Characterising the application of the “progressive overload” principle of exercise training within cardiac rehabilitation: A United Kingdom-based community programme

Background: Recent concerns have cast doubt over the effectiveness of cardiac rehabilitation [CR] programmes for improving cardiorespiratory fitness [CRF] in patients with a history of cardiac disease in the United Kingdom [UK]. We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies. Design: Observational study. Methods: We evaluated a community-based Phase III CR programme in the UK. During each training session, patients wore an Apple Watch and the weekly progression of exercise training dose/load was quantified. The analysis was based on 332 individual training sessions. Exercise intensity [% heart rate reserve] during the cardiovascular [CV] exercise training component [%HRR-CV], CV training duration; estimated changes in cardiorespiratory fitness [change in estimated metabolic equivalents (METs)]; session rating of perceived exertion [sRPE], sRPE training load [sRPE-TL], and exercise training impulse [TRIMP] were evaluated. Results: Thirty cardiac patients [83% male; age [SD] 67.0 [10.0] years; body mass index [SD] 28.3 [4.6] kg∙m-2] were recruited to an 8-week programme [16 sessions in total]. Bayesian repeated-measures ANOVA indicated anecdotal evidence for the alternative hypothesis for changes in %HRR-CV (BF10 = 0.61), sRPE (BF10 = 1.1), and change in estimated METs (BF10 = 1.2) during CR. Conversely, Bayesian repeated-measures ANOVA showed extreme evidence for changes in CV training duration (BF10 = 2.438e+26), TRIMP (BF10 = 71436), and sRPE-TL (BF10 = 779570). Conclusion: The key exercise training principle of progressive overload was only partially applied. Increases observed in exercise dose were due to increases in the duration of CV training, rather than combined with increases in exercise intensity [%HRR-CV and sRPE]. Accordingly, allied health professionals must ensure that exercise intensity is more consistently progressed to optimise the exercise stimulus and improvements in CRF and patient outcomes

Effect of Exercise Interventions on Health-Related Quality of Life After Stroke and Transient Ischemic Attack: A Systematic Review and Meta-Analysis

Exercise interventions have been shown to help physical fitness, walking and balance after stroke, but data is lacking on whether such interventions lead to improvements in health-related quality of life (HRQoL). In this systematic review and meta-analysis, thirty randomised controlled trials (n=1,836 patients) were found from PubMed, OVID MEDLINE, Web of Science, CINAHL, SCOPUS, The Cochrane Library and TRIP databases when searched from 1966 to Feb 2020, that examine the effects of exercise interventions on HRQoL after strokem or transient ischaemic attack (TIA). Exercise interventions resulted in small to moderate beneficial effects on HRQoL at intervention end (standardised mean difference (SMD) -0.23; 95% CI -0.40 to -0.07) that appeared to diminish at longer term follow up (SMD -0.11; 95%CI -0.26 to 0.04). Exercise was associated with moderate improvements in physical health (SMD -0.33; 95% CI -0.61 to -0.04) and mental health (SMD -0.29; 95% CI -0.49 to -0.09) domains of HRQoL while effects on social or cognitive composites showed little difference. Interventions that were initiated within 6 months, lasted at least 12 weeks in duration, involved at least 150 minutes per week, and included resistance training appeared most effective. Exercise can lead to moderate beneficial effects on HRQoL and should be considered an integral part of stroke rehabilitatio

Public Health Emergency of International Concern (PHEIC) has Declared Twice in 2014; Polio and Ebola at the Top

Background: The current Ebola outbreak in West Africa and the large scale wild Polio virus outbreak in several countries are the top most issues among international public health and scientific communities' debates and concerns. These two outbreaks were judged to be declared as Public Health Emergency of International Concern (PHEIC) during 2014. This is the first time ever to have such circumstance of two PHEICs at the same time. Discussion: PHEIC, which has to be declared by WHO Director General after a recommendation of IHR Emergency Committee; is observed to start in countries with fragile health system and conflict areas. Then it rapidly spread to threaten the global public health. The year 2014 has uniquely witnessed declaration of two events as PHEIC according to IHR (2005); Polio and Ebola Virus Disease (EVD). Both outbreaks are caused by viruses such as H1N1 which was previously declared as PHEIC in 2009. Summary: Public Health Emergencies of International Concern in 2014 occurred in countries with weak health systems and conflicts and threatening the whole globe. International collaborative work is required to contain the event and to mobilize resources/capacities between countries. Moreover, public health surveillance systems as core capacity for IHR (2005) should be strengthened in all countries with focus on those with limited capacity and ongoing conflicts. The ultimate aim is timely detection of potential PHEIC events in the future along with early preparedness and response plans

Antibiotic resistance among patients with urinary tract infections in Kandahar, Afghanistan

Background: Antimicrobial resistance is a global public health threat. Highest burden of resistance is reported from low- and middle-income countries. Objectives: To investigate and report the current scenario of increased antibiotic resistance of uropathogens among symptomatic urinary tract infection patients in Kandahar, Afghanistan. Methods: From January 2018 to December 2021, this retrospective study was carried out at two main hospitals in Kandahar City, Afghanistan. Here, culture and sensitivity profiles of uropathogens were studied among symptomatic Bacteriuria in the presence of genitourinary symptoms (i.e., dysuria, suprapubic pain or tenderness, frequency, or urgency) (UTI) patients. Results: Among urine samples of 1589 patients, 1047 (65.9%) were culture positive and included in this study. Most of these patients (626/1047 [59.8%]) were females, with majority (818 [78.1%]) having age between 19 and 39 years. Gram-negative bacteria were the most prevalent (840/1047 [80.2%]), with E. coli (653/1047 [62.4%]) as the most common isolated uropathogen. Overall gram-negative bacteria had higher resistance against commonly used antibiotics of cotrimoxazole (62.8%), ciprofloxacin (56.0%), levofloxacin (47.5%), cefixime (44.5%), fosfomycin (41.5%), and even ceftriaxone (48.3%). Conclusions: Kandahar province has higher resistance rates against commonly used empirical antibiotics like norfloxacin, ciprofloxacin, levofloxacin, and cefixime. Nitrofurantoin should be used as the first-line antibiotic in treating UTI patients. Public health authorities should make strict regulations and policies to reduce irrational use, inappropriate prescription, and over-the-counter availability of antibiotics in Kandahar