Search

Background. Poststroke guidelines recommend moderate-intensity, continuous aerobic training (MCT) to improve aerobic capacity and mobility after stroke. High-intensity interval training (HIT) has been shown to be more effective than MCT among healthy adults and people with heart disease. However, HIT and MCT have not been compared previously among people with stroke. Objective. The purpose of this study was to assess the feasibility and justification for a definitive randomized controlled trial (RCT) comparing HIT and MCT in people with chronic stroke. Design. A preliminary RCT was conducted. Setting. The study was conducted in a cardiovascular stress laboratory and a rehabilitation research laboratory. Patients. Ambulatory people at least 6 months poststroke participated. Intervention. Both groups trained 25 minutes, 3 times per week, for 4 weeks. The HIT strategy involved 30-second bursts at maximum-tolerated treadmill speed alternated with 30to 60-second rest periods. The MCT strategy involved continuous treadmill walking at 45% to 50% of heart rate reserve. Measurements. Measurements included recruitment and attendance statistics, qualitative HIT acceptability, adverse events, and the following blinded outcome variables: peak oxygen uptake, ventilatory threshold, metabolic cost of gait, fractional utilization, fastest treadmill speed, 10-Meter Walk Test, and Six-Minute Walk Test. Results. During the 8-month recruitment period, 26 participants consented to participate. Eighteen participants were enrolled and randomly assigned to either the HIT group (n= 13) or the MCT group (n=5). Eleven out of the 13 HIT group participants attended all sessions. Participants reported that HIT was acceptable and no serious adverse events occurred. Standardized effect size estimates between groups were moderate to very large for most outcome measures. Only 30% of treadmill speed gains in the HIT group translated into overground gait speed improvement. Limitations. The study was not designed to definitively test safety or efficacy. Conclusions. Although further protocol optimization is needed to improve overground translation of treadmill gains, a definitive RCT comparing HIT and MCT appears to be feasible and warranted., Stroke rehabilitation guidelines recommend moderate-intensity, continuous aerobic training (MCT) to improve mobility, aerobic capacity, and cardiovascular health. (1) However, accumulating evidence suggests that higher-intensity exercise may be significantly more effective [...]

Abstract Rates of breastfeeding are increasing, but the methods by which human milk is fed to infants is not well described. Using a retrospective survey design, the authors collected information [...]

OBJECTIVE--Diabetes is a well known risk factor for stroke, but the impact of diabetes on stroke incidence rates is not known. This study uses a population-based study to describe the [...]

Background: Vitamin K has been suggested to have a role in bone metabolism, and low vitamin K intake has been related to low bone density and increased risk of osteoporotic fracture. Objective: The objective of this study was to determine whether phylloquinone (vitamin [K.sub.1]) intake and biochemical indicators of vitamin K status are related to bone mineral content (BMC) and markers of bone formation and bone resorption in girls. Design: Vitamin K status [plasma phylloquinone concentration and percentage of undercarboxylated osteocalcin (%ucOC)] was measured at baseline in a study of 245 healthy girls aged 3-16 y. Cross-linked N-telopeptide of type 1 collagen (NTx) breakdown, osteocalcin, and bone-specific alkaline phosphatase were measured to reflect bone resorption and formation. BMC of the total body, lumbar spine, and hip and dietary phylloquinone intake were measured annually for 4 y. Results: Phylloquinone intake (median: 45 [micro]g/d) was not consistently associated with bone turnover markers or BMC. Better vitamin K status (high plasma phylloquinone and low %ucOC) was associated with lower bone resorption and formation. Plasma phylloquinone was inversely associated with NTx and osteocalcin concentrations (P < 0.05), and %ucOC was positively associated with NTx and bone-specific alkaline phosphatase concentrations (p < 0.05). Indicators of vitamin K status were not consistently associated with current BMC or gain in BMC over the 4-y study period. Conclusions: Better vitamin K status was associated with decreased bone turnover in healthy girls consuming a typical US diet. Randomized phylloquinone supplementation trials are needed to further understand the potential benefits of phylloquinone on bone acquisition in growing children. KEY WORDS Vitamin K, phylloquinone, osteocalcin, under-carboxylated osteocalcin, bone density, bone turnover, bone resorption, girls, dietary intake

