Blood Pressure Surge with Alarm Is Reduced after Exercise and Diet Intervention in Firefighters

BACKGROUND: Cardiac-related incidents are a public health concern for tactical occupations, and cardiovascular disease rates are higher in these populations compared with civilians. Research is needed to examine blood pressure (BP) responses in firefighters. The pager alert is one occupational hazard, and it is unknown if lifestyle change can reduce the systolic surge response. PURPOSE: To measure BP surge with alarm in firefighters to determine whether the magnitude is lower after a 6-week tactical exercise and Mediterranean-diet intervention. METHODS: SBP and DBP and BP surge levels, circulating markers, vascular health, and fitness were analyzed. BP surge with alarm was captured during a 12-hour workshift. Exercise and diet were self-reported. Diet was tracked with diet scores based on number of servings. RESULTS: Twenty five firefighters (43.4 ± 13.9 years) participated. We found changes in the magnitude of BP surge with alarm (SBP surge from16.7 ± 12.9 to 10.5 ± 11.7 mmHg, P \u3c 0.05; DBP surge from 8.2 ± 10.8 to 4.9 ± 5.6 mmHg, P \u3e 0.05) after intervention. We confirm that clinical (127.6 ± 9.1 to 120 ± 8.2 mmHg) and central (122.7 ± 11.3 to 118.2 ± 10.7 mmHg) SBP levels improve with exercise and diet. We report for the first time in firefighters that oxidative stress markers superoxide dismutase (9.1 ± 1.5 to 11.2 ± 2.2 U/ml) and nitric oxide (40.4 ± 7 to 48.9 ± 16.9 μmol/l) levels improve with an exercise and diet intervention. CONCLUSION: These findings have implications toward the benefit that short-term lifestyle changes make toward reducing the alarm stress response in first responders

Blood Pressure Responses Are Dependent on Call Type and Related to Hypertension Status in Firefighters

Background: Impaired cardiovascular health is a concern for firefighters, with over 50% of line-of-duty deaths having cardiac causes. Many firefighters have hypertension and \u3c25% have their blood pressure (BP) controlled. The alarm response could be an unidentified cardiac risk, but interestingly, the BP response to different calls and on-the-job activity is unknown. Purpose: We aimed to measure the physiological stress resulting from different call types (fire, medical) and job activity (riding apparatus, pre-alert alarms) through ambulatory BP (ABP) monitoring in a population of firefighters. Materials and methods: During 111 12-h work shifts firefighters wore an ABP monitor. BP was measured at 30-min intervals and manual measurements were prompted when the pager went off or whenever they felt stress. Results: Firefighters were hypertensive (124.3 ± 9.9/78.1 ± 6.7 mmHg), overweight (30.2 ± 4.6 kg/m2), middle-aged (40.5 ± 12.6 years) and experienced (17.3 ± 11.7 years). We calculated an average 11% increase in systolic and 10.5% increase in diastolic BP with alarm. Systolic BP (141.9 ± 13.2 mmHg) and diastolic BP (84.9 ± 11.1 mmHg) and the BP surges were higher while firefighters were responding to medical calls compared to fire calls. Between BP groups we found that medical call systolic BP (p = .001, d = 1.2), diastolic BP (p = .017, d = 0.87), and fire call systolic BP (p = .03, d = 0.51) levels were higher in the hypertensive firefighters. Conclusion: This is the first report of BP surge responses to alarms and to occupational activities in firefighters, and medical calls elicited the largest overall responses.PLAIN LANGUAGE SUMMARYCardiovascular disease and impaired cardiovascular health are substantially more prevalent in firefighters, with over 50% of line-of-duty deaths being cardiac related.Many firefighters are diagnosed with high blood pressure (hypertension), which is known to increase the risk of heart attacks, strokes, heart disease, and other serious health complications.Upon stress, our body enacts the \u27fight or flight\u27 response where sympathetic nervous system activity triggers an immediate increase in heart rate and blood pressure. This response can be dangerous when surges reach extreme levels due to underlying impaired cardiovascular function. It is known that alarm sounds trigger a stress response.Firefighters respond to different alarms while on the job, each indicating different call types, such as a house fire or a medical emergency. Due to the prevalence of impaired cardiovascular health in firefighters, the physical stress resulting from these alerts is cause for concern.The blood pressure surge response to different call types and job activities in healthy and hypertensive firefighters had not been measured before this study.Through the ambulatory blood pressure monitoring of 111 on-duty firefighters, this study discovered that medical calls caused the greatest blood pressure and heart rate surge.Also, firefighters with hypertension experienced a greater blood pressure surge in response to alarms than their non-hypertensive co-workers

Pleiotropic Associations of Risk Variants Identified for Other Cancers With Lung Cancer Risk: The PAGE and TRICL Consortia

