patients not taking a recorded medication (n = 158 [29%]); and differences in dosage (n = 109 [20%]). Overall, discrepancies were randomly distributed among different drugs and discrepancy types with no discernible pattern. On multivariate analysis, patient age and number of recorded medications were the 2 most significant predictors of medication discrepancy. Discrepancies among recorded and reported medications were common and involved all classes of medications, including cardiac and prescription drugs. Older age and polypharmacy were the most significant correlates of discrepancy. The pervasiveness of discrepancies can have significant health care implications, and action is urgently needed to address their causes. Such action would likely have a positive impact on patient care.

Components of heart rate variability have attracted considerable attention in psychology and medicine and have become important dependent measures in psychophysiology and behavioral medicine. Quantification and interpretation of heart rate variability, however, remain complex issues and are fraught with pitfalls. The present report (a) examines the physiological origins and mechanisms of heart rate variability, (b) considers quantitative approaches to measurement, and (c) highlights important caveats in the interpretation of heart rate variability. Summary guidelines for research in this area are outlined, and suggestions and prospects for future developments are considered.