The Activity Director in a Nursing Care Facility

No abstract available for this article.     

Multi-Discipline HIV Longitudinal Training

Abstract

This article describes a multi-disciplinary HIV clinical training model developed and implemented by the Division of AIDS Education at the University of Medicine and Dentistry of New Jersey (UMDNJ)-Center for Continuing and Outreach Education (CCOE), the New Jersey Local Performance Site (LPS) of the New York/New Jersey AIDS Education and Training Center (AETC). The Longitudinal Training (LT) model combines AETC, Minority AIDS Initiative (MAI) and other available training resources into an adaptable framework that can be implemented by any clinical training entity (e.g., other AETCs, Public Health Training Centers, Center for Mental Health Services grantees, state health departments, STD/HIV Prevention Training Centers, etc.) to provide needs-based, multi-discipline longitudinal training of healthcare providers so as to enhance the HIV care capacity of community health centers serving predominantly minority populations. In addition to describing the AETC and MAI Programs, this paper will discuss the methods used in developing the Longitudinal Training model and will include styles of training, identification of program successes and barriers, a composite case study and continuous outcome measures.     

John A. Hartford Foundation Centers of Excellence Program: History,Impact, and Legacy

The John A. Hartford Foundation (JAHF) created the Centers of Excellence in Geriatric Medicine and Geriatric Psychiatry in 1988 with the goal of establishing academic training environments to increase geriatrics‐trained faculty. The initiative identified medical schools with the necessary components for training academic geriatricians. JAHF grants provided the resources to create a cadre of physicians whose research, teaching and practice leads to substantial contributions in geriatrics. Results from two evaluations show that the program has successfully increased geriatrics‐prepared faculty who have achieved promotion and institutional retention, success in winning competitive research grants, and positions of leadership. The initiative strengthened the national network of geriatrics programs and served as a major driver of increased prestige for the fields of geriatric medicine and psychiatry.     

Effects of resistance training on insulin-like growth factor and its binding proteins in men and women aged 60 to 85

OBJECTIVES: We have reported that resistance training (RT) elevates insulin-like growth factor (IGF-I) in healthy young adults. Our goals were to determine whether RT produces a similar effect in the healthy older persons and to determine the effects of low- versus high-intensity RT on hormonal status. SETTING: Center for Exercise Science, University of Florida, Gainesville. PARTICIPANTS: Sixty-two men and women (mean age = 68.1). INTERVENTION: A 6-month, 3-day/week program of low-intensity RT (LEX), high-intensity RT (HEX), or no exercise (CON). MEASUREMENTS: Before and after training, blood was drawn for hormone analysis. IGF-I, IGF binding protein-1 (IGFBP-1), and IGFBP-3 were measured at rest. Testosterone and cortisol were measured at rest and immediately after exercise. RESULTS: RT caused significant increases in 1-repetition maximum (1RM) strength and peak oxygen consumption (V02peak), which we have reported separately. Currently, we report that RT had no effect on the resting serum concentrations of IGF-I, IGFBP-1, IGFBP-3, testosterone, or cortisol. Acute resistance exercise caused no change in circulating testosterone in men or women but did cause a significant elevation of cortisol in the HEX group. This increase in cortisol was blunted as a result of training. CONCLUSIONS: We conclude that the increases in strength and endurance caused by RT were not mediated by increases in circulating IGF-I, IGFBPs, or testosterone.     

Gastroenterology training in a resource-limited setting: Zambia,Southern Africa

AIM: To evaluate need for and efficacy of a structured gastroenterology didactic session in expanding awareness and understanding of digestive disorders. METHODS: A four-day symposium was developed with didactic sessions (days 1, 2) and practical endoscopy (days 3, 4). Didactic sessions included case presentations highlighting pathophysiology and management. One nurse and four practicing gastroenterologists from the United Kingdom led lectures and supervised work-shops with audience participation. Practical endoscopy focused on diagnostic and therapeutic procedures and their application to diagnosis and treatment of ailments of the gastrointestinal tract. Preand post-workshop questionnaires were distributed to participants during didactic sessions. A pre-workshop questionnaire gauged expectations and identified objectives to be met at thesymposium. Post-workshop questionnaires were administered to assess efficacy of each session. Participants graded sessions from 1 (poor) to 5 (excellent) on quality of case presentations, knowledge, clarity and mode of presentation. We assessed if time allotted to each topic was sufficient, value of sessions, impact on practice and interest in future symposiums. RESULTS: There were 46 attendees on day 1: 41% undergraduates, 41% residents, 11% consultants and 4% unspecified. Day 2 (a Saturday) had 24 participants: 17% undergraduates, 71% residents, 9% consultants, 4% unspecified. Primary pre-workshop symposium expectation was to gain knowledge in: general gastroenterology (55.5%), practical endoscopy (13.8%), pediatric gastroenterology (5%), epidemiology of gastrointestinal disorders specific to Zambia (6%), and interaction with international speakers (6%). The post-symposium questionnaire was answered by 19 participants, of whom 95% felt specific aims were met; all would attend future conferences and recommend to others. CONCLUSION: The beneficial effect of a structured symposium in developing countries warrants further attention as a mechanism to improve disease awareness in ar     