BackgroundGenome-wide association studies have identified hundreds of genetic variants associated with specific cancers. A few of these risk regions have been associated with more than one cancer site; however, a systematic evaluation of the associations between risk variants for other cancers and lung cancer risk has yet to be performed.MethodsWe included 18023 patients with lung cancer and 60543 control subjects from two consortia, Population Architecture using Genomics and Epidemiology (PAGE) and Transdisciplinary Research in Cancer of the Lung (TRICL). We examined 165 single-nucleotide polymorphisms (SNPs) that were previously associated with at least one of 16 non–lung cancer sites. Study-specific logistic regression results underwent meta-analysis, and associations were also examined by race/ethnicity, histological cell type, sex, and smoking status. A Bonferroni-corrected P value of 2.5×10–5 was used to assign statistical significance.ResultsThe breast cancer SNP LSP1 rs3817198 was associated with an increased risk of lung cancer (odds ratio [OR] = 1.10; 95% confidence interval [CI] = 1.05 to 1.14; P = 2.8×10–6). This association was strongest for women with adenocarcinoma (P = 1.2×10–4) and not statistically significant in men (P = .14) with this cell type (P het by sex = .10). Two glioma risk variants, TERT rs2853676 and CDKN2BAS1 rs4977756, which are located in regions previously associated with lung cancer, were associated with increased risk of adenocarcinoma (OR = 1.16; 95% CI = 1.10 to 1.22; P = 1.1×10–8) and squamous cell carcinoma (OR = 1.13; CI = 1.07 to 1.19; P = 2.5×10–5), respectively.ConclusionsOur findings demonstrate a novel pleiotropic association between the breast cancer LSP1 risk region marked by variant rs3817198 and lung cancer risk

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Examining the Impact of the Greening of Urban Blight on Mental Health: A Rapid Systematic Review

The conditions of an individual’s neighborhood built-environment can have a substantial impact on their health and welfare overall. Urban blight includes the presence of abandoned or poorly maintained properties and is characterized by land overgrowth, trash buildup, and vandalization. Blight can have a major influence on the value of a community and impacts those who work and live nearby. Blighted properties are associated with unhealthy habits as well as increased rates of mental and chronic illness (Garvin, et al., 2013). ‘Greening’ is a trending remediation solution that includes the restoration of blighted or abandoned spaces through periodic land maintenance, disposal of trash, and creation of community gardens and other green spaces. Living near restored and greened spaces are associated with a reduction in levels of stress, anxiety, and depression (South et al., 2018). This understanding supports the notion that restoring blighted properties may lessen the impact of inequitable environmental conditions on an individual’s health. This rapid systematic review includes an analysis of literature outlining the impacts of greening interventions for blight and how they impact the mental health of a community. After examining the literature, findings will be condensed and presented to environmental justice attorneys in Philadelphia to provide a report of the range of research that can support greening as a necessary solution to lessening the impacts of urban blight

Efficacy of cycling interventions to improve function in children and adolescents with cerebral palsy: a systematic review and meta-analysis

Objectives: The aim of this study was to determine the efficacy of cycling to improve function and reduce activity limitations in children with cerebral palsy; the optimal training parameters for improved function; and whether improvements in function can be retained. Method: Six databases were searched (until February 2019) and articles were screened in duplicate. Randomized or quasi-randomized controlled trials and pre–post studies were included. Methodological quality was assessed using the Downs and Black scale. Outcomes were reported under the International Classification of Functioning, Disability and Health domains of body functions and activity limitations. Quantitative analyses were completed using RevMan V5.3. Results: A total of 533 articles were identified and 9 studies containing data on 282 participants met full inclusion criteria. Methodological quality ranged from low (14 of 32) to high (28 of 32). Significant improvements were reported for hamstring strength (effect size = 0.77–0.93), cardiorespiratory fitness (effect size = 1.13–1.77), balance (effect size = 1.03–1.29), 3-minute walk test distance (effect size = 1.14) and gross motor function (effect size = 0.91). Meta-analysis suggested that cycling can improve gross motor function (standardized mean difference = 0.35; 95% confidence interval = (−0.01, 0.70); P = 0.05); however, the effect was insignificant when a poor-quality study was omitted. Conclusion: Cycling can improve muscle strength, balance and gross motor function in children with cerebral palsy; however, optimal training doses are yet to be determined. There was insufficient data to determine whether functional improvements can be retained. Conclusions were limited by small sample sizes, inconsistent outcome measures and a lack of follow-up testing

Functional electrical stimulation cycling, goal‐directed training, and adapted cycling for children with cerebral palsy: a randomized controlled trial

Aim: To test the efficacy of functional electrical stimulation (FES) cycling, goal-directed training, and adapted cycling, compared with usual care, to improve function in children with cerebral palsy (CP). Method: The intervention was delivered between 2017 and 2019 and included three sessions per week for 8 weeks (2×1h sessions at a children’s hospital, and 1h home programme/week). Hospital sessions included 30 minutes of FES cycling and 30 minutes of goal-directed training. Home programmes included goal-directed training and adapted cycling. The comparison group continued usual care. Primary outcomes were gross motor function assessed by the Gross Motor Function Measure (GMFM) and goal performance/satisfaction assessed using the Canadian Occupational Performance Measure (COPM). Secondary outcomes were sit-to-stand and activity capacity, participation in home, school, and community activities, and power output. Linear regression was used to determine the between-group mean difference immediately post-training completion after adjusting for baseline scores. Results: This randomized controlled trial included 21 participants (mean age=10y 3mo, standard deviation [SD]=3y; Gross Motor Function Classification System level: II=7, III=6, IV=8) who were randomized to the intervention (n=11) or usual care group (n=10). Between-group differences at T2 favoured the intervention group for GMFM-88 (mean difference=7.4; 95% confidence interval [CI]: 2.3–12.6; p=0.007), GMFM-66 (mean difference=5.9; 95% CI: 3.1–8.8;