Associations Between Heart Rate Variability and Metabolic Syndrome Risk Factors

Metabolic syndrome (MetS) is a clustering of risk factors for cardiovascular disease (CVD) and type 2 diabetes (T2D) – two major causes of morbidity and mortality worldwide. Heart rate variability (HRV) is a non-invasive measure of cardiac autonomic regulation that predicts mortality and morbidity. Additionally, HRV is reduced in CVD, T2D and MetS. As such, HRV has potential to be a novel cardiometabolic risk factor to be included in clinical risk assessment. Therefore, the purpose of this thesis was to examine the relationships between MetS and HRV. A systematic review of cross-sectional studies examining relationships between HRV and MetS was completed to consolidate existing evidence and to guide future studies. This was followed by a cross-sectional investigation of time and frequency domain and nonlinear HRV in a population with MetS risk factors to determine which MetS risk factors were associated with HRV parameters. A pilot study was then conducted to study the feasibility of conducting a mobile health (mHealth) and exercise intervention in a rural population, which was followed by a 24-week randomized clinical trial to examine the effects of the interactive mHealth exercise intervention compared to standard of care exercise in participants with MetS risk factors. Overall, HRV was reduced in women with MetS compared to those without, though there were no differences in men. Waist circumference and lipid profiles were most commonly related to HRV parameters when studied cross-sectionally. The changes in waist circumference and fasting plasma glucose were associated with the change in HRV parameters when studied longitudinally. Following the intervention period, waist circumference and blood pressure were improved with no other changes in MetS risk factors. HRV parameters indicative of vagal activity were reduced over the intervention period, but there were no changes in other HRV parameters. There were no differences in changes between the intervention and control groups. In conclusion, MetS and HRV are associated in women but not men. However, there were no clear associations between MetS and HRV to suggest that HRV would be a valuable clinical risk factor

Public Health Guidelines for Physical Activity: Is There an App for That? A Review of Android and Apple App Stores

BACKGROUND: Physical activity participation is an important behavior for modifying lifestyle-related disease risk. Mobile health apps for chronic disease management and prevention are being developed at a rapid rate. However, it is unclear whether these apps are evidence-based. Current public health recommendations for physical activity participation for adults highlight the importance of engaging in 150 minutes weekly of purposeful exercise, and muscle strengthening activities on at least 2 days of the week. OBJECTIVE: The aims of the present review were to (1) identify available evidence-based physical activity apps, and (2) identify technological features that could be leveraged to improve health outcomes. METHODS: iTunes and Google Play mobile app stores were searched using keyword and category searching during a single day (February 18, 2014) for physical activity apps available in English. The description pages of eligible apps were reviewed by 4 independent reviewers for evidence-based content, technological, and descriptive features. An a priori subset of apps was downloaded for further review (n=6 affiliated with a non-commercial agency; n=10 top rated; n=10 random selection), and developers were contacted for information regarding evidence-informed content. RESULTS: The initial search yielded 2400 apps, of which 379 apps (n=206 iTunes; n=173 Google Play) were eligible. Primary results demonstrated no apps (n=0) adhering to evidence-based guidelines for aerobic physical activity, and 7 out of 379 implementing evidence-based guidelines for resistance training physical activity. Technological features of apps included social networking (n=207), pairing with a peripheral health device (n=61), and measuring additional health parameters (n=139). Secondary results revealed 1 app that referenced physical activity guidelines (150 minutes/weekly of exercise), and demonstrated that apps were based on various physical activity reports (n=4) or personal expertise (n=2). CONCLUSIONS: The present study demonstrated a shortage of evidence-based physical activity apps. This gap underscores the need for development of evidence-informed mobile apps. Results highlight the opportunity to develop evidence-informed mobile apps that can be used clinically to enhance health outcomes

Circus-specific extension of the International Olympic Committee consensus statement: Methods for recording and reporting of epidemiological data on injury and illness in sport 2020

