An analysis of finger and hand injuries in children in a tertiary paediatric emergency department.

AIMS OF THE STUDY This study set out to examine the association between current subspecialty (paediatric and hand surgery) consultation practice for children with hand and finger injuries presenting to a tertiary paediatric emergency department and length of stay in the paediatric emergency department. Also, incidence and injury pattern of hand and finger injuries in this patient group were analysed. METHODS This was a retrospective cross-sectional study, which was undertaken as a clinical audit service. All patients under 17 years presenting to our paediatric emergency department with hand and finger injuries over a 17-month period were included in the analysis. We studied incidence and injury mechanism, current subspecialty referral practice, as well as paediatric emergency department and hospital length of stay. RESULTS We identified 929 children for inclusion in the analysis. The most frequent reasons for presentation were hand contusions (25.5%) and fractures (20.8%). Paediatric emergency medicine physicians alone managed 845 patients (90.6%), paediatric surgery referral occurred in 50 (5.4%) and hand surgery consultation in 37 (4.0%) cases. Mean length of stay in the paediatric emergency department was 154 min and significantly longer when subspecialty review occurred. Hospital admission occurred in 87 cases (9.3%). CONCLUSIONS Involvement of subspecialties in the care of hand and finger injuries was associated with significantly increased length of stay in the paediatric emergency department. We discuss obstacles and enablers for timely patient referral and management. We suggest the implementation of referral guidelines, tailored to the individual emergency department, to reduce unnecessary patient journey delays and to ensure higher quality repair of complex hand injuries by the appropriate surgeon, with better outcomes. Making use of the emergence of multiple surgical subspecialties for targeted treatment of paediatric finger and hand injuries might be desirable

Prolonged constant load cycling exercise is associated with reduced gross efficiency and increased muscle oxygen uptake

This study investigated the effects of prolonged constant load cycling exercise on cycling efficiency and local muscle oxygen uptake responses. Fourteen well-trained cyclists each completed a 2-h steady-state cycling bout at 60% of their maximal minute power output to assess changes in gross cycling efficiency (GE) and muscle oxygen uptake (mVO2) at time points 5, 30, 60, 90, and 120 min. Near-infrared spatially resolved spectroscopy (NIRS) was used to continually monitor tissue oxygenation of the Vastus Lateralis muscle, with arterial occlusions (OCC) applied to assess mVO2 . The half-recovery time of oxygenated hemoglobin (HbO2 ) was also assessed pre and post the 2-h cycling exercise by measuring the hyperemic response following a 5-min OCC. GE significantly declined during the 2-h cycling bout (18.4 ± 1.6 to 17.4 ± 1.4%; P < 0.01). Conversely, mVO2 increased, being significantly higher after 90 and 120 min than at min 5 (+0.04 mlO2 /min/100 g; P = 0.03). The half-recovery time for HbO2 was increased comparing pre and post the 2-h cycling exercise (+7.1 ± 19s), albeit not significantly (d: 0.48; P = 0.27). This study demonstrates that GE decreases during prolonged constant load cycling exercise and provides evidence of an increased mVO2 , suggestive of progressive mitochondrial or contractile inefficiency

Cardiovascular training improves fitness in patients with ankylosing spondylitis

Objective: Several studies suggest that patients with ankylosing spondylitis (AS) have an increased risk of cardiovascular disease. This study aimed to evaluate the effects of a 12-week individually heart rate-monitored, moderately intensive cardiovascular training on cardiovascular fitness and perceived disease activity in AS patients. Methods: Patients diagnosed with AS according to modified New York criteria were to either 'cardiovascular training' or 'attention control'. The training group performed three cardiovascular trainings per week. All participants attended one weekly usual care flexibility training. Attention control contained regular discussion groups on coping strategies. Adherence was self-monitored. Assessments were performed at baseline and after the intervention period of 3 months. Physical fitness was the primary endpoint, measured in watts using a submaximal bicycle test following the PWC75% protocol. All analyses controlled for gender, age, body mass index, baseline fitness and physical activity levels, and BASDAI. Results: Of 106 AS patients enrolled, 40% were women, mean age was 49 (SD +/-12) years. 76.5% of the training group reported exercising at least three times a week. At 3 month follow-up, fitness level in the training group was significantly higher than in the control group (90.32 (SD 4.52) vs.109.84 (SD 4.72) respectively, p=0.001), independent of other covariates. Average BASDAI total score was 0.31 points lower (p = 0.31) in the training group, reaching significance for the 'peripheral pain' subscore (1.19; p=0.01), but not for 'back pain' or 'fatigue'. Conclusions: Cardiovascular training, in addition to flexibility exercise, increased fitness in AS patients and reduced their peripheral pain

Association of Sedentary Time with Mortality Independent of Moderate to Vigorous Physical Activity

