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Subtle increases in immaturity of immune function in early infancy have been implicated in the rising susceptibility to allergic disease, particularly relative impairment of type 1 interferon (IFN)-γ responses in the neonatal period. Although genetic predisposition is a clear risk factor, the escalating rates of allergic disease in infancy suggest that environmental factors are also implicated. We previously showed that maternal smoking in pregnancy may impair neonatal IFN-γ responses. Our more recent studies now indicate that this common avoidable toxic exposure is also associated with attenuation of innate immune function, with attenuated Toll-like receptor (TLR)-mediated microbial responses (including TLR-2, -3, -4, and -9 responses). Most notably, the effects were more marked if the mothers were also allergic. In this review, we discuss the significance of these observations in the context of the emerging hypothesis that variations in TLR function in early life may be implicated in allergic propensity. There is now growing evidence that many of the key pathways involved in subsequent T-cell programming and regulation (namely, antigen-presenting cells and regulatory T cells) rely heavily on microbe-driven TLR activation for maturation and function. Factors that influence the function and activity of these innate pathways in early life may contribute to the increasing predisposition for allergic disease. Although "cleaner" environments have been implicated, here we explore the possibility that other common environmental exposures (such as maternal smoking) could also play a role.

The aim of this study was to examine the impact of emotional eliciting pictures on neuromuscular performance during repetitive supramaximal cycling exercises (RSE). In a randomized order, twelve male participants were asked to perform five 6-s cycle sprints (interspaced by 24 s of recovery) on a cycle ergometer in front of neutral, pleasant or unpleasant pictures. During each RSE, mean power output (MPO) and electromyographic activity [root mean square (RMS) and median frequency (MF)] of the vastus lateralis and vastus medialis muscles were analyzed. Neuromuscular efficiency (NME) was calculated as the ratio of MPO to RMS. Higher RMS (232.17 ± 1.17 vs. 201.90 ± 0.47 μV) and MF (68.56 ± 1.78 vs. 64.18 ± 2.17 Hz) were obtained in pleasant compared to unpleasant conditions (p < 0.05). This emotional effect persisted from the first to the last sprint. Higher MPO was obtained in pleasant than in unpleasant conditions (690.65 ± 38.23 vs. 656.73 ± 35.95 W, p < 0.05). However, this emotional effect on MPO was observed only for the two first sprints. NME decreased from the third sprint (p < 0.05), which indicated the occurrence of peripheral fatigue after the two first sprints. These results suggested that, compared with unpleasant pictures, pleasant ones increased the neuromuscular performance during RSE. Moreover, the disappearance of the beneficial effect of pleasant emotion on mechanical output from the third sprint appears to be due to peripheral fatigue.

The objective of this study was to measure the effects on serum lipids and plasma phytosterols of 6.6 g/day phytosterols from three foods (bread, breakfast cereal, and spread) consumed for 12 weeks compared with a diet that was not enriched with phytosterols. Thirty-five subjects undertook a nonrandomized, single-blind study consisting of a 2 week baseline period, 6 weeks on high-phytosterol intake, 6 weeks on high-phytosterol intake plus increased fruit and vegetable intake, and a final 2 week washout period. Serum total cholesterol decreased by 8.3% from 6.59 to 6.04 mmol/l, and LDL cholesterol decreased by 12.6% from 4.44 to 3.88 mmol/l. Plasma phytosterol levels increased by 45% (sitosterol) and 105% (campesterol). Cholesterol-adjusted plasma α- and β-carotene levels decreased by 19–23%, lutein by 14%, and lycopene by 11%. Levels of α-carotene and lutein increased with extra fruit and vegetables. Only lycopene failed to increase during the washout phase. There were no significant changes in biochemical parameters.Serum LDL cholesterol lowering with 6.6 g/day ingested phytosterols was in the range seen with 1.6–3.2 g/day phytosterols. Lowering of plasma carotenoids was greater than that seen with lower phytosterol intake and was partially reversed by increased fruit and vegetable intake.

