Occupational Physical Activity and Cardiovascular Risk Factors Profile in the Adult Population of the Southern Cone of Latin America: Results From the CESCAS I Study

OBJECTIVE: We explore the association between occupational physical activity (OPA) and cardiovascular risk factors in four cities of the Southern Cone. METHODS: Robust multivariable linear regression models were used to examine the associations. RESULTS: The working population was constituted by 1868 men and 1672 women. Men performing high levels of OPA showed higher levels of high-density lipoprotein (HDL; mean adj. diff. = 2.24 mg/dL; P = 0.004), lower levels of triglycerides (-24.59 mg/dL; P = 0.006), and total cholesterol (TC)/HDL ratio values (-0.21; P = 0.015) than reference. Women in the highest category of OPA had higher levels of HDL (2.85 mg/dL; P = 0.006), lower TC/HDL (0.27; P = 0.001), and low-density lipoprotein/HDL ratios (-0.18; P = 0.003) than sedentary activities. CONCLUSION: Individuals who performed high levels of OPA did not exhibit a worse cardiovascular risk profile and an improvement on selected biomarkers was observed when compared with those performing sedentary activities.Fil: Poggio, Rosana. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Melendi, Santiago Ezequiel. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Elorriaga, Natalia. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentin

The Effects and Differences of Sprint Interval Training, Endurance Training and the Training Types Combined on Physiological Parameters and Exercise Performance

Sprint Interval Training (SIT) is a time efficient way in order to elicit similar changes as Endurance Training (ET) on aerobic capacity, with the purpose of the exercise training to alter physiological systems and exceed resting homeostasis to improve and enhance physical work capacity (Hawley et al., 1997), ultimately achieving the most out of each training session, beneficial for health and performance. Research in the area has demonstrated, the positive effects of SIT and ET on some physiological, performance and health parameters, with further needed to establish these adaptations. Yet no research is currently available combining these two training types, in a single training session to obtained potentially greater benefits over the same period of time. The aim of this study was to compare and contrast the effects of SIT, ET and COMB training modalities on physiological parameters and exercise performance after an 8 week training programme. Twenty nine participants volunteered to take part in the 10 week matched paired study, which included an 8 week training programme (age; 35.1±13.1 years, female; 16). All participants undertook a preliminary VO2max test and baseline measurements were taken. Participants were then matched paired into groups, based on sex, VO2peak (ml/kg/min) and resting heart rate (HR), then randomly assigned into a sprint interval (SIT), endurance (ET), a combined (COMB) sprint interval and endurance group or control group (CON). Participants in the SIT group undertook; 5-8 repetitions of 5-second sprints over the 8 weeks, on a cycle ergometer with intervals of 30 seconds, twice, interspaced with 4 minutes rest (<50rpm) three times per week. Those assigned to the ET group carried out cycling for 40 increasing to 60 minutes over the 8 weeks, at 60% of VO2peak equivalent to 78.5% of maximum HR, three times per week. The COMB group undertook combination of the above two protocols based on the pilot study undertaken. The CON group were not required to undertake any training regime. After 4 week and 8 weeks of the training, all participants were required to undertake a VO2max test and baseline measures were re-recorded. Prior to each VO2max test, capillary blood samples were taken for the colorimetric assessment of cholesterol. Two way factorial analysis of variance (ANOVA) were used for statistical analysis with lowest standard deviation (LSD) correction to reduce the type 1 error. Repeated measures ANOVA were used to assess changes within each individual training modality. Results indicate that SIT, ET, COMB and CON groups were not significantly different at baseline in VO2max (p=0.993) and Resting HR (p=0.790) after being match paired into groups by these variables. Significant differences were evident in resting HR between the CON and SIT (p=0.005), CON and ET (p=0.016) as well as CON and COMB (0.026) after the 8 weeks of training. Additionally within the training groups in resting HR; SIT (p=0.006), COMB (p=0.016), ET (p=0.036). Significant differences were seen in relative AT between SIT and CON (p=0.097) after 8 weeks, as well as within the COMB group (p=0.028). Furthermore in diastolic blood pressure after 4 weeks between SIT and COMB (p=0.024), COMB and CON (p=0.029) and after 8 weeks between COMB and ET (p=0.032), COMB and SIT (p=0.033) and COMB and CON (p=0.029). In addition, significance was shown in triglycerides after 8 weeks of training, between ET and CON (p=0.032), SIT and COMB (p=0.025) and COMB and CON (p=0.008) CON. Finally significance was evident in blood glucose between COMB and SIT, halfway (p=0.002) and post training (p=0.019). In terms of age, there was a significant difference in VO2max between those aged 35 years in VO2max after 4 (p=0.022) and 8 weeks (p=0.020) of the training programme. Overall the results indicated that when ET is substituted partly with SIT greater beneficial effects are obtained in numerous variables, demonstrated in this study, which has previously established, SIT is a time efficient training method. Furthermore, a lower duration of sprint i.e. 5 seconds, a more feasible sprint duration, as undertaken in this study provided comparable benefits to previous studies who have adopted longer sprint duration. Finally, these findings on various physiological measures and in a range of ages, indicate that a short time frame or by adopting a combined approach to training, can assist with reducing important health and performance parameters such as blood cholesterol, resting HR, blood pressure and ultimately maximal oxygen consumption and exercise performance, key indicators of cardiorespiratory fitness and health

