Females overweight and osteoarthritis : a complex puzzle

Every year many people consult their general practitioner (GP) for complaints related to the musculoskeletal system. Osteoarthritis (OA) is a common progressive joint disease causing pain and disability. This disorder is frequently experienced by middle-aged and older people [1] and generally affects hips, knees and hands. GPs are most often consulted for complaints of the hip and knee joint, with knee joint twice as often as the hip. In middle-aged and elderly people joint complaints are often thought to be caused by OA. With the increase in life expectancy and in the prevalence of obesity (both major risk factors for OA), the prevalence of OA will probably continue to rise [2, 3], as will the associated costs and burden for society. OA is a disease that affects the whole joint. Not only cartilage degenerates, but also subchondral bone thickens, osteophytes grow and the synovial membrane gets inflamed. All of these symptoms are associated with laxity and decreased muscle strength [4]. Current OA treatment is mainly symptom driven, since no cure is available. Pharmacological treatments commonly used for OA management are often outweighed by their undesired side-effects [5]. Also, disease modification is not yet possible because no effective treatments are currently available. Studies on disease-modifying interventions have had variable results. One problem with such interventions is that they are tested in populations already showing signs of clinically manifest OA. Treatment with disease-modifying interventions (such as losing weight, exercise therapy or early suppression of pain with medication) might be more effective in an earlier stage of the disease, i.e. in a pre-clinical stage. However, this possibility still needs to be investigated and confirmed in stages of the disea

The green game: investigating golf management practices

Published ArticleWorldwide, golf is the largest sports-related travel market segment showing tremendous economic growth. Unfortunately, tourism and the so-called ‘green game’ contribute to environmental damage. Golf tourism is a rapidly expanding special interest activity linked to tourism. With a degraded physical environment, a destination may be in danger of losing its original appeal, which may force ‘nature-based’ tourists to move on to other destinations. The private sector, governments and the environment will benefit from responsible and sustainable practices including the management of golf courses. This will ensure that destinations continue to attract tourists for future generations. Therefore, green golf tourism is the only logical option placing the responsibility on golf course management to take a second look at the nature of this game. The study focused on the effects that golf course management might have on the environment and the adaptation methods implemented to reduce environmental damage. The management of George Golf Club and Pinnacle Point, located along the Garden Route, one of South Africa’s prime attractions were included in the study. Results indicated that management did not specifically monitor the impact of the golf course on the environment and did not educate golf tourists about environmental friendly practices on golf courses. Little was also done to motivate golf tourists to demand environmental friendly golf courses

Destination South Africa: Analysis of Destination Awareness and Image by International Visitors

Published ArticleInternational tourism is vital to South Africa’s economy and tourism industry. It accounts for 48% of the country’s tourism volume and 3% of GDP. It is important to establish the image that international visitors have of South Africa to safeguard the performance efficacy of the country’s tourism industry. This study shows the efforts that South Africa have made to build a Nation Brand and describes the impact it’s had on the perceptions of international visitors. The study population was international visitors to South Africa. Questionnaires were used to interview departing passengers at OR Tambo International Airport. Results indicated that the overall attractiveness of South Africa was positive. A majority indicated that they will return to South Africa

Empathy and associated influencing factors in occupational therapy students: A cross-sectional study

INTRODUCTION: Empathy, often described as the comprehension of another person's state of mind, enables one to appreciate social environments and anticipate others' behaviour. In occupational therapy, the therapeutic use of self, which is grounded in empathy, is commonly considered essential, as it enables therapists to manage a therapeutic relationship with clients. However, high caseloads, stressors and pressure to perform often impact empathy levels. This study aimed to determine the empathy levels of undergraduate occupational therapy students, as well as factors affecting empathy levels METHOD: A quantitative approach was used, with an observational, cross-sectional study methodology, employing an electronic survey consisting of the Interpersonal Reactivity Index (IRI) and a questionnaire developed by the researchers RESULTS: In total, 112 (response rate 70.4%) students participated in the study. Overall, the students had a satisfactory level of empathy. Of concern, however, was the impact of the Covid-19 pandemic and the lack of clinical fieldwork experience, which possibly contributed to the lower empathy levels observed among second-and third-year students CONCLUSION: From the findings, it is suggested that more attention should be given to empathy, as it plays an integral role in practice with clients, as well as in the training of occupational therapy students Implications for practice The findings suggest the opportunity for interventions and support systems that can help students manage high caseloads, stressors, and performance pressures, while also fostering and maintaining empathy. Implementing strategies such as stress management programs, mindfulness training, and self-care initiatives can help mitigate the negative impact on empathy levels and promote the development of empathetic skills in future occupational therapists. The research study's results have implications for the professional practice of occupational therapy. It emphasizes the need for ongoing education and training programs that focus on empathy development and maintenance throughout a therapist's career. By providing therapists with the tools, resources, and support to sustain their empathy levels in challenging work environments, the study suggests that the quality of care provided to clients can be enhanced, leading to better therapeutic outcomes and overall client satisfaction. Organizational changes within healthcare settings may be necessary to address workload issues and create a supportive environment that nurtures empathy among occupational therapy professionals

Subclinical cardiac dysfunction in obesity patients is linked to autonomic dysfunction:findings from the CARDIOBESE study