Purpose: This study was designed to determine whether the acceptance of self-responsibility is an important determinant of the successful outcome of coronary artery bypass graft (CABG) surgery. The success of this costly intervention may be limited unless patients understand and adhere to the prescribed medical regimen, including diet and exercise after surgery. Patients suffering from chronic diseases must take charge of their own health and not abrogate that responsibility to the care providers. Method: Questionnaires were designed to determine aspects of improved quality of life and self-responsibility. For the study, 73 patients who had undergone CABG surgery were selected from surgical patients in the private as well as the public sector. In order to assess the acceptance of self-responsibility, the spouses/care-givers of the patients were included in the study. Patients were interviewed during the first few days after the operation when they had returned to the wards and again six months and 12 months later. Successful outcome was measured in terms of improved quality of life using the criteria suggested by the Coronary Artery Surgery Study (Coronary Artery Surgical Study Principal Investigators, 1983). The acceptance of self-responsibility was then investigated as a possible factor influencing the improvement of the quality of life of these patients. Results: The acceptance of self-responsibility was a significant factor predicting the successful outcome of CABG surgery in the group of patients who achieved an improved quality of life following surgery (p R50 000 (US $8 000), who had a normal sex-life prior to the operation. They differ significantly from the group without an improved quality of life in the following aspects: they spend more hours participating in sport at school (p=0.04), stop their sporting activities for a shorter period of time prior to the operation (p grade 12 (p=0.01), have an annual income > R50 000 (p=0.05). They differ from the group who did not accept personal responsibility in that they and their spouses/care-givers had a greater knowledge about the disease and the risk factor modification (p=0.01; p

A study was conducted to determine the outcome of Coronary artery bypass graft (CABG) surgery in terms of patients’ improved quality of life one year after the intervention. Quality of life was assessed in terms of return to work, absence of angina and increased activity. The analysis of the variables identified on admission between two groups (those who had an improved quality of life and those who did not have an improved quality of life) are presented. Patients with improved quality of life were married (p=0.02), men (p=0.01), with an income >R50,000 p/a (p=0.03), reported a normal sex-life prior to hospital admission (p=0.04), were taller (p=0.01), spent more hours at school participating in sporting activities (p=0.04) and had carried on with sport for more years prior to the surgery (p=0.01). There were no significant differences in weight or body mass index between the two groups.

Although allergic inflammation is characterized by a T helper (Th) 2-dominant immune response, the discovery of a role for new T cell subsets in inflammatory diseases has added an additional layer of complexity to the understanding of the pathogeneses of allergic diseases. We evaluated plasma cytokine profiles in infants with cows’ milk allergy (CMA), who were being treated with an elimination diet. In a prospective, randomized and controlled study, infants (aged 8.4 ± 3.9 months) with CMA were treated with an elimination diet for 120 days, which replaced cows’ milk with a hydrolysed soy protein formula (n = 26) or a free amino acid formula (n = 20). Blood samples were collected before treatment during active disease (T0) and after 120 days, when symptoms were absent (T1). Plasma cytokine concentrations were measured. Infants with CMA had higher plasma concentrations of interleukin (IL)-4 and IL-13 and lower concentrations of IL-9, IL-17A and interferon-γ, compared with healthy breast-fed infants. At T0, there was a positive correlation between blood eosinophil numbers and plasma concentrations of IL-4, IL-9, IL-17A and IL-22. Treatment with a cows’ milk elimination diet resulted in a decrease in plasma IL-4, IL-9, IL-13 and IL-22 and an increase in plasma IL-17A. We conclude that IL-4 and IL-13 are elevated in active CMA. The association of IL-9 and IL-22 with eosinophilia, and the decrease in these two cytokines with cows’ milk elimination, suggests that they both play a role in the symptoms observed in CMA and may be important targets for future interventions.

There are few dietary assessment tools that are scientifically developed and freely available online. The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Healthy Diet Score survey asks questions about the quantity, quality, and variety of foods consumed. On completion, individuals receive a personalised Diet Score—reflecting their overall compliance with the Australian Dietary Guidelines. Over 145,000 Australians have completed the survey since it was launched in May 2015. The average Diet Score was 58.8 out of a possible 100 (SD = 12.9). Women scored higher than men; older adults higher than younger adults; and normal weight adults higher than obese adults. It was most common to receive feedback about discretionary foods (73.8% of the sample), followed by dairy foods (55.5%) and healthy fats (47.0%). Results suggest that Australians’ diets are not consistent with the recommendations in the guidelines. The combination of using technology and providing the tool free of charge has attracted a lot of traffic to the website, providing valuable insights into what Australians’ report to be eating. The use of technology has also enhanced the user experience, with individuals receiving immediate and personalised feedback. This survey tool will be useful to monitor population diet quality and understand the degree to Australians’ diets comply with dietary guidelines.

