Influence of stress induced by the first announced state of emergency due to coronavirus disease 2019 on outpatient blood pressure management in Japan

To prevent further spread of coronavirus disease 2019 (COVID-19), the Japanese government announced a state of emergency, resulting in major stress for the population. The aim of this study was to investigate a possible association between changes in daily stress and blood pressure (BP) in Japanese patients. We retrospectively investigated 748 patients with chronic disease who were treated by the Sagamihara Physicians Association to determine changes in stress during the COVID-19 state of emergency from 7 April to 31 May 2020. During the state of emergency, office BP significantly increased from 136.5 ± 17.5/78.2 ± 12.0 to 138.6 ± 18.6/79.0 ± 12.2 (p < 0.001 and p = 0.03, respectively). In contrast, home BP significantly decreased from 128.2 ± 10.3/75.8 ± 8.8 to 126.9 ± 10.2/75.2 ± 9.0 (p < 0.001 and p = 0.01, respectively), and the ratio of white coat hypertension was significantly increased (p < 0.001). Fifty-eight percent of patients worried about adverse effects of hypertension as a condition contributing to the severity and poor prognosis of COVID-19; decreased amounts of exercise and worsened diet compositions were observed in 39% and 17% of patients, respectively. In conclusion, a significant increase in office BP with the white coat phenomenon was observed during the state of emergency, as well as an increase in related stress. To prevent cardiovascular events, general practitioners should pay more attention to BP management during stressful global events, including the COVID-19 pandemic.

Prevalence and risk factors of white-coat hypertension and masked hypertension in Shunde District,Southern China:Observational Study (Preprint)

BACKGROUND White-coat hypertension (WCH) and masked hypertension (MH) can increase the risk of target organ damage. Home blood pressure monitoring is an important method for detecting WCH and MH. However, the prevalence and risk factors of WCH and MH in China has been rarely reported. OBJECTIVE To explore the prevalence and risk factors associated with white coat hypertension (WCH) and masked hypertension (MH) in Shunde District, Southern China. METHODS This study recruited subjects from the Physical Examination Center in Shunde Hospital, Southern Medical University. Office blood pressure and home blood pressure values were collected. The prevalence of WCH and MH was calculated by combining the office blood pressure and home blood pressure values. Multivariate logistic regression was used to explore the related risk factors for WCH and MH. RESULTS Four-hundred and sixty-one participants (61% male), with an average age of 49 years, were included. The incidence of WCH and MH was 5.1% and 15.2%, respectively. Multivariate logistic regression analysis showed that smoking (OR=4.71, 95%CI=1.05-21.15) and family history of coronary heart disease (OR=4.51, 95%CI=1.08-18.93) were associated with higher odds of WCH. The associated factors for higher odds of MH were smoking (OR=2.83, 95%CI=1.11-7.23), family history of hypertension (OR=2.17, 95%CI=1.11-4.26) and family history of coronary heart disease (OR=2.82, 95%CI=1.07-7.45). CONCLUSIONS WCH and MH are highly prevalent in the health check-up population in Southern China. Out-of-office blood pressure monitoring, especially home blood pressure monitoring with a telemedicine device should be recommended to identity abnormal BP phenotype. CLINICALTRIAL It has been registered in the Chinese Clinical Trial Registry(ChiCTR1800018515)

White-Coat Hypertension: Pathophysiological and Clinical Aspects: Excellence Award for Hypertension Research 2020

Few issues of modern cardiovascular medicine have been as controversial as the relationship between white-coat hypertension (WCH), that is, a common condition in which office blood pressure is elevated while out-of-office blood pressure (ambulatory blood pressure or home blood pressure) is normal. While earlier studies showed no increased risk of cardiovascular events in WCH compared with the normotensive state, more recent studies have changed this conclusion by showing that an increased cardiovascular risk represents a trait of this hypertensive phenotype. The present article will review a number of issues related to WCH, that is, its definition, pathophysiological background, clinical alterations, and prognostic significance. This will be done by considering the available evidence published during the last decades, with special focus on the data collected in PAMELA (Pressioni Arteriose Monitorate e Loro Associazioni)—a research project performed with a cross-sectional and longitudinal design, which has provided a series of novel clinical information on WCH throughout the years. The final part of the article will discuss the therapeutic implications of the abovementioned evidence, as well as some controversial or still undefined issues related to WCH, whose investigation will be an important goal to pursue by future research.

