Feasibility and acceptability of a multiple risk factor intervention: The Step Up randomized pilot trial

<p>Abstract</p> <p>Background</p> <p>Interventions are needed which can successfully modify more than one disease risk factor at a time, but much remains to be learned about the acceptability, feasibility, and effectiveness of multiple risk factor (MRF) interventions. To address these issues and inform future intervention development, we conducted a randomized pilot trial (n = 52). This study was designed to assess the feasibility and acceptability of the Step Up program, a MRF cognitive-behavioral program designed to improve participants' mental and physical well-being by reducing depressive symptoms, promoting smoking cessation, and increasing physical activity.</p> <p>Methods</p> <p>Participants were recruited from a large health care organization and randomized to receive usual care treatment for depression, smoking, and physical activity promotion or the phone-based Step Up counseling program plus usual care. Participants were assessed at baseline, three and six months.</p> <p>Results</p> <p>The intervention was acceptable to participants and feasible to offer within a healthcare system. The pilot also offered important insights into the optimal design of a MRF program. While not powered to detect clinically significant outcomes, changes in target behaviors indicated positive trends at six month follow-up and statistically significant improvement was also observed for depression. Significantly more experimental participants reported a clinically significant improvement (50% reduction) in their baseline depression score at four months (54% vs. 26%, OR = 3.35, 95% CI [1.01- 12.10], <it>p </it>= 0.05) and 6 months (52% vs. 13%, OR = 7.27, 95% CI [1.85 - 37.30], <it>p </it>= 0.004)</p> <p>Conclusions</p> <p>Overall, results suggest the Step Up program warrants additional research, although some program enhancements may be beneficial. Key lessons learned from this research are shared to promote the understanding of others working in this field.</p> <p>Trial registration</p> <p>The trial is registered with ClinicalTrials.gov (<a href="http://www.clinicaltrials.gov/ct2/show/NCT00644995">NCT00644995</a>).</p

Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients

<p>Abstract</p> <p>Background</p> <p>The Cochrane review of hallux valgus surgery has disputed the scientific validity of hallux valgus research. Scoring systems and surrogate measures such as x-ray angles are commonly reported at just one year post operatively but these are of dubious relevance to the patient. In this study we extended the follow up to a minimum of 8 years and sought to address patient specific concerns with hallux valgus surgery. The long term follow up also allowed a comprehensive review of the complications associated with the combined rotation scarf and Akin osteotomies.</p> <p>Methods</p> <p>Between 1996 and 1999, 101 patients underwent rotation scarf and Akin osteotomies for the treatment of hallux valgus. All patients were contacted and asked to participate in this study. 50 female participants were available allowing review of 73 procedures. The average follow up was over 9 years and the average age at the time of surgery was 57. The participants were physically examined and interviewed.</p> <p>Results</p> <p>Post-operatively, in 86% of the participants there were no footwear restrictions. Stiffness of the first metatarsophalangeal joint was reported in 8% (6 feet); 10% were unhappy with the cosmetic appearance of their feet, 3 feet had hallux varus, and 2 feet had recurrent hallux valgus. There were no foot-related activity restrictions in 92% of the group. Metatarsalgia occurred in 4% (3 feet). 96% were better than before surgery and 88% were completely satisfied with their post-operative result. Hallux varus was the greatest single cause of dissatisfaction. The most common adverse event in the study was internal fixation irritation. Hallux valgus surgery is not without risk and these findings could be useful in the informed consent process.</p> <p>Conclusions</p> <p>When combined the rotation scarf and Akin osteotomies are an effective treatment for hallux valgus that achieves good long-term correction with a low incidence of recurrence, footwear restriction or metatarsalgia. The nature of the osteotomies allows early return to normal shoes and activity without the need for postoperative immobilisation in a plaster cast.</p

Development of a specific anaerobic field test for aerobic gymnastics

The current investigation aimed to develop a valid specific field test to evaluate anaerobic physical performance in Aerobic Gymnastics athletes. We first designed the Specific Aerobic Gymnast Anaerobic Test (SAGAT), which included gymnastics-specific elements performed in maximal repeated sprint fashion, with a total duration of 80-90 s. In order to validate the SAGAT, three independent sub-studies were performed to evaluate the concurrent validity (Study I, n=8), the reliability (Study II, n=10) and the sensitivity (Study III, n=30) of the test in elite female athletes. In Study I, a positive correlation was shown between lower-body Wingate test and SAGAT performance (Mean power: p = 0.03, r = -0.69, CI: -0.94 to 0.03 and Peak power: p = 0.02, r = -0.72, CI: -0.95 to -0.04) and between upper-body Wingate test and SAGAT performance (Mean power: p = 0.03, r = -0.67, CI: -0.94 to 0.02 and Peak power: p = 0.03, r = -0.69, CI: -0.94 to 0.03). Additionally, plasma lactate was similarly increased in response to SAGAT (p = 0.002), lower-body Wingate Test (p = 0.021) and a simulated competition (p = 0.007). In Study II, no differences were found between the time to complete the SAGAT in repeated trials (p = 0.84; Cohen's d effect size = 0.09; ICC = 0.97, CI: 0.89 to 0.99; MDC95 = 0.12 s). Finally, in Study III the time to complete the SAGAT was significantly lower during the competition cycle when compared to the period before the preparatory cycle (p < 0.001), showing an improvement in SAGAT performance after a specific Aerobic Gymnastics training period. Taken together, these data have demonstrated that SAGAT is a specific, reliable and sensitive measurement of specific anaerobic performance in elite female Aerobic Gymnastics, presenting great potential to be largely applied in training settings

Antidiarrheal, antisecretory, and bronchodilatory activities of Hypericum perforatum.

This study describes the antidiarrheal, antisecretory, and bronchodilatory activities of Hypericum perforatum Linn. (Hypericaceae), commonly known as St. John’s wort, to justify its traditional use in the hyperactivity of the gastrointestinal and respiratory systems. The crude extract of Hypericum perforatum (Hp.Cr) at a dose of 500 mg/kg caused 20% protection against castor oil-induced diarrhea in mice and 60% at 1000 mg/kg (p \u3c 0.05 vs. saline). Hp.Cr at 300 and 1000 mg/kg reduced the castor oil-induced fluid accumulation in mice to 107.0 ± 3.3 g (p \u3c 0.01) and 84.0 ± 4.2 g (p \u3c 0.001) respectively, whereas in the castor oil-treated group, it was 126.9 ± 3.9 g. When tested against carbachol (CCh)-mediated bronchoconstriction in rats under anesthesia, Hp.Cr dose-dependently (3– 30 mg/kg) suppressed the CCh (1 μmol/kg)-induced increase in the inspiratory pressure. Thus this study rationalizes the Hypericum perforatum usefulness in overactive gut and airways disorders, such as diarrhea and asthma