Search

Methacholine challenge testing (MCT) is considered when asthma remains clinically suspected despite normal spirometry. Few studies have attempted to determine the predictive factors of MCT results. We aimed to establish which demographic data, clinical symptoms, pulmonary function testing results, and laboratory values were associated with abnormal MCT (provocation concentration causing a 20% decrease in FEVsub1/sub(PC20) ≤ 16 mg/mL) in subjects without airflow obstruction on spirometry.All patients who completed MCT at Montfort Hospital between January 1supst/sup, 2016 and December 31supst/sup, 2018 were identified. Subjects with a reduced FEVsub1/sub/FVC ratio were excluded. We used Pearson's chi-squared test and point-biserial correlation method to determine which variables had a significant relationship (ip/i lt; 0.05) with MCT results.23.3% of patients who underwent MCT had airflow limitation. In the 1126 subjects with a normal FEVsub1/sub/FVC ratio, PC20 ≤ 16 mg/mL was found in 13.0%. Younger age, female gender, body mass index ≥ 40, and reported wheezing were factors associated with increased probability of airway hyper responsiveness. Lower FEVsub1/sub, significant improvement of the FEVsub1/subpost-bronchodilator, reduced FEF25%-75%, greater FEF25%-75% reversibility, airway resistance measurements above the upper limit of normal, and increased blood eosinophil counts were predictive of abnormal MCT.Only 13.0% of patients referred for MCT had a PC20 ≤ 16 mg/mL when the FEVsub1/sub/FVC ratio was normal, highlighting the need to further define in which individuals this test is truly warranted. Further investigation is required to develop an easy-to-use and validated prediction model in order to better understand patients' pretest probability of abnormal MCT.

The relationship between body and mind is increasingly recognized in the occurrence and prognosis of cardiac disease. Based on reports detailing the potential (and the influence of certain risk factors) of developing depression and anxiety following cardiovascular disease, or a cardiac event, most notably acute coronary syndrome (ACS), we investigated whether such symptoms also existed in patient cases found at the cardiac rehabilitation unit of an academic hospital of Eastern Ontario. We examined data from charts during a 6-year period (2012–2017). The Hospital Anxiety and Depression Scale cumulated data within a retrospective cross-sectional study, was used to estimate the prevalence of anxious and depressive symptoms that might reflect the presence of psychological distress. Overall, our sample included 1178 patient files, 81.3% of which were diagnosed with ACS and 69.6% were male. 63.1% of the patients were between 60 and 79 years old at the time of diagnosis. Most patients were Caucasian (81.1%), married (60.3%), and living with their family (74.3%), and 49.7% were recorded as overweight or obese. We found that 29.3% of patients reported symptoms of psychological distress. Regression analyses revealed strong negative correlations between the proportion of symptoms of psychological distress and factors like age and functional capacity as measured by metabolic equivalents. Significant associations were also established between symptoms of psychological distress and factors such as obesity, sedentary lifestyle, smoking, and sex (female). This study was undertaken as part of a business case to implement a new cardiac rehabilitation programme in an academic hospital of Eastern Ontario and illustrate to the managers and decision-makers, the important factors to consider and to target when developing a stepped-care program for patients in cardiac rehabilitation in order to prevent psychological distress and how such a program was relevant to their institution.

A low DLCO should be valued as a predictor of all-cause hospital admissions in patients with reduced LVEF or isolated diastolic dysfunction. The severity of the impairment seen on DLCO testing also appears to affect the risk of hospitalisation.https://bit.ly/3e4r8bH

