Home-based isometric exercise training induced reductions resting blood pressure

Purpose: Isometric exercise training (IET) reduces resting blood pressure (BP). Most previous protocols impose exercise barriers which undermine its effectiveness as a potential physical therapy for altering BP. An inexpensive, home-based programme would promote IET as a valuable tool in the fight against hypertension. The aims of this study were: (a) to investigate whether home-based wall squat training could successfully reduce resting BP, and (b) to explore the physiological variables that might mediate a change in resting BP. Methods: Twenty-eight healthy normotensive males were randomly assigned to a control and a 4 week home-based IET intervention using a crossover design with a 4 week ‘washout’ period in-between. Wall squat training was completed 3x weekly over 4 weeks with 48 hours between sessions. Each session comprised 4x 2 minute bouts of wall squat exercise performed at a participant-specific knee joint angle relative to a target HR of 95% HRpeak, with 2 minutes rest between bouts. Resting heart rate, BP, cardiac output, total peripheral resistance and stroke volume were taken at baseline and post each condition. Results: Resting BP (systolic = -4 ± 5, diastolic = -3 ± 3 and mean arterial = -3 ± 3 mmHg), cardiac output (-0.54 ± 0.66 L∙min-1) and heart rate (-5 ± 7 beats∙min-1) were all reduced following IET, with no change in total peripheral resistance or stroke volume compared to the control. Conclusion: These findings suggest the wall squat provides an effective method for reducing resting BP in the home resulting primarily from a reduction in resting heart rate

Blunted endogenous opioid release following an oral amphetamine challenge in pathological gamblers

Pathological gambling is a psychiatric disorder and the first recognized behavioral addiction, with similarities to substance use disorders but without the confounding effects of drug-related brain changes. Pathophysiology within the opioid receptor system is increasingly recognized in substance dependence, with higher mu-opioid receptor (MOR) availability reported in alcohol, cocaine and opiate addiction. Impulsivity, a risk factor across the addictions, has also been found to be associated with higher MOR availability. The aim of this study was to characterize baseline MOR availability and endogenous opioid release in pathological gamblers (PG) using [(11)C]carfentanil PET with an oral amphetamine challenge. Fourteen PG and 15 healthy volunteers (HV) underwent two [(11)C]carfentanil PET scans, before and after an oral administration of 0.5 mg/kg of d-amphetamine. The change in [(11)C]carfentanil binding between baseline and post-amphetamine scans (ΔBPND) was assessed in 10 regions of interest (ROI). MOR availability did not differ between PG and HV groups. As seen previously, oral amphetamine challenge led to significant reductions in [(11)C]carfentanil BPND in 8/10 ROI in HV. PG demonstrated significant blunting of opioid release compared with HV. PG also showed blunted amphetamine-induced euphoria and alertness compared with HV. Exploratory analysis revealed that impulsivity positively correlated with caudate baseline BPND in PG only. This study provides the first evidence of blunted endogenous opioid release in PG. Our findings are consistent with growing evidence that dysregulation of endogenous opioids may have an important role in the pathophysiology of addictions

Mental health nurses' psychological well-being, mental distress, and workplace resilience: A cross-sectional survey.

Mental health nurses (MHNs) frequently face emotional adversity and stressors at work that can negatively impact their psychological well-being and result in mental distress. This can affect their capacity for therapeutic work, professional relationships, and overall work performance. In the context of work, resilience is a dynamic process of positive adaptation to adversity that can lead to psychological well-being and increased work performance. There is limited knowledge, however, on MHNs' psychological well-being and resilience from an Australian perspective. This study aimed to investigate the levels of, and relationships between, psychological well-being, mental distress, and workplace resilience in Australian MHNs. A cross-sectional online survey using Ryff's Scales of Psychological Well-being (PWS) 18, Depression, Anxiety and Stress (DASS) 21, and Resilience at Work measures was completed by registered nurses (n = 482) working in a mental health setting or role. Mean scores were 85.38 for psychological well-being and 70.27 for workplace resilience, with more than half reporting levels above the mean. However, some participants scored in the severe to extremely severe categories for depression (7.8%), anxiety (8.7%) or stress (7.3%). Psychological well-being had strong positive and negative associations, respectively, with workplace resilience (r = 0.571, P < 0.01) and depression (r = -0.563, P < 0.01). Having a postgraduate specialist qualification was positively associated with psychological well-being. Postgraduate speciality education may be a key protective factor that can increase MHNs' psychological well-being. Strengthening workplace resilience is an important strategy for organizations to implement to support MHNs' psychological well-being and reduce the risk of mental distress

