The Duke treadmill score with bicycle ergometer : Exercise capacity is the most important predictor of cardiovascular mortality

BackgroundThe Duke treadmill score, a widely used treadmill testing tool, is a weighted index combining exercise time or capacity, maximum ST-segment deviation and exercise-induced angina. No previous studies have investigated whether the Duke treadmill score and its individual components based on bicycle exercise testing predict cardiovascular death.DesignTwo populations with a standard bicycle testing were used: 3936 patients referred for exercise testing (2371 men, age 56?±?13 years) from the Finnish Cardiovascular Study (FINCAVAS) and a population-based sample of 2683 men (age 53?±?5.1 years) from the Kuopio Ischaemic Heart Disease study (KIHD).MethodsCox regression was applied for risk prediction with cardiovascular mortality as the primary endpoint.ResultsIn FINCAVAS, during a median 6.3-year (interquartile range (IQR) 4.5?8.2) follow-up period, 180 patients (4.6%) experienced cardiovascular mortality. In KIHD, 562 patients (21.0%) died from cardiovascular causes during the median follow-up of 24.1 (IQR 18.0?26.2) years. The Duke treadmill score was associated with cardiovascular mortality in both populations (FINCAVAS, adjusted hazard ratio (HR) 3.15 for highest vs. lowest Duke treadmill score tertile, 95% confidence interval (CI) 1.83?5.42, P?Peer reviewe

Post-Exercise Assessment of Cardiac Repolarization Alternans in Patients With Coronary Artery Disease Using the Modified Moving Average Method

ObjectivesWe sought to evaluate the utility of T-wave alternans (TWA) assessment in the immediate post-exercise period to identify and validate cutpoints for the modified moving average (MMA) assessment method.BackgroundThe presence of TWA is associated with an increased risk of cardiovascular death (CVD). The immediate post-exercise period, where increased physiologic stress and minimal surface artifact coexist, appears ideal to implement the MMA method.MethodsA test (n = 322) and validation cohort (n = 681) provided 1,003 patients with coronary artery disease (CAD). We assessed TWA immediately after exercise. The outcomes, CVD and mortality, were adjudicated independent of the TWA results.ResultsDuring 48 months of follow-up 85 deaths, 54 categorized as CVD (64%), were observed. A linear relationship between the magnitude of TWA and the risk of CVD was identified. As a continuous measure TWA voltage was equivalent to ejection fraction in predicting the risk of CVD. To facilitate clinical application, a sensitive, modest predictive accuracy (20 μV) and a specific, greater predictive accuracy MMA cutpoint (60 μV) were identified and validated. Each cutpoint was associated with a 2.5-fold greater risk of CVD, independent of other important variables, including ejection fraction.ConclusionsPost-exercise assessment of TWA using the MMA method is a strong, independent predictor of risk in patients with CAD. The 20-μV cutpoint (87% sensitivity) appears to be most suitable in higher-risk patients, whereas the 60-μV cutpoint (95% specificity) appears more appropriate when TWA is used as a single screening test in those at lower risk. (Assessment of Noninvasive Methods to Identify Patients at Risk of Serious Arrhythmias After a Heart Attack; NCT00399503

Effect of heart rate correction on pre- and post-exercise heart rate variability to predict risk of mortality - an experimental study on the FINCAVAS cohort

Peer reviewe

Threatened habitat types in Finland 2018: the Baltic Sea. Red List of habitats. Part 2: Descriptions of habitat types

This report is a partial translation of the final report in Finnish on threatened habitat types (Threatened habitat types in Finland 2018, Part II: Descriptions of habitat types, The Finnish Environment 5/2018) that presents a total of 420 habitat types. This report includes all the evaluated habitat types of the Baltic Sea, as well as six new marine habitat types, which were described but not yet evaluated (NE). Also included are habitat types regarded as of least concern (LC) and those with deficient data (DD). For each habitat type a description, distribution map, photo, and the reasoning behind the assessment result are presented. The descriptions of the habitat types include their characteristics, geographical variation, connectivity to other habitat types, occurrence in Finland, reasons for being threatened and future threats, trend in the state of the habitat type, correspondence of the habitats type with habitat types covered by statutory protection, and whether the habitat type is one for which Finland has an international responsibility. Part I of the final report (in Finnish Suomen luontotyyppien uhanalaisuus 2018, SY 5/2018 and in English Threatened Habitat Types in Finland 2018, FE 2/2019) presents the assessment method for threatened habitat types, results and reasoning of the assessment, and proposals for measures prepared by the experts groups. In the whole country 186 habitats types were assessed as threatened (48% of the number of habitats types). The share of threatened habitat types is much larger in southern Finland (59%) than in northern Finland (32%). The assessment was conducted by broadly-based expert groups in 2016–2018. This was the second assessment of threatened habitat types in Finland. This assessment was conducted using the international IUCN Red List of Ecosystems method. Because of the new assessment method, the results of the first and second assessment of threatened habitat types are not directly comparable with each other. The conclusion that can be made, however, is that the decline and degradation of habitats has not diminished