Menopausal transition and postmenopause are usually associated with changes in body composition and a decrease in physical activity energy expenditure (PAEE). This study investigated body composition, cardiometabolic risk factors, PAEE, and inflammatory markers in premenopausal women after a 10-year follow-up.In all, 102 premenopausal women participated in the 5-year observational longitudinal Montreal Ottawa New Emerging Team (MONET) study. This present substudy included 48 participants (age: 60.0 ± 1.7 years; body mass index: 23.2 ± 2.2 kg/m) 6.0 ± 0.3 years after completion of the initial MONET study. Measures included body composition, waist circumference (WC), fasting glucose and insulin levels, insulin sensitivity (QUICKI model), plasma lipid levels, PAEE, and inflammatory markers.Compared with baseline measures of the MONET study, analyses revealed no significant increase in body weight, although there were significant increases in WC, fat mass (FM), % FM, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, haptoglobin, apolipoprotein B, ferritin, adiponectin, and soluble cluster of differentiation 14 (all P 0.001) after the 10-year follow-up. However, significant decreases were observed for fat-free mass, PAEE, fasting glucose levels, interleukin-8 levels, and soluble tumor necrosis factor receptors 1 and 2 (sTNFR-1 and sTNFR-2) levels (all P 0.05). To determine the effect of postmenopausal years, data were restructured based on final menstrual period (FMP), and one-way analyses of variance were performed.Waist circumference, % FM, total cholesterol, high-density lipoprotein cholesterol, apolipoprotein B, ferritin, adiponectin, and soluble cluster of differentiation 14 were higher in early and late postmenopausal periods in these women. sTNFR-1 and sTNFR-2 levels were higher at the FMP and early postmenopausal years as compared with the late postmenopausal periods. Finally, interleukin-8 levels were lower in years after FMP.The number of years elapsed since the FMP can affect body composition, cardiometabolic risk factors, and inflammatory markers in healthy premenopausal women going through menopausal transition and postmenopausal periods.

Background: Missed appointments (no-shows) are a problem and common in outpatient clinics especially in psychiatric setting.Objective: This study aimed to describe the extent of no-shows in a regular psychiatric outpatient clinic, and to assess associations of missed appointments with patients’ demographic and clinical characteristics and types of services provided.Methods: Data collection from a hospital psychiatric clinic charts was conducted from administrative years 2017-18 and 2018-19, using descriptive analyses.Results: In the administrative year of 2017-18, the no-show rate was 9.5%, adding 10.7% for cancellations, for a total of 20.2%. In 2016-17, rates were 9.7%, with 17.3% cancellations, for a total of 27%. Rates varied from clinical groups (2.5% for borderline personality disorders patients to 30% for young psychotic patients) and by professionals (psychiatrists 5.6%, psychotherapists 23.3%) and for crisis services 21.9%.Conclusions: No-show numbers are comparable to other clinical sites but remain a challenge in delivering seamless and efficient services. A qualitative study will be conducted as a second phase to examine root causes and provide opportunities for service improvement.

To determine the influence of cardiorespiratory fitness (hereafter “fitness”) and physical activity levels on cardiometabolic risk factors in premenopausal women going through the menopause transition. An ancillary study including 66 premenopausal women who participated to a 5-year observational, longitudinal study (2004 to 2009 in Ottawa) on the effects of menopause transition on body composition and cardiometabolic risk factors. Women underwent a graded exercise test on treadmill to measure peak oxygen uptake (VO2 peak) at year 1 and 5 and physical activity levels were measured using accelerometers. Cardiometabolic risk factors included: waist circumference, fasting plasma lipids, glucose and insulin levels, HOMA-IR score, c-reactive protein, apolipoprotein B (apoB) and resting systolic and diastolic blood pressure. Change in fitness was not associated with changes in cardiometabolic risk factors. The changes in total physical activity levels on the other hand showed a significant negative association with apoB levels. Three-way linear mixed model repeated measures, showed lower values of waist circumference, fasting triglycerides, insulin levels, HOMA-IR score, apoB and diastolic blood pressure in women with a fitness ≥ 30.0 mlO2 kg− 1 min− 1 compared to women with a fitness, Highlights • Fitness and physical activity levels are independent predictors of CVD. • Change in total physical activity levels was negatively association with apoB. • Fitness was associated with more favorable values of cardiometabolic risk factors.

Objective: To investigate if an exaggerated peak exercise systolic blood pressure (peak ESBP) is associated with alteration of cardiometabolic risk factors and predict future resting hypertension in middle aged women. Methods: Data analysis was performed in 95 healthy normotensive premeno-pausal women at baseline and 84 after 5-year follow-up (age, 49.9 ± 1.9 years; BMI, 23.3 ± 2.2 kg/m2; resting BP, 117/73 ± 11.8/7.6 mmHg). Blood pressure was measured at rest and during a progressive exercise test on treadmill. Women were divided into two groups according to their peak ESBP