Indepth knowledge of injury and illness epidemiology in circus arts is lacking. Comparing results across studies is difficult due to inconsistent methods and definitions. In 2020, the International Olympic Committee (IOC) consensus group proposed a standard method for recording and reporting epidemiological data on injuries and illnesses in sports and stated that sport-specific extension statements are needed to capture the context of each sport. This is the circus-specific extension to be used with the IOC consensus statement. International circus arts researchers in injury and illness epidemiology and performing arts medicine formed a consensus working group. Consensus statement development included a review of literature, creation of an initial draft by the working group, feedback from external reviewers, integration of feedback into the second draft and a consensus on the final document. This consensus statement contains circus-specific information on (1) injury definitions and characteristics; (2) measures of severity and exposure, with recommendations for calculating the incidence and prevalence; (3) a healthcare practitioner report form; (4) a self-report form capturing health complaints with training and performance exposure; and (5) a demographic, health history and circus experience intake questionnaire. This guideline facilitates comparing results across studies and enables combining data sets on injuries in circus arts. This guideline informs circus-specific injury prevention, rehabilitation, and risk management to improve the performance and health of circus artists

GWAS meta-analysis of intrahepatic cholestasis of pregnancy implicates multiple hepatic genes and regulatory elements

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder affecting 0.5–2% of pregnancies. The majority of cases present in the third trimester with pruritus, elevated serum bile acids and abnormal serum liver tests. ICP is associated with an increased risk of adverse outcomes, including spontaneous preterm birth and stillbirth. Whilst rare mutations affecting hepatobiliary transporters contribute to the aetiology of ICP, the role of common genetic variation in ICP has not been systematically characterised to date. Here, we perform genome-wide association studies (GWAS) and meta-analyses for ICP across three studies including 1138 cases and 153,642 controls. Eleven loci achieve genome-wide significance and have been further investigated and fine-mapped using functional genomics approaches. Our results pinpoint common sequence variation in liver-enriched genes and liver-specific cis-regulatory elements as contributing mechanisms to ICP susceptibility

Psychiatric and Behavioral Complications of GPi DBS in an Adolescent with Myoclonus Dystonia

Myoclonus dystonia is a rare movement disorder that often causes significant disability. Deep brain stimulation of the internal pallidum (GPi DBS) is a recommended treatment for those who do not respond to pharmacotherapy or who have intolerable side effects. This paper reports on the case of a 17-year-old male who was admitted to a tertiary level mental healthcare facility for treatment of psychiatric and behavioral symptoms thought to be related to GPi DBS. Prior to GPi DBS insertion, the patient was diagnosed with anxiety and mild obsessive compulsive disorder (OCD). Following insertion, his OCD became severe and he developed depression, Tourette syndrome, and stuttering. His first admission to a psychiatric unit was for management of a manic episode following treatment for depression with fluoxetine, and he began to exhibit severe aggressive behavior. GPi DBS was turned off, but there were neither changes in dystonic movements nor improvement in aggressive behavior or psychiatric symptoms, though stuttering improved. The patient was transferred to a secure treatment centre where he was able to gain control over his behaviors with intense dialectical behavior therapy, but the aggressive behavior and safety concerns continue to persist today.Peer Reviewe

Untangling risk factors including discipline-specific exposure for injuries in preprofessional and professional circus artists in the USA

Objective This prospective cohort study quantified injury patterns related to specific circus discipline exposure in preprofessional and professional circus artists.Methods Circus artists (n=201; ages 13–69; 172 female, 29 male assigned sex at birth) were enrolled in 10 cities across the USA. Participants were followed for 1 year from enrolment, completing a weekly training log and undergoing a physical therapist evaluation for injuries. The circus-specific extension of the International Olympic Committee 2020 consensus on recording injury and illness in sports was used to analyse injury patterns.Results The study completion rate was 77% (n=155). Data were analysed by participant subgroup (age, professional status, sex at birth). The highest injury rates in participant subgroups were for males (5.69/1000 exposures) and related to discipline subgroups, were in aerial with ground elements (5.93/1000 exposures) and aerial (4.26/1000 exposures). Adults had more injuries related to aerial, whereas adolescents had more related to ground disciplines (χ2 (2)=10.62, p=0.005) and non-time loss injuries (χ2 (1)=5.45, p=0.02). Females had a higher proportion of repetitive injuries (70% vs 55%) than males (χ2 (1) = 4.43, p=0.035). Individuals with an eating disorder history had more (p<0.004) injuries (mean 2.27±2.29) than those without (mean=1.48±0.96).Conclusions This study showed that intrinsic factors (age, sex at birth and history of eating disorder) and extrinsic factors (circus discipline exposure) affect injury risk. We need to account for the intersectionality of these factors to address risk management at an individual and group level

Diabetes and Technology for Increased Activity (DaTA Study): The effects of exercise and technology on heart rate variability and metabolic syndrome risk factors.

