Study of peripheral muscle strength and severity indexes in individuals with chronic obstructive pulmonary disease

Background and Purpose. Individuals with chronic obstructive pulmonary disease (COPD) present reduced peripheral muscle strength, which leads to impaired mobility and increased mortality risk. However, it is not clear whether there is any relationship between muscle strength, muscle mass and the body mass index, airflow obstruction, dyspnea, exercise performance (BODE) index scale, which is considered to be the best predictor of survival for individuals with COPD. The BODE Index is a multidimensional system that measures body composition (B), airway obstruction (O), dyspnea perception (D) and the ability to exercise (E), and rates the severity of the major changes found in individuals with COPD. The objective of this study was to verify any relationship between the BODE Index, muscle mass and maximum muscle strengths of the upper limb (UL) and lower limb (LL) in subjects with moderate to very severe COPD. Methods. Twenty‐six individuals with moderate to very severe COPD were evaluated by body composition (body mass index and muscle mass), BODE Index, handgrip strength (HS) and one repetition maximum (1RM) test of the UL and LL. Results. There was a positive correlation (Pearson, p < 0.05) of peripheral muscle strength, evaluated by HS and 1RM (pectoral and triceps, round muscles and dorsal section, quadriceps), to muscle mass (0.74, 0.57, 0.74 and 0.62, respectively) and the distance walked in the six‐minute walking test (0.52, 0.50, 0.46 and 0.58, respectively), but no correlation of muscle strength was found to forced expiratory volume in one second to dyspnea or the BODE Index. Conclusion. In accordance with the results of this study, peripheral muscle strength as measured by HS and 1RM is not related to the severity indexes for COPD, unlike UL and LL muscle strength. Therefore, UL and LL measurements now have an additional importance in COPD evaluation. Copyright © 2010 John Wiley & Sons, Ltd.     

A prospective study of managers’ turnover and health in a healthcare organization

Aims To assess turnover and health of Swedish healthcare managers, and identify important supporting factors relating to work and individual resources. Background Individual managers’ own sustainability in terms of turnover and health may be influenced by managerial working conditions and individual resources. Methods A 4-year prospective questionnaire study of 216 healthcare managers. Turnover and indicators of good health (healthy work attendance and no burnout) were related to work factors and individual resources using Cox regressions with constant time at risk. Results Forty per cent of the healthcare managers had left after 4 years. Fifty-two per cent had a healthy work attendance record and the proportion with no burnout had increased. Experiencing moderate/high job control was a predictor of remaining in the managerial position. Good health was predicted by having energy left for domestic work and being thoroughly rested after sleep. Conclusions Managerial turnover seems high in Swedish healthcare and linked to working conditions, while sustained health are linked to individual resources. Implications for nursing management Healthcare organizations should focus not only on developing individuals in their managerial role but also on strengthening the conditions that allow managers to exercise their leadership and to ensuring that the managers most suitable for their posts do not leave.     

Human jaw-opening muscle responses elicited by multiple-site electrical stimulation

Electrical stimuli were applied to subjects' upper and/or lower gingivae around the right canines; (i) during maintained relaxation of masticatory muscles; (ii) at an active opening position; (iii) while clenching in an incisal edge-to-edge contact (IEC) position; and (iv) at the wide-open position. Reflex responses of the suprahyoid and jaw-closing muscles were obtained using surface electrodes. The electrical stimulation produced segmented reflex excitation(s) in the suprahyoid muscle and conventional reflex excitation and/or inhibition in the jaw-closing muscles when some background activity was maintained in the muscle(s). The excitatory reflex in the suprahyoid muscle responded to multiple site electrical stimulation which was delivered on both the upper and lower jaw simultaneously rather than to single site stimulation. Also, the responses depended on the intensity of the electrical stimulation. In particular, stronger intensities resulted in longer latencies. The results support the suggestions in our previous studies with mechanical stimuli, i.e. that the human jaw-opening reflex can be obtained only when some background activity is maintained in the jaw openers, perhaps due to low threshold afferent input, and that spatial summation may be effective for the reflex.     

Genetic analysis of thermolabile methylenetetrahydrofolate reductase as a risk factor for myocardial infarction

Hyperhomocyst(e)inemia is associated with an increased risk of coronary artery disease and myocardial infarction. Both genetic and environmental factors influence the plasma level of homocysteine. One of the metabolic pathways for homocysteine involves the enzyme methylenetetrahydrofolate reductase (MTHFR), which regulates the conversion of homocysteine to methionine. A thermolabile variant of MTHFR is associated with reduced enzyme activity and increased plasma homocysteine levels. Recently, the cause of this variant of MTHFR has been identified as a single base change altering an alanine to a valine residue in the protein. Using a PCR-based assay to distinguish the normal and thermolabile variants of MTHFR in this study, we investigated whether the thermolabile variant is a genetic risk factor for myocardial infarction. In a study of 532 subjects (310 myocardial infarction patients and 222 population-based controls), we found no difference in either MTHFR genotype distribution (<it>p</it> = 0.57) or allele frequencies (<it>p</it> = 0.68) between cases and controls. The allele frequencies of the thermolabile variant were 0.34 and 0.35 in cases and controls, respectively. The age- and sex-stratified odds ratio for risk of myocardial infarction associated with homozygosity for the thermolabile variant was 0.85 (95% CI 0.50-1.50, <it>p</it> = 0.57) and that with carriage of the thermolabile allele was 1.06 (95% CI 0.73-1.52, <it>p</it> = 0.76). The odds ratio remained non-significant when restricted to young subjects (&lt;60 years) or males, and were not influenced by several other risk factors for myocardial infarction considered either singly or in combination. Interestingly, in both cases and controls, there was a trend toward a higher prevalence of hypertension in subjects carrying the normal allele, although as this is a <it>post-hoc</it> finding it needs to be interpreted with caution. The thermolabile variant of MTHFR is not a major risk factor for myocardial infarction and is unlikely to explain a significant proportion of the reported association of hyperhomocyst(e)inemia with coronary artery disease.      

Choledochal Cyst Presenting as Pancreatitis

A patient with choledochal cyst presenting with recurrent pancreatitis is described. The cyst was suspected on endoscopic retrograde cholangiography (ERCP), then was diagnosed by intravenous cholangiography and abdominal angiography. It was confirmed at surgery. The clinical, radiological and surgical features of this disorder are described and the importance of this entity as a possible correctable cause of pancreatitis is stressed.