Health care and hospitalisation costs of cardiovascular disease (CVD) in Thailand

Background: Cardiovascular disease (CVD) has become a leading cause of death and disability in Thailand due to the unhealthy lifestyle of the populace; triggering high risk of exposure to CVD, increase in the number of hospital admissions year on year. Objectives: The concerns generated by the inflation in the health care expenditure among service providers motivated this study to examine the costs of hospitalisation of inpatients with (CVD) conditions in Thailand, 2009. Methods: Anonymised secondary data of 327,435 CVD inpatients under “Universal Coverage” (UC) health care scheme were obtained from the National Health Security Office (NHSO), Thailand. The data(51.69%- women and 48.31% - men) were classified using International Classification of Diseases, Tenth Revision (ICD-10) code, of which I20-I25 are Ischemic heart disease (IHD), I60-I69 are stroke and I00- I99areallCVD conditions. Results: Average costs of treatments for all CVD conditions, IHD and stroke were ฿21,921 (£1 = ฿50), ฿32,884 (highest) and ฿25,617.67per patient respectively. Absolute total cost increased with age and the cost of admission of male patients is higher than female. The average (three months) length of stay for stroke patients was found to be the highest. Conclusion: Providers generally spent a total of ฿7,177 million on the treatment of CVD with IHD and stroke taking ฿2,544 million and ฿1,920 million respectivel

The influence of push-off timing in a robotic ankle-foot prosthesis on the energetics and mechanics of walking

Background Robotic ankle-foot prostheses that provide net positive push-off work can reduce the metabolic rate of walking for individuals with amputation, but benefits might be sensitive to push-off timing. Simple walking models suggest that preemptive push-off reduces center-of-mass work, possibly reducing metabolic rate. Studies with bilateral exoskeletons have found that push-off beginning before leading leg contact minimizes metabolic rate, but timing was not varied independently from push-off work, and the effects of push-off timing on biomechanics were not measured. Most lower-limb amputations are unilateral, which could also affect optimal timing. The goal of this study was to vary the timing of positive prosthesis push-off work in isolation and measure the effects on energetics, mechanics and muscle activity. Methods We tested 10 able-bodied participants walking on a treadmill at 1.25 m · s−1. Participants wore a tethered ankle-foot prosthesis emulator on one leg using a rigid boot adapter. We programmed the prosthesis to apply torque bursts that began between 46% and 56% of stride in different conditions. We iteratively adjusted torque magnitude to maintain constant net positive push-off work. Results When push-off began at or after leading leg contact, metabolic rate was about 10% lower than in a condition with Spring-like prosthesis behavior. When push-off began before leading leg contact, metabolic rate was not different from the Spring-like condition. Early push-off led to increased prosthesis-side vastus medialis and biceps femoris activity during push-off and increased variability in step length and prosthesis loading during push-off. Prosthesis push-off timing had no influence on intact-side leg center-of-mass collision work. Conclusions Prosthesis push-off timing, isolated from push-off work, strongly affected metabolic rate, with optimal timing at or after intact-side heel contact. Increased thigh muscle activation and increased human variability appear to have caused the lack of reduction in metabolic rate when push-off was provided too early. Optimal timing with respect to opposite heel contact was not different from normal walking, but the trends in metabolic rate and center-of-mass mechanics were not consistent with simple model predictions. Optimal push-off timing should also be characterized for individuals with amputation, since meaningful benefits might be realized with improved timing

Beliefs and attitudes in judo coaching : toward a new model of coaching

The purpose of this research programme was to propose a new structure for judo coaching. Judo coaching predominantly uses traditional methods emphasising progression through belts rather than success in competition as the measure of achievement. The research programme examined this issue in four stages involving seven studies. Stage 1 involved a qualitative examination of five elite coaches on what constitutes an effective coach, leading to the initial development of a 39-item judo coaching scale. Given the importance of demonstrating measures are valid, stage 2 investigated the validity of the scale among judo players and coaches. Factor analytic studies on data from 260 (130 coaches and 130 players) yielded a 7-factor solution; 1) Coaching is about winning, 2) Attitudes to coaching at different levels, 3) Attitudes to judo structure, 4) Relationships with players, 5) Presentational issues, 6) Technical knowledge link to coach level, and 7) Coach-player interactions. Multisample confirmatory factor analysis found support for the invariance of the model between coaches and players, thereby showing that relationships are consistent between different groups. Stage 3 used a multi-method approach, combining quantitative and qualitative methods. Responses to the judo coaching scale indicated perceptions of coach effectiveness vary as a function of being a player or a coach, and by level of participation (elite-v-non-elite). Qualitative results emphasise the importance of emotional control, an aspect not focused on in the interviews completed in stage 1. Stage 4 of the research investigated relationships between judo coaching scale scores and emotional intelligence. The study also investigated levels of emotional intelligence between elite and club coaches. High emotional intelligence is associated is proposed to be indicative of being able to manage the emotional states of other people and so should be a desirable quality in coaches. Results show significant relationship between judo coaching scale score and emotional intelligence factors, with further analysis showing that elite coaches reported higher emotional intelligence scores than club coaches. Based on the findings from the studies completed above, a revised judo coaching structure is presented. An elite structure should be based on players having specific performance targets including technical and tactical skills, psychological, and physiological, aligning judo more closely with the structure used in other Olympic sports. Coaches should also be given targets related to developing emotional control among players and instilling players with a self-belief to attain performance targets related to the above. Effective integration and usage of such personnel is required including developing and inculcating sport science knowledge into the practice of elite coaches, and then modifying this knowledge for use in the club system. It is hoped that findings from this research stimulates discussion, and action in the British Judo Association to revise the current system, which could lead to better judo coaching, better players, and ultimately enhanced Olympic success at London 2012.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