Matched dose interval and continuous exercise training induce similar cardiorespiratory and metabolic adaptations in patients with heart failure

Background

The best format of exercise training in patients with chronic heart failure (CHF) is controversial. We tested the hypothesis that aerobic continuous training (ACT) and aerobic interval training (AIT) induce similar effects on functional capacity, central hemodynamics and metabolic profile in patients with postinfarction CHF provided that the training load is equated by an individually-tailored volume/intensity dose of exercise.

Methods

Twenty patients with postinfarction CHF under optimal medical treatment were randomized to ACT or AIT for 12 weeks. Exercise training consisted in individualized loads prescribed according to the Training Impulses (TRIMP_i) method, which was determined using the individual HR and lactate profiling obtained during a treadmill test at baseline.

Results

Peak VO₂ increased significantly by 22% with both ACT and AIT, without differences between the two training programs. Changes in anaerobic threshold and VE/VCO₂ slope were not significantly different between ACT and AIT. Resting HR significantly decreased with both exercise modes. Resting cardiac output and stroke volume, left ventricular diastolic dimension and ejection fraction did not change from baseline with both exercise modes. Lipid profile and glucose metabolism were not substantially altered by ACT and AIT.

Conclusions

ACT and AIT both induce significant improvement in aerobic capacity in patients with postinfarction CHF, without significant differences between the two training modes, provided that patients are trained at the same, individually tailored, dose of exercise. The TRIMPi method might represent a step forward in the individualization of an aerobic training tailored to the patient's clinical and functional status within cardiac rehabilitation programs.     

Effects of endurance,circuit, and relaxing training on cardiovascular risk factors in hypertensive elderly patients

Recommendations for prevention of cardiovascular diseases (CVDs) risk factors among older adults highlighted the importance of exercise-based interventions, including endurance training (ET). However, the evidence of efficacy of other interventions based on short-bouts of exercise (circuit training, CT), and the practice of breath-control and meditation (relaxing training, RT) is growing. The aim of this study was to elucidate if CT or RT are equally effective in CVD risk factors reduction compared to ET. To this purpose, in 40 elderly participants, with clinically diagnosed grade 1 hypertension, resting blood pressure, blood glucose, and cholesterol levels, peak oxygen uptake (V˙o2peak), mechanical efficiency and quality of life were evaluated before and after 12 weeks of ET, CT, and RT treatments. Resting blood pressure reduced significantly in all groups by ∼11 %. In ET, blood cholesterol levels (−18 %), V˙o2peak (+8 %), mechanical efficiency (+9 %), and quality of life scores (+36 %) ameliorated. In CT blood glucose levels (−11 %), V˙o2peak (+7 %) and quality of life scores (+35 %) were bettered. Conversely, in RT, the lower blood pressure went along only with an improvement in the mental component of quality of life (+42 %). ET and CT were both appropriate interventions to reduce CVDs risk factors, because blood pressure reduction was accompanied by decreases in blood glucose and cholesterol levels, increases in V˙o2peak, mechanical efficiency, and quality of life. Although RT influenced only blood pressure and quality of life, this approach would be an attractive alternative for old individuals unable or reluctant to carry out ET or CT.     

Benefits of combined aerobic/resistance/inspiratory training in patients with chronic heart failure. A complete exercise model? A prospective randomised study

Background

We hypothesised that combined aerobic training (AT) with resistance training (RT) and inspiratory muscle training (IMT) could result in additional benefits over AT alone in patients with chronic heart failure (CHF).

Methods

Twenty-seven patients, age 58 ± 9 years, NYHA II/III and LVEF 29 ± 7% were randomly assigned to a 12-week AT (n = 14) or a combined AT/RT/IMT (ARIS) (n = 13) exercise program. AT consisted of bike exercise at 70–80% of max heart rate. ARIS training consisted of AT with RT of the quadriceps at 50% of 1 repetition maximum (1RM) and upper limb exercises using dumbbells of 1–2 kg as well as IMT at 60% of sustained maximal inspiratory pressure (SPI_max). At baseline and after intervention patients underwent cardiopulmonary exercise testing, echocardiography, evaluation of dyspnea, muscle function and quality of life (QoL) scores.

