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Objective. Thoraco-abdominal asynchrony (TAA), the discordant movement of the abdomen and thorax, may impact upon health-related variables. Here, we investigated the extent to which TAA is associated with health-related variables, particularly perceived asthma control and quality of life. Methods. Ambulatory respiratory data from 43 patients diagnosed with asthma and 43 healthy age and sex-matched controls were recorded over 4 hours. Phase relation (Ph Rel Total), the percentage of time that the effects of rib cage (RC) and diaphragmatic movement result in opposite effects on intra-thoracic volume, quantified TAA. Subjects completed the Mini Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Questionnaire (ACQ), Nijmegen questionnaire (NQ), Hospital Anxiety and Depression Scale (HADS), Spielberger State-Trait Anxiety Inventory (STAI), and General Health Perception (GHP) subscale of the short form 36 questionnaire'. Capnography profiling, breath-hold time (BHT), and standard spirometry were performed. Results. The time in asynchrony was significantly greater in the asthma than in the healthy control group (Ph Rel Total = 14% (interquartile range (IQR) 8.5-20.7%) versus 10.4% (IQR 7.1-14.5%), p = .012). In patients with asthma, Ph Rel Total was weakly associated with poorer ACQ scores ( r = 0.33, p = .03), and in the healthy control group with GHP ( r = 0.319, p = .037). Post-hoc exploratory analysis revealed a moderate relationship in the female asthma subgroup between Ph Rel Total and AQLQ ( r = −0.56, p = .003). Conclusions. TAA may be associated with decreased perceived asthma control. In healthy individuals, asynchrony may be associated with low perception of general health. Further studies are required to investigate if the reduction of TAA improves these health-related variables. [ABSTRACT FROM AUTHOR]

Abstract: Background: Patients with chronic heart failure have a reduced quality of life due in part to their limited range of physical activity and independence. Objectives: The paper examines whether a physical activity ‘lifestyle’ intervention, based on motivational interviewing, will improve quality of life at five months from baseline, compared with conventional treatment. Methods: Sixty older patients with chronic heart failure were randomly assigned to either a ‘standard care’, ‘motivational interviewing’ or ‘both’ treatment groups for five months in 2002. The primary outcome measures were the Medical Outcomes Short Form-36 Health Survey, the disease-specific Minnesota Living with Heart Failure questionnaire and the Motivation Readiness for Physical Activity scale. Results: There were non-significant differences between the groups at baseline for age, coronary risk factors, severity of chronic heart failure, ejection fraction, specific laboratory tests, length of hospitalisation, medication and social support. Following treatment there was a significant increase for three of the dimensions of the health survey in the ‘motivational interviewing’ group. All groups improved their scores on the heart failure questionnaire. Over the five month period there was a general trend towards improvements in self-efficacy and motivation scores. Conclusions: This study has demonstrated that a ‘motivational interviewing’ intervention, incorporating behaviour change principles to promote physical activity, is effective in increasing selected aspects of a general quality of life questionnaire and a disease-specific quality of life questionnaire. Thus a ‘motivational interviewing’ approach is a viable option compared with traditional exercise programming. It is important to test these motivational interviewing interventions more widely, especially to match individuals to treatments. [Copyright &y& Elsevier]

Abstract: Background: Research evidence suggests that clinical placements are important to both the perceptions and outcomes of nurse education. Nevertheless, despite this knowledge, research also indicates that many students receive negative experiences whilst attending these ‘remote’ settings, sometimes resulting in missed opportunities for learning and negative impressions of potential places of employment. Objective: In this context, this study investigates the experiences and perceptions of students relating to their clinical placements and, in particular, their views on professional structuring. Specifically it addresses the roles of, and communications between, the key academics, clinical professionals and institutions responsible for their organization. Methods: Focus group discussions with students (n=7) and an interview survey of ex-students (n=30) each from two British universities in Southeast England. Findings: The research highlights the diverse experiences that student receive on clinical placements, as well as their own suggestions for improvements. Student informed models of worst, minimum, current and best practice are then presented, as well as a cross-setting evaluation feedback model. These highlight responsibilities and communications across health professionals and educational sites. The models include an emphasis on the roles of ward managers, mentors, link tutors and more generally on shared but clearly delineated institutional responsibility for quality assurance mechanisms. They offer the opportunity to improve educational practice in clinically-based education and concurrently to improve student experiences and outcomes. Conclusions: Clinical placements are designed to provide practical learning through a ‘slice of practice life’. However, it is necessary to maximize this learning experience. Placements certainly need not be the worst slice. [Copyright &y& Elsevier]

Classic risk factors for mortality due to chronic heart failure (CHF), such as low left ventricular ejection fraction, NYHA functional stage, and increased heart rate perform well in the prediction of death from pump failure. The prediction of sudden cardiac death (SCD) remains somewhat problematic. Numerous studies have analyzed the potential contribution heart rate variability (HRV) can make to risk assessment in CHF. The aim of this review was to summarize the literature and identify the role HRV might play in identifying mode of death, as well as overall mortality risk. In studies where all-cause mortality or cardiac events were the clinical end point(s), global and slow oscillatory measures of HRV were the strongest risk predictors. In the fewer studies that used SCD as an end point, the strongest risk factors were HRV measures of short-term oscillations and sympathovagal interaction. We concluded from these findings that different HRV measurements predict different modes of death in CHF. Additionally, further studies using short-term analysis of HRV and non-linear analyses are warranted. Furthermore, studies with multiple end points, which clearly delineate pump failure from SCD, may be useful to identify more clearly the role HRV measures can play in the prediction of SCD. [ABSTRACT FROM AUTHOR]

Abstract: During the past decade, a distinct body of research has started to investigate the dynamics between nursing and place. However, despite attention being paid to a wide-range of nursing subjects, few studies have engaged with the important topic of labour force recruitment. In this context, this study uses a combined questionnaire (), interview () and focus group () survey of London-based students, and investigates the complex mix of experiences and perceptions that result in hospitals having varying degrees of popularity as potential workplaces. The findings suggest experiences and perceptions of institutions—often gained on clinical placements—to be important, particularly relating to feeling valued, the quality of patient care, clinical and educational opportunities and team cohesion. These are often combined with experiences and perceptions of locality, relating to factors such as cost of living, travel considerations and sense of personnel safety. The study demonstrates that place is relevant to employment decision-making on multiple scales from wards to regions. Furthermore, that perceptions of potential workplaces result from engagements with complex mixes of cultural, economic and physical features, many of which are the consequences of management. It is argued that in order to effectively unpack workplaces, geographical research of nursing labour may benefit from researching simultaneously both ‘inside’ institutions, focusing on their dominant cultures of production and sub-cultures, and ‘outside’, focusing on their local urban or rural contexts. [Copyright &y& Elsevier]

andrews G. J., Brodie D. A., Andrews J. P., Wong J.& Thomas B. G. (2005) Journal of Nursing Management 13, 345–355 Improving first-destination recruitment: nursing students' perceptions of three initiatives in London, England In the face of recruitment problems, managers are becoming increasingly proactive by introducing novel initiatives designed to encourage newly qualified nurses to apply to their institutions and catchment areas for employment. Based on a multimethod survey of students from two British universities, this paper explores their perceptions of three very different initiatives, each at different stages of development and implementation. The‘Home Trust’ initiative, provided the majority of clinical placements in one hospital. It was experienced by almost all the students who reported on it in questionnaires ( n = 650), focus groups ( n = 7) and interviews ( n = 30). The‘On Secondment’ initiative, seconded Health Care Assistants from their jobs into nurse education. It was experienced by a small number of students who reported on it in questionnaires ( n = 32) and focus groups ( n = 3). The‘Recruitment Clearing House’ initiative planned to provide one interview for a range of hospitals and job vacancies in a large geographical catchment area. At the time of data collection, it was in a conceptual phase and was commented on in a small number of focus groups with students ( n = 3). In addition, this initiative was commented on by recruitment managers in interviews ( n = 3). Students held strong views on the positive and negative features of both current and prospective initiatives. Unique consumer insights were gained, particularly into their finer details and consequences. Student experiences and perceptions are valuable in the planning, implementation and review stages of local recruitment initiatives. [ABSTRACT FROM AUTHOR]

