Abnormal shortened diastolic time length at increasing heart rates in patients with abnormal exercise-induced increase in pulmonary artery pressure

<p>Abstract</p> <p>Background</p> <p>The degree of pulmonary hypertension is not independently related to the severity of left ventricular systolic dysfunction but is frequently associated with diastolic filling abnormalities. The aim of this study was to assess diastolic times at increasing heart rates in normal and in patients with and without abnormal exercise-induced increase in pulmonary artery pressure (PASP). Methods. We enrolled 109 patients (78 males, age 62 ± 13 years) referred for exercise stress echocardiography and 16 controls. The PASP was derived from the tricuspid Doppler tracing. A cut-off value of PASP ≥ 50 mmHg at peak stress was considered as indicative of abnormal increase in PASP. Diastolic times and the diastolic/systolic time ratio were recorded by a precordial cutaneous force sensor based on a linear accelerometer.</p> <p>Results</p> <p>At baseline, PASP was 30 ± 5 mmHg in patients and 25 ± 4 in controls. At peak stress the PASP was normal in 95 patients (Group 1); 14 patients (Group 2) showed an abnormal increase in PASP (from 35 ± 4 to 62 ± 12 mmHg; P < 0.01). At 100 bpm, an abnormal (< 1) diastolic/systolic time ratio was found in 0/16 (0%) controls, in 12/93 (13%) Group 1 and 7/14 (50%) Group 2 patients (p < 0.05 between groups).</p> <p>Conclusion</p> <p>The first and second heart sound vibrations non-invasively monitored by a force sensor are useful for continuously assessing diastolic time during exercise. Exercise-induced abnormal PASP was associated with reduced diastolic time at heart rates beyond 100 beats per minute.</p

Associations of objectively measured total duration and maximum bout length of standing at work with lower-extremity pain intensity. A 2-year follow-up of construction and healthcare workers

Background Musculoskeletal disorders are among the major reasons for years lived with disability. Approximately one third of the European working population report lower-extremity discomfort and many attribute these discomforts to work-related factors. Employees in the healthcare and construction sectors reports high levels of lower-extremity pain and commonly relate the pain to their profession. These workers spend a large part of their workday standing. Periods of prolonged standing is suggested to increase lower-extremity symptoms, but this cannot be concluded on, since limited evidence is available from longitudinal studies using objective measures. This study aimed to determine possible associations between objectively measured total duration and maximum bout length of static- and dynamic standing at work and lower-extremity pain intensity (LEPi) among Norwegian construction- and healthcare workers. Methods One-hundred and twenty-three construction and healthcare workers wore two accelerometers for up to four consecutive days, to establish standing behavior at baseline. The participants reported LEPi (Likert scale 0–9) for the preceding 4 weeks at baseline and after 6, 12, 18, and 24 months. We investigated associations between standing at work and average and change in LEPi using linear mixed models with significance level p ≤ 0.05. Results Total duration of static- and dynamic standing showed weak associations with average LEPi, for the total sample and for construction workers. Maximum bout of static- and dynamic standing was associated with average LEPi in construction workers, but not in healthcare workers. Furthermore, we found no associations between standing and change in LEPi over the 2-year follow-up in any of our analyses. Conclusions This study indicate that objectively measured standing is associated with average LEPi over 2-years follow-up in construction workers, and that maximal bout of standing have a stronger association to LEPi than total duration. For every 10 min added to the maximal length of continuous standing during an average workday, we found approximately one unit increase in pain on a 0–9 scale. The lack of significant findings in analyses on healthcare workers suggest that the association between standing and LEPi depend on work-tasks, gender and/or other sector-specific factors

An exploratory study on the physical activity health paradox – musculoskeletal pain and cardiovascular load during work and leisure in construction and healthcare workers

Using a novel approach, this exploratory study investigated whether the physical activity (PA) paradox extends to cardiovascular load and musculoskeletal pain. At baseline, 1-2 days of 24h heart rate was assessed in 72 workers from construction and healthcare. Workers then reported pain intensity in 9 body regions (scale 0 - 3) every 6 months for two years. Using a novel ilr structure in compositional data analysis, time spent during work and leisure above three thresholds of percentage heart rate reserve (%HRR), i.e. ≥20 %HRR, ≥30 %HRR, ≥40 %HRR, was related to the 2-year average musculoskeletal pain (sum of 9 pain scores; scale 0-27). Analyses were stratified for several important variables. Workers spending more time in physical activity at work had higher pain, while workers with more time in physical activity during leisure had less pain (i.e. the PA paradox), but none of the associations were statistically significant. Higher aerobic capacity and lower body mass index lowered the pain score among those with higher physical activity at work. This exploratory study suggests that the PA paradox may apply to musculoskeletal pain and future studies with larger sample sizes and additional exposure analyses are needed to explain why this occurs

Prognostic factors for sudden drops in hearing level after minor head injury in patients with an enlarged vestibular aqueduct: A meta-analysis

Objective: To identify factors associated with sudden drops in hearing level after minor head trauma in patients with an enlarged vestibular aqueduct (EVA). Methods: A systematic review of the literature on sudden drops in hearing level after minor head trauma in patients with an EVA was conducted. The studies were retrieved from Embase, PubMed, CINAHL, and Cochrane and critically appraised using predefined criteria. Data on all described parameters were collected, and their relation with sudden drops after minor head trauma was statistically analyzed. Results: Pooled data of 31 articles included 179 patients with 351 EVAs. Drops in hearing level after minor head trauma were experienced by 34% of the patients. We found a significant association between sudden deterioration of hearing after minor head trauma and preexisting fluctuating hearing loss (HL) (odds ratio, 8.6; p G 0.001; 95% confidence interval, 3.9Y19.3). The diameter of the VA, type of preexisting HL, severity of HL, preexisting progressive HL, and the diagnosis Pendred syndrome were not significantly associated with sudden drops in hearing levels after head trauma. Conclusion: Only one-third of the patients with a proven EVA experienced sudden drops in hearing level because of head trauma. There is a significant association between preexisting fluctuating HL and the chance of sudden drops in hearing level caused by trauma. Stringent lifestyle advices, like avoiding activities with a risk of minor head trauma such as contact sports, might be restricted to patients with a fluctuating HL and those with a history of sudden drops on minor head trauma