Background: Calcium supplements increase bone mass in children, but the effect does not persist once supplementation is discontinued. Objective: The objective of this study was to determine whether milk intake during childhood and adolescence, when controlled for current calcium intake, is associated with adult bone mass (ie, bone mineral content), bone mineral density, and the incidence of osteoporotic fracture. Design: We used data from the third National Health and Nutrition Examination Survey of 3251 non-Hispanic, white women age [greater than or equal to] 20 y. Bone density was measured at the hip. History of fracture of the hip, spine, or forearm was classified as a lifetime fracture (occurring after age 13 y) or an osteoporotic fracture (occurring after age 50 y). Subjects reported frequency of milk consumption during childhood (aged 5-12 y) and during adolescence (aged 13-17 y). Regression models controlled for weight, height, age, menopause and use of estrogen, physical activity, smoking, and current calcium intake. Results: Among women aged 20-49 y, bone mineral content was 5.6% lower in those who consumed < 1 serving of milk/wk (low intake) than in those who consumed > 1 serving/d (high intake) during childhood (P < 0.01). Low milk intake during adolescence was associated with a 3% reduction in hip bone mineral content and bone mineral density (P < 0.02). Among women aged [greater than or equal to] 50 y, there was a nonlinear association between milk intake during childhood and adolescence and hip bone mineral content and bone mineral density (P < 0.04). Low milk intake during childhood was associated with a 2-fold greater risk of fracture (P < 0.05). Conclusion: Women with low milk intake during childhood and adolescence have less bone mass in adulthood and greater risk of fracture. KEY WORDS Bone density, milk intake during childhood and adolescence, calcium intake, osteoporosis, peak bone mass, fracture, women

A decrease in blood flow through the uterus of pregnant sheep causes greater than normal resistance in the umbilical blood vessels. This could explain why decreases in uterine blood flow have been linked to fetal growth restriction.

Endothelin-A appears to regulate the flow of blood in the uterus, according to a study in sheep. Endothelin-A is a natural substance in the body that causes blood vessels to contract.

Giving pregnant women at risk of premature delivery corticosteroids and antibiotics does not increase the risk of bacterial infection in the newborn baby. These drugs are used to prevent respiratory distress syndrome and group B streptococcal infections in newborn babies. However, corticosteroids can suppress the immune system and antibiotics can kill protective bacteria.

A vaginal suppository containing misoprostol is more effective than oral misoprostol in inducing labor, according to a study of 330 pregnant women. However, vaginal misoprostol can adversely affect the uterus.

Leptin appears to be involved in regulating the growth of the fetus, especially during intrauterine growth restriction. Leptin is a hormone produced by fat cells that regulates body weight and the amount of fat in the body.

Taking a small sample of uterine tissue at the time of a cesarean delivery does not adversely affect the woman, according to a study of 118 women who had this procedure and 236 who did not. Uterine tissue samples are needed for research purposes to determine exactly how the uterus changes during labor.

The use of insulin lispro by 12 pregnant women with diabetes did not cause the formation or progression of diabetic retinopathy. In fact, 14% of 42 pregnant women who used regular insulin either developed retinopathy or experienced a progression of the disease.

Fetuses with a ventral wall defect can be delivered vaginally unless there is another reason to perform a cesarean. This was the conclusion of a study of 102 fetuses with a prenatal diagnosis of ventral wall defect, which is an abdominal hernia.

Byline: Rashmi Kothari, Edward Jauch, Joseph Broderick, Thomas Brott, Laura Sauerbeck, Jane Khoury, Tiepu Liu Abstract: Study objective: To document prehospital and inhospital time intervals from stroke onset to emergency department evaluation and to identify factors associated with presentation to the ED within 3 hours of symptom onset, the current time window for thrombolytic therapy. Methods: Patients admitted through the ED with a diagnosis of stroke were identified through admitting logs. Time intervals were obtained from EMS runsheets and ED records. Information regarding first medical contact, education, and income was obtained by patient interview. Baseline variables were analyzed to assess association with ED arrival within 3 hours of symptom onset; variables significant on univariate analysis were placed in a multivariable model. Results: There were 151 stroke patients (59% white and 41% black). Time of stroke onset and time to ED arrival were documented for 119 patients (79%). The median time from stroke onset to ED arrival was 5.7 hours; 46 patients (30%) presenting within 3 hours. Of those with times recorded, the median time from stroke onset to EMS arrival was 1.7 hours. Multivariable logistic regression identified use of EMS (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.3 to 12.1) and white race (OR, 3.5; 95% CI, 1.3 to 10) as being independently associated with ED arrival within 3 hours of symptom onset. Median time from ED arrival to physician evaluation was 20 minutes. Median time from ED arrival to computed tomographic evaluation was 72 minutes. When patients were asked the main reason they sought medical attention, 40% (60/141) of those able to be interviewed said that they themselves did not decide to seek medical attention, but rather a friend or family member told them they should go to the hospital. Conclusion: The median time from stroke onset to ED evaluation was 5.7 hours, with almost a third of patients presenting within 3 hours. Use of EMS and white race were independently associated with arrival within 3 hours. [Kothari R, Jauch E, Broderick J, Brott T, Sauerbeck L, Khoury J, Liu T: Acute stroke: Delays to presentation and emergency department evaluation. Ann Emerg Med January 1999;33:3-8.] Author Affiliation: From the Departments of Emergency Medicine,.sup.* Neurology,.sup.a and Environmental Health,.sup.As. University of Cincinnati Medical Center Cincinnati, OH Article History: Received 20 April 1998; Revised 16 July 1998; Accepted 29 July 1998 Article Note: (footnote) [star] Supported by a Young Investigators Award from the American Heart Association, Ohio Affiliate (SW-93944-YI)., [star][star] Address for reprints: Rashmi Kothari, MD, Department of Emergency Medicine, University of Cincinnati, PO Box 670769,Cincinnati, OH 45267-0769;E-mail rashmikant.kothari@uc.edu. , a 0196-0644/99/$8.00 + 0, aa 47/1/94119