The Finnish Cardiovascular Study (FINCAVAS): characterising patients with high risk of cardiovascular morbidity and mortality

BACKGROUND: The purpose of the Finnish Cardiovascular Study (FINCAVAS) is to construct a risk profile – using genetic, haemodynamic and electrocardiographic (ECG) markers – of individuals at high risk of cardiovascular diseases, events and deaths. METHODS AND DESIGN: All patients scheduled for an exercise stress test at Tampere University Hospital and willing to participate have been and will be recruited between October 2001 and December 2007. The final number of participants is estimated to reach 5,000. Technically successful data on exercise tests using a bicycle ergometer have been collected of 2,212 patients (1,400 men and 812 women) by the end of 2004. In addition to repeated measurement of heart rate and blood pressure, digital high-resolution ECG at 500 Hz is recorded continuously during the entire exercise test, including the resting and recovery phases. About 20% of the patients are examined with coronary angiography. Genetic variations known or suspected to alter cardiovascular function or pathophysiology are analysed to elucidate the effects and interactions of these candidate genes, exercise and commonly used cardiovascular medications. DISCUSSION: FINCAVAS compiles an extensive set of data on patient history, genetic variation, cardiovascular parameters, ECG markers as well as follow-up data on clinical events, hospitalisations and deaths. The data enables the development of new diagnostic and prognostic tools as well as assessments of the importance of existing markers

Terapeuttisen harjoittelun tarpeen tunnistaminen epäspesifin alaselkäkipuasiakkaan osteopaattisen hoidon tukena

Tämän opinnäytetyön tarkoitus on auttaa osteopaatteja tunnistamaan, millä menetelmillä epäspesifin alaselkäkipuasiakkaan (non-specific low back pain) harjoittelun tarve tunnistetaan ja mitä harjoitteita ohjataan. Työn teoreettista taustaa kuvataan keskeisien käsitteiden pohjalta ja työ on pyritty sitomaan jo olemassa olevaan kirjallisuuteen. Opinnäytetyön aiheena on terapeuttisen harjoittelun tarpeen tunnistaminen epäspesifin alaselkäkipuasiakkaan osteopaattisen hoidon tukena. Tutkimusmenetelmäksi valikoitui integroiva kirjallisuuskatsaus, sillä se sallii laajan lähestymisnäkökulman työn tutkimuskysymyksiin. Tulosten mukaan liikekontrolliharjoitteilla on saatu parhaita tuloksia alaselkäkivun hoidossa. Opinnäytetyön tuotokseksi rakentui opas terapeuttisen harjoittelun tarpeen tunnistamisesta ja sen ohjeistuksesta epäspesifisen alaselkäkivun hoitoon. Tuloksissa nousi esiin lukuisia liikekontrollitestejä lannerangan hallitsemattoman liikkeen, ja sitä kautta epäspesifin alaselkäkivun tunnistamiseksi. Liikekontrollitestejä suoritetaan seisten, istuen, hoitopöydällä maaten sekä nelinkontin. Liikekontrollihäiriön yhteys epäspesifiin alaselkäkipuun mainitaan aineistossa. Liikekontrollitestit toimivat tulosten mukaan sellaisenaan myös harjoitteina. Opinnäytetyön tuotoksena syntyi opas terapeuttisen harjoittelun tarpeen tunnistamisesta ja sen ohjeistuksesta epäspesifisen alaselkäkivun hoitoon. Infograafiin valikoitui yksi testi jokaiselle liikesuunnalle, jokaisessa testattavan asennossa. Toistuvasti molemmissa lähteissä kussakin liikesuunnassa ja testattavan asennossa esiintynyt testi valikoitui infograafiin.The purpose of this thesis is to assist osteopaths in identifying the need for exercise in patients with non-specific low back pain, as well as to provide guidance on the appropriate exercises to prescribe. The theoretical background of the work is described based on key concepts and existing literature is incorporated. The thesis focuses on identifying the need for therapeutic exercise as a support for osteopathic treatment of non-specific low back pain. An integrative literature review was chosen as the research method, as it allows for a broad approach to the research questions. The results indicate that movement control exercises have shown the best results in the treatment of low back pain. The output of the thesis is a guide for identifying the need for therapeutic exercise and providing guidance for the treatment of non-specific low back pain. The results highlighted numerous movement control tests for identifying uncontrolled movement in the lumbar spine and, in turn, non-specific low back pain. The movement control tests are performed while standing, sitting, lying on a treatment table, and on all fours. The link between movement control disorders and non-specific low back pain is mentioned in the material. According to the results, the movement control tests can also be used as exercises. The output of the thesis is a guide for identifying the need for therapeutic exercise and providing guidance for the treatment of non-specific low back pain. An infographic was created with one test for each movement direction and tested position. The test that was repeatedly present in both sources for each movement direction and tested position was chosen for the infographic