To cannulate or not to cannulate? Variation, appropriateness and potential for reduction in cannulation rates by ambulance staff

Background: Peripheral intravenous (IV) cannulation is a key intervention in the prehospital setting, but inappropriate use may cause unnecessary pain, distress or risk of infection. The aim of this study was to examine the rate and appropriateness of prehospital cannulation and the relative importance of factors associated with increased likelihood of cannulation. Design and setting: Cross-sectional survey of patients transported in Lincolnshire, East Midlands Ambulance Service. Methods: Retrospective non-identifiable data for September 2006 were extracted. Clinical conditions were classified according to whether they warranted, did not warrant or were uncertain as to the need for cannulation. Other potential indications for cannulation including IV drug administration, reduced consciousness, systolic hypotension, respiratory depression and haemorrhage were combined to determine whether cannulation was indicated. Other variables were investigated as predictors of cannulation. The method of analysis was agreed at the outset. Results: Paramedics cannulated 14.6% (1295/8866) of patients. IV drug administration, clinical indication, reduced conscious level, respiratory depression and hypotension were associated with greater likelihood of cannulation (p,0.001). Cannulation was more likely in older patients but was not associated with gender, haemorrhage or hypoglycaemia. Multivariate logistic regression showed IV drug administration as the strongest predictor of cannulation. Cannulation rates varied threefold by ambulance station (mean 13.4%, 5.8% to 19.0%). It was estimated that 202 (15.6%) of the cannulations performed could potentially have been avoided. Conclusion: Rates of cannulation were higher than previous studies with wide variations between ambulance stations. 15.6% of cannulations performed could have been avoided, thus reducing pain, distress and other potential complications such as thrombophlebitis, extravasation and infection. The generalisability of this study was limited by use of a single site, short duration and dependence on accurate retrospective data. The data demonstrating wide variations suggest that there may be scope for consideration of interventions to reduce cannulation rates

A core curriculum for the continuing professional development of nurses: Developed by the Education Committee on behalf of the Council on Cardiovascular Nursing and Allied Professions of the ESC

Background: The European Society of Cardiology and the Council on Cardiovascular Nursing and Allied Professions share a vision; to decrease the burden of cardiovascular disease in Europe. Nurses represent the largest sector of the health professional workforce and have a significant contribution to make, which has not yet been fully realised. Recent evidence highlights an association between the level of nurse education and inpatient mortality making this an important topic, particularly as the provision of nurse education in Europe is variable. Aim: To develop a core curriculum to inform the education of nurses following initial qualification for work in cardiovascular settings. Method: A syllabus was developed using published literature, policy documents and existing curricula with expert input from service users, specialist nurses, cardiologists, educationalists and academics. The syllabus formed the framework for the development of the core curriculum. Results: Eight key themes characterise the core curriculum which are presented together with an account of the development process. While the curriculum is not intended to cover all aspects of the highly complex role of the cardiovascular nurse, the themes do exemplify the science and art of nursing and are transferable across different levels of clinical practice and settings. The curriculum functions both as a ‘map’, which identifies key themes to include in nurse education, and as a ‘tool’ to inform educational provision that bridges’ the gap between initial nurse education and advanced specialist practice. Content can be adapted for use to fit the national context and reflects the specific needs, health priorities, legislative and regulatory standards that govern safe nursing practice across different countries. Conclusion: The core curriculum can be used as a learning framework to guide nurse education, in particular the continuing professional education of post-qualifying nurses working in cardiovascular settings. This represents a significant step towards streamlining cardiovascular nurse education in Europ