BackgroundThe high number of adult males engaging in low levels of physical activity and poor dietary practices, and the health risks posed by these behaviors, necessitate broad-reaching intervention strategies. Information technology (IT)-based (Web and mobile phone) interventions can be accessed by large numbers of people, yet there are few reported IT-based interventions targeting males’ physical activity and dietary practices. ObjectiveThis study examines the effectiveness of a 9-month IT-based intervention (ManUp) to improve the physical activity, dietary behaviors, and health literacy in middle-aged males compared to a print-based intervention. MethodsParticipants, recruited offline (eg, newspaper ads), were randomized into either an IT-based or print-based intervention arm on a 2:1 basis in favor of the fully automated IT-based arm. Participants were adult males aged 35-54 years living in 2 regional cities in Queensland, Australia, who could access the Internet, owned a mobile phone, and were able to increase their activity level. The intervention, ManUp, was based on social cognitive and self-regulation theories and specifically designed to target males. Educational materials were provided and self-monitoring of physical activity and nutrition behaviors was promoted. Intervention content was the same in both intervention arms; only the delivery mode differed. Content could be accessed throughout the 9-month study period. Participants’ physical activity, dietary behaviors, and health literacy were measured using online surveys at baseline, 3 months, and 9 months. ResultsA total of 301 participants completed baseline assessments, 205 in the IT-based arm and 96 in the print-based arm. A total of 124 participants completed all 3 assessments. There were no significant between-group differences in physical activity and dietary behaviors (P≥.05). Participants reported an increased number of minutes and sessions of physical activity at 3 months (exp(β)=1.45, 95% CI 1.09-1.95; exp(β)=1.61, 95% CI 1.17-2.22) and 9 months (exp(β)=1.55, 95% CI 1.14-2.10; exp(β)=1.51, 95% CI 1.15-2.00). Overall dietary behaviors improved at 3 months (exp(β)=1.07, 95% CI 1.03-1.11) and 9 months (exp(β)=1.10, 95% CI 1.05-1.13). The proportion of participants in both groups eating higher-fiber bread and low-fat milk increased at 3 months (exp(β)=2.25, 95% CI 1.29-3.92; exp(β)=1.65, 95% CI 1.07-2.55). Participants in the IT-based arm were less likely to report that 30 minutes of physical activity per day improves health (exp(β)=0.48, 95% CI 0.26-0.90) and more likely to report that vigorous intensity physical activity 3 times per week is essential (exp(β)=1.70, 95% CI 1.02-2.82). The average number of log-ins to the IT platform at 3 and 9 months was 6.99 (SE 0.86) and 9.22 (SE 1.47), respectively. The average number of self-monitoring entries at 3 and 9 months was 16.69 (SE 2.38) and 22.51 (SE 3.79), respectively. ConclusionsThe ManUp intervention was effective in improving physical activity and dietary behaviors in middle-aged males with no significant differences between IT- and print-based delivery modes. Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12611000081910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000081910 (Archived by WebCite at http://www.webcitation.org/6QHIWad63).

Aim: To assess electromyographic (EMG) gait pattern changes during stair descent in subjects with chronic anterior cruciate ligament (ACL) deficiency, and in subjects after ACL reconstruction. Methods: Thirteen ACL deficient subjects (ACLdef), 8 ACL reconstructed subjects (ACLrec), and 10 controls (CON) participated in the study. All subjects were assessed for functional and lean thigh volume (LTV) differences in the injured and uninjured limb. All subjects then stepped off a bench with EMG electrodes on the vastus medialis, vastus lateralis and hamstrings muscles of both limbs. Results: Step down activity caused similar EMG responses in the injured and supporting limb in the ACLdef group compared to that in the control group. In contrast, in the ACLrec group, the onset of EMG activity occurred earlier during the step down activity in the vastus medialis and vastus lateralis of the supporting limb. There was significantly greater EMG activity in the vastus lateralis and hamstring muscles of the supporting limb (p < 0.05) in the ACLrec group compared to ACLdef and control groups. The changes in EMG activity did not appear to be related to differences in LTV, since greater LTV deficits were present in the ACLdef compared to the ACLrec group (p < 0.01). Conclusions: In ACL reconstructed subjects, changes in muscle recruitment patterns in the supporting limb during step down activity have been identified. This altered activity pattern was not present in the supporting limb of ACL deficient subjects

