The potential use of spectral electromyographic fatigue as a screening and outcome monitoring tool of sarcopenic back muscle alterations

Background: To examine whether or not median frequency surface electromyographic (MF-EMG) back muscle fatigue monitoring would be able to identify alterations in back muscle function in elderly muscles, if a protocol was used that allowed optimum standardization of the processes underlying electromyographic fatigue, and whether these tests were reliable from day to day. Methods: A total of 42 older (21 females; 67 (±10.5) years old) and 44 younger persons (19 females; 33 (±10) years) performed maximum isometric back extensions which were followed by one 30 s lasting 80% submaximum extension. Participants were seated on a dynamometer with their trunks 30° anteflexed, and they repeated all tests after 1-2 days and 6 weeks. SEMG was recorded bilaterally from the L1 (iliocostalis lumborum), L2 (longissimus), and L5 (multifidus) recording sites. Outcome variables included maximum back extension torque, initial MF-EMG (IMF-EMG), MF-EMG slope declines, and individual MF-EMG muscular imbalance scores. Two-factorial ANOVAs served to examine the age and gender-specific effects, and models from Generalizability Theory (G-Theory) were used for assessing retest-reliability. Results: Maximum back extension moment was non-significantly smaller in elders. IMF-EMG was overall higher in elders, with significant differences at the L5 recordings sites. In the elderly, MF-EMG fatigue declines were significantly smaller in L5, in the recording with the most negative slope, or if the slope of all electrodes was considered. Retest reliability was unanimous in young and older persons. ICC-type measurements from G-Theory of both the IMF and the fatigue slopes ranged from 0.7 to 0.85. Absolute SEM values were found clinically acceptable for the IMF-EMG, but relatively high for the fatigue slope declines. Conclusions: The MF-EMG fatigue method is able to elucidate alterations of aging back muscles. This method, thus, might be suggested as a potential biomarker to objectively identify persons at risk for sarcopenia. Considering the clinical relevance of the IMF-EMG relative to the MF-EMG slope declines, spectral EMG may also be used as an outcome monitoring tool in elderly populations

Methamphetamine - knocking on Europe's door?

Einleitung und Zielsetzung. Methamphetamin ist ein stark suchterzeugendes, weltweit häufig konsumiertes psychostimulans (EMCDDA, 2009a; EMCDDA & Europol, 2009; UNODC, 2009b). Gebrauch scheint in Europa (mit Ausnahme der Tschechischen- und Slowakischen Republik) nicht wesentlich verbreitet zu sein (EMCDDA, 2009a; Zábranský, 2007). Es stellt sich die Frage: „Steht Methamphetamin vor Europas Türe?“. Anhand der international publizierten Eigenschaften der Substanz erfolgte eine explorative Untersuchung der Konsumenten im deutschsprachigen Europa. Design und Methoden. Es wurde ein Online-Fragebogen als Synthese aus dem SF-36 (Bullinger & Kirchberger, 1998) und dem EuropASI (Gsellhofer, et al., 1997) erstellt. Erhobene Variablen waren Konsummuster, Auswirkungen auf Kognition, Emotion, Verhalten, das soziale Gefüge sowie die psychische- und körperliche Gesundheit Dieser wurde mittels deskriptiv- und inferenzstatistischer Methoden analysiert. Eine Typologisierung wurde anhand der TwoStep-Clusteranalyse, als strukturfindendes Verfahren, erstellt und mittels Diskriminanzanalyse, als multivariate Analysemethode, untersucht. Ergebnisse. Drei voneinander unterscheidbare Konsummuster wurden entdeckt. Der „typische Freizeitdrogenkonsument“ mit geringem Leidensdruck, kontrolliertem, mäßigen und hedonistisch motiviertem Gebrauch. Ebenfalls im Partysetting gebraucht der „Ausprobierer“, interessanterweise in höheren Mengen und mit schlechteren subjektiven Einschätzungen betreffend psychischer- und körperlicher Gesundheit. Der „problematische Konsument“ mit bis zu täglichem Gebrauch und Binge-Konsum, sowie hohen subjektiven psychischen- und physischen Leidensdruck. Das Internet konnte, aufgrund hoher Rücklaufquoten und positiver subjektiver Bewertungen des adaptiv programmierten Fragebogens, als sinnvolles psychologisches Forschungsmedium bestätigt werden. Diskussion und Conclusio. Methamphetamin scheint auch in Europa bereits „den Fuß in der Türe zu haben“. Die gefundenen Konsumtypen geben Auskunft über unterschiedliche Gebrauchsmuster bis zum problematischen und gesundheitsschädlichen Gebrauch. Damit ergeben sich Implikationen für Ausbildung, Praxis, Prävention, Beratung, Behandlung und Politik.Introduction and aims. Methamphetamine is a very popular highly addictive psychostimulant drug used worldwide (EMCDDA, 2009a; EMCDDA & Europol, 2009; UNODC, 2009b). Nevertheless abuse seems to be more or less unessential for Europe, with exception to the Czech- and Slovak Republic (EMCDDA, 2009a; Zábranský, 2007). Various indicators give rise to the question: ‘Is Methamphetamine knocking on Europe’s door?’ An explorative investigation assessed consumers of the German-speaking part of Europe. Design and Methods. Regarding international publications an online-survey was designed combining questions from the SF-36 (Bullinger & Kirchberger, 1998) and the EuropASI (Gsellhofer, et al., 1997). Investigated variables were cognition, emotion, behaviour, social consequences, psychological- and physical health. Data exploration using inferential- and descriptive statistics, as well as cluster- and discriminant analysis, was conducted. Results. Three distinct types of users were revealed. The recreational drug user is low on psychological- and physical strain. Use is controlled, moderate and hedonistic. Interestingly experimental users take more of the drug and report worse subjective well-being. Users with problem drug use (PDU) consume Methamphetamine up to a daily basis and show binge use. Reports of high strain in this group are more likely. Because of return rates and positive subjective rating of the online-survey, the internet as a method for psychological investigations, could be confirmed. Discussion and conclusions. Results indicate that Methamphetamine already seems ‘to have its foot in Europe’s door’. Besides recreational drug use, problem drug use (PDU) was determinable. The three clusters found show different forms of consumption. These findings suggest new strategies for training, praxis, prevention, counselling, treatment and politics