Conflicting results have been reported concerning the prevalence of cardiometabolic risk factors in women experiencing vasomotor symptoms (VMS).To compare cardiometabolic risk factors between women with and without VMS during the menopause transition and to determine the influence of physical activity on the prevalence of VMS.Yearly assessment of women transitioning through menopause included self-reported VMS (hot flushes and night sweats), body composition and fat distribution, fasting glucose, insulin and lipids, and physical activity levels.Eighty-five of the 102 premenopausal women at baseline were included (age: 49.9 ± 2.0 years; body mass index: 23.2 ± 2.2 kg/m(2)). According to linear mixed model analyses, no statistically significant differences were observed for fat mass, lean body mass, body fat distribution indices and cardiometabolic risk factors, when comparing symptomatic vs. asymptomatic women. Neither physical activity levels nor intensity were associated with the prevalence of VMS.Our results suggest that women transitioning through menopause who reported VMS did not show greater deteriorations in body composition, body fat distribution and cardiometabolic risk factors. Furthermore, physical activity levels were not associated with lower prevalence of vasomotor symptoms in the present cohort.

Objective: Cardiovascular disease is the first cause of mortality in women in North America. The risk of car-diovascular disease increases sharply after middle age in women, especially after menopause. The aim was toinvestigate changes in body composition and cardiometabolic profile throughout the menopausal transition.Methods: This was a 5-year observational, longitudinal study on the menopausal transition. The study included102 premenopausal women at baseline (age, 49.9 T1.9 y; body mass index, 23.3 T2.2 kg/m 2 ). Outcome measuresinclude menopause status, body composition by dual-energy x-ray absorptiometry (total fat mass [FM], trunk FM,and total fat-free mass), waist circumference, visceral and abdominal subcutaneous fat, fasting glucose and insulinlevels, homeostasis model assessment of insulin resistance, plasma lipid levels (triglycerides, total cholesterol, andhigh- and low-density lipoprotein cholesterol), and resting blood pressure.Results: Repeated-measure analyses revealed significant increases for FM, percentage FM, trunk FM, visceralfat, plasma fasting glucose, and high-density lipoprotein cholesterol (0.05 9P G0.01) and a significant decrease forplasma glucose levels after follow-up. Those who were in perimenopause or postmenopause by year 3 of the studyshowed a significant increase in visceral fat (P G0.01) compared with baseline. Despite some significant changes inthe metabolic profile among the menopause statuses, the women did not show any cardiometabolic deterioration bythe end of the study.Conclusions: Our results suggest that changes in body composition and fat distribution can occur in nonobesewomen as they go through the menopausal transition. However, these changes were not accompanied by car-diometabolic deteriorations in the present study.Key Words: Menopause YBody composition YCardiometabolic risk factors YVisceral fat.

Objective.To determine the effectiveness of exercise and/or nutrition interventions and to address body weight changes during the menopause transition.Methods.A systematic review of the literature was conducted using electronic databases, grey literature, and hand searching. Two independent researchers screened for studies using experimental designs to evaluate the impact of exercise and/or nutrition interventions on body weight and/or central weight gain performed during the menopausal transition. Studies were quality appraised using Cochrane risk of bias. Included studies were analyzed descriptively.Results.Of 3,564 unique citations screened, 3 studies were eligible (2 randomized controlled trials, and 1 pre/post study). Study quality ranged from low to high risk of bias. One randomized controlled trial with lower risk of bias concluded that participation in an exercise program combined with dietary interventions might mitigate body adiposity increases, which is normally observed during the menopause transition. The other two studies with higher risk of bias suggested that exercise might attenuate weight loss or weight gain and change abdominal adiposity patterns.Conclusions.High quality studies evaluating the effectiveness of interventions targeting body weight changes in women during their menopause transition are needed. Evidence from one higher quality study indicates an effective multifaceted intervention for women to minimize changes in body adiposity.