Research has identified a number of negative societal perceptions of nursing related to gendered stereotyping, subordination to doctors, low academic standards, limited career opportunities and poor pay and conditions, and importantly how these perceptions may affect levels of recruitment into nursing. Focusing specifically on nurses, research has also considered the extent to which these societal perceptions are realities in their workplaces, and the direct experiences that contribute to attrition from both nursing courses and jobs. However, to date, few research has actually bridged the above approaches and considered the perceptions that nursing students hold as they first enter their education and how these change, or are confirmed, as a result of their experiences. In this context, the current study uses a combined questionnaire (n=650), interview (n=30) and focus group (n=7) methodology to investigate the experiences of students based at two British Universities. The findings suggest that many students were surprised, yet not overwhelmed, by the high academic standards required of them and came to recognize and value the tremendous knowledge, skills set and responsibilities of nurses as they acquired them. However, their experiences reinforced both society''s and their own image of an underpaid, overworked profession that lacks respect and has low morale. The findings support media initiatives that emphasize nurses’ skills in order to influence public opinion. They also support a range of subtle changes in nurse education at the institutional level to make student life easier. Nevertheless, it is acknowledged that these may have a limited impact unless pay and conditions are adequately addressed at the national level. [Copyright &y& Elsevier]

Develops an objective method for nurses in making equipment loans to home-based patients using a prioritization system based on clinical need. Importance of involving all stakeholders in decision-making; Highlights of the existing attitudes and perceptions of equipment loans service among health professionals.

Despite a substantial body of research over the last two decades the nature and role of body-image distortion in the variety of eating disorders is unclear. The purpose of the present paper is to review the evidence and largely on the basis of mare recent work to suggest a reconceptualization of the problem. Five sets of studies/observations, which are described in this paper, have led us to the following formulation: individuals suffering flora either anorexia or bulimia nervosa do not have a fixed and implacable distorted image of their own bodies, but rather have an ‘uncertain, unstable and weak body-image’, and that in making size estimation judgments they err on the side of caution and in consequence exhibit a bias towards overestimation of body size. It is further proposed that this judgemental bias is primarily influenced by social and cultural factors. The therapeutic implications of this reconceptualization are briefly highlighted. [ABSTRACT FROM AUTHOR]

Offers details of a study, the objective of which was to provide clinicians with a technology assessment of the safety and effectiveness of laparoscopic herniorrhaphy for the surgical repair of inguinal hernias. Information on a Diagnostic and Therapeutic Technology Assessment survey questionnaire; Methods and results of survey; Conclusions.

Determines the influence of oral hygiene practices and additional fluoride on erosive tooth wear in eating disorders. Dental assessment; Use of the tooth wear index; Frequency of oral hygiene among the bulimics; Effect of the ph of vomitus; Display of worsening tooth wear; Recommendation for immediate post-vomiting oral hygiene practices.

Background and Aim: High levels of physical activity and cardiorespiratory fitness may protect against non‐alcoholic fatty liver disease. We investigated whether different physical activity intensities and cardiorespiratory fitness were independent predictors of non‐alcoholic fatty liver disease. Methods: We included healthy adults with no prior diagnosis of liver dysfunction. Non‐alcoholic fatty liver disease prevalence was estimated based on fatty liver index scores. We created tertiles of self‐reported low, moderate, and vigorous physical activity. Participants completed an incremental treadmill test to estimate cardiorespiratory fitness, and data were subsequently separated into quintile groups (Q1 [least fit] through Q5 [most fit]). Results: Non‐alcoholic fatty liver disease prevalence in our sample of 7111 adults was 28.3% in male adults and 6.5% in female adults. Logistic regression showed the relative odds of non‐alcoholic fatty liver disease were 42% lower if > 60 min/week of vigorous physical activity was maintained (odds ratio [OR] = 0.58, confidence interval [CI]: 0.49–0.68). There was a negative dose–response association between cardiorespiratory fitness and non‐alcoholic fatty liver disease between Q1 and Q4. Compared with Q1, odds were 39% (OR = 0.61, CI: 0.51–0.73) lower in Q2, through to 51% lower in Q5 (OR = 0.49, CI: 0.41–0.60). Moderate physical activity did not reduce the odds of non‐alcoholic liver disease. Conclusions: We found the lowest prevalence of non‐alcoholic fatty liver disease in adults achieving > 60 min/week of vigorous physical activity. However, a stronger dose–response relationship existed between cardiorespiratory fitness and non‐alcoholic fatty liver disease. Improving cardiorespiratory fitness as a potential therapeutic target for treatment and prevention of non‐alcoholic fatty liver disease warrants further investigation. [ABSTRACT FROM AUTHOR]

Objectives: To develop normative reference standards for estimated cardiorespiratory fitness (eCRF) measured from treadmill-based incremental exercise testing in ~12 000 British men and women. Methods: Cross-sectional study using retrospectively collected eCRF data from five preventative health screening clinics in the United Kingdom. Reference centiles were developed using a parametric approach by fitting fractional polynomials. We selected the 'best' powers by considering both the smallest deviance, and clinical knowledge from the following set of a priori decided powers (-2,-1,-0.5, 0, 0.5,1,2,3). A series of fractional polynomials (FPs) were investigated with three-parameters (median, standard deviation and skewness). The following reference centiles were plotted (3, 5, 10, 25, 50, 75, 90, 95, 97). Results: We included 9 204 males (median [25th,75th centiles] age 48 [44, 53] years; BMI 27 {25, 29] kg∙m-2; peak VO2 36.9 [30.5, 44.7] ml∙kg-1∙min-1) and 2 687 females (age 48, [41, 51] years; BMI 24 {22, 27] kg∙m-2; peak VO2 36.5 [30.1, 44.8] ml∙kg-1∙min-1) in our analysis to develop the normative values. Conclusion: Reference values and nomograms for eCRF were derived from a relatively large cohort of preventative health care screening examinations of apparently healthy British men and women. Age- and sex-specific eCRF percentiles were similar to data from international cohort studies. The adoption of submaximal exercise testing protocols reduces individual risk when exercise history is unknown and testing is conducted in a community-based setting. Our findings can be used by health professionals to help guide clinical decision making. [ABSTRACT FROM AUTHOR]

We calculated the prevalence of the metabolically healthy but obese (MHO) phenotype in ( n = 9177) British men (age 48.9 ± 7.4 years) attending preventive health screening between 2000 and 2009. We examined differences in cardiorespiratory fitness (Fitness) and self-reported physical activity levels, according to whether the men were metabolically healthy (< 2 components of the metabolic syndrome), and by BMI category (normal-weight, overweight, obese). Fitness was estimated from treadmill exercise as VO 2peak and classified as: Low, Moderate, or High using age-specific cut-offs. We identified 21.6% of our sample as obese, of whom 83.1% were metabolically healthy. Compared with the metabolic unhealthy obese (MUO; 3.7% of sample), MHO phenotypes were fitter (effect size d = 0.21) and were more physically active ( d = 0.31). Logistic regression showed high fitness (OR = 2.40, 95% CI 1.38–4.19), and being physically active (OR = 1.71, 95% CI 1.14–2.56) to be independently associated with the MHO phenotype. Our findings agree with US data suggesting that higher cardiorespiratory fitness is a characteristic of the MHO phenotype. Our finding that meeting physical activity guidelines was associated with the MHO phenotype independent of fitness is, however, novel. If confirmed, our findings indicate that public health messages that encourage active lifestyles to promote fitness should be encouraged regardless of weight status. [ABSTRACT FROM AUTHOR]

The article provides tips on how to select ergonomics risk assessment tool. It suggests reading original articles or documentation in understanding the design, use, and intent of the tool. It indicates the importance of the interpretation of the design and approach of the tool. It cites the need for creating appropriate strategies to implement the tool consistently and accurately. It also recommends the provision of sufficient time for training and practice of an individual on the design and boundaries of the tool.