A Consent Support Resource with Benefits and Harms of Vaccination Does Not Increase Hesitancy in Parents-An Acceptability Study

It is unclear whether information given about the benefits and risks of routine childhood vaccination during consent may cue parental vaccine hesitancy. Parents were surveyed before and after reading vaccine consent information at a public expo event in Sydney, Australia. We measured vaccine hesitancy with Parent Attitudes about Childhood Vaccine Short Scale (PACV-SS), informed decision-making with Informed Subscale of the Decisional Conflict Scale (DCS-IS), items from Stage of Decision Making, Positive Attitude Assessment, Vaccine Safety and Side Effect Concern, and Vaccine Communication Framework (VCF) tools. Overall, 416 parents showed no change in vaccine hesitancy (mean PACV-SS score pre = 1.97, post = 1.94; diff = −0.02 95% CI −0.10 to 0.15) but were more informed (mean DCS-IS score pre = 29.05, post = 7.41; diff = −21.63 95% CI −24.17 to −18.56), were more positive towards vaccination (pre = 43.8% post = 50.4%; diff = 6.5% 95% CI 3.0% to 10.0%), less concerned about vaccine safety (pre = 28.5%, post = 23.0%, diff = −5.6% 95% CI −2.3% to −8.8%) and side effects (pre = 37.0%, post = 29.0%, diff = −8.0% 95% CI −4.0% to −12.0%) with no change in stage of decision-making or intention to vaccinate. Providing information about the benefits and risks of routine childhood vaccination increases parents’ informed decision-making without increasing vaccine hesitancy

Associations between clinical indicators of quality and aged-care residents' needs and consumer and staff satisfaction: the first Australian study

© 2019 AHHA. Objectives: To ascertain Australian multistate prevalence and incidence of five commonly collected clinical indicators of aged-care home quality and to measure associations between these clinical indicators and levels of care needs and consumer and staff satisfaction. Methods: A retrospective analysis of national audit data collected from 426 facilities between 2015 and 2016 was performed. Regression models were used to examine associations between five clinical indicators (falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy) and level of care needs measured by the Aged Care Funding Instrument (ACFI) and consumer and care staff survey responses. Results: With the exception of polypharmacy, commonly collected negative clinical outcomes were rare events. Compared with care homes with <25% of residents having high-level care needs (high ACFI), homes with 25<75% high-ACFI residents had more occurrences of all negative clinical outcomes except pressure injury. Homes with ≥75% high-ACFI residents reported the highest rates of polypharmacy (odds ratio 1.48, 95% confidence interval 1.39-1.57). Falls, unplanned weight loss and pressure injury were inversely associated with satisfaction scores adjusted for residents' level of care needs. Conclusions: This first Australian study of multistate clinical indicator data suggests interpretation of clinical indicators of aged-care home quality requires consideration of the level of residents' care needs. What is known about the topic?: Many Australian aged-care providers use quality indicators (QI) through benchmarking companies or in-house programs. The five most widely used aged-care clinical QIs in Australia are falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy. Prevalence and incidence of these QIs are highly variable among Australian studies. A consistent message in the international literature is that residents' clinical characteristics influence QI outcomes at baseline and may continue to influence outcomes over time. Study of associations between Australian aged-care home characteristics and QI outcomes has been limited. What does this paper add?: This is the first Australian study of multistate clinical QI data. It is also the first to consider the level of resident care needs in the interpretation of clinical QI outcomes and exploration of the association between level of consumer and staff satisfaction and QI outcomes. What are the implications for practitioners?: Understanding the connections between aged-care home characteristics, consumer and staff perceptions and clinical QIs is crucial in the meaningful interpretation of QI outcomes in context. With the recent introduction of the National Aged Care Quality Indicator Program, it is timely to review national policy, to gauge current quality of care and the measure of care quality in the sector, and to develop directions for possible research to inform and resolve debates regarding the potential influence and unplanned effects that such a program may have

