Association between support group attendance and weight loss after Roux-en-Y gastric bypass

BACKGROUND: Attending support group meetings has been linked to increased weight loss after gastric bypass surgery. However, the degree to which support group attendance influences weight loss is still unclear. This study quantitatively described the association between support group attendance and weight loss after Roux-en-Y gastric bypass. METHODS: The weight loss data and support group attendance of 78 consecutive Roux-en-Y gastric bypass patients were studied retrospectively. The patients were analyzed in 2 groups: those who attended >5 monthly support group meetings (group A) compared with those who went to < or =5 support group meetings (group B). The data from the first 12 months after surgery were analyzed. RESULTS: Group A achieved a mean percentage of excess weight loss of 10.5% at 2 weeks after surgery, 21.4% at 6 weeks, 30.9% at 3 months, 45.4% at 6 months, 53.6% at 9 months, and 55.5% at 12 months. Group B achieved a mean percentage of excess weight loss of 11.3% at 2 weeks, 21.8% at 6 weeks, 31.8% at 3 months, 41.3% at 6 months, 45.2% at 9 months, and 47.1% at 12 months. The differences between the 2 groups were significant at P <0.05 at 9 and 12 months. The weight loss was nonlinear and slowed as patients approached 1 year after surgery. CONCLUSION: Support groups are important for maintaining weight loss throughout the first year after surgery, especially after 6 months when the rate of weight loss from surgery begins to naturally decline. The amount of postoperative weight loss was greater than, or comparable to, the published data. Implementing regular support groups within the postoperative follow-up care may provide patients with the best chances of achieving maximal weight loss.     

Volume of Physical Activity and Injury Occurrence in Young Basketball Players

Participation in organised, competitive physical activity by young athletes is increasing rapidly. This is concurrent with an increase in sporting injuries in the young population. This pilot study aimed to compare the weekly volume and types of physical activity in young basketball players injured and not injured during the season. Detailed physical activity and injury data were prospectively collected in 46 school-level basketball players aged 14 to 18 years. Participants completed physical activity logs which documented the type of physical activity undertaken, what the activity consisted of (i.e. training, competition) and the level at which it was played on a daily basis. Allied health staff completed a weekly injury form. Results showed that injured and uninjured athletes participated in a similar volume of total weekly physical activity over the season. However, injured athletes (p = 0.04) and athletes who specifically sustained overuse injuries (p = 0.01) participated in a greater amount of basketball refereeing than uninjured athletes. Based on these findings it was concluded that greater participation in running-type physical activity such as refereeing, as an addition to training and competition, may predispose the young basketball player to increased injury risk. Future research using larger sample sizes are required to further investigate the role of participation volume and type on injury occurrence in adolescent athletes.

Key points

• Basketball players participating in larger amounts of running-type physical activity, in addition to regular training and competition, may be predisposed to overuse injury
• Future studies using larger sample sizes are required to investigate the precise volumes of physical activity that increase injury risk
• This would assist in the development of participation guidelines to decrease the current injury rates observed in the young athletic population.

Key words: Adolescent, sport injury, overuse, workload     

Discrepancy between training,competition and laboratory measures of maximum heart rate in NCAA division 2 distance runners

A percentage of either measured or predicted maximum heart rate is commonly used to prescribe and measure exercise intensity. However, maximum heart rate in athletes may be greater during competition or training than during laboratory exercise testing. Thus, the aim of the present investigation was to determine if endurance-trained runners train and compete at or above laboratory measures of ''maximum'' heart rate. Maximum heart rates were measured utilising a treadmill graded exercise test (GXT) in a laboratory setting using 10 female and 10 male National Collegiate Athletic Association (NCAA) division 2 cross-country and distance event track athletes. Maximum training and competition heart rates were measured during a high-intensity interval training day (TR HR) and during competition (COMP HR) at an NCAA meet. TR HR (207 ± 5.0 b·min^-1; means ± SEM) and COMP HR (206 ± 4 b·min^-1) were significantly (p < 0.05) higher than maximum heart rates obtained during the GXT (194 ± 2 b·min^-1). The heart rate at the ventilatory threshold measured in the laboratory occurred at 83.3 ± 2.5% of the heart rate at VO₂ max with no differences between the men and women. However, the heart rate at the ventilatory threshold measured in the laboratory was only 77% of the maximal COMP HR or TR HR. In order to optimize training-induced adaptation, training intensity for NCAA division 2 distance event runners should not be based on laboratory assessment of maximum heart rate, but instead on maximum heart rate obtained either during training or during competition.

Key points

• A percentage of maximum heart rate is commonly used to prescribe and measure exercise intensity. However, maximum heart rate may be greater during competition or training than during laboratory exercise testing.
• Heart rates during training and competition were significantly higher than maximum heart rates obtained during laboratory exercise testing.
• To optimize training-induced adaptation, training intensity for NCAA division 2 distance event runners should not be based on laboratory assessment of maximum heart rate, but instead on maximum heart rate measure obtained either during training or during competition.