The article presents an obituary for William Stewart Ogden, former general practitioner at Chalfont St. Peter and Buckinghamshire, England.

Heart rate variability (HRV) is a known risk factor for mortality in both healthy and patient populations. There are currently no normative data for short-term measures of HRV. A thorough review of short-term HRV data published since 1996 was therefore performed. Data from studies published after the 1996 Task Force report (i.e., between January 1997 and September 2008) and reporting short-term measures of HRV obtained in normally healthy individuals were collated and factors underlying discrepant values were identified. Forty-four studies met the pre-set inclusion criteria involving 21,438 participants. Values for short-term HRV measures from the literature were lower than Task Force norms. A degree of homogeneity for common measures of HRV in healthy adults was shown across studies. A number of studies demonstrate large interindividual variations (up to 260,000%), particularly for spectral measures. A number of methodological discrepancies underlined disparate values. These include a systematic failure within the literature (a) to recognize the importance of RR data recognition/editing procedures and (b) to question disparate HRV values observed in normally healthy individuals. A need for large-scale population studies and a review of the Task Force recommendations for short-term HRV that covers the full-age spectrum were identified. Data presented should be used to quantify reference ranges for short-term measures of HRV in healthy adult populations but should be undertaken with reference to methodological factors underlying disparate values. Recommendations for the measurement of HRV require updating to include current technologies. (PACE 2010; 1407-1417) [ABSTRACT FROM AUTHOR]

In coronary artery disease (CAD) and following myocardial infarction (MI), activity of the autonomic nervous system is altered. Reduced heart rate variability (HRV) is a risk factor for future cardiac event. Studies reporting changes in HRV post-cardiac rehabilitation (CR) are heterogeneous, due possibly to varied data collection and analysis protocols. To evaluate changes in spectral measures of HRV derived from 5-minute ECG recordings in patients completing an 8 weeks CR programme. Thirty-eight patients (21 males, 17 females, aged 65.6 ± 11.6 years) underwent 5 minutes, supine ECG recordings and standard physiological and psychological assessment pre- and post-CR. A further 23 patients (14 males, 9 females aged 64.9 ± 9 years) acted as controls. Outcome measures were: low frequency power, (LF, 0.04–0.15 Hz) high frequency power (HF, 0.15–0.40 Hz), LF:HF ratio and mean RR interval. Change was assessed by ANCOVA and paired t-tests. When compared with the CT group, the CR group showed significant increases in: SDNN (Δ +6 ms, CR vs. 0 ms CT), HFln (Δ 0.4 log units CR vs. 0 log units CT), LFln (Δ +0.6 log units CR, vs. +0.1 log units CT) and RR interval (Δ +30 ms, CR vs. −28 ms CT). This is the first study to show significant increases in raw LF and HF power derived from short-term ECG recordings in CR patients. These measures are risk factors for future cardiac event. As CR is associated with increases in these measures it may be viewed as an effective therapy capable of bringing about favourable alterations in autonomic control. [ABSTRACT FROM AUTHOR]

Aims The purpose of this study was to indicate the normal range for peak cardiac power output (CPOpeak) in healthy adults and to explore age- and sex-related variations of this parameter. Methods and results Using the non-invasive exponential CO2 rebreathing technique [J.G. Defares, J Appl Physiol 13 (1958) 159], cardiac output was measured at an exercise intensity determined to coincide with ≥95% of peak oxygen consumption in 102 healthy adults (mean ± SD, age 43 ± 13 years, body mass 74 ± 13 kg). Peak cardiac power was then computed from measurements of peak cardiac output ( ) and peak mean arterial pressure (MAPpeak) using the equation described by Cooke et al. [ Heart 79 (1998) 289]. Peak oxygen consumption in the study population was 2·42 (±0·74) l min−1 and subjects achieved 101 ± 7% of this value during the measurement of . was 17·3 (±4) l min−1, and CPOpeak was computed as 4·5 (±1·2) W. CPOpeak ranged from 3·11 to 7·94 W in men and 2·53 to 5·57 W in women. Additionally, ageing appears to be associated with a significant loss of peak cardiac power in men that is not apparent in women. Conclusion Although the sample size remains moderate, the CPO values attained were normally distributed and these values provide a useful indication of the normal range for CPOpeak in healthy adults. [ABSTRACT FROM AUTHOR]

Abstract: Short-term assessment of heart rate variability (HRV) is a non-invasive technique to examine ANS function. Within the literature, HRV is commonly referred to as a reliable measurement technique. The aim of this review was to assess the accuracy of this description based upon a comprehensive review of the available data concerning reliability of short-term HRV measures. Reviewing only studies using appropriate statistical analyses, it was determined that reliability coefficients for HRV measures were highly varied. Coefficients of variation ranged from &#60;1% to >100%. Similar variation was found in studies using the intraclass correlation coefficient values, and limits of agreement. Reliability coefficients reported displayed some distinct patterns. Firstly, where measurements were made during interventions such as tilt or pharmacological stimulation, reliability was poorer than when HRV was measured at rest. Secondly, clinical populations displayed poorer reliability than healthy subjects. There was little effect of test–retest duration on reliability and although no single HRV measurement appeared less reliable than another, there was evidence that optimal data collection conditions for specific frequency domain measures exist. Describing HRV as a reliable measurement technique appears to be a gross oversimplification, as results of reliability studies are heterogenous, and dependent on a number of factors. Further studies are required, particularly in clinical populations to assess HRV reliability. Authors should refer to coefficients from similar populations measured under similar conditions when making future sample size calculations. [Copyright &y& Elsevier]

Objectives: Heart rate variability (HRV) and haemodynamic response to exercise (i.e. peak cardiac power output) are strong predictors of mortality in heart failure. The present study assessed the relationship between measures of HRV and peak cardiac power output.Design: In a prospective observational study of 33 patients (age 54 ± 16 years) with chronic heart failure with reduced left ventricular ejection fraction (29 ± 11%), measures of the HRV (i.e. R-R interval and standard deviation of normal R-R intervals, SDNN) were recorded in a supine position. All patients underwent maximal graded cardiopulmonary exercise testing with non-invasive (inert gas rebreathing) cardiac output assessment. Cardiac power output, expressed in watts, was calculated as the product of cardiac output and mean arterial blood pressure.Results: The mean RR and SDNN were 837 ± 166 and 96 ± 29 ms, peak exercise cardiac power output 2.28 ± 0.85 watts, cardiac output 10.34 ± 3.14 L/min, mean arterial blood pressure 98 ± 14 mmHg, stroke volume 91.43 ± 40.77 mL/beat, and oxygen consumption 19.0 ± 5.6 mL/kg/min. There was a significant but only moderate relationship between the RR interval and peak exercise cardiac power output (r = 0.43, p = .013), cardiac output (r = 0.35, p = .047), and mean arterial blood pressure (r = 0.45, p = .009). The SDNN correlated with peak cardiac power output (r = 0.42, p = .016), mean arterial blood arterial (r = 0.41, p = .019), and stroke volume (r = 0.35, p = .043).Conclusions: Moderate strength of the relationship between measures of HRV and cardiac response to exercise suggests that cardiac autonomic function is not good indicator of overall function and pumping capability of the heart in chronic heart failure. [ABSTRACT FROM AUTHOR]

