Moderate physical exercise: a simplified approach for ventricular rate control in older patients with atrial fibrillation

Aims  This prospective pilot-study was performed to assess whether regular moderate physical activity elevates the parasympathetic tone to the atrio-ventricular node and decreases VR during permanent AF. Background  Adequate ventricular rate (VR) control in patients with permanent atrial fibrillation (AF) is not easy to accomplish. Methods  10 patients (mean age 59 ± 10 years) with permanent AF (duration: 10 ± 8 years) underwent moderate physical exercise adjusted to their individual physical capability (45 min walking/jogging twice a week). To analyze VR control physical exercise tests and Holter-ECG recordings were performed before and after 4 months. In addition, stepwise lactate tests and psycho-pathometric examinations were obtained. Results  After 4 months of training, there was a trend toward a decrease of mean VR in 24 h Holter-ECGs by 12% from 76 ± 20 to 67 ± 12 bpm (P = 0.05) while there was no significant decrease of the minimal VR (38 ± 8 vs. 36.3 ± 4.5 bpm, P = 0.54). At a lactate threshold of 2 mmol/l there was a trend towards an increase of the running speed from 105 ± 11 to 116 ± 12 m/min (P = 0.05). A significant VR decrease of 8% (range 5–10%) was observed at almost all exercise levels during exercise treadmill testing. Increases of exercise capacity and decreases of VR were accompanied by subjective improvements of health perception. Conclusion  Regular moderate physical activity decreases VR at rest and during exercise while increasing exercise capacity. Physical training should be taken into account for ventricular rate control during AF. The study was supported by the German Atrial Fibrillation Competence Network (AFCN) funded by the Fedral Ministry of Education and Research (FMBI). A. Blumberg and J. Plisiene contributed equally to this study.     

Evaluation of cosmetic outcome following breast‐conserving therapy in trials: panel versus digitalized analysis and the role of PROMs

Cosmetic outcome is an important quality of life‐related end point following breast‐conserving therapy (BCT). To advise on a gold standard, we compare cosmetic outcome evaluated by panel and an objective evaluation (BCCT.core software). Second, patient‐reported outcome measures (PROMs) are compared to cosmetic outcome evaluation by panel and BCCT.core. Sixty‐eight breast cancer patients were included following BCT between 2007 and 2012. Two independent 6‐member panels and two observers using the BCCT.core evaluated cosmetic outcome. First, reproducibility, repeatability, and relatedness of panel and BCCT.core were analyzed using the interclass correlation coefficient (ICC). Second, the association between panel/BCCT.core with PROMs (EORTC‐QLQ‐C30/BR23, EQ‐5D‐5L, and BREAST‐Q) was analyzed with a linear regression and the goodness of fit by the R². Both panel and BCCT.core evaluations showed “excellent” intraobserver agreement (ICC 0.93 [95% CI: 0.83; 0.97] and 0.93 [95% CI: 0.84; 0.97]) for respectively panel 1 and BCCT.core 1 and “excellent” interobserver agreement (ICC 0.94 [95% CI: 0.90; 0.96] and 0.85 [95% CI: 0.77; 0.91]) respectively for panel and BCCT.core. Association between panel and BCCT.core varied, ICC 0.59‐0.69. Only the PROM BREAST‐Q showed a significant association with both panel evaluations and BCCT.core observers (panel 1 and BCCT.core 1; R² of .157 [P = .002] and .178 [P = .001]). Both panel and BCCT.core showed comparable “excellent” intraobserver and interobserver agreement. For future trials evaluating cosmetic outcome following BCT, one of those can be chosen. Solely, the PROM BREAST‐Q showed a significant association with panel and/or BCCT.core evaluation. To enable standardized cosmetic outcome evaluation and corresponding patient satisfaction in future trials, at least the BREAST‐Q should be combined with a panel or BCCT.core evaluation.     

The effect of dyshemoglobins on pulse oximetry: Part I,theoretical approach and part II,experimental results using an in vitro test system

Pulse oximeters are known to be inaccurate in the presence of elevated concentrations of carboxyhemoglobin and methemoglobin. This paper attempts to alleviate some of the confusion that exists between fractional and functional saturation, and to clarify the comparison of each with SpO₂. A series of theoretical relationships between pulse oximeter reading (SpO₂) and actual oxygen saturation (both fractional and functional) is derived using simple absorption theory. The theoretical relationships are checked using an experimental in vitro test system. This consists of a blood circuit containing a model finger, capable of simulating the pulsatile transmission signals through a real finger. Theoretical predictions and experimental results are compared and are found to agree well in the presence of carboxyhemoglobin, but less well with methemoglobin. Possible reasons are discussed.     