Pregnancy may not cause women with insulin-dependent diabetes to have an increased risk or increased progression of kidney disease. Researchers studied 182 pregnant women with insulin-dependent diabetes mellitus (IDDM) whose pregnancies continued for at least 20 weeks and followed them up for at least three years. Neither pregnancy nor having many children were found to be risk factors for kidney disease. Significant risk factors for kidney disease were protein in the urine and poor blood sugar control during pregnancy. Women with kidney disease were more likely to have complications of pregnancy, including newborn complications. No significant predictors of kidney disease progressing to end-stage kidney disease were found.

OBJECTIVE: To test the hypothesis that women with insulin-dependent diabetes and chronic or pregnancy-induced hypertensive disorders are at increased risk for developing retinopathic complications during pregnancy. STUDY DESIGN: One hundred fifty-four women with insulin-dependent diabetes were prospectively followed in an intensive program of diabetes in pregnancy. Ophthalmologic evaluations were obtained through pregnancy and at 6 to 12 weeks post partum, and findings were graded by a standard scale. Association of retinopathic progression with risk factors was tested with [X.sup.2] and multiple logistic regression analysis. RESULTS: Fifty-one women had progression of retinopathy during pregnancy; postpartum regression was observed in 13 women. Changes in glycemic control early in pregnancy, chronic hypertension, and pregnancy-induced hypertension were significantly associated with progression of retinopathy. CONCLUSION: Women with insulin-dependent diabetes who have hypertensive disorders in pregnancy are at increased risk for progression of retinopathy. (Am J Obstet Gynecol 1992;166:1214-8.)

Diabetics tend to develop infection easily, and this is related to alterations in immune cell activity, especially in subjects with poorly controlled elevated glucose levels. Pregnancy is also associated with increased risk for infection, as immune system function is altered during that time. Thus, pregnant diabetic women are highly likely to develop infections. The risk of infection associated with diabetes was evaluated in 65 diabetic and 65 nondiabetic pregnant women, and the association of infection rate with poor glycemic control in diabetic patients was studied. Eighty-five percent of diabetic women developed infections during pregnancy, compared with an infection rate of only 26 percent in nondiabetic women. Postpartum rates of infection were also higher in diabetic women. Infection rates at all sites were elevated. No particular bacterial species was implicated, but diabetic women did tend to have more infections caused by a common fungus (or yeast), Candida. The results suggested that glycemic control may have been poorer preceding the development of infections in diabetic women. Further research is needed to determine if improved metabolic control will result in a lower risk of infection in diabetic pregnant women. (Consumer Summary produced by Reliance Medical Information, Inc.)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2008.06.066 Byline: Sina Haeri (a), Jane Khoury (b), Oormila Kovilam (c), Menachem Miodovnik (a) Keywords: diabetes; fetal growth restriction; pregnancy; vasculopathy Abstract: The purpose of this study was to test whether vasculopathy in type 1 diabetes mellitus (DM) is associated with fetal growth abnormalities. Author Affiliation: (a) Department of Obstetrics and Gynecology, Washington Hospital Center, Washington, DC (b) Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH (c) Department of Obstetrics and Gynecology, University of Cincinnati School of Medicine, Cincinnati, OH Article History: Received 1 March 2008; Revised 2 May 2008; Accepted 21 June 2008 Article Note: (footnote) Cite this article as: Haeri S, Khoury J, Kovilam O, et al. The association of intrauterine growth abnormalities in women with type 1 diabetes mellitus complicated by vasculopathy. Am J Obstet Gynecol 2008;199:278.e1-278.e5.

The recent article by Geraghty et al (J Hum Lact. 2006;21:413-420) documents that mothers of presumably healthy singletons are just as likely to use breast pumps as are mothers of [...]