Age and gender related neuromuscular pattern during trunk flexion-extension in chronic low back pain patients

Background: The root mean square surface electromyographic activity of lumbar extensor muscles during dynamic trunk flexion and extension from standing has repeatedly been recommended to objectively assess muscle function in chronic low back pain patients. However, literature addressing older patients is sparse. This cross sectional study sought to examine differences in neuromuscular activation between age groups (>60 versus 40-60 versus <40 years) and sexes during a standardized trunk flexion-extension task. Methods: A total of 216 patients (62 older, 84 middle-aged, 70 younger) performed maximum trunk extensions followed by trunk flexion extension testing thereby holding static positions at standing, half, and full trunk flexion. The lumbar extensor muscle activity and 3d-accelerometric signals intended to monitor hip and trunk position angles were recorded from the L5 (multifidus) and T4 (semispinalis thoracis) levels. Permutation ANOVA with bootstrapped confidence intervals were performed to examine for age and gender related differences. Ridge-regressions investigated the impact of physical-functional and psychological variables to the half flexion relaxation ratio (i.e. muscle activity at the half divided by that in maximum flexion position). Results: Maximum back extension torque was slightly but significantly higher in youngest compared to oldest patients if male and females were pooled. Normalized RMS-SEMG revealed highest lumbar extensor muscle activity at standing in the oldest and the female groups. Patients over 60 years showed lowest activity changes from standing to half (increments) and from half to the maximum flexion position (decrements) leading to a significantly lower half flexion relaxation ratio compared to the youngest patients. These oldest patients demonstrated the highest hip and lowest lumbothoracic changes of position angles. Females had higher regional hip and gross trunk ranges of movement compared to males. Lumbothoracic flexion and the muscle activity at standing had a significant impact on the half flexion relaxation ratio. Conclusions: The neuromuscular activation pattern and the kinematics in this trunk flexion-extension task involving static half flexion position changed according to age and sex. The test has a good potential to discriminate between impaired and unimpaired neuromuscular regulation of back extensors in cLBP patients, thereby allowing the design of more individualized exercise programs. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0121-1) contains supplementary material, which is available to authorized users

The link between obesity and vitamin D in bariatric patients with omega-loop gastric bypass surgery - a vitamin D supplementation trial to compare the efficacy of postoperative cholecalciferol loading (LOAD): study protocol for a randomized controlled trial