Background: Left ventricular assist devices (LVADs) have been used as an effective therapeutic option in patients with advanced heart failure, either as a bridge to transplantation, as destination therapy, or in some patients, as a bridge to recovery.Objectives: This study evaluated whether patients undergoing an LVAD bridge-to-recovery protocol can achieve cardiac and physical functional capacities equivalent to those of healthy controls.Methods: Fifty-eight male patients-18 implanted with a continuous-flow LVAD, 16 patients with LVAD explanted (recovered patients), and 24 heart transplant candidates (HTx)-and 97 healthy controls performed a maximal graded cardiopulmonary exercise test with continuous measurements of respiratory gas exchange and noninvasive (rebreathing) hemodynamic data. Cardiac function was represented by peak exercise cardiac power output (mean arterial blood pressure × cardiac output) and functional capacity by peak exercise O2 consumption.Results: All patients demonstrated a significant exertional effort as demonstrated with the mean peak exercise respiratory exchange ratio >1.10. Peak exercise cardiac power output was significantly higher in healthy controls and explanted LVAD patients compared with other patients (healthy 5.35 ± 0.95 W; explanted 3.45 ± 0.72 W; LVAD implanted 2.37 ± 0.68 W; and HTx 1.31 ± 0.31 W; p < 0.05), as was peak O2 consumption (healthy 36.4 ± 10.3 ml/kg/min; explanted 29.8 ± 5.9 ml/kg/min; implanted 20.5 ± 4.3 ml/kg/min; and HTx 12.0 ± 2.2 ml/kg/min; p < 0.05). In the LVAD explanted group, 38% of the patients achieved peak cardiac power output and 69% achieved peak O2 consumption within the ranges of healthy controls.Conclusions: The authors have shown that a substantial number of patients who recovered sufficiently to allow explantation of their LVAD can even achieve cardiac and physical functional capacities nearly equivalent to those of healthy controls. [ABSTRACT FROM AUTHOR]

Background: Iodine deficiency is a major public health problem in many developing countries including Nepal. The present study was designed to investigate the urinary iodine excretion (UIE), thyroid function status and household salt iodine content (SIC) in school-aged children (SAC) and to establish the relationships between these factors. Methods: A community-based cross sectional study was conducted in selected schools of two districts, Tehrathum and Morang, lying in the hill and plain region of eastern Nepal respectively. A total of 640 SAC, (Tehrathum n = 274 and Morang n = 366) aged 6-11 years, were assessed for UIE and household SIC. Among the 640 children, 155 consented to blood samples (Tehrathum n = 78 and Morang n = 77) to test for serum thyroglobulin (Tg), thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4). UIE was measured by ammonium persulfate digestion method. SIC was measured by iodometric titration method and Tg, TSH, fT4 and fT3 were measured by immunoassay based kit method. Results: In Tehrathum and Morang, 9.5 and 7.7 % of SAC had UIE values of UIE <100 µg/L while 59.5 and 41 % had iodine nutrition values of >299 µg/L, with median UIE of 345.65 and 270.36 µg/L respectively. The overall medians were as follows, Tg 14.29 µg/L, fT3 3.94 pmol/L, fT4 16.25 pmol/L and TSH 3.61 mIU/L. There was a negative correlation between UIE and Tg (r = -0.236, p = 0.003) and a positive correlation between UIE and SIC (r = 0.349, p < 0.0001). We found 19.5 %, n = 15 and 16.7 %, n = 13 subclinical hypothyroid cases in Morang and Tehrathum respectively. Iodometric titration showed only 6.4% (n = 41) of the samples had household SIC <15 ppm. Multivariate analysis revealed that use of packaged salt by SAC of Tehrathum district correlated with higher UIE value. Conclusions: Our focused data suggests that collaborative universal salt iodization (USI) programs are improving the health of children in the Tehrathum and Morang districts of Nepal. We also found that excessive iodine in a large portion of the study groups is a substantial concern and iodine intervention programs need to deal with both deficient and excessive iodine scenarios that can both be present simultaneously in study populations. [ABSTRACT FROM AUTHOR]

Background: Iodine deficiency is a major public health problem in many developing countries including Nepal. The present study was designed to investigate the urinary iodine excretion (UIE), thyroid function status and household salt iodine content (SIC) in school-aged children (SAC) and to establish the relationships between these factors. Methods: A community-based cross sectional study was conducted in selected schools of two districts, Tehrathum and Morang, lying in the hill and plain region of eastern Nepal respectively. A total of 640 SAC, (Tehrathum n = 274 and Morang n = 366) aged 6–11 years, were assessed for UIE and household SIC. Among the 640 children, 155 consented to blood samples (Tehrathum n = 78 and Morang n = 77) to test for serum thyroglobulin (Tg), thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4). UIE was measured by ammonium persulfate digestion method. SIC was measured by iodometric titration method and Tg, TSH, fT4 and fT3 were measured by immunoassay based kit method. Results: In Tehrathum and Morang, 9.5 and 7.7 % of SAC had UIE values of UIE <100 μg/L while 59.5 and 41 % had iodine nutrition values of >299 μg/L, with median UIE of 345.65 and 270.36 μg/L respectively. The overall medians were as follows, Tg 14.29 μg/L, fT3 3.94 pmol/L, fT4 16.25 pmol/L and TSH 3.61 mIU/L. There was a negative correlation between UIE and Tg (r = −0.236, p = 0.003) and a positive correlation between UIE and SIC (r = 0.349, p < 0.0001). We found 19.5 %, n = 15 and 16.7 %, n = 13 subclinical hypothyroid cases in Morang and Tehrathum respectively. Iodometric titration showed only 6.4% (n = 41) of the samples had household SIC <15 ppm. Multivariate analysis revealed that use of packaged salt by SAC of Tehrathum district correlated with higher UIE values. Conclusions: Our focused data suggests that collaborative universal salt iodization (USI) programs are improving the health of children in the Tehrathum and Morang districts of Nepal. We also found that excessive iodine in a large portion of the study groups is a substantial concern and iodine intervention programs need to deal with both deficient and excessive iodine scenarios that can both be present simultaneously in study populations. [ABSTRACT FROM AUTHOR]