The major objective of medical care is to preserve life. If patients cannot be cured and are left with residual chronic diseases then the aim is to provide them with the means to lead a life of quality within the confines of their disease. Rehabilitation in chronic disease means restoring or creating a life of acceptable quality. This is achieved by restoring the patient to optimal physiological and psychological health compatible with the extent of the disease and in doing so improve the quality of life. Improved quality of life is the best indicator of successful rehabilitation. Patients with chronic diseases are increasingly expected to become partners when decisions are made regarding their therapy and therefor their evaluation of the outcome is of great importance. There are a number of shortcomings with quality of life evaluations and the most important one is that it does not seem to be adequately defined. Another major problem is that this evaluation usually focuses on aspects of physical function and few studies include subjective indicators. It is generally felt that the opinion of the spouse or caregiver should be included.

Aim: The aim of this study was to assess the relationship between the quadriceps muscle atrophy and strength deficits caused by chronic ACL deficiency, and to ascertain whether these deficits were rectified in subjects who had undergone ACL reconstruction. Methods: Thirteen ACL deficient subjects (ACLD) and eight subjects who had undergone ACL reconstruction (ACLR) participated in the study. Functional capacity, lean thigh volume (LTV), and isokinetic peak torque of the quadriceps and hamstrings muscles were assessed. Results: The ACLD group had a significantly lower score for episodes of giving way compared to the ACLR group (7.4 +/- 3.8 vs. 18.0 +/- 3.7; p < 0.01) and a lower score for inability to perform jumping/twisting activities (1.8 +/- 0.8 vs. 3.6 +/- 1.1; p

We have conducted a dietary trial in 54 men and 51 women with a wide range of fasting cholesterol values to examine the use of low density lipoprotein (LDL) particle size to predict the lipoprotein response to dietary fat and cholesterol. After a 2-week low fat period, subjects were given two liquid supplements in addition to their low fat diet for 3 weeks each, one containing 31–40 g of fat and 650–845 mg of cholesterol, the other fat free. LDL particle type was determined by 3–15% gradient gel electrophoresis. On multiple regression, LDL type was independently related to plasma triglyceride (P < 0.001), waist circumference (P < 0.01), and high density lipoprotein (HDL) (P < 0.001) accounting for 56% of the variance in LDL type in the whole group. Change in LDL cholesterol with dietary fat and cholesterol was unrelated to LDL particle size in either men or women. However, change in HDL cholesterol in men was strongly related to LDL particle type (r = –0.52, P = 0.001) and change in HDL2 cholesterol in women was related to LDL particle type (r = –0.40, P < 0.01). In conclusion, we are unable to confirm the finding that LDL particle type can predict changes in LDL cholesterol following changes in dietary fat intake. However, LDL particle type can independently predict changes in HDL cholesterol in men and accounts for 27% of the variance.—Clifton, P. M., M. Noakes, and P. J. Nestel. LDL particle size and LDL and HDL cholesterol changes with dietary fat and cholesterol in healthy subjects.

The aim of medical intervention in patients suffering from chronic diseases is to maintain a life of quality. Patients who have undergone coronary artery bypass surgery provide a good example of an intervention that will not necessarily result in the prolongation of life but the improved quality of life. Rehabilitation outcome should focus on the improved quality of life and the issue of who should be responsible for maintaining improved quality of life. In order to determine if self-responsibility was an aspect of improved quality of life 73 subjects and their spouses were followed up over a period of one year. Self-responsibility was identified as a significant variable (p=0.003) in patients with improved quality of life. Based on the evidence provided by this study it was concluded that unless patients accepted responsibility for their rehabilitation they would not have an improved quality of life.