To investigate the relationship between time spent performing physical activity (PA) and adiposity across the menopausal transition.Body weight and body composition were analyzed in 65 women (47-54 years old; body mass index 23.2 ± 2.4 kg/m(2)) in a 5-year prospective study. Time spent in PA of varying intensities (sedentary, light, moderate and vigorous) was determined from 7-day accelerometer measurement and energy intake with a 7-day food diary.Significant negative correlations were observed between the time spent in light-intensity PA and fat mass (FM) (r = -0.38, p0.005), central FM (r = -0.36, p0.005), peripheral FM (r = -0.33, p0.01), and percent body fat (r = -0.42, p0.001) at year 1, respectively. No significant correlations were noted between measures of adiposity and time spent performing either moderate or vigorous PA. Analyses using tertiles of time spent in light PA at year 1 showed that FM (20.7 ± 4.0 vs. 20.3 ± 6.6 vs. 16.6 ± 4.6 kg, p0.05), central FM (10.1 ± 2.6 vs. 10.0 ± 3.8 vs. 7.8 ± 2.4 kg; p0.05) and percent body fat (34.5 ± 5.1 vs. 32.2 ± 7.7 vs. 28.1 ± 6.2%, p0.01) were all significantly lower in women in the highest tertile. These differences remained significant after covariate analyses using time spent in moderate- and high-intensity PA and total energy intake. Finally, lower levels of FM, percent body fat, central and peripheral FM persisted in women who spent more time in light PA (highest tertiles) over the 5-year follow-up.Our results suggest that the time spent performing light PA may have a greater impact on adiposity than moderate and/or vigorous PA, an observation independent of the menopausal status.

Objective To measure the circulating levels of endocannabinoids and related molecules at fasting, after acute hyperinsulinemia and after weight loss in insulin sensitive vs. insulin resistant obese postmenopausal women. Design and Methods The sample consisted of 30 obese postmenopausal women (age: 58.9 ± 5.2 yrs; BMI: 32.9 ± 3.6 kg/m2). Subjects underwent a 3-hour hyperinsulinaemic-euglycaemic clamp (HEC) (glucose disposal rate (M-value): 10.7 ± 3.3 mg min−1 kg−1 FFM) and 6-month weight loss intervention. Participants were classified as insulin sensitive obese (ISO) or insulin resistant obese (IRO) based on a predefined cutoff. Plasma levels of the endocannabinoids, anandamide (AEA), 2-arachidonoylglycerol (2-AG), and of the AEA-related compounds, palmitoylethanolamide (PEA) and oleoylethanolamide (OEA), were measured by liquid chromatography-mass spectrometry. Results IRO presented higher levels of 2-AG (P < 0.05) independently of the HEC and weight loss, whereas the HEC had an independent inhibitory effect on AEA, PEA, and OEA levels (P < 0.05) in both groups. Furthermore, there was an independent stimulatory effect of weight loss only on PEA levels in both groups (P < 0.05). Conclusions This study is the first to show that higher circulating levels of the endocannabinoid 2-AG are found in IRO compared to ISO postmenopausal women, and that weight loss is associated with an increase in PEA, a PPAR-α ligand.

The purpose of the present secondary analysis study was to investigate the ability of the body adiposity index (BAI) to detect changes in % body fat levels before and after a weight loss intervention when compared to % body fat levels measured using dual-energy X-ray absorptiometry (DXA) and to examine the relationship between the BAI with cardiometabolic risk factors.The study population for this secondary analysis included 132 non-diabetic obese sedentary postmenopausal women (age: 57.2 ± 4.7 years, BMI: 35.0 ± 3.7 kg/m(2)) participating in a weight loss intervention that consisted of a calorie-restricted diet with or without resistance training. We measured: (1) visceral fat using CT-scan, (2) body composition using DXA, (3) hip circumference and height from which the BAI was calculated, and (4) cardiometabolic risk factors such as insulin sensitivity (using the hyperinsulinemic-euglycemic clamp), blood pressure as well as fasting plasma lipids, hsC-reactive protein (CRP), leptin, and glucose.Percent body fat levels for both methods significantly decreased after the weight loss intervention. In addition, the percent change in % body fat levels after the weight loss intervention was significantly different between % body fat measured using the DXA and the BAI (-4.5 ± 6.6 vs. -5.8 ± 5.9%; p = 0.03, respectively). However, we observed a good overall agreement between the two methods, as shown by the Bland-Altman analysis, for percent change in % body fat. Furthermore, similar correlations were observed between both measures of % body fat with cardiometabolic risk factors. However, results from the multiple linear regression analysis showed that % body fat using the BAI appeared to predict cardiometabolic risk factors differently than % body fat using the DXA in our cohort.Estimating % body fat using the BAI seems to accurately trace variations of % body fat after weight loss. However, this index showed differences in predicting cardiometabolic risk factors when compared to % body fat measured using DXA.