International Olympic Committee Consensus Statement: Molecular Basis of Connective Tissue and Muscle Injuries in Sport

Tendon and ligament injures cause significant loss of performance in sport and decreased functional capacity in the workplace. Many of these injures remain difficult to treat, and many individuals have long-term pain and discomfort. Animal studies of growth factor and cell-based therapies have shown promising results, but these treatments also can be misused to enhance athletic performance. The International Olympic Committee (IOC) now has high-level scientific advisors who can advise the IOC as to the use and abuse of these technologies

Human genetic variation, Sport and Exercise Medicine, and Achilles tendinopathy: role for angiogenesis-associated genes

Sport and Exercise Medicine is one of the important subspecialties of 21st century healthcare contributing to improving the physical function, health, and vitality of populations while reducing the prevalence of lifestyle-related diseases. Moreover, sport and exercise are associated with injuries such as Achilles tendinopathy, which is a common tendon injury. The angiogenesis-associated signaling pathway plays a key role in extracellular matrix remodeling, with increased levels of angiogenic cytokines reported after cyclic stretching of tendon fibroblasts. We investigated the variants in angiogenesis genes in relation to the risk of Achilles tendinopathy in two population samples drawn independently from South Africa (SA) and the United Kingdom (UK). The study sample comprised 120 SA and 130 UK healthy controls, and 108 SA and 87 UK participants with Achilles tendinopathy. All participants were genotyped for five functional polymorphisms in the vascular endothelial growth factor, A isoform (VEGFA) (rs699947, rs1570360, rs2010963) and kinase insert-domain receptor (KDR) genes (rs1870377, rs2071559). The VEGFA A-G-G inferred haplotype was associated with an increased risk of Achilles tendinopathy in the SA group (15% in controls vs. 20% in cases, p = 0.048) and the combined SA+UK group (14% in controls vs. 20% in cases, p = 0.009). These new findings implicate the VEGFA gene with Achilles tendinopathy risk, while highlighting the potential biological significance of the angiogenesis signaling pathway in the etiology of Achilles tendinopathy. The evidence suggesting a genetic contribution to the susceptibility of sustaining a tendon injury is growing. We anticipate that high-throughput and multi-omics approaches, building on genomics, proteomics, and metabolomics, may soon uncover the pathophysiology of many diseases in the field of Sports and Exercise Medicine, as a new frontier of global precision medicine

The partners in health scale: the development and psychometric properties of a generic assessment scale for chronic condition self-management

Bundoora, VI

Functional COL1A1 variants are associated with the risk of acute musculoskeletal soft tissue injuries

Studies have reported the association of the COL1A1 Sp1 binding site variant (rs1800012) with the risk of acute musculoskeletal soft tissue injuries. Interaction with the COL1A1 promoter variant (rs1107946) has also been proposed to modulate acute injury risk. Conversely, neither of these loci have been associated with chronic musculoskeletal soft tissue phenotypes. Therefore, the primary aim of this study involved characterizing these variants in a cohort of participants with chronic Achilles tendinopathy. Second, this study aimed to support the contribution of the rs1107946 and rs1800012 variants to the profile predisposing for acute musculoskeletal soft tissue injuries including Achilles tendon and anterior cruciate ligament (ACL) ruptures. A hypothesis‐driven association study was conducted. In total, 295 control participants, 210 participants with clinically diagnosed Achilles tendinopathy, and 72 participants with Achilles tendon ruptures recruited independently from South Africa and the United Kingdom were genotyped for the prioritized variants. In addition, a cohort including 232 control participants and 234 participants with surgically diagnosed ACL ruptures was also analyzed. Although no associations were observed in the recruited cohorts, the rare rs1800012 TT genotype was associated with decreased ACL injury risk when the results from the current study were combined with that from previously published studies (P = .040, OR: 2.8, 95% CI: 1.0‐11.0). In addition, the G‐T (rs1107946‐rs1800012) inferred haplotype was associated with decreased risk for Achilles tendon ruptures. These results support previous observations and reiterate the heterogeneity of musculoskeletal phenlotypes whereby certain markers may be common to the predisposing profiles while others may be unique

Divergent dysregulation of gene expression in murine models of fragile X syndrome and tuberous sclerosis

Background: Fragile X syndrome and tuberous sclerosis are genetic syndromes that both have a high rate of comorbidity with autism spectrum disorder (ASD). Several lines of evidence suggest that these two monogenic disorders may converge at a molecular level through the dysfunction of activity-dependent synaptic plasticity. Methods: To explore the characteristics of transcriptomic changes in these monogenic disorders, we profiled genome-wide gene expression levels in cerebellum and blood from murine models of fragile X syndrome and tuberous sclerosis. Results: Differentially expressed genes and enriched pathways were distinct for the two murine models examined, with the exception of immune response-related pathways. In the cerebellum of the Fmr1 knockout (Fmr1-KO) model, the neuroactive ligand receptor interaction pathway and gene sets associated with synaptic plasticity such as long-term potentiation, gap junction, and axon guidance were the most significantly perturbed pathways. The phosphatidylinositol signaling pathway was significantly dysregulated in both cerebellum and blood of Fmr1-KO mice. In Tsc2 heterozygous (+/−) mice, immune system-related pathways, genes encoding ribosomal proteins, and glycolipid metabolism pathways were significantly changed in both tissues. Conclusions: Our data suggest that distinct molecular pathways may be involved in ASD with known but different genetic causes and that blood gene expression profiles of Fmr1-KO and Tsc2+/− mice mirror some, but not all, of the perturbed molecular pathways in the brain