Der Schweizer Weg der kardiologischen Rehabilitation

Zusammenfassung: Seit den späten 60er-Jahren wird auch in der Schweiz die strukturierte kardiale Rehabilitation angeboten. Diese erfolgte anfänglich ausschließlich in Rehabilitationskliniken. 1972 wurden die ersten ambulanten Rehabilitationsprogramme für Herzpatienten in Zürich und Bern angeboten. In den folgenden Jahren entwickelten sich neben der steigenden Zahl von stationären Rehabilitationszentren immer mehr ambulante Rehabilitationsprogramme, vor allem in den größeren Bevölkerungsgebieten des deutschsprachigen Mittellandes und in der französischsprachigen Schweiz. Im Jahr 1985 hat die Schweizerische Arbeitsgruppe für Kardiale Rehabilitation (SAKR) als offizielle Arbeitsgruppe der Schweizerischen Gesellschaft für Kardiologie ihre Tätigkeit aufgenommen und als eine ihrer ersten Aufgaben eine Bestandsaufnahme der Institutionen der kardialen Rehabilitation in der Schweiz gemacht. Im Jahr 1989 gab es bei einer Gesamtbevölkerung von rund 6,5Mio. 42Rehabilitationsprogramme, wovon 21Programme stationär und 21 ambulant durchgeführt wurden, allerdings mit rund 90% der Patienten in stationären Rehabilitationsprogrammen. 1992 hat die SAKR erstmals Qualitätskriterien im Sinne eines Anforderungsprofils für Institutionen der kardialen Rehabilitation in der Schweiz aufgestellt. Die Zahl der stationären Rehabilitationszentren ist zwischen 1989 und 2011 von 21 auf 11 zurückgegangen, während die Zahl der ambulanten Programme von 21 auf 51 zugenommen hat. Die ambulanten Rehabilitationszentren werden teilweise durch lokale Ärztegruppen organisiert, mehrheitlich sind sie aber an Spitäler angegliedert. Für die Zukunft ist ein anhaltender Trend zur Verschiebung von der stationären zur ambulanten Rehabilitation zu erwarten. Dafür werden immer mehr ältere polymorbide Herzpatienten stationäre Rehabilitationsprogramme beanspruche

Rotational thrombelastometry: a step forward to safer patient care?

Purpose – This article aims to analyse the discourse about khat in the Swedish newspaper media and to present the concept of moral entrepreneurship as a useful analytical tool for understanding mobilisation against khat use in the Somali diaspora.Design/methodology/approach – The material analysed consists of daily newspaper articles about khat published between 1986 and 2012. The method of analysis is inspired by the critical discourse analysis framework developed by Norman Fairclough. Drawing on Howard S. Becker's concept of moral entrepreneur, the article focuses on anti-khat campaigners who speak out against khat in the media. These are often representatives from Somali voluntary associations or organisations, who sometimes employ moral entrepreneurship. The article discusses these actors' role in framing khat use as a tangible threat to the Somali community in Sweden.Findings – When employing moral entrepreneurship, anti-khat campaigners spread a certain type of knowledge about khat that is presented to the general public via the media. The key issues that repeatedly are of concern are how khat destroys Somali families and how the use might spread to other groups. In this manner khat use is constructed as a threat to Somali social cohesion. The knowledge produced could potentially influence policy makers to introduce stricter punishments for possession, sale and use of khat, thereby possibly increasing stigma and marginalisation in relation to the Somali immigrant community.Originality/value – The literature about khat has pointed to the centrality of Somali organisations mobilising against khat in the diaspora. This article presents moral entrepreneurship as a theoretical tool to further the understanding of the mobilisation against khat and its use

