Validity of telemetric-derived measures of heart rate variability: a systematic review

Heart rate variability (HRV) is a widely accepted indirect measure of autonomic function with widespread application across many settings. Although traditionally measured from the 'gold standard' criterion electrocardiography (ECG), the development of wireless telemetric heart rate monitors (HRMs) extends the scope of the HRV measurement. However, the validity of telemetric-derived data against the criterion ECG data is unclear. Thus, the purpose of this study was twofold: (a) to systematically review the validity of telemetric HRM devices to detect inter-beat intervals and aberrant beats; and (b) to determine the accuracy of HRV parameters computed from HRM-derived inter-beat interval time series data against criterion ECG-derived data in healthy adults aged 19 to 62 yrs. A systematic review of research evidence was conducted. Four electronic databases were accessed to obtain relevant articles (PubMed, EMBASE, MEDLINE and SPORTDiscus. Articles published in English between 1996 and 2016 were eligible for inclusion. Outcome measures included temporal and power spectral indices (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996). The review confirmed that modern HRMs (Polar® V800™ and Polar® RS800CX™) accurately detected inter-beat interval time-series data. The HRV parameters computed from the HRM-derived time series data were interchangeable with the ECG-derived data. The accuracy of the automatic in-built manufacturer error detection and the HRV algorithms were not established. Notwithstanding acknowledged limitations (a single reviewer, language bias, and the restricted selection of HRV parameters), we conclude that the modern Polar® HRMs offer a valid useful alternative to the ECG for the acquisition of inter-beat interval time series data, and the HRV parameters computed from Polar® HRM-derived inter-beat interval time series data accurately reflect ECG-derived HRV metrics, when inter-beat interval data are processed and analyzed using identical protocols, validated algorithms and software, particularly under controlled and stable conditions

Early exposure to secondhand tobacco smoke and the development of allergic diseases in 4 year old children in Malmö, Sweden

<p>Abstract</p> <p>Background</p> <p>Earlier studies have shown an association between secondhand tobacco smoke and allergy development in children. Furthermore, there is an increased risk of developing an allergy if the parents have an allergy. However, there are only few studies investigating the potential synergistic effect of secondhand tobacco smoke and allergic heredity on the development of an allergy.</p> <p>Methods</p> <p>The study was population-based cross-sectional with retrospective information on presence of secondhand tobacco smoke during early life. The study population consisted of children who visited the Child Health Care (CHC) centres in Malmö for their 4-year health checkup during 2006-2008 and whose parents answered a self-administered questionnaire (n = 4,278 children). The questionnaire was distributed to parents of children registered with the CHC and invited for the 4-year checkup during the study period.</p> <p>Results</p> <p>There was a two to four times increased odds of the child having an allergy or having sought medical care due to allergic symptoms if at least one parent had an allergy, while there were rather small increased odds related to presence of secondhand smoke during the child's first month in life or at the age of 8 months. However, children with heredity for allergies and with presence of secondhand tobacco smoke during their first year in life had highly increased odds of developing an allergy and having sought medical care due to allergic symptoms at 4 years of age. Thus, there was a synergistic effect enhancing the independent effects of heredity and exposure to secondhand tobacco smoke on allergy development.</p> <p>Conclusions</p> <p>Children with a family history of allergies and early exposure to secondhand tobacco smoke is a risk group that prevention and intervention should pay extra attention to. The tobacco smoke effect on children is an essential and urgent question considering it not being self chosen, possibly giving life lasting negative health effects and being possible to reduce.</p

To be an immigrant and a patient in Sweden: A study with an individualised perspective

The aim is to describe how experiences of being an immigrant can influence the situation when becoming a patient in Swedish health care. A hermeneutic approach was used. Sixteen persons born in non-Nordic countries were interviewed. The data was analysed with an empirical hermeneutical method. The findings indicate that positive experiences (i.e., establishing oneself in a new home country) enhance the possibilities of taking part in caring situations and vice versa. Hence, there is a need for individually adapted care that takes one's whole life situation into consideration. Consequently, it is suggested that the concept, “cultural competence” merely serves the purpose of illuminating caregivers' need for categorisation. It does not illuminate individual needs in a caring situation