Results

The ARIS program as compared to AT alone, resulted in additional improvement in quadriceps muscle strength (1RM, p = 0.005) and endurance (50%1RM × number of max repetitions, p = 0.01), SPI_max (p < 0.001), exercise time (p = 0.01), circulatory power (peak oxygen consumption × peak systolic blood pressure, p = 0.05), dyspnea (p = 0.03) and QoL (p = 0.03).

Conclusions

ARIS training was safe and resulted in incremental benefits in both peripheral and respiratory muscle weakness, cardiopulmonary function and QoL compared to that of AT. The present findings may add a new prospective to cardiac rehabilitation programs of heart failure patients whilst the clinical significance of these outcomes need to be addressed in larger randomised studies.     

The Contribution of Public Health to Gerontology:

Public health brings a unique focus to the study of health and aging, but public health programs have been slow in developing such course offerings. This article presents a content analysis of 71 courses taught in public health degree programs that focus on the elderly, demonstrating both the strengths and weaknesses of providing education on health and aging in public health programs.     

Short- and long-term benefits of cognitive training

Does cognitive training work? There are numerous commercial training interventions claiming to improve general mental capacity; however, the scientific evidence for such claims is sparse. Nevertheless, there is accumulating evidence that certain cognitive interventions are effective. Here we provide evidence for the effectiveness of cognitive (often called “brain”) training. However, we demonstrate that there are important individual differences that determine training and transfer. We trained elementary and middle school children by means of a videogame-like working memory task. We found that only children who considerably improved on the training task showed a performance increase on untrained fluid intelligence tasks. This improvement was larger than the improvement of a control group who trained on a knowledge-based task that did not engage working memory; further, this differential pattern remained intact even after a 3-mo hiatus from training. We conclude that cognitive training can be effective and long-lasting, but that there are limiting factors that must be considered to evaluate the effects of this training, one of which is individual differences in training performance. We propose that future research should not investigate whether cognitive training works, but rather should determine what training regimens and what training conditions result in the best transfer effects, investigate the underlying neural and cognitive mechanisms, and finally, investigate for whom cognitive training is most useful.     

Effect of Different Endurance Training Protocols During Cardiac Rehabilitation on Quality of Life

BackgroundThis study aimed to assess the effect of different types of endurance training during outpatient cardiac rehabilitation on patients’ health-related quality of life (HRQL).MethodsThe MacNew Heart Disease HRQL questionnaire and the Hospital Anxiety and Depression Scale were used to assess changes in HRQL in 66 patients before and after 6 weeks of cardiac rehabilitation. Patients were randomized to 1 of 3 types of supervised endurance training: continuous endurance training, high-intensity interval training, and pyramid training. Two-way analysis of variance for repeated measure and chi-square test were used to analyze changes before and after rehabilitation.ResultsAttendance rate during the 6 weeks of exercise training was 99.2%. Physical work capacity increased from 136.1 to 165.5 watts (+22.9%; P < .001), and there were no statistical differences between training protocols. Fully completed questionnaires at both time points were available in 46 patients (73.9%; 61.3±11.6 years, 34 males, 12 females). Regardless of the type of supervised endurance training, there was significant improvement during rehabilitation in each of the categories of the MacNew questionnaire (ie, emotion, physical, social, global; all P < .05) and the Hospital Anxiety and Depression Scale (anxiety: P = .05; depression: P = .032), without significant differences between protocols.ConclusionsAll 3 types of endurance training led to significant and well comparable increases in physical work capacity, which was associated with an increase in HRQL independent of the type of training. Our findings support further individualization of training regimes, which could possibly lead to better compliance during life-long home-based exercise training.     

Differential effects of single versus combined cognitive and physical training with older adults: the SimA study in a 5-year perspective

The present study evaluates the effect of cognitive training, of psychoeducational training and of physical training on cognitive functioning, physical functioning, physical health, independent living and well-being in older people. Also the combination of physical training with cognitive training or psychoeducational training, respectively, was evaluated. In contrast to most training studies with older people, training effects were evaluated in a longitudinal perspective over 5 years to analyse long-term-results of cognitive and physical activity on older adults. Training effects were evaluated compared to a no-treatment-control group. Subjects were 375 community residents aged 75–93 years. Up to 5 years after baseline examination, significant training effects were observed in the group exposed to the combined cognitive and physical training. The physical and cognitive status in the participants of this group could be preserved on a higher level compared to baseline, and the participants displayed fewer depressive symptoms than the no-treatment-control group. The results are discussed in the light of recent research regarding the effects of mental and physical activity on brain function in older adults.     