Bewegungskontrolldysfunktion als Subgruppe von unspezifischen Rückenschmerzen

Zusammenfassung: Schmerzen des untere Rückens sind meist unspezifisch, d.h. es gibt keinen spezifischen medizinischen Grund für die Schmerzen. Eine Subgruppierung unspezifischer Rückenschmerzen wurde deswegen als einer der wichtigsten Forschungsschwerpunkte genannt. Eine mögliche Subgruppe ist die Bewegungskontrolldysfunktion, bei der der Patient seine Bewegungen nicht bewusst kontrollieren kann. Eine Testbatterie wurde entwickelt und validiert, um diese Patientengruppe zu untersuchen und zu behandeln. Sie besteht aus 6Bewegungstests und wurde als reliabel bewertet. Mit diesem Testverfahren können Personen mit Rückenschmerzen zuverlässig von gesunden Personen unterschieden werden. Ebenfalls untersucht wurde der Zusammenhang mit der Körperwahrnehmung. Dabei zeigte sich, dass Zweipunktdiskriminationsfähigkeit mit der verschlechterten Bewegungskontrolle des Rückens korreliert. Eine Fallserienstudie (n=38) ergab, dass diesen Patienten mit spezifischen Übungen gut geholfen werden kann. Da es in dieser Studie keine Kontrollgruppe gab, kann jedoch eine Kausalität nicht hergestellt werde

Eccentric endurance training in subjects with coronary artery disease: a novel exercise paradigm in cardiac rehabilitation?

This study evaluated the effects of 8weeks of eccentric endurance training (EET) in male subjects (age range 42-66years) with coronary artery disease (CAD). EET was compared to concentric endurance training (CET) carried out at the same metabolic exercise intensity, three times per week for half an hour. CET (n=6) was done on a conventional cycle ergometer and EET (n=6) on a custom-built motor-driven ergometer. During the first 5weeks of the training program the metabolic load was progressively increased to 60% of peak oxygen uptake in both groups. At this metabolic load, mechanical work rate achieved was 97 (8)W [mean (SE)] for CET and 338 (34)W for EET, respectively. Leg muscle mass was determined by dual-energy X-ray absorptiometry, quadriceps strength with an isokinetic dynamometer and muscle fibre composition of the vastus lateralis muscle with morphometry. The leg muscle mass increased significantly in both groups by some 3%. Strength parameters of knee extensors improved in EET only. Significant changes of +11 (4.9)%, +15 (3.2)% and +9 (2.5)% were reached for peak isometric torque and peak concentric torques at 60°s−1 and 120°s−1, respectively. Fibre size increased significantly by 19% in CET only. In conclusion, the present investigation showed that EET is feasible in middle-aged CAD patients and has functional advantages over CET by increasing muscle strength. Muscle mass increased similarly in both groups whereas muscle structural composition was differently affected by the respective training protocols. Potential limitations of this study are the cautiously chosen conditioning protocol and the restricted number of subject

Is Lone Hypertension a Risk Factor for More Severe COVID-19 Outcomes?

Background Based on current evidence, it is not clear whether lone hypertension increases the risk for severe illness from COVID-19, or if increased risk is mainly associated with age, obesity and diabetes. The objective of the study was to evaluate whether lone hypertension is associated with increase mortality or a more severe course of COVID-19, and if treatment and control of hypertension mitigates this risk. Methods This is a prospective multi-center observational cohort study with 30-day outcomes of 9,531 consecutive SARS-CoV-2 PCR-positive patients ≥ 18 years old (41.9 ± 9.7 years, 49.2% male), Uzbekistan, June 1-September 30, 2020. Patients were subclassified according to JNC8 criteria into six blood pressure stages. Univariable and multiple logistic regression was conducted to examine how variables predict outcomes. Results The 30-days all-cause mortality was 1.18% (n = 112) in the whole cohort. After adjusting for age, sex, history of myocardial infarction (MI), type-2 diabetes, and obesity, none of six JNC8 groups showed any significant difference in all-cause mortality. However, age was associated with an increased risk of 30-days all-cause mortality (OR = 1.09, 95%CI [1.07-1.12], p < 0.001), obesity (OR = 7.18, 95% CI [4.18-12.44], p < 0.001), diabetes (OR 4.18, 95% CI [2.58-6.76], p < 0.001), and history of MI (OR = 2.68, 95% CI [1.67-4.31], p < 0.001). In the sensitivity test, being ≥ 65 years old increased mortality 10.56-fold (95% CI [5.89-18.92], p < 0.001). Hospital admission was 12.4% (n = 1,183), ICU admission 1.38% (n = 132). The odds of hospitalization increased having stage-2 untreated hypertension (OR = 4.51, 95%CI [3.21-6.32], p < 0.001), stage-1 untreated hypertension (OR = 1.97, 95%CI [1.52-2.56], p < 0.001), and elevated blood pressure (OR = 1.82, 95% CI [1.42-2.34], p < 0.001). Neither stage-1 nor stage-2 treated hypertension patients were at statistically significant increased risk for hospitalization after adjusting for confounders. Presenting with stage-2 untreated hypertension increased the odds of ICU admission (OR = 3.05, 95 %CI [1.57-5.93], p = 0.001). Conclusions Lone hypertension did not increase COVID-19 mortality or in treated patients risk of hospitalization