BACKGROUND: Sedentary behavior has emerged as a novel health risk factor independent of moderate to vigorous physical activity (MVPA). Previous studies have shown self-reported sedentary time to be associated with mortality; however, no studies have investigated the effect of objectively measured sedentary time on mortality independent of MVPA. The objective our study was to examine the association between objectively measured sedentary time and all-cause mortality. METHODS: 7-day accelerometry data of 1906 participants aged 50 and over from the U.S. nationally representative National Health and Nutrition Examination Survey (NHANES) 2003-2004 were analyzed. All-cause mortality was assessed from the date of examination through December 31, 2006. RESULTS: Over an average follow-up of 2.8 years, there were 145 deaths reported. In a model adjusted for sociodemographic factors, lifestyle factors, multiple morbidities, mobility limitation, and MVPA, participants in third quartile (hazard ratio (HR):4.05; 95%CI:1.55-10.60) and fourth quartile (HR:5.94; 95%CI: 2.49-14.15) of having higher percent sedentary time had a significantly increased risk of death compared to those in the lowest quartile. CONCLUSIONS: Our study suggests that sedentary behavior is a risk factor for mortality independent of MVPA. Further investigation, including studies with longer follow-up, is needed to address the health consequences of sedentary behavior

Even low level of physical activity is associated with reduced mortality among people with metabolic syndrome, a population based study (the HUNT 2 study, Norway)

<p>Abstract</p> <p>Background</p> <p>Low levels of physical activity may increase the risk of developing metabolic syndrome, a cluster of metabolic factors that are associated with the risk of premature death. It has been suggested that physical activity may reduce the impact of factors associated with metabolic syndrome, but it is not known whether physical activity may reduce mortality in people with metabolic syndrome.</p> <p>Methods</p> <p>In a prospective study of 50,339 people, 13,449 had metabolic syndrome at baseline and were followed up for ten years to assess cause-specific mortality. The population was divided into two age groups: those younger than 65 years of age and those older than age 65. Information on their physical activity levels was collected at baseline.</p> <p>Results</p> <p>Metabolic syndrome was associated with higher mortality from all causes (hazard ratio (HR) 1.35, 95% confidence interval (95% CI) 1.20 to 1.52) and from cardiovascular causes (HR 1.78, 95% CI 1.39 to 2.29) in people younger than 65 years old than among other populations. In older people, there was no overall association of metabolic syndrome with mortality. People with metabolic syndrome who reported high levels of physical activity at baseline were at a reduced risk of death from all causes compared to those who reported no physical activity, both in the younger age group (HR 0.52, 95% CI 0.37 to 0.73) and in the older age group (HR 0.59, 95% CI 0.47 to 0.74).</p> <p>Conclusion</p> <p>Among people with metabolic syndrome, physical activity was associated with reduced mortality from all causes and from cardiovascular causes. Compared to inactivity, even low levels of physical activity were associated with reduced mortality.</p

2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).

European Society of CardiologyThis is the author accepted manuscript. The final version is available from Oxford University Press via http://dx.doi.org/10.1093/eurheartj/ehw10

Combined Impact of Lifestyle-Related Factors on Total and Cause-Specific Mortality among Chinese Women: Prospective Cohort Study

Findings from the Shanghai Women's Health Study confirm those derived from other, principally Western, cohorts regarding the combined impact of lifestyle-related factors on mortality

Characteristics of control group participants who increased their physical activity in a cluster-randomized lifestyle intervention trial

<p>Abstract</p> <p>Background</p> <p>Meaningful improvement in physical activity among control group participants in lifestyle intervention trials is not an uncommon finding, and may be partly explained by participant characteristics. This study investigated which baseline demographic, health and behavioural characteristics were predictive of successful improvement in physical activity in usual care group participants recruited into a telephone-delivered physical activity and diet intervention trial, and descriptively compared these characteristics with those that were predictive of improvement among intervention group participants.</p> <p>Methods</p> <p>Data come from the Logan Healthy Living Program, a primary care-based, cluster-randomized controlled trial of a physical activity and diet intervention. Multivariable logistic regression models examined variables predictive of an improvement of at least 60 minutes per week of moderate-to-vigorous intensity physical activity among usual care (n = 166) and intervention group (n = 175) participants.</p> <p>Results</p> <p>Baseline variables predictive of a meaningful change in physical activity were different for the usual care and intervention groups. Being retired and completing secondary school (but no further education) were predictive of physical activity improvement for usual care group participants, whereas only baseline level of physical activity was predictive of improvement for intervention group participants. Higher body mass index and being unmarried may also be predictors of physical activity improvement for usual care participants.</p> <p>Conclusion</p> <p>This is the first study to examine differences in predictors of physical activity improvement between intervention group and control group participants enrolled in a physical activity intervention trial. While further empirical research is necessary to confirm findings, results suggest that participants with certain socio-demographic characteristics may respond favourably to minimal intensity interventions akin to the treatment delivered to participants in a usual care group. In future physical activity intervention trials, it may be possible to screen participants for baseline characteristics in order to target minimal-intensity interventions to those most likely to benefit. (Australian Clinical Trials Registry, <url>http://www.anzctr.org.au/default.aspx</url>, ACTRN012607000195459)</p