Chronic Kidney Disease – Where Next? : Predicting Outcomes And Planning Care Pathways

Peer reviewedPublisher PD

The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging

The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination. Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function. When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed. With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR

Exercise and hypertrophic cardiomyopathy: Two incompatible entities?

A greater understanding of the pathogenic mechanisms underpinning hypertrophic cardiomyopathy (HCM) has translated to improved medical care and better survival of affected individuals. Historically these patients were considered to be at high risk of sudden cardiac death (SCD) during exercise; therefore, exercise recommendations were highly conservative and promoted a sedentary life style. There is emerging evidence that suggests that exercise in HCM has a favorable effect on cardiovascular remodeling and moderate exercise programs have not raised any safety concerns. Furthermore, individuals with HCM have a similar burden of atherosclerotic risk factors as the general population in whom exercise has been associated with a reduction in myocardial infarction, stroke, and heart failure, especially among those with a high-risk burden. Small studies revealed that athletes who choose to continue with regular competition do not demonstrate adverse outcomes when compared to those who discontinue sport, and active individuals implanted with an implantable cardioverter defibrillator do not have an increased risk of appropriate shocks or other adverse events. The recently published exercise recommendations from the European Association for Preventative Cardiology account for more contemporary evidence and adopt a more liberal stance regarding competitive and high intensity sport in individuals with low-risk HCM. This review addresses the issue of exercise in individuals with HCM, and explores current evidence supporting safety of exercise in HCM, potential caveats, and areas of further research

Changes in the prevalence, treatment and control of hypertension in Germany? : a clinical-epidemiological study of 50.000 primary care patients

INTRODUCTION: Medical societies have developed guidelines for the detection, treatment and control of hypertension (HTN). Our analysis assessed the extent to which such guidelines were implemented in Germany in 2003 and 2001. METHODS: Using standardized clinical diagnostic and treatment appraisal forms, blood pressure levels and patient questionnaires for 55,518 participants from the cross-sectional Targets and Essential Data for Commitment of Treatment (DETECT) study (2003) were analyzed. Physician's diagnosis of hypertension (HTN(doc)) was defined as coding hypertension in the clinical appraisal questionnaire. Alternative definitions used were physician's diagnosis or the patient's self-reported diagnosis of hypertension (HTN(doc,pat)), physician's or patient's self-reported diagnosis or a BP measurement with a systolic BP≥140 mmHg and/or a diastolic BP≥90 (HTN(doc,pat,bp)) and diagnosis according to the National Health and Nutrition Examination Survey (HTN(NHANES)). The results were compared with the similar German HYDRA study to examine whether changes had occurred in diagnosis, treatment and adequate blood pressure control (BP below 140/90 mmHg) since 2001. Factors associated with pharmacotherapy and control were determined. RESULTS: The overall prevalence rate for hypertension was 35.5% according to HTN(doc) and 56.0% according to NHANES criteria. Among those defined by NHANES criteria, treatment and control rates were 56.0% and 20.3% in 2003, and these rates had improved from 55.3% and 18.0% in 2001. Significant predictors of receiving antihypertensive medication were: increasing age, female sex, obesity, previous myocardial infarction and the prevalence of comorbid conditions such as coronary heart disease (CHD), hyperlipidemia and diabetes mellitus (DM). Significant positive predictors of adequate blood pressure control were CHD and antihypertensive medication. Inadequate control was associated with increasing age, male sex and obesity. CONCLUSIONS: Rates of treated and controlled hypertension according to NHANES criteria in DETECT remained low between 2001 and 2003, although there was some minor improvement