Registered nurses psychophysiological stress and confidence during high-fidelity emergency simulation:Effects on performance

Introduction: Simulation has been used extensively to train students and health professionals in the assessment and early intervention of patients with acutely deteriorating conditions. These simulations evoke psychophysiological stress in learners which may affect performance. We examined the relationship between stress variables, confidence, and performance during repeated scenarios in clinically-based emergency simulations. Methods: Twenty-six registered nurses completed three simulation scenarios focussing on life-threatening clinical events in a single group pre-test/post-test study design. Trait anxiety was measured at baseline. Visual analogue ratings of anxiety and stress were measured before (‘pre’), recalled ‘during’, and immediately following (‘post’) each simulation scenario, with a self-rating of confidence completed after each simulation scenario. Heart rate was measured continuously throughout the simulation program. Participants self-rated their clinical performance prior to and following the simulation program (‘pre’ and ‘post’). Results: Participants’ trait anxiety was not elevated at baseline (mean: 39.6, SD 6.1). Across the three simulation scenarios, anxiety and stress was elevated ‘during’ simulation compared to ‘pre’ and ‘post’ time points. However, the magnitude of elevation of stress and anxiety during all time points (‘pre’, ‘during’ and ‘post’ simulation) decreased significantly (p Discussion: We observed temporal-dependent changes in psychophysiological stress variables across the simulation scenarios, with decreased magnitudes of elevations of psychological (self-reported anxiety and stress) and physiological (heart rate) stress variables during successive simulation scenarios. This study has shown that simulation increased stress, especially before and during scenarios; however, the learning effect decreased the magnitude of the stress response with repeated simulation scenarios. Simulation educators need to create simulations that change stress in a purposeful manner to enhance learning.</p

Triggering of Acute Coronary Occlusion by Episodes of Vigorous Physical Exertion

© 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) Background: There is increasing recognition that heavy exertion can occasionally trigger an acute myocardial infarction (MI), although some uncertainties exist regarding the link. The primary aim of this study was to compare the relative risk (RR) of MI following vigorous exertion between those with confirmed coronary occlusion and those with a non-occluded culprit artery on acute angiography. Secondary aims were to determine if the risk of coronary occlusion is modified by the type of exercise (dynamic or isometric resistance), the frequency of regular exertion or whether the exertion was emotionally charged. Methods: Seven hundred sixty-two (762) participants with MI (410 with coronary occlusion TIMI 0,1), and 352 (46%) with a non-occluded culprit artery (TIMI 2,3) completed a questionnaire within 4 days of admission, detailing episodes of physical exertion in the 28 hours prior to symptom onset and the usual frequency of such exertion. Exertion exposures within 1 hour prior to symptom onset were compared to subjects’ usual yearly exposure, with case-crossover methodology. Results: The RR of symptom onset following heavy physical exertion level ≥6 (exertion scale 1–8), was higher in those with TIMI 0,1 compared to those with TIMI 2,3 flow (RR 6.30, 95% CI 4.70–8.50 vs 3.93, 2.89–5.30). The increased risk of coronary occlusion following vigorous exertion was observed following both dynamic exertion and isometric resistance, and did not differ between exertion types. The highest risk of coronary occlusion following exertion was observed in those who were sedentary (regular vigorous exertion 4 days weekly), the RR of symptom onset during exertion was significantly lower, RR 2.3 (95% CI 1.5–3.6). There was no significant difference in relative risk based on whether the exertion was reported as emotionally charged. Conclusions: The relative risk that heavy exertion will trigger a non-fatal MI with an occluded artery is greater than for a non-occluded culprit artery. Both dynamic and isometric exertion increase the relative risk of event, while exposure to regular vigorous exertion reduces the relative risk