We studied the effectiveness of a home-based exercise programme with information technology (IT) support in people with metabolic syndrome in India. Ninety-four participants with metabolic syndrome (mean age 50 years) were randomized into two groups. Both groups received a 12-week home exercise programme and Group 2 received additional IT support for health education. Before and after the exercise programme, participants were measured for arterial stiffness using applanation tonometry, exercise capacity using an incremental shuttle walk test and quality of life (QoL) using the SF-36 questionnaire. Sixty-one participants completed the post intervention tests. There was a significant reduction in systolic blood pressure, mean pressure and aortic systolic pressure in both groups. Pulse wave velocity, aortic pulse pressure and aortic diastolic pressure showed significant reductions only in Group 2. There were no significant changes in QoL measures, except vitality in Group 2. There was significant improvement in fasting blood glucose in Group 2, cholesterol in Group 1 and triglycerides in both groups. The participants’ exercise capacity did not change significantly, although the mean duration of regular exercise was 7.2 weeks for Group 1 and 10.0 weeks for Group 2 (P = 0.019). Metabolic syndrome was reversed in 16% of the participants in both groups. IT support, through mobile text messages and phone calls, may be helpful in metabolic syndrome. Longer-term studies are now required. [ABSTRACT FROM PUBLISHER]

Abstract: Objectives: The objective of the study is to determine cardiac autonomic control in patients undergoing assessment for and/or LVAD therapy. Methods: Heart rate variability (HRV) was measured in 17 explanted LVAD, 17 implanted LVAD and 23 NYHA III–IV classified chronic heart failure (CHF) patients and ten healthy matched controls under three conditions: supine free breathing, standing and supine controlled breathing. Five measures of HRV were assessed: mean R–R interval (mR–R), high frequency (HF) and low frequency (LF) spectral power, LF in normalised units (LFnu), and LF to HF (LF:HF) ratio. Results: Repeat measures ANOVA showed significant (p<0.05) differences in HRV between all three conditions within groups. Lower values were observed in CHF for LF(in log natural units) compared with explanted patients (−1.4 [95% CI −2.6 to −0.7], p=0.04) and controls (−2.1 [−3.5 to −0.7], p=0.001) and for LF:HF compared with implanted patients under paced breathing conditions (z =−2.7, p=0.007) and controls in standing (z =−2.9, p=0.004) and paced breathing conditions (z =−2.3, p=0.02). However, no significant differences were seen between explanted, implanted and control groups under any condition. Conclusions: Patients implanted with an LVAD and explanted from a LVAD following myocardial recovery demonstrate a more normal dynamic response to autonomic stimuli and have a lower HRV risk profile compared to CHF patients. [Copyright &y& Elsevier]

Background: Universal salt iodization remains the best strategy for controlling iodine deficiency disorders in Nepal. Aims: This study was designed to study the salt types and the household salt iodine content of school aged children in the hilly and the plain districts of eastern Nepal. Material and Methods: This cross-sectional study was carried out on school children of seven randomly chosen schools from four districts, namely, Sunsari, Dhankuta, Sankhuwasabha and Tehrathum of eastern Nepal. The school children were requested to bring two teaspoonfuls (approx. 12-15 g) of the salt which was consumed in their households, in a tightly sealed plastic pouch. The salt types were categorized, and the salt iodine content was estimated by using rapid test kits and iodometric titrations. The association of the salt iodine content of the different districts were tested by using the Chi-square test. The sensitivity, specificity, positive predictive values, and negative predictive values of the rapid test kits were compared with the iodometric titrations. Results: Our study showed that mean±SD values of the salt iodine content in the four districts, namely, Sunsari, Dhankuta, Sankhuwasabha and Tehrathum were 34.2±17.9, 33.2±14.5, 27.4±15.1 and 48.4±15.6 parts per million (ppm). There were 270 (38.2%) households which consumed crystal salt and 437(61.8%) of the households consumed packet salts. Conclusions: Our study recommends a regular monitoring of the salt iodization programs in these regions. More families should be made aware of the need to ensure that each individual consumes iodized salt. [ABSTRACT FROM AUTHOR]

Cardiac power output ( CPO) is a unique and direct measure of overall cardiac function (i.e. cardiac pumping capability) that integrates both flow- and pressure-generating capacities of the heart. The present study assessed the relationship between peak exercise CPO and selected indices of cardio-respiratory fitness. Thirty-seven healthy adults (23 men and 14 women) performed an incremental exercise test to volitional fatigue using the Bruce protocol with gas exchange and ventilatory measurements. Following a 40-min recovery, the subjects performed a constant maximum workload exercise test at or above 95% of maximal oxygen consumption. Cardiac output was measured using the exponential CO2 rebreathing method. The CPO, expressed in W, was calculated as the product of the mean arterial blood pressure and cardiac output. At peak exercise, CPO was well correlated with cardiac output ( r = 0·92, P<0·01), stroke volume ( r = 0·90, P<0·01) and peak oxygen consumption ( r = 0·77, P<0·01). The coefficient of correlation was moderate between CPO and anaerobic threshold ( r = 0·47, P<0·01), oxygen pulse ( r = 0·57, P<0·01), minute ventilation ( r = 0·53, P<0·01) and carbon dioxide production ( r = 0·56, P<0·01). Small but significant relationship was found between peak CPO and peak heart rate ( r = 0·23, P<0·05). These findings suggest that only peak cardiac output and stroke volume truly reflect CPO. Other indices of cardio-respiratory fitness such as oxygen consumption, anaerobic threshold, oxygen pulse, minute ventilation, carbon dioxide production and heart rate should not be used as surrogates for overall cardiac function and pumping capability of the heart. [ABSTRACT FROM AUTHOR]

Cardiac power output is a direct measure of overall cardiac function that integrates both flow-and pressure-generating capacities of the heart. The present study assessed the reproducibility of cardiac power output and other more commonly reported cardiopulmonary exercise variables in patients with chronic heart failure. Metabolic, ventilatory and non-invasive (inert gas re-breathing) central haemodynamic measurements were undertaken at rest and near-maximal exercise of the modified Bruce protocol in 19 patients with stable chronic heart failure. The same procedure was repeated 7 days later to assess reproducibility. Cardiac power output was calculated as the product of cardiac output and mean arterial pressure. Resting central haemodynamic variables demonstrate low CV (coefficient of variation) (ranging from 3.4% for cardiac output and 5.6% for heart rate). The CV for resting metabolic and ventilatory measurements ranged from 8.2% for respiratory exchange ratio and 14.2% for absolute values of oxygen consumption. The CV of anaerobic threshold, peak oxygen consumption, carbon dioxide production and respiratory exchange ratio ranged from 3.8% (for anaerobic threshold) to 6.4% (for relative peak oxygen consumption), with minute ventilation having a CV of 11.1%. Near-maximal exercise cardiac power output and cardiac output had CVs of 4.1 and 2.2%, respectively. Cardiac power output demonstrates good reproducibility suggesting that there is no need for performing more than one cardiopulmonary exercise test. As a direct measure of cardiac function (dysfunction) and an excellent prognostic marker, it is strongly advised in the assessment of patients with chronic heart failure undergoing cardiopulmonary exercise testing. [ABSTRACT FROM AUTHOR]