Does the white coat influence satisfaction, trust and empathy in the doctor–patient relationship in the General and Family Medicine consultation? Interventional study

ObjectivesTo understand the influence of the white coat on patient satisfaction, opinions about medical clothing, perception about confidence, empathy and medical knowledge and the satisfaction and comfort level of physicians in consultation.SettingAn interventional study was conducted with a representative sample of the population attending primary care in central Portugal.ParticipantsThe sample was composed by 286 patients divided into two groups exposed or not to a doctor wearing a white coat. The first and last patients in consultation every day for 10 consecutive days were included.InterventionsEvery other day the volunteer physicians consulted with or without the use of a white coat. At the end of the consultation, a questionnaire was distributed to the patient with simple questions with a Likert scale response, the Portuguese version of the ‘Trust in physician’ scale and the Jefferson Scale of Patient Perceptions of Physician Empathy - Portuguese Version (JSPPPE-VP scale). A questionnaire was also distributed to the physician.OutcomesPlanned and measured primary outcomes were patient satisfaction, trust and perception about empathy and secondary outcomes were opinion about medical clothing, satisfaction and comfort level of physicians in consultation.ResultsThe sample was homogeneous in terms of sociodemographic variables. There were no statistically significant differences between the groups in terms of satisfaction, trust, empathy and knowledge perceived by the patients. There were differences in the opinion of the patients about the white coat, and when the physician was wearing the white coat this group of patients tended to think that this was the only acceptable attire for the physician (p<0.001). But when the family physician was in consultation without the white coat, this group of patients tended to agree that communication was easier (p=0.001).ConclusionsThere was no significant impact of the white coat in patient satisfaction, empathy and confidence in the family physician.Trial registration numberClinicalTrials.gov ID number: NCT03965416.

Dress to Impress: Public Perception of Plastic Surgeon Attire

Background Physician attire has been shown to impact patients’ perceptions of their provider with regards to professionalism, competency, and trustworthiness in various surgical subspecialties, except in plastic and reconstructive surgery. Objectives This study aims to address this knowledge gap and obtain objective information regarding patients’ preferences. Methods A survey was distributed to adult, English-speaking participants in the U.S. using Amazon MTurk platform from February 2020 to December 2020. Participants were asked to evaluate six attires (scrubs, scrubs w/ white coat, formal attire, formal attire w/ white coat, casual, casual w/ white coat) in terms of professionalism, competency, and trustworthiness for male and female plastic surgeons during their first encounter in clinic using a 5-point Likert scale. Results A total of 316 responses were obtained, which consists of 43.4% men and 56.6% women. Mean age of participants was 53.2 years. The highest scores across all metrics of professionalism, competency, trustworthiness, willingness to share information, confidence in the provider, and confidence in surgical outcomes were given to the formal attire with white coat group with average scores of 4.85, 4.71, 4.69, 4.73, 4.79, 4.72, respectively. The lowest scores across all metrics belonged to the casual attire group with scores of 3.36, 3.29, 3.31, 3.39, 3.29, 3.20, respectively. Patients preferred formal attires for young plastic surgeons (p=0.039). Conclusions Our study suggests that physician attire impacts patients’ perception of plastic surgeons with regards to their professionalism, competency, and trustworthiness. White coats continue to remain a powerful entity in clinical settings given that attires with white coats were consistently ranked higher.

Holstein Friesian dairy cattle edited for diluted coat color as a potential adaptation to climate change

Background High-producing Holstein Friesian dairy cattle have a characteristic black and white coat, often with large proportions of black. Compared to a light coat color, black absorbs more solar radiation which is a contributing factor to heat stress in cattle. To better adapt dairy cattle to rapidly warming climates, we aimed to lighten their coat color by genome editing. Results Using gRNA/Cas9-mediated editing, we introduced a three bp deletion in the pre-melanosomal protein 17 gene (PMEL) proposed as causative variant for the semi-dominant color dilution phenotype observed in Galloway and Highland cattle. Calves generated from cells with homozygous edits revealed a strong color dilution effect. Instead of the characteristic black and white markings of control calves generated from unedited cells, the edited calves displayed a novel grey and white coat pattern. Conclusion This, for the first time, verified the causative nature of the PMEL mutation for diluting the black coat color in cattle. Although only one of the calves was healthy at birth and later succumbed to a naval infection, the study showed the feasibility of generating such edited animals with the possibility to dissect the effects of the introgressed edit and other interfering allelic variants that might exist in individual cattle and accurately determine the impact of only the three bp change.