Middle Eastern mothers in Sweden, their experiences of the maternal health service and their partner's involvement

<p>Abstract</p> <p>Background</p> <p>Traditional patterns relating to how to handle pregnancy and birth are often challenged due to migration. The purpose of this study was to describe Middle Eastern mothers' experiences of the maternal health care services in Sweden and the involvement of their male partner.</p> <p>Methods</p> <p>Thirteen immigrant mothers from the Middle East who had used the maternal health services in Sweden were interviewed using focus group discussions and individual interviews. These were taped, transcribed and analysed according to Content analysis.</p> <p>Results</p> <p>The four main categories that developed were:</p> <p>• Access to the professional midwife</p> <p>• Useful counselling</p> <p>• Stable motherhood in transition</p> <p>• Being a family living in a different culture</p> <p>Conclusion</p> <p>According to the respondents in this study, understanding the woman's native language or her culture was not vital to develop a good relationship with the midwife. Instead the immigrant woman developed trust in the midwife based on the knowledge and the empathy the midwife imparted.</p> <p>Increasing the amount of first trimester antenatal visits could avoid spontaneous visits to the emergency clinic. There was a greater need for involvement and support by the father during the perinatal period, such as caring for older children and carrying out household chores since the mothers' earlier female network was often lost.</p> <p>Clinical implications</p> <p>There is a need to involve immigrant parents in the available parental education in order to prepare them for parenthood in their new country as well as to explore their altered family situation. Collecting immigrant women and their partner's, experiences of maternal health care services offers a possibility to improve the existing care, both in content, access and availability where the timing of visits and content require further evaluation.</p

The European construction social partners: gender equality in theory and practice

This article explores the social partners' role in the gender equality agenda in construction at skilled operative level. It draws on a survey of the European construction social partners that investigated the presence of women in skilled trades and the policies, collective agreements and practices that play a role in women's integration. The responses indicate that the construction industry still displays inertia and conservatism, and that the social partners corroborate rather than counter this. They express a 'discourse' of gender equality, but this does not automatically lead to equal opportunity policies or programmes. The social partners have the platform to make inroads and to change the industry from within, but need further encouragement to put this on their agenda

Cross-cohort gut microbiome associations with immune checkpoint inhibitor response in advanced melanoma

The composition of the gut microbiome has been associated with clinical responses to immune checkpoint inhibitor (ICI) treatment, but there is limited consensus on the specific microbiome characteristics linked to the clinical benefits of ICIs. We performed shotgun metagenomic sequencing of stool samples collected before ICI initiation from five observational cohorts recruiting ICI-naive patients with advanced cutaneous melanoma (n = 165). Integrating the dataset with 147 metagenomic samples from previously published studies, we found that the gut microbiome has a relevant, but cohort-dependent, association with the response to ICIs. A machine learning analysis confirmed the link between the microbiome and overall response rates (ORRs) and progression-free survival (PFS) with ICIs but also revealed limited reproducibility of microbiome-based signatures across cohorts. Accordingly, a panel of species, including Bifidobacterium pseudocatenulatum, Roseburia spp. and Akkermansia muciniphila, associated with responders was identified, but no single species could be regarded as a fully consistent biomarker across studies. Overall, the role of the human gut microbiome in ICI response appears more complex than previously thought, extending beyond differing microbial species simply present or absent in responders and nonresponders. Future studies should adopt larger sample sizes and take into account the complex interplay of clinical factors with the gut microbiome over the treatment course

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The impact of dietary nitrate supplementation on 2000 m rowing performance in well-trained, male, competitive rowers.