Background: Bradykinin type 2 receptor (B2BRK) genotype was reported to be associated with changes in the left-ventricular mass as a response to aerobic training, as well as in the regulation of the skeletal muscle performance in both athletes and non-athletes. However, there are no reports on the effect of B2BRK 9-bp polymorphism on the response of the skeletal muscle to strength training, and our aim was to determine the relationship between the B2BRK SNP and triceps brachii functional and morphological adaptation to programmed physical activity in young adults. Methods: In this 6-week pretest-posttest exercise intervention study, twenty nine healthy young men (21.5 ± 2.7 y, BMI 24.2 ± 3.5 kg/m2) were put on a 6-week exercise protocol using an isoacceleration dynamometer (5 times a week, 5 daily sets with 10 maximal elbow extensions, 1 minute rest between sets). Triceps brachii muscle volumes were assessed by using magnetic resonance imaging before and after the strength training. Bradykinin type 2receptor 9 base pair polymorphism was determined for all participants. Results: Following the elbow extensors training, an average increase in the volume of both triceps brachii was5.4 ± 3.4% (from 929.5 ± 146.8 cm3 pre-training to 977.6 ± 140.9 cm3 after training, p<0.001). Triceps brachii volume increase was significantly larger in individuals homozygous for ?9 allele compared to individuals with one or two+9 alleles (−9/-9, 8.5 ± 3.8%; vs. -9/+9 and +9/+9 combined, 4.7 ± 4.5%, p < 0.05). Mean increases in endurance strength in response to training were 48.4 ± 20.2%, but the increases were not dependent on B2BRK genotype(-9/-9, 50.2 ± 19.2%; vs. -9/+9 and +9/+9 combined, 46.8 ± 20.7%, p > 0.05). Conclusions: We found that muscle morphological response to targeted training - hypertrophy - is related to polymorphisms of B2BRK. However, no significant influence of different B2BRK genotypes on functional muscle properties after strength training in young healthy non athletes was found. This finding could be relevant, not only in predicting individual muscle adaptation capacity to training or sarcopenia related to aging and inactivity, but also in determining new therapeutic strategies targeting genetic control of muscle function, especially for neuromuscular disorders that are characterized by progressive adverse changes in muscle quality, mass, strength and force production (e.g., muscular dystrophy, multiple sclerosis, Parkinson's disease [ABSTRACT FROM AUTHOR]

Aim Exercise-derived variables have been used in the assessment of functional capacity and prognosis in patients with chronic heart failure. The aim of this study was to assess the relationship between cardiac pumping capability represented by peak cardiac power output and peak oxygen consumption, anaerobic threshold, ventilatory efficiency slope, and peak circulatory power in patients undergoing the ‘Harefield Protocol’. Methods and results Haemodynamic and gas exchange measurements were undertaken during a graded treadmill exercise test. They were performed on 54 patients—18 implanted with left ventricular assist devices (LVADs), 16 explanted (recovered), and 20 moderate-to-severe heart failure patients. Peak oxygen consumption was only highly correlated with peak cardiac power output in explanted LVAD (r = 0.85, P< 0.01), but not in implanted LVAD and heart failure patients (r = 0.55 and 0.53, P< 0.05). The anaerobic threshold was only modestly correlated with peak cardiac power output in heart failure and explanted (r = 0.46 and 0.54, P< 0.05) and weakly in implanted LVAD patients (r = 0.37, P< 0.05). Peak cardiac power output was well correlated with peak circulatory power in LVAD explanted and implanted (r = 0.82, P< 0.01; r = 0.63, P< 0.01) but not in heart failure patients (r = 0.31, P> 0.05). Ventilatory efficiency slope was only moderately correlated with peak cardiac power output in LVAD-explanted patients (r = −0.52, P< 0.05). Conclusion Exercise-derived prognostic indicators demonstrate limited capacity in reflecting cardiac pumping capability in patients treated with LVADs and should therefore be used with caution in interpretation of cardiac organ function. [ABSTRACT FROM AUTHOR]

The effects of different recovery protocols on heart rate recovery (HRR) trend through fitted heart rate (HR) decay curves were assessed. Twenty one trained male athletes and 19 sedentary male students performed a submaximal cycle exercise test on four occasions followed by 5 min: 1) inactive recovery in the upright seated position, 2) active (cycling) recovery in the upright seated position, 3) supine position, and 4) supine position with elevated legs. The HRR was assessed as the difference between the peak exercise HR and the HR recorded following 60 seconds of recovery (HRR60). Additionally the time constant decay was obtained by fitting the 5 minute post-exercise HRR into a first-order exponential curve. Within-subject differences of HRR60 for all recovery protocols in both groups were significant (p < 0.001) except for the two supine positions (p > 0.05). Values of HRR60 were larger in the group of athletes for all conditions (p < 0.001). The time constant of HR decay showed within-subject differences for all recovery conditions in both groups (p < 0.01) except for the two supine positions (p > 0.05). Between group difference was found for active recovery in the seated position and the supine position with elevated legs (p < 0.05). We conclude that the supine position with or without elevated legs accelerated HRR compared with the two seated positions. Active recovery in the seated upright position was associated with slower HRR compared with inactive recovery in the same position. The HRR in athletes was accelerated in the supine position with elevated legs and with active recovery in the seated position compared with non-athletes. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine morphological and functional changes of the elbow extensor muscles in response to a 12-week self-perceived maximal resistance training (MRT). Twenty-one healthy sedentary young men were engaged in elbow extensor training using isoacceleration dynamometry for 12 weeks with a frequency of five sessions per week (five sets of ten maximal voluntarily contractions, 1-min rest period between each set). Prior to, at 6 weeks and after the training, a series of cross-sectional magnetic resonance images of the upper arm were obtained and muscle volumes were calculated. Maximal and endurance strength increased ( P<0·01) by 15% and 45% at 6 weeks, and by 29% and 70% after 12 weeks compared with baseline values, while fatigue rate of the elbow extensors decreased by 67%. The volume of triceps brachii increased in both arms ( P<0·01) by 4% at 6 weeks, and by 8% after 12 weeks compared with baseline values (right arm - from 487·4 ± 72·8 cm3 to 505·8 ± 72·3 cm3 after 6 weeks and 525·3 ± 73·7 cm3 after 12 weeks; left arm - from 475·3 ± 79·1 cm3 to 493·2 ± 72·7 cm3 after 6 weeks and 511·3 ± 77·0 cm3 after 12 weeks). A high correlation was found between maximal muscle strength and muscle volume prior ( r2 = 0·62) and after ( r2 = 0·69) the training ( P≤0·05). A self-perceived MRT resulted in an increase in maximal and endurance strength. Morphological adaptation changes of triceps brachii as a result of 12-week specific strength training can explain only up to 26% of strength gain. [ABSTRACT FROM AUTHOR]

Background The use of the HeartMate II continuous-flow left ventricular assist device (LVAD) improves survival, quality of life and functional capacity of patients with advanced heart failure. However, no study so far has shown the benefits of these devices for cardiac function during peak exercise. Objective To assess cardiac and exercise performance in patients implanted with the HeartMate II LVAD under two settings: (i) optimal device support and (ii) reduced device support. Methods Twelve patients implanted with a HeartMate II LVAD performed a graded cardiopulmonary exercise test with respiratory gas exchange and non-invasive (rebreathing) haemodynamic measurements. After a 4 h resting period, patients performed an additional cardiopulmonary exercise test with reduced LVAD support (pump speed was reduced from optimal 9000-9600 to 6000 revs/min). Results In response to reduced HeartMate II LVAD support, resting cardiac power output and cardiac output decreased by 21% and 13%, respectively. Also at reduced device support, peak exercise cardiac power output was 39% lower (1.40±0.50 vs 2.31±0.58 W; p<0.05), peak cardiac output 30% lower (8.6±2.5 vs 12.2±2.1 l/min; p<0.05) and mean blood pressure 13% lower (74.3±14.9 vs 85.4±15.4 vs mm Hg; p<0.05). Exercise capacity was also diminished with 23% lower peak oxygen consumption (14.1±5.3 vs 18.2±4.5 ml/kg/min; p<0.05) and an 18% shorter exercise duration (516±119 vs 628±192 s; p<0.05). Conclusion It has been shown for the first time that the HeartMate II LVAD can confer both resting and peak cardiac functional benefits to patients with end-stage heart failure, thus improving exercise capacity. [ABSTRACT FROM AUTHOR]