Key words: Competition, heart rate, laboratory, performance, running, training     

An evaluation of a specialist multiagency home support service for older people with dementia using qualitative methods

BACKGROUND: Standard home care support for people with dementia has been criticised in statutory inspection reports, and may lead to unnecessary crises, hospital or care home admissions. OBJECTIVE: To establish whether a specialist multiagency home care service for older people with dementia delivered better quality care than standard services, and how any improvements were achieved. DESIGN: Qualitative study, using semi-structured interviews, focus groups and small group interviews. SETTING: Two demographically similar areas in Nottingham, one served by a specialist home care team, the other by standard services. PARTICIPANTS: Twenty-seven service users, 18 family carers, 17 home care workers, 20 health/social care professionals, across both services. RESULTS: The specialist service demonstrated greater flexibility and responsiveness to the particular needs and circumstances of service users and family carers, who were encouraged to participate in routine decision-making and activities. By sharing responsibilities, the specialist service helped reduce carer stress and prevent crises. These outcomes depended on the configuration of the service, including multidisciplinary health and social services input, careworker autonomy and independence, continuous reassessment of clients' circumstances and preferences and the capacity to develop long-term relationships, through careworker continuity. The standard service, which used a task-orientated approach, lacked these characteristics. CONCLUSIONS: This study provides evidence of the benefits of a specialist multiagency home support service over standard home care, in the opinion of service users, carers and careworkers, and defines the operational model that achieves this. Findings confirm best practice recommendations, based on models of dementia care which emphasise respect for 'personhood'.     

Caregiving is associated with low secretion rates of immunoglobulin A in saliva

Although the chronic stress of caring for a sick/disabled relative has been associated with poorer immunity using a range of outcomes, its impact on secretory immunoglobulin A (S-IgA) in saliva has yet to be examined. Three hypotheses were tested in analyses of data from a large community sample: first, caregivers would have lower S-IgA secretion rates than non-caregivers; second, the impact of caregiving on S-IgA would be particularly apparent in older participants; third, for caregivers, caregiving burden would be negatively associated with S-IgA. The sample comprised three distinct age cohorts, one young (N=623), one middle aged (N=639), and the other elderly (N=582). Participants were classified as caregivers if they regularly cared for somebody other than routine childcare. Caregiving strain was measured and a caregiving burden index was then derived as the composite of the number of people being cared for, the type of care provided, and the residential status of the person being cared for. From 2-min saliva samples, S-IgA secretion rate was measured. There was a significant caregiver status by age cohort interaction; caregivers in the eldest cohort had lower S-IgA secretion rates than their non-caregiving counterparts. Caregiving strain and burden and S-IgA were related, such that caregivers who experienced greater strain and burden had lower S-IgA secretion rates. These findings resonate with those from other studies using different immune outcomes. Considered together, it is clear that that the chronic stress of caregiving has widespread effects on immunity.     

Is facial emotion recognition impairment in schizophrenia identical for different emotions? A signal detection analysis

Patients with schizophrenia have difficulty recognising the emotion that corresponds to a given facial expression. According to signal detection theory, two separate processes are involved in facial emotion perception: a sensory process (measured by sensitivity which is the ability to distinguish one facial emotion from another facial emotion) and a cognitive decision process (measured by response criterion which is the tendency to judge a facial emotion as a particular emotion). It is uncertain whether facial emotion recognition deficits in schizophrenia are primarily due to impaired sensitivity or response bias. In this study, we hypothesised that individuals with schizophrenia would have both diminished sensitivity and different response criteria in facial emotion recognition across different emotions compared with healthy controls. Twenty-five individuals with a DSM-IV diagnosis of schizophrenia were compared with age and IQ matched healthy controls. Participants performed a "yes-no" task by indicating whether the 88 Ekman faces shown briefly expressed one of the target emotions in three randomly ordered runs (happy, sad and fear). Sensitivity and response criteria for facial emotion recognition was calculated as d-prime and In(beta) respectively using signal detection theory. Patients with schizophrenia showed diminished sensitivity (d-prime) in recognising happy faces, but not faces that expressed fear or sadness. By contrast, patients exhibited a significantly less strict response criteria (In(beta)) in recognising fearful and sad faces. Our results suggest that patients with schizophrenia have a specific deficit in recognising happy faces, whereas they were more inclined to attribute any facial emotion as fearful or sad.     

Temozolomide for the treatment of metastatic melanoma: a systematic review

BACKGROUND: This systematic review examines the role of temozolomide in patients with metastatic melanoma. Outcomes of interest include response rate, progression-free survival, overall survival, quality of life, and adverse effects. METHODS: The MEDLINE, EMBASE, and Cochrane Library databases were searched from 1980 through to 2005 using variations on the search terms: melanoma, clinical trial, random, temozolomide, temodal, and temodar. The American Society of Clinical Oncology Annual Meeting proceedings were searched from 1996 to 2005. Relevant articles and abstracts were selected and reviewed by two reviewers, and the reference lists from these sources were searched for additional trials. RESULTS: Two randomized phase III trials and three randomized phase II trials were located. In addition, 21 phase I or II trials investigating single-agent temozolomide, temozolomide plus interferon-alpha, and temozolomide plus thalidomide were reviewed. A direct comparison of temozolomide and dacarbazine demonstrated equal efficacy for response rates and overall survival; however, no significant difference was reported. A second phase III study comparing single-agent temozolomide with temozolomide combined with interferon-alpha indicated a significantly higher response rate for the combination treatment arm, but no difference in overall survival was noted. Further phase III studies are required to confirm whether there is a benefit associated with the combination of temozolomide and interferon-alpha or thalidomide. CONCLUSION: Our review of the available literature suggests that temozolomide demonstrates comparable activity to the current standard treatment, dacarbazine, with the additional benefit of being a convenient oral treatment that penetrates the blood-brain barrier.