Six days of dietary nitrate supplementation (500 ml.d-1) has been shown to enhance rowing ergometer performance in junior, male rowers. More recently, concentrated dietary nitrate beverages, of smaller quantity, have emerged to the market. The aim of this study was to explore the impact of dietary nitrate ingestion on 2000m indoor rowing performance in well-trained, competitive, young adult, male rowers following a 4 day concentrated beetroot juice supplementation intervention (140 ml.d-1). A within-subjects double-blind, randomised, placebo-controlled cross-over study design was adopted. The study received institutional ethical approval. Six well-trained, male competitive rowers were voluntarily recruited (age, 22±2 years; stature, 1.83±0.09 m; body mass, 75.8±11.7 kg). Each completed three 2000 m rowing trials: Baseline (no supplementation), experimental (beetroot juice [BR] supplementation, James White Ltd, 140 ml.d-1 over 4 days) and a control (BR placebo, James White Ltd, 140 ml.d-1 over 4 days). Trial order was randomised and a wash-out period of 7 days between trials was included. Participants were asked to abstain from heavy exercise for 24 h before trials to ensure they were in a fully rested state, and asked to avoid alcohol, caffeine or any other stimulant or non-prescribed nutritional supplement for 24-48 h. Participants were instructed to ingest the BR and the BR placebo beverages in the morning and evening for the three days prior to each rowing trial, and on the day of testing consumed the BR and the BR placebo beverages 2 h prior to the rowing trial. On test days participant resting systolic and diastolic blood pressures (SBP and DBP) and heart rate (HR) were monitored in the laboratory between the point of BR or BR placebo ingestion and the start of the rowing trial. Following a self-selected warm-up, participants completed the 2000 m rowing trials at a fixed stroke rate (22-28 strokes.min-1; drag factor 135-139). HR, Blood lactate and respiratory parameters (breath-by-breath gas analysis) were recorded every 500 m. Overall performance time, and 500 m split performance times were noted. Main findings showed an improved 2000 m rowing performance following BR supplementation compared to baseline (mean±SD: 425±25 s v 431±22 s, 0.9%, d=-0.25) and compared to BR placebo (mean±SD: 429±26 s 0.9%, d=0.16). Performance improvements were also noted compared to baseline in the control (BR placebo) group (0.5%, d=0.08). To conclude, BR supplementation over 4 days elicits small enhancements in 2000 m rowing performance in young, well-trained, male competitive rowers

The heightened cardiovascular risk in young females with athletic amenorrhea: A systematic review.

The female athlete triad is commonly known to be composed of three elements; low energy availability, amenorrhea and osteoporosis. It has been suggested these elements, though separate, are interrelated. However, increased research suggests a fourth element; endothelial dysfunction, which increases cardiovascular risk in young female athletes. Those with athletic amenorrhea demonstrate similar hormonal profiles to menopausal women, in which the cardio protection of oestrogen is no longer present. Thus suggesting females with athletic amenorrhea may, in fact, be at risk. To obtain the literature to review, one electronic database, PubMed, was searched by one individual. All searches were performed between February and May 2017. After a screening process, a total of 7 research papers were included in the review, with publication dates ranging from the years 2003 to 2016. A total of 285 female participants were included in the review. Emphasis was placed upon those with athletic amenorrhea, however those who were not classified by this term were included for comparison. The studies reviewed included those directly relating to vascular function and dysfunction, measured using flow-mediated dilation techniques. Indirect factors, such as altered hormone and cholesterol levels, were also discussed in terms of their relation to cardiovascular risk and consequent atherosclerosis. In 5 articles, flow mediated dilation (FMD) measurements of the brachial artery were conducted. In 4 of these articles, FMD was reported to be 6.3% (P < 0.05), 5.3% (P < 0.05), 5% (P = 0.0016) and 3.5% (P < 0.05) lower in females with athletic amenorrhea, compared to eumenorrheic athletes. One study measured calf blood flow using venous occlusion strain-gauge plethysmography. Those with athletic amenorrhea had reduced resting and peak blood flow at the calf (P < 0.05). In one study, grehlin secretion was 39% higher (P < 0.05), leptin secretion was 34% lower (P < 0.05), and total pulsatile secretion of luteinizing hormone was 40% lower (P < 0.05) in those with amenorrhea. Furthermore, one study demonstrated elevated cholesterol levels (P < 0.01) in athletes with amenorrhea. Based upon the findings in the review, it may be suggested that young female athletes with amenorrhea, have an increased risk of atherosclerosis. However further research is essential