Identify the underlying role of resting heart rate variability (HRV) in the hearts response to graded exercise testing (GXT). Resting 5-min HRV and heart rate (HR) measurements were made in 33 volunteers (19 males, median age 34, range 25–63 years and 14 females median age 48, range 21–63 years). Measures of $$ \dot{V}{\text{O}}_{{ 2 {\text{peak}}}} $$ and HR obtained during a maximal GXT and heart rate recovery (HRR) post-GXT were assessed for associations with resting HRV. Differences and effect size ( d) for measures of HRV were assessed between groups based on established risk cut-points for resting, exercise and recovery HR responses. Small associations were observed for the majority of resting HRV and GXT HR responses (best r value = −0.27, P > 0.05). Measures of HRV demonstrated moderate associations with HRR (best r value = 0.46, P < 0.05) and were able to predict a negative risk HRR. In contrast to other dependent variables, measures of HRV were consistently able to demonstrate significant and moderate to large ( d = 0.9–2.0) differences between groups based on literature defined prognostic HR cut-points. Small associations with HR responses to exercise prevent their accurate prediction from resting HRV. Data support the use of vagally mediated resting HRV in predicting better HRR. Lower resting autonomic modulations underlined high risk resting and exercise HR responses. Resting short-term HRV measurements should be considered when assessing cardiac autonomic health from the HR response before, during and/or after exercise. [ABSTRACT FROM AUTHOR]

In patients with cardiac failure, bioreactance-based cardiac output (CO) monitoring provides a valid non-invasive method for assessing cardiac performance during exercise. The purpose of this study was to evaluate the efficacy of this technique during strenuous exercise in healthy, trained individuals. Fourteen recreational cyclists, mean (SD) age of 34 (8) years and relative peak oxygen uptake of (VO(2)) 56 (6) ml kg(-1) min(-1), underwent incremental maximal exercise testing, whilst CO was recorded continuously using a novel bioreactance-based device (CO(bio)). The CO(bio) was evaluated against relationship with VO(2), theoretical calculation of arterial-venous oxygen difference (C(a - v) O(2)) and level of agreement with an inert gas rebreathing method (CO(rb)) using a Bland-Altman plot. Bioreactance-based CO measurement was practical and straightforward in application, although there was intermittent loss of electrocardiograph signal at high-intensity exercise. At rest and during exercise, CO(bio) was strongly correlated with VO(2) (r = 0.84; P < 0.001), however, there was evidence of systematic bias with CO(bio) providing lower values than CO(rb); mean bias (limits of agreement) -19% (14.6 to -53%). Likewise, calculated (C(a - v) O(2)) was greater when determined using CO(bio) than CO(rb) (P < 0.001), although both devices provided values in excess of those reported in invasive studies. Bioreactance-based determination of CO provides a pragmatic approach to the continuous assessment of cardiac performance during strenuous exercise in trained individuals. Our findings, however, suggest that further work is needed to refine the key measurement determinants of CO using this device to improve measurement accuracy in this setting. [ABSTRACT FROM AUTHOR]

Peak cardiac power output (CPO), as a direct measurement of overall cardiac function, has been shown to be a most powerful predictor of prognosis for patients with chronic heart failure. The present study assessed CPO and exercise performance in patients implanted with a left ventricular assist device (LVAD), those explanted due to myocardial recovery, and those with moderate to severe heart failure. Hemodynamic and respiratory gas exchange measurements were undertaken at rest and at peak graded exercise. These were performed in 54 patients—20 with moderate to severe heart failure, 18 with implanted LVADs, and 16 with explanted LVADs. At rest there was a nonsignificant difference in CPO among groups (p >0.05). Peak CPO was significantly higher in the explanted LVAD than in the heart failure and implanted LVAD groups (heart failure 1.90 ± 0.45 W, implanted LVAD 2.37 ± 0.55 W, explanted LVAD 3.39 ± 0.61 W, p <0.01) as was peak cardiac output (heart failure 9.1 ± 2.1 L/min, implanted LVAD 12.4 ± 2.2 L/min, explanted LVD 14.6 ± 2.9 L/min, p <0.01). Peak oxygen consumption was higher in the explanted LVAD than in the heart failure and implanted LVAD groups (heart failure 15.8 ± 4.1 ml/kg/min, implanted LVAD 19.8 ± 5.8 ml/kg/min, explanted LVAD 28.2 ± 5.0 ml/kg/min, p <0.05) as was anaerobic threshold (heart failure 11.2 ± 1.9 ml/kg/min, implanted LVAD 14.7 ± 4.9 ml/kg/min, explanted LVAD 21.4 ± 5.0 ml/kg/min, p <0.05). In conclusion, peak CPO differentiates well during cardiac restoration using LVADs and emphasizes the benefits of this therapy. CPO has the potential to be a key physiologic marker of heart failure severity and can guide management of patients with LVAD. [Copyright &y& Elsevier]

The purpose of this study was to assess the effect of three different body positions on HRV measures following short-term submaximal exercise. Thirty young healthy males performed submaximal cycling for five minutes on three different occasions. Measures of HRV were obtained from 5-min R to R wave intervals before the exercise (baseline) and during the last five minutes of a 15 min recovery (post-exercise) in three different body positions (seated, supine, supine with elevated legs). Measures of the mean RR normal-to-normal intervals (RRNN), the standard deviation of normal-to-normal intervals (SDNN), the root mean square of successive differences (RMSSD) and the low-frequency (LF) and the high-frequency (HF) spectral power were analyzed. Post-exercise RRNN, RMSSD were significantly higher in the two supine positions (p < 0.01) compared with seated body position. Post-exercise ln LF was significantly lower in the supine position with elevated legs than in the seated body position (p < 0.05). No significant difference was found among the three different body positions for postexercise ln HF (p > 0.05). Post-exercise time domain measures of HRV (RRNN, SDNN, RMSSD) were significantly lower compared with baseline values (p < 0.01) regardless body position. Post-exercise ln LF and ln HF in all three positions remained significantly reduced during recovery compared to baseline values (p < 0.01). The present study suggests that 15 minutes following short-term submaximal exercise most of the time and frequency domain HRV measures have not returned to pre-exercise values. Modifications in autonomic cardiac regulation induced by body posture present at rest remained after exercise, but the post-exercise differences among the three positions did not resemble the ones established at rest. [ABSTRACT FROM AUTHOR]

The article focuses on the validity and reliability of short-term resting heart-rate variability (HRV) measures obtained using the Polar S810 heart-rate monitor and accompanying software. It notes the marginal differences between Polar and the CardioPerfect (CP) mean measures of HRV and shows that the uncertainty in the differences was small. It states that Polar S810 demonstrated high correlations with CP for all measures of HRV and does not add any substantial technical errors in the measurements of HRV. It suggests that HRV measures obtained with the Polar S810 have no appreciable bias or additional random error in comparison with criterion measures but the measures are inherently unreliable over a 1-week interval.