AIMS: Obesity doubles the lifetime risk of developing heart failure. Current knowledge on the role of obesity in causing cardiac dysfunction is insufficient for optimal risk stratification. The aim of this study was first to estimate the prevalence of subclinical cardiac dysfunction in obesity patients and second to investigate the underlying pathophysiology. METHODS AND RESULTS: The CARDIOBESE study is a cross-sectional multicentre study of 100 obesity patients [body mass index (BMI) ≥ 35 kg/m2 ] without known cardiovascular disease and 50 age-matched and gender-matched non-obese controls (BMI ≤ 30 kg/m2 ). Echocardiography was performed, blood samples were collected, and a Holter monitor was affixed. Fifty-nine obesity patients [48 (42-50) years, 70% female] showed subclinical cardiac dysfunction: 57 patients had decreased global longitudinal strain (GLS), and two patients with normal GLS had either diastolic dysfunction or increased brain natriuretic peptide (BNP). Only one non-obese control had diastolic dysfunction, and none had another sign of cardiac dysfunction. Multivariable logistic analysis identified male gender and standard deviation of all NN intervals (SDNN) index, which is a measure of autonomic dysfunction, as independent significant risk factors for subclinical cardiac dysfunction in obesity patients. CONCLUSIONS: There was a high prevalence (61%) of subclinical cardiac dysfunction in obesity patients without known cardiovascular disease, which appeared to be best identified by GLS. Subclinical cardiac dysfunction in obesity was linked to autonomic dysfunction and male gender, and not to the presence of traditional cardiac risk factors, increased C-reactive protein, increased BNP, increased high-sensitivity troponin I, or increased left ventricular mass

Subclinical cardiac dysfunction in obesity patients is linked to autonomic dysfunction: findings from the CARDIOBESE study

Aims: Obesity doubles the lifetime risk of developing heart failure. Current knowledge on the role of obesity in causing cardiac dysfunction is insufficient for optimal risk stratification. The aim of this study was first to estimate the prevalence of subclinical cardiac dysfunction in obesity patients and second to investigate the underlying pathophysiology. Methods and results: The CARDIOBESE study is a cross-sectional multicentre study of 100 obesity patients [body mass index (BMI) ≥ 35 kg/m2] without known cardiovascular disease and 50 age-matched and gender-matched non-obese controls (BMI ≤ 30 kg/m2). Echocardiography was performed, blood samples were collected, and a Holter monitor was affixed. Fifty-nine obesity patients [48 (42–50) years, 70% female] showed subclinical cardiac dysfunction: 57 patients had decreased global longitudinal strain (GLS), and two patients with normal GLS had either diastolic dysfunction or increased brain natriuretic peptide (BNP). Only one non-obese control had diastolic dysfunction, and none had another sign of cardiac dysfunction. Multivariable logistic analysis identified male gender and standard deviation of all NN intervals (SDNN) index, which is a measure of autonomic dysfunction, as independent significant risk factors for subclinical cardiac dysfunction in obesity patients. Conclusions: There was a high prevalence (61%) of subclinical cardiac dysfunction in obesity patients without known cardiovascular disease, which appeared to be best identified by GLS. Subclinical cardiac dysfunction in obesity was linked to autonomic dysfunction and male gender, and not to the presence of traditional cardiac risk factors, increased C-reactive protein, increased BNP, increased high-sensitivity troponin I, or increased left ventricular mass

Cross-sectional and prospective follow-up study to detect early signs of cardiac dysfunction in obesity: Protocol of the CARDIOBESE study

Introduction In view of the increasing occurrence of both obesity and heart failure, a growing overlap of these two clinical entities in the near future is expected. Significant advances in our understanding of the pathophysiological consequences of obesity for the cardiovascular system have been made over the past two decades. However, to optimise management and treatment of obesity patients, further research is required to improve early identification of cardiac dysfunction in obesity and to gain insight in the underlying pathophysiology. The CARdiac Dysfunction In OBesity - Early Signs Evaluation (CARDIOBESE) study has been designed to address these issues. Methods and analysis CARDIOBESE is a cross-sectional multicentre study of 100 obesity patients scheduled for bariatric surgery (body mass index (BMI) ≥35 kg/m 2) without known cardiovascular disease, and 50 age-matched and gender-matched non-obese controls (BMI <30 kg/m 2). Echocardiography, blood and urine biomarkers and Holter monitoring will be used to identify parameters that are able to show cardiac dysfunction at a very early stage in obesity patients (primary objective). Furthermore, a prospective follow-up study of obesity patients before and 1 year after bariatric surgery will be done to gain insight in the pathophysiology of obesity causing cardiac dysfunction (secondary objective). Ethics and dissemination The study was approved by the Medical Ethics Committee Toetsingscommissie Wetenschappelijk Onderzoek Rotterdam e.o. (TWOR). Inclusion of patients and controls is almost complete. Analyses of the investigations are currently being performed, and dissemination through peer-reviewed publications and conference presentations is expected from the first quarter of 2019. By identifying early markers of cardiac dysfunction in obesity, and by understanding the underlying pathophysiology of the abnormalities of these markers, the CARDIOBESE study may provide guidance for risk stratification, monitoring and treatment strategies for obesity patients