BACKGROUND: Beyond its classical role in calcium homoeostasis and bone metabolism, vitamin D deficiency has been found to be associated with several diseases, including diabetes, non-alcoholic fatty liver disease, and even obesity itself. Importantly, there are limited data on therapeutic strategies for vitamin D deficiency in bariatric patients, and the procedure-specific guidelines may not be sufficient. To improve long-term outcomes, nutritional screening and appropriate supplementation to prevent nutrient deficiencies are urgently needed. Therefore, the aim of this study is to examine effects and safety of a forced dosing regimen of vitamin D versus conventional dose supplementation on vitamin D levels and other parameters in bariatric patients. METHODS/DESIGN: The study includes loading plus repeat dosing compared with repeated administration of vitamin D without a loading dose, according to guidelines, in a prospective, double-blind, randomized controlled trial. Up to a triple oral loading dose is given on day 1, then 2 and 4 weeks after surgery (100,000 IU dose each time), followed by an oral maintenance dose (3420 IU/day). The control group (n = 25) will receive placebo, followed by administration of a standard dose (3420 IU/day). We hypothesize that a significant increase in vitamin D levels will occur in patients in the treatment group (n = 25) by 24 weeks after surgery. Further measurements are aimed at evaluating changes in inflammation, bone turnover, insulin resistance, blood pressure, liver, mental health, and gut microbiota of patients undergoing omega-loop gastric bypass surgery. Furthermore, possible associations between concentrations of vitamin D, the involved enzymes, or vitamin D receptor in adipose and/or liver tissues will be determined. DISCUSSION: To our knowledge, this trial is the first of its kind with this type of vitamin D supplementation in bariatric patients. Its major strength is the design and implementation of evaluation of influencing factors such as liver function, bone health, inflammation, insulin resistance, blood pressure, symptoms of depression, or microbiota. This alternative vitamin D dosing regimen has the potential to be a safe, fast, evidence-based treatment of vitamin D deficiency in bariatric patients. Owing to the increasing number of bariatric patients, it is also of interest to elucidate the link between obesity and vitamin D. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02092376. Registered on 17 March 2014

The Effect of Roux-en-Y vs. Omega-Loop Gastric Bypass on Liver, Metabolic Parameters, and Weight Loss

BACKGROUND: Omega-loop gastric bypass (OLGB) results in weight loss (WL) but data on its impact on liver and glucose metabolism compared to Roux-en-Y gastric bypass (RYGB) is lacking. Therefore, the aim of this study was to compare the development of hepatic and metabolic markers as well as WL between the above-mentioned surgical groups during the first postoperative year. METHODS: We retrospectively evaluated the respective parameters in non-diabetic morbidly obese patients who underwent either RYGB (n = 25) or OLGB (n = 25). RESULTS: Compared to RYGB, OLGB showed a greater WL percentage. Liver transaminases dropped in RYGB, while rose in OLGB. No correlation between aspartate transaminase, alanine transaminase, and WL could be detected. Gamma-glutamyltransferase decreased significantly in RYGB over the first 3 months, while it increased in OLGB. We found higher levels of triglycerides, insulin, homeostasis model assessment of insulin resistance (HOMA2-IR), and liver fat percentage in RYGB at baseline, despite matching the groups for age, sex, and BMI. Those differences disappeared, except for triglycerides, within 1 year. All metabolic parameters correlated with WL. CONCLUSION: OLGB results in greater WL but transiently deteriorated several liver parameters in the first postoperative year. This was not associated with WL. The impact of these results on hepatic outcomes such as non-alcoholic steatohepatitis and fibrosis progression requires further studies. In both groups, improved insulin resistance and sensitivity were correlated with higher WL and lower liver fat percentage, respectively

Forensische Arbeit mit Kindern und Jugendlichen ::Praxishandbuch für die interdisziplinäre Zusammenarbeit: Psychologie-Medizin-Recht-Sozialarbeit /

Interprofessioneller Zugang erforderlich Forensische Psychologie sowie Forensische Psychiatrie im Kindes- und Jugendalter stellen Spezialgebiete dar und bedingen zumeist die Zusammenarbeit verschiedener Berufsgruppen aus dem psychosozialen, medizinischen und juristischen Umfeld. Damit die forensische Tätigkeit entsprechend wissenschaftlichen Standards geleistet werden kann, ist ein regelmäßiger Wissensaustausch der einzelnen Fachdisziplinen notwendig und dazu möchte dieses Buch einen Beitrag leisten. Dieses Buch soll sämtliche im forensischen psychologischen und psychiatrischen Kontext mit Kindern und Jugendlichen arbeitende Fachleute ansprechen und so einen praktischen Leitfaden für Ärzte, Psychologen und Psychotherapeuten, Juristen, Sozialarbeiter und Pädagogen darstellen. Es fokussiert auf die österreichische Gesetzeslage in einem Strafverfahren bzw. Pflegschaftsverfahren, wirft jedoch auch einen Blick über die Ländergrenzen im deutschsprachigen Raum. Inhalt: Kinder- und Jugendliche als Opfer von Gewalt Psychologische Diagnostik Neurobiologische und neuropsychologische Erkenntnisse Kinder- und Jugendliche als Opfer in einem Strafverfahren.- Strittige Pflegschaftsverfahren Jugendliche als Beschuldigte in einem Strafverfahren Die Herausgeber: Ass. Prof. Dr. Sabine Völkl-Kernstock, Medizinische Universität Wien, Universitätsklinik für Kinder- und Jugendpsychiatrie Dr. Christian Kienbacher, SOS-Kinderdorf, Ambulatorium für Kinder- und Jugendpsychiatrie