Heart rate variability estimates cardiac autonomic modulation, but the relationship between habitual physical activity and heart rate variability remains unclear. The aims of this study were to compare RR-interval and heart rate variability indices in individuals of different habitual physical activity levels, and examine the relationship between habitual physical activity and heart rate variability. Ninety-two healthy volunteers (47 men, 45 women; mean age 23.1 years, s = 2.1) were divided into tertiles according to the Baecke Questionnaire score. Standard heart rate variability indices were derived from 5-min resting RR-interval recordings with paced respiration (0.25 Hz). Between-group differences and the relationship between habitual physical activity and heart rate variability were assessed. More active participants (tertiles 2-3) had longer RR-intervals than those in tertile 1 (P < 0.05). Participants in tertile 2 had higher root mean squared differences of successive normal RR-intervals than those in tertile 1 and a higher standard deviation of normal RR-intervals than those in tertiles 1 and 3. There was a positive linear relationship between habitual activity and RR-interval. Differing RR-interval lengths were found in subgroups of young individuals according to level of habitual physical activity. More active individuals showed resting bradycardia without evidence of enhanced cardiac parasympathetic modulation. The mechanism linking habitual physical activity and RR-interval length appears to be independent of physiological mechanisms that can be measured by heart rate variability. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the agreement between HRV measures derived from a time series of RR intervals recorded by a standard 12-lead ECG (CP) and a commercially available RR interval recorder (S810). Thirty-three participants (19 males) (median age 36, range 20-63) underwent simultaneous, 5-min, supine RR-interval recordings. Each RR interval time series was analysed using the software supplied with the recording equipment. Two comparisons were then made. First, a comparison of RR interval data recording and editing only was made. Second, comparisons were made for measures of HRV derived from edited RR interval data. Agreement between RR intervals and standard HRV measures were assessed using intraclass correlation coefficient and limits of agreement. Agreement of HRV measures derived from RR intervals recorded and edited by individual systems was not acceptable. Agreement analyses for the number of RR intervals recorded and edited by each systems software showed excellent intraclass correlation coefficients (ICC lower 95% CI > 0.75) and acceptably narrow limits of agreement (LoA). These data indicate that the number of RR intervals recorded by S810 can agree well those recorded from a standard 12-lead ECG. This is true even after application of system specific data editing procedures. Commercial RR-interval recorders may offer a simple, inexpensive alternative to full 12-lead ECG in the recording and editing of RR intervals for subsequent HRV analysis in healthy populations. [ABSTRACT FROM AUTHOR]

Several rebreathing methods are available for cardiac output ( Q T) measurement. The aims of this study were threefold: first, to compare values for resting Q T produced by the equilibrium-CO2, exponential-CO2 and inert gas-N2O rebreathing methods and, second, to evaluate the reproducibility of these three methods at rest. The third aim was to assess the agreement between estimates of peak exercise Q T derived from the exponential and inert gas rebreathing methods. A total of 18 healthy subjects visited the exercise laboratory on different days. Repeated measures of Q T, measured in a seated position, were separated by a 5 min rest period. Twelve participants performed an incremental exercise test to determine peak oxygen consumption. Two more exercise tests were used to measure Q T at peak exercise using the exponential and inert gas rebreathing methods. The exponential method produced significantly higher estimates at rest (averaging 10.9 l min−1) compared with the equilibrium method (averaging 6.6 l min−1) and the inert gas rebreathing method (averaging 5.1 l min−1; P < 0.01). All methods were highly reproducible with the exponential method having the largest coefficient of variation (5.3%). At peak exercise, there were non-significant differences between the exponential and inert gas rebreathing methods ( P = 0.14). The limits of agreement were −0.49 to 0.79 l min−1. Due to the ability to evaluate the degree of gas mixing and to estimate intra-pulmonary shunt, we believe that the inert gas rebreathing method has the potential to measure Q T more precisely than either of the CO2 rebreathing methods used in this study. At peak exercise, the exponential and inert gas rebreathing methods both showed acceptable limits of agreement. [ABSTRACT FROM AUTHOR]

Several rebreathing methods are available for cardiac output (Q (T)) measurement. The aims of this study were threefold: first, to compare values for resting Q (T) produced by the equilibrium-CO(2), exponential-CO(2) and inert gas-N(2)O rebreathing methods and, second, to evaluate the reproducibility of these three methods at rest. The third aim was to assess the agreement between estimates of peak exercise Q (T) derived from the exponential and inert gas rebreathing methods. A total of 18 healthy subjects visited the exercise laboratory on different days. Repeated measures of Q (T), measured in a seated position, were separated by a 5 min rest period. Twelve participants performed an incremental exercise test to determine peak oxygen consumption. Two more exercise tests were used to measure Q (T) at peak exercise using the exponential and inert gas rebreathing methods. The exponential method produced significantly higher estimates at rest (averaging 10.9 l min(-1)) compared with the equilibrium method (averaging 6.6 l min(-1)) and the inert gas rebreathing method (averaging 5.1 l min(-1); P < 0.01). All methods were highly reproducible with the exponential method having the largest coefficient of variation (5.3%). At peak exercise, there were non-significant differences between the exponential and inert gas rebreathing methods (P = 0.14). The limits of agreement were -0.49 to 0.79 l min(-1). Due to the ability to evaluate the degree of gas mixing and to estimate intra-pulmonary shunt, we believe that the inert gas rebreathing method has the potential to measure Q (T) more precisely than either of the CO(2) rebreathing methods used in this study. At peak exercise, the exponential and inert gas rebreathing methods both showed acceptable limits of agreement. [ABSTRACT FROM AUTHOR]

The article discusses a study which assesses the agreement and consistency between gas exchange variables measured by two online metabolic systems including Innocor and CardiO2 systems during an incremental exercise test. The metabolic data have been analyzed during the last 30 seconds of each stage and at peak exercise. It is concluded that the Innocor and CardiO2 metabolic systems cannot be used interchangeably without affecting the diagnosis of an individual patient.

The article presents a study to analyze whether heart rate variability (HRV) measured at rest and during exercise could be altered by an exercise training programme designed to increase walking performance in patients with peripheral arterial disease. Effect sizes for change in HRV measures were all very small and in some cases negative. In this study, improved walking performance was not accompanied by central cardiorespiratory or neuroregulatory adaptations.

Loneliness and isolation can be a major cause of unhappiness and can contribute towards depression and mental illness in older age. These associations are recognized by academics, policy makers and older people's representative organisations alike in several countries, and many corrective ad hoc and country-specific initiatives have been supported. This study examines the opinions of the users of a local home-visiting befriending service in the United Kingdom. The befrienders are volunteers, and most users were introduced to the service by female relatives or health service professionals. Positive opinions of the service predominated, and users placed a high value on the reliability of their befrienders. The service provided the users with an opportunity to develop a new bond, and many reported friendly reciprocity, which they recognized as an ingredient of 'real' friendship. These friendships sometimes developed beyond the agreed rules and remits of the 'formal' service, and incorporated various forms of supplementary assistance and social activities. The paper demonstrates the value of befriending services and examines carefully the aspects of their implementation that required exceptional sensitivity. [ABSTRACT FROM AUTHOR]

Objectives: Deficiency as well as excess dietary iodine is associated with several thyroid disorders including Grave's disease and goitre. Previously, cross sectional studies conducted among school children in Nepal showed high prevalence of iodine deficiency. In contrast, recently, few studies have revealed emerging trends of excess urinary iodine concentration in children. This paper, reports excess urinary iodine excretion and thyroid dysfunction among school age children from eastern Nepal. Results: It was a community based cross sectional study in which we measured urinary iodine excretion levels among school age children at baseline and after educational program. The educational program consisted of audio-visual and pamphlets on thyroid health. We also screened them for thyroid function status by physical examination and measuring serum thyroid hormones. Our results show that 34.4% of the children had excess urinary iodine concentration above the WHO recommended levels. Overall, 3.2% of the children were identified to have thyroid dysfunction. Urinary iodine concentration was significantly different between types of salt used and between salt iodine content categories. [ABSTRACT FROM AUTHOR]