Blood Flow and Vascular Conductance Responses to Dynamic Handgrip Exercise in Hispanic American and Non-Hispanic White Women

Hispanic Americans (HA) are the fastest growing ethnic minority in the United States, with disproportionately higher incidence of obesity, hyperlipidemia and type 2 diabetes compared to their non-Hispanic white (NHW) counterparts. As such, the risk of cardiovascular complications is significantly higher in this population, while the underlying mechanisms remain largely unexplored. Alterations in vascular function occur early in cardiovascular diseases and have not been comprehensively studied in the HA population. Previous studies have demonstrated higher flow-mediated dilation (FMD, an index of resting vascular function) in young HA compared to NHW women. However, whether these differences in vasodilation also occur in response to dynamic exercise remains unknown. PURPOSE: We tested the hypothesis that during increasing intensities of rhythmic handgrip exercise, young, healthy HA women would demonstrate greater forearm blood flow and vascular conductance responses compared to age- and weight-matched NHW women. METHODS: Six HA women (20 ± 2 yr; BMI = 21.45 ± 2.2 kg/m2) and 9 NHW women (20 ± 2 yr; BMI = 21.49 ± 2.2 kg/m2) performed rhythmic handgrip exercise for 3 minutes at 15%, 30%, and 45% of their maximum voluntary contraction (MVC). Each exercise bout was separated by at least 10 minutes of rest. Mean arterial pressure (MAP; finger photoplethysmography), heart rate (ECG), and forearm blood flow (FBF; duplex Doppler ultrasound) was measured at rest and during the last minute of rhythmic exercise. Forearm vascular conductance was calculated as FBF/MAP. RESULTS: Baseline FBF (HA: 53.3 ± 7.6 and NHW: 52.4 ± 11.3 ml/min, mean ± SD, p = 0.87), FVC (HA: 0.64 ± 0.09 and NHW: 0.62 ± 0.16 ml/min/mmHg, p = 0.85), MAP (HA: 83.3 ± 3.18 and NHW: 84.75 ± 6.85 mmHg, p = 0.64), and MVC (HA: 53 ± 13 and NHW: 49 ± 6 kg, p = 0.36) were similar between groups. In response to exercise, both groups demonstrated an intensity dependent increase in FBF (%DFBF during 45%: HA= 437± 90% and NHW= 459 ± 162%, p = 0.76) but no significant difference was found between groups (repeated-measures 2-way ANOVA; interaction effect: p = 0.66, intensity effect: p = 0.0001, ethnicity effect: p = 0.73). Similar to FBF, there was no significant difference in FVC responses between groups (%DFVC 45%: HA= 385 ± 110 and NHW= 393 ± 135, p = 0.91). CONCLUSION: Forearm blood flow and vascular conductance responses during increasing intensities of rhythmic handgrip exercise were not different between HA and NHW women

Forearm Vascular Responses to Rhythmic Handgrip Exercise in Young Healthy Hispanic Men

Hispanic American (HA) men have higher prevalence of Type 2 Diabetes (T2D) when compared to Caucasian American (CA) men (15.3% vs 10.8%). Impaired vascular function is a hallmark of T2D, increasing the risk of cardiovascular morbidity and mortality in this clinical population. However, vascular function in the Hispanic population has not been investigated thoroughly. To date, only two studies have examined the resting flow mediated dilation (FMD) and found a higher FMD in young, healthy, HA adults. Whether exercise-induced reactive hyperemia is preserved in HA adults remains unknown. PURPOSE: We tested the hypothesis that young, healthy HA men would have a higher response in forearm blood flow (FBF) and forearm vascular conductance (FVC) when compared to age-matched CA men. METHODS: In young, healthy HA (n = 7, BMI = 25±2 cm/kg2) and CA men (n = 6, BMI = 24±3), FBF (Duplex doppler ultrasound), heart rate (3-lead ECG), and mean arterial pressure (MAP; finger plethysmography) were measured at rest and during rhythmic handgrip exercise performed for 3 min at 15%, 30%, and 45% of their maximum voluntary contraction (MVC). FVC was calculated by FBF/MAP. Lean muscle mass was measured via dual-energy X-ray absorptiometry (DEXA). RESULTS: Baseline MAP (HA: 85±7 mmHg, CA: 84±7, Mean ± SD, p = 0.85), and MVC (HA: 74 ± 18 kg, CA: 80 ± 17, p = 0.51) were not significantly different between the groups at baseline. Baseline FBF (HA: 83.9±21.9 mL/min, CA: 135.5±39.7, p\u3c0.05) and FVC (HA: 1.0 ± 0.3 mL/min/mmHg, CA: 1.6 ± 0.5, p \u3c 0.05) were significantly greater in CA when compared to HA. In both groups, an intensity dependent increase in FBF and FVC was observed with a significant ethnicity effect between the groups but no significant interaction effect (repeated-measures 2-way ANOVA; interaction effect: p = 0.63, intensity effect: p \u3c 0.01, ethnicity effect: p = 0.006). For example, increase in FVC from baseline (%DFVC) at 45% MVC in HA men was 442 ± 82%, compared to 311 ± 97% CA men, with similar increases in MAP from baseline (45% MVC DMAP; HA: 15 ± 12, CA: 7 ± 5, p = 0.17) or lean muscle mass (HA: 57 ± 4 kg, CA: 61 ± 9 kg, p = 0.41). CONCLUSION: Our preliminary data indicate a higher forearm blood flow and vascular conductance response in response to rhythmic handgrip in HA men compared to matched CA men

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Exploring the ecological footprint of the "average" American student: case of The University of Alabama

This research establishes the current consumption and environmental awareness levels associated with the use of water and energy resources for dormitory students on The University of Alabama's campus. During this study, the recently constructed Lakeside East and Ridgecrest East dormitories were analyzed by means of content analysis and subsequent ecological footprint calculations. These were performed from the available water and energy records. Pertaining to the two dormitories from 2007 to 2008, the calculations suggest that consumption levels concerning electricity have decreased; whereas, natural gas levels have increased slightly for Lakeside East and decreased slightly for Ridgecrest East. Additionally, a sample of residents from within the two dormitories was surveyed to determine environmental awareness and lifestyle behaviors associated with the use of energy and water resources. Though a majority of the students indicated they were interested in environmental issues, lifestyle behaviors and preferences did not always positively correlate to the subsequent environmental issues. Resources associated with high-tech devices were overconsumed. Thus, additional educational opportunities may promote more sustainable lifestyle choices. As a consequence, this study serves as a snapshot from which future environmental strategies may be derived. (Published By University of Alabama Libraries