2 results
Identifying elements for a comprehensive paediatric cardiac rehabilitation programme
- Tracy Curran, Naomi Gauthier, Susan M. Duty, Rachele Pojednic
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- Journal:
- Cardiology in the Young / Volume 30 / Issue 10 / October 2020
- Published online by Cambridge University Press:
- 11 August 2020, pp. 1473-1481
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Introduction:
The aim of this study was to identify relevant content among four important domains for the development and structure of a paediatric cardiac rehabilitation curriculum for young patients with congenital heart disease using a consensus approach.
Methods:A three-round e-Delphi study among congenital heart disease and paediatric exercise physiology experts was conducted. Round 1, experts provided opinions in a closed- and open-ended electronic questionnaire to identify specific elements necessary for inclusion in a paediatric cardiac rehabilitation programme. Round 2, experts were asked to re-rate the same items after feedback and summary data were provided from round 1. Round 3, the same experts were asked to re-rate items that did not reach consensus from round 2.
Results:Forty-seven experts were contacted via e-mail to participate on the Delphi panel, 37 consented, 35 completed round 1, 29 completed round 2, and 28 completed the final round. After round 2, consensus was reached in 55 of 60 (92%) questionnaire items across four domains: exercise training, education, outcome metrics, and self-confidence.
Conclusion:This study established consensus towards programme structure, exercise training principles, educational content, patient outcome measures, and self-confidence promotion. By identifying the key components within each domain, there is potential to benchmark recommended standards and practice guidelines for the development of a paediatric cardiac rehabilitation curriculum to be used and tested by exercise physiologists, paediatric and adult congenital cardiologists, and other healthcare team members for optimising the health and wellness of paediatric patients with congenital heart disease.
The association between Vitamin D deficiency and risk of pre-diabetes among older adults
- Emily Trussler, Julia Navon, Rachele Pojednic, Elizabeth Metallinos-Katsaras
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E348
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Introduction
Type 2 Diabetes Mellitus is one of the most common conditions affecting older adults, and is one of few diseases with a distinct liminal stage: prediabetes. Dietitians and healthcare practitioners currently recognize prediabetes as a lifestyle disease,and “reversing” it relies largely on dietary modifications and increased exercise.Some research suggests that vitamin D may also be a target since its deficiency has been tentatively linked to many chronic conditions,5 and a high prevalence has been observed among subjects with prediabetes and type 2 diabetes.6, 7 The purpose of this study was to examine the association between vitamin D deficiency and risk of pre-diabetes in people 50 + years of age living in the United States.
Materials and MethodsThis was a cross-sectional analysis of the US National Health and Nutrition Examination Survey (2007–2012) subjects, ages 50 + years, free of kidney/liver diseases and diabetes. Outcome: Prediabetes, was defined as: HbA1c level 5.7–6.5%, or fasting plasma glucose level 100–125 mg/dL, or Oral Glucose Tolerance Test result 140–199 mg/dL, with no laboratory value in the diabetic range. Those with normal glucose tolerance (NGT) with no marker in the prediabetes/diabetes range were the comparison group. Exposure: subjects' vitamin D status was classified based on total serum 25(OH)D levels as follows: deficient = < 50 nmol/L, insufficient = 50–75 nmol/L, and sufficient = > 75 nmol/L. The final sample (n = 2,286) was sufficient to detect a 7% difference in odds of prediabetes (the average difference observed in the literature) with 80% power and 95% confidence. Multivariate logistic regression analysis included strata, cluster and weight variables. Models were adjusted for BMI, ethnicity, age and gender.
ResultsThe final sample was 2,286 subjects, predominantly white (80.4%) and female (56.6%), with a mean age of 62.3 years; 1,387 had prediabetes (59.1%) and 899 were NGT (40.9%). Vitamin D status was associated with pre-diabetes (p = 0.03). Those with vitamin D deficiency were more likely to have prediabetes compared to vitamin D sufficient individuals (crude OR = 1.48 95%CI 1.15–1.91), which remained significant after adjustment for ethnicity, BMI, age and gender (aOR = 1.39 95%CI 1.02–1.89). There was no effect modification by BMI, gender or ethnicity.
DiscussionOur results contributed to this existing literature by demonstrating that vitamin D status is associated with pre-diabetes in a nationally representative sample of older US adults.Vitamin D status was significantly associated with risk of prediabetes in Americans 50 + years of age. Prevention efforts should incorporate awareness of vitamin D.