This study tested the hypothesis that an eight-week exercise intervention supported by mobile health (mHealth) technology would improve metabolic syndrome (MetS) risk factors and heart rate variability (HRV) in a population with MetS risk factors. Participants (n=12; 3 male; aged 56.9±7.0y) reported to the laboratory for assessment of MetS risk factors and fitness (VO2max) at baseline (V0) and after eight-weeks (V2) of intervention. Participants received an individualized exercise prescription and a mHealth technology kit for remote monitoring of blood pressure (BP), blood glucose, physical activity and body weight via smartphone. Participants underwent 24-h ambulatory monitoring of R-R intervals following V0 and V2. Low and high frequency powers of HRV were assessed from the recording and the ratio of low-to-high frequency powers and low and high frequency power in normalized units were calculated. One-way repeated measures analysis of variance showed that waist circumference (V0: 113.1±11.0cm, V2: 108.1±14.7cm; p=0.004) and diastolic BP (V0: 81±6mmHg, V2: 76±11mmHg; p=0.04) were reduced and VO2max increased (V0: 31.3ml/kg/min, V2: 34.8ml/kg/min; p=0.02) with no changes in other MetS risk factors. Low and high frequency powers in normalized units were reduced (V0: 75.5±12.0, V2: 72.0±12.1; p=0.03) and increased (V0: 24.5±12.0, V2: 28.0±12.1; p=0.03), respectively, with no other changes in HRV. Over the intervention period, changes in systolic BP were correlated negatively with the changes in R-R interval (r=-0.600; p=0.04) and positively with the changes in heart rate (r=0.611; p=0.03), with no other associations between MetS risk factors and HRV parameters. Thus, this eight-week mHealth supported exercise intervention improved MetS risk factors and HRV parameters, but only changes in systolic BP were associated with improved autonomic function

Implementation of a clinical practice guideline for schizophrenia in a specialist mental health center: an observational study

Abstract Background In mental health settings, implementation of and adherence to clinical practice guidelines (CPGs) is low. Strategies are needed to overcome barriers and facilitate successful implementation of CPGs into standard care. The goals of this study were to develop a framework for the implementation of a CPG for schizophrenia for hospitalized service users in a mental health care facility, and to monitor adherence to the guideline. Methods An eight-step framework was developed based on project management principles: 1) the Appraisal Guideline for Research and Evaluation (AGREE) tool was used to rate and select a CPG; 2) an algorithm was created from the guideline; 3) a gap analysis identified clinical services and processes not conforming with the CPG recommendations; 4) a governance structure was created; 5) a modified Delphi process determined key outcome and process adherence metrics; 6) a project charter was developed; 7) clinical informatics ensured that systems and tools were in place to support the CPG; and 8) therapeutic services were realigned to match the requirements of the CPG within specified fiscal constraints. Percent adherence to the identified process adherence metrics was calculated before (March 2014) and for 12 months after implementation (April 2014-March 2015). Results The National Institute of Health and Care Excellence guideline scored highest on AGREE and was used to develop the algorithm. Cognitive behavior therapy for psychosis (CBT-P), art therapy and carer assessments were identified as gaps in care. Clinical global impression – Schizophrenia score was identified as the primary service user outcome variable and antipsychotic polypharmacy, metabolic monitoring, CBT-P referral and supported employment/vocational services referral as the primary process adherence measures. Adherence to guidance for metabolic monitoring (March 2014, 76.7 %; March 2015, 81.6 %), CBT-P referral (March 2014, 6.5 %; March 2015, 11.4 %) and vocational rehabilitation referral (March 2014, 36.6 %; March 2015, 49.1 %) were increased after CPG implementation. There was an initial increase in adherence to antipsychotic monotherapy (March 2014, 53.4 %; November 2014, 62.7 %), which decreased back toward baseline (March 2015, 55.1 %). Conclusions The eight-step framework was used to implement a CPG process, though further quality improvements initiatives may be needed to improve adherence