Breast self-examination: an analysis of self-reported practice

The aim of this study was to investigate the relationship between the performance of breast self-examiniation (BSE) and age, place of residence, ethnic background and religion, as well as whether a group willing to take part in an interview regarding BSE mirrored the whole population. Six hundred and ninety-four (69.4%) women, aged 25–80, responded to the questionnaire. Of gthese, 69.6% examined their breasts. Whether the subjects lived in urban or rural areas was of no importance for practising BSE, nor was country of birth or number of years in Sweden. A larger proportion of women aged 45–80 practised BSE compared with women aged 25–44 ( P < 0.001), the former practising BSE once a month or more. Step-wise logistic regression analysis showed that, for the whole sample as well as for the interview group, age was the only significant predictor of breast self-examination ( P < 0.001). There were no significant differences between the whole sample and the interview group. The importance of younger women performing the examiniation is stressed. Dur to nurses being strategically located in a wide range of geographical locations, allowing them to meet women in different settings, they are a good choice for motivating women to prctise BSE.     

LRRK2 R1628P variant is a risk factor of Parkinson's disease among Han‐Chinese from mainland China

Mutations in LRRK2, the gene that encodes leucine‐rich repeat kinase 2 (LRRK2), are associated with autosomal dominant and sporadic forms of Parkinson's disease (PD) and are the most common genetic causes of PD. Recently, a R1628P variant has been reported as a risk factor for PD in Taiwan and Singapore. To determine the association of this variant and PD in the Han‐Chinese population from mainland China, we analyzed its frequency in a cohort of 600 patients and 459 unrelated healthy controls. Forty (6.7%) patients were heterozygous and 3 (0.5%) homozygous for the R1628P variant, which was significantly more frequent than in the controls [2.4% heterozygous and 0.0% homozygous, Odds ratio = 3.14, 95%CI: 1.60–6.17, P < 0.01]. Considering the age at onset, this difference was found only in late‐onset PD (older than 50) [Odds ratio = 3.76, 95% CI: 1.90–7.45, P < 0.01]. Our data confirms that the LRRK2 R1628P variant is associated with an increased risk to develop late onset PD in the ethnic Han‐Chinese population. © 2009 Movement Disorder Society     

Psychometric evaluation of social phobia and anxiety inventory for children (SPAI-C) and social anxiety scale for children-revised (SASC-R)

The study evaluated the psychometric properties of Finnish versions of the Social Phobia and Anxiety Inventory for Children (SPAI-C) and the Social Anxiety Scale for Children-Revised (SASC-R). 352 students (M = 12.2 years) participated in the study and completed the SPAI-C and SASC-R. In addition, 68 participants (M = 12.2 years) and their parents were interviewed with the Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS-PL). The SPAI-C was more sensitive for identifying youth meeting criteria for social phobia (SP), whereas the SASC-R demonstrated greater specificity. The youth in this sample had lower mean total scores on the self-report questionnaires than did those in the original validitation studies of the SPAI-C and SASC-R conducted in America. These findings question whether cross-cultural differences in the expression of SP influence the clinical cut-off scores used in translated versions of social anxiety questionnaires.     

Associations Between School Recreational Environments and Physical Activity

Background:  School environments may promote or hinder physical activity in young people. The purpose of this research was to examine relationships between school recreational environments and adolescent physical activity.
Methods:  Using multilevel logistic regression, data from 7638 grade 6 to 10 students from 154 schools who participated in the 2005/06 Canadian Health Behaviour in School-Aged Children Survey were analyzed. Individual and cumulative effects of school policies, varsity and intramural athletics, presence and condition of fields, and condition of gymnasiums on students' self-reported physical activity (≥2 h/wk vs <2 h/wk) were examined.
Results:  Moderate gradients in physical activity were observed according to number of recreational features and opportunities. Overall, students at schools with more recreational features and opportunities reported higher rates of class-time and free-time physical activity; this was strongest among high school students. Boys' rates of class-time physical activity were 1.53 (95% confidence interval (CI) = 1.12-1.80) times as high at high schools with the most recreational features as at schools with the fewest. Similarly, girls' rates of free-time physical activity at school were 1.62 (95% CI: 0.96-2.21) times as high at high schools with the most opportunities and facilities as compared to schools with the fewest. Modest associations were observed between individual school characteristics and class-time and free-time physical activity.
Conclusions:  Taken together, the cumulative effect of school recreational features may be more important than any one characteristic individually.