Diagnostisches und therapeutisches Vorgehen in der Akutphase nach kranio-zervikalem Beschleunigungstrauma (sog. Schleudertrauma) : Empfehlungen einer schweizerischen Arbeitsgruppe

https://digitalrepository.unm.edu/abq_eh_news/1514/thumbnail.jp

Secondary Prevention Through Cardiac Rehabilitation: Position Paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology

The purpose of this statement is to provide specific recommendations in regard to evaluation and intervention in each of the core components of cardiac rehabilitation (CR) to assist CR staff in the design and development of their programmes; the statement should also assist health care providers, insurers, policy makers and consumers in the recognition of the comprehensive nature of such programmes. Those charged with responsibility for secondary prevention of cardiovascular disease, whether at European, at national or at individual centre level, need to consider where and how structured programmes of CR can be delivered to the large constituency of patients now considered eligible for C

Lower diurnal HPA-axis activity in male hypertensive and coronary heart disease patients predicts future CHD risk.

BACKGROUND Coronary heart disease (CHD) and its major risk factor hypertension have both been associated with altered activity of the hypothalamus-pituitary-adrenal (HPA)-axis but the biological mechanisms underlying prospective associations with adverse disease outcomes are unclear. We investigated diurnal HPA-axis activity in CHD-patients, hypertensive (HT) and healthy normotensive men (NT) and tested for prospective associations with biological CHD risk factors. METHODS Eighty-three male CHD-patients, 54 HT and 54 NT men repeatedly measured salivary cortisol over two consecutive days. Prospective CHD risk was assessed by changes between baseline and follow-up in the prothrombotic factors D-dimer and fibrinogen, the pro-inflammatory measures interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and acute phase protein C-reactive protein (CRP), as well as blood lipids in terms of total cholesterol (tChol)/high-density-lipoprotein cholesterol (HDL)-ratio. We aggregated coagulation and inflammatory measures to respective indices. RESULTS The groups differed in repeated daytime cortisol (dayCort) secretion (p=.005,η2 p=.03,f=0.18) and cortisol awakening response (CAR) (p=.006,η2 p=.03,f=0.18), with similarly lower overall dayCort and CAR in CHD-patients and HT, as compared to NT. The groups differed further in cortisol at awakening (p=.015,η2 p=.04,f=0.20) with highest levels in HT (p´s≤.050), and in diurnal slope between waking and evening cortisol (p=.033,η2 p=.04,f=0.20) with steepest slopes in HT (p´s≤.039), although in part not independent of confounders. Lower aggregated dayCort and CAR in terms of area-under-the-curve (AUC) independently predicted increases in future overall CHD risk (AUCdayCort: p=.021,η2 p=.10,f=0.33;AUCCAR: p=.028,η2 p=.09,f=0.31) 3.00 ± 0.06(SEM) years later, with risk prediction most pronounced in fibrinogen (AUCdayCort: p=.017,ΔR 2= 0.12;AUCCAR: p=.082). CONCLUSION We found evidence for an HPA-axis hypoactivity in CHD and HT with lower diurnal HPA-axis activity predicting increases in cardiovascular risk as evidenced by increases in circulating levels of biomarkers of atherothrombotic risk. Down-regulation of basal HPA-axis activity may contribute to the pathogenesis of atherosclerosis and thrombosis in CHD via effects on coagulation