CPR training in the community

To provide a profile of potential rescuers of cardiac arrest victims, 1,271 randomly selected subjects were interviewed by telephone. Thirty-nine percent had formal instruction in cardiopulmonary resuscitation (CPR), 90% knew the emergency telephone number (911), and 5% had performed CPR. Subjects with training were significantly younger than those without (36 vs 48 years old) (P less than .001), and they had a lower incidence of known heart disease in family members (7% vs 15%) (P less than .001). More men than women were trained in CPR (44% vs 37%) (P less than .015). We recommend that efforts be undertaken to reach target groups of middle-age and older women for CPR training, and that physicians assume an active role in encouraging families of cardiac patients to learn this procedure.     

下肢康复机器人联合任务导向训练对卒中后步行能力的康复作用

目的探讨下肢康复机器人联合任务导向训练对卒中后步行能力的康复作用。方法前瞻性连续收集2014年2月至2015年8月首都医科大学宣武医院康复科住院及门诊进行康复治疗且符合纳入标准的卒中患者74例,均为发病1~12个月的初发卒中,根据患者是否接受下肢康复机器人治疗分为观察组(39例)和对照组(35例)。两组患者均接受任务导向训练,2次/d,2 0 m in/次,5 d/周,共1 2周。观察组另给予1 2周的下肢康复机器人治疗,1次/d,3 0 m in/次,5 d/周。疗效评定采用Berg平衡量表、Fugl-Meyer运动功能量表(FMA)、站起-行走计时(TUG)测试、膝关节屈曲的主动关节活动度评测(KFAROM)。结果 (1)治疗后,观察组与对照组Berg量表和FMA量表评分均较治疗提高,差异均有统计学意义[Berg量表:(28±9)分比(22±9)分,(29±9)分比(24±9)分;FMA评分:(47±8)分比(36±8)分,(40±6)分比(36±7)分;均P0.01],但组间Berg评分比较差异无统计学意义(P0.05),而组间FMA量表评分的差异有统计学意义(P0.01)。观察组与对照组治疗前后Berg量表评分的差值分别为(10.75±0.30)、(4.71±0.14)分,组间差异无统计学意义(t=0.95,P=0.345);观察组与对照组治疗前后FMA量表评分的差值分别为(5.8±0.6)、(4.9±0.8)分,组间差异有统计学意义(t=5.16,P0.01)。(2)治疗后,观察组与对照组TUG测试及KFAROM均较治疗前改善,差异均有统计学意义[TUG测试:(35±13)s比(56±18)s,(53±17)s比(58±18)s;KFAROM:(82±24)°比(60±23)°,(63±23)°比(57±26)°;均P0.01],且组间差异均有统计学意义(均P0.01)。观察组与对照组治疗前后TUG测试的差值分别为(21.5±5.0)、(4.6±0.6)s,组间差异有统计学意义(t=9.55,P0.01);观察组与对照组治疗前后KFAROM的差值分别为(5.8±0.6)、(4.9±0.8)°,组间差异有统计学意义(t=4.17,P0.01)。结论任务导向性联合下肢康复机器人训练可改善卒中后患者下肢运动功能、行走能力、膝关节屈曲的关节活动度,但对下肢平衡改善效果不明显。     

A comparison of the effects of strength and aerobic exercise training on exercise capacity and lipids after coronary artery bypass surgery

BACKGROUND: Coronary artery surgery improves symptoms and prognosis in patientswith angina. Aerobic exercise rehabilitation improves exercisecapacity and prognosis in cardiac patients. Strength exercisetraining has not been extensively studied. DESIGN: We studied the effects of 6 months aerobic and strength exercisetraining after coronary artery surgery in 81 men, mean age 57years. RESULT: Treadmill time(s) increased by l30·3 (95% confidenceinterval 467·4 to 214·2) in the aerobic group;by 83·1 (0·9 to l65·3) in the strengthgroup, and by 34·3 (–1 to 69·6 in the controlgroup (P=0·04 control versus aerobic) after 3 months;and by l96·4 (112·2 to 280·7) in the aerobicgroup, by 122·7 (37·7 to 207·6) in thestrength group and by 27 (– 40·4 to 94·4)in the control group (P=0·002, control versus aerobic,and P=0·03 control versus strength) after 6 months. Thelevel of fitness improved more in the strengthtrained group,and there was a minor reduction in body weight and degree offatness. There were no changes in lipoprotein levels. Aerobicexercise training causes early and sustained benefit in treadmillexercise capacity, while the effects of strength exercise trainingare later in onset. Exercise training alone did not influencelipid levels. CONCLUSION: Cardiac rehabilitation programmes should be comprehensive, includingadvice on diet and other risk factor modifications in additionto exercise sessions involving aerobic and strength trainingelements.