Value of exercise capacity and physical activity in the prevention of cardiovascular diseases—brief review of the current literature

A low level of physical activity and decreased exercise capacity are independent risk factors for cardiovascular and all-cause mortality. The assessment of the level of physical activity and its improvement following preventive procedures is methodologically difficult. In population studies, subjective methods, such as questionnaires, activity records and other somewhat imperfect measures (accelerometers, pedometers, and pulse monitors), are used. Direct and especially indirect assessment of physical capacity with exercise tests has become increasingly more accessible and cheap. Both methods have been proved to have high prognostic value. Assessment of physical capacity enables objectification of information on the level and effects of a subjects physical activity acquired via a questionnaire. Taking into account the above-mentioned issues, the role of the assessment of exercise capacity and its improvement is not adequately appreciated. Routine evaluation of exercise capacity has not been included in the current statements on epidemiology and prevention, even in those with an increased Framingham or SCORE risk index in whom low exercise tolerance has been proved to have an unfavorable influence on prognosis. The importance of an increase in the level of physical activity resulting in an improvement in exercise capacity in different population groups should be verified in the near future, but in our opinion there is indirect but strong evidence that actions to improve exercise capacity should become the main goals in the prevention of cardiovascular and all-cause mortality, such as cessation of cigarette smoking, body weight reduction, correction of lipid and carbohydrate metabolism disturbances, and a decrease in blood pressure.     

Current concepts in the recognition and treatment of superior labral (SLAP) lesions

Pathology of the superior aspect of the glenoid labrum (SLAP lesion) poses a significant challenge to the rehabilitation specialist due to the complex nature and wide variety of etiological factors associated with these lesions. A thorough clinical evaluation and proper identification of the extent of labral injury is important to determine the most appropriate nonoperative and/or surgical management. Postoperative rehabilitation is based on the specific surgical procedure as well as the extent, location, and mechanism of labral pathology and associated lesions. Emphasis is placed on protecting the healing labrum, while gradually restoring range of motion, strength, and dynamic stability of the glenohumeral joint. The purpose of this paper is to provide an overview of the anatomy and pathomechanics of SLAP lesions and review specific clinical examination techniques used to identify these lesions, including 3 newly described tests. Furthermore, a review of the current surgical management and postoperative rehabilitation guidelines is provided.     

The mother and her sick newborn (author's transl)]

The care of the mother during the pre- and postnatal period is of great importance not only for the act of birth but also for the establishment of the mother child relationship. There are indications that the quality of mothering during later childhood is determined by the way the mother child relations are established during the first days of life. It is important to realise the needs of the mother to see and to touch her child and to enable her to do so as often as possible even if this child is under special care. In cases of neonatal illness the mother especially needs the psychological help of her doctor and the nurses. The professional persons can provide this help better if they are aware of the normal reactions of the mother to neonatal illness or even death of her child.     

Patterns and quality of treatment for patients with schizophrenia in routine psychiatric practice

OBJECTIVES: This study provided generalizable national data on the treatment of adult patients with schizophrenia in the United States and assessed conformance with the practice guideline treatment recommendations of the Schizophrenia Patient Outcomes Research Team and the American Psychiatric Association. METHODS: National data from the American Psychiatric Institute for Research and Education's 1999 Practice Research Network study of psychiatric patients and treatments were used to examine treatment patterns for 151 adult patients with schizophrenia. Analyses were performed and adjusted for the weights and sample design to generate nationally representative estimates. RESULTS: Findings indicated that patients with schizophrenia who were treated by psychiatrists had complex clinical problems and were markedly disabled. Forty-one percent of patients had a comorbid axis I disorder, and 75 percent were currently unemployed. Thirty-five percent were currently experiencing medication side effects, and 37 percent were currently experiencing problems with treatment adherence. Although most patients received guideline-consistent psychopharmacologic treatment, treatment was characterized by significant polypharmacy. Rates of conformance with the guideline recommendations were significantly lower for psychosocial recommendations than for psychopharmacologic recommendations. Although 69 percent of patients received at least some psychosocial treatment, none of the unemployed patients received vocational rehabilitation services in the past 30 days. CONCLUSIONS: These data suggest unmet need for psychosocial treatment services among individuals with schizophrenia. These findings raise questions about whether currently available antipsychotic medications are being used optimally or whether they offer limited effectiveness for patients with complex clinical problems who are treated in routine psychiatric practice.     

BDNF genetic variants are associated with onset age of familial Parkinson disease: GenePD Study

Brain-derived neurotrophic factor (BDNF) stimulates neuronal growth and protects nigral dopamine neurons in animal models of Parkinson disease (PD). Therefore, BDNF is a candidate gene for PD. The authors investigated five single-nucleotide polymorphisms in 597 cases of familial PD. Homozygosity for the rare allele of the functional BDNF G196A (Val66Met) variant was associated with a 5.3-year older onset age (p = 0.0001). These findings suggest that BDNF may influence PD onset age.     

Asymmetric limb loading with true or simulated leg-length differences

Unequal leg lengths result in asymmetric limb loading but opinions vary on the size of the difference inducing abnormal loading, and which limb sustains the greater load. Our study compared limb-loading asymmetries during walking for subjects with anatomic leg-length discrepancies between 1.0 and 3 cm, subjects without length discrepancies, and for subjects with a simulated a 1.31-cm leg-length discrepancy. Symmetry indices were calculated for peak ground reaction force during weight acceptance, rate of change of weight acceptance force, peak push-off force, and rate of change of push-off force. All symmetry measures were significantly different from normal for the simulated leg-length discrepancy. The shorter limb sustained a greater proportion of the load and loading rate. The anatomic leg-length discrepancy group showed the same trend with the exception of the push-off force rate. There were equivalent size-effect differences for both leg-length discrepancy conditions; however, for the anatomic leg-length discrepancy group, only the weight acceptance force symmetry value was statistically different from normal. The shorter limb sustains a greater proportion of load and loading rates; therefore, equalizing leg lengths should be considered even with bilateral differences less than 3 cm.     

Analysis of mode of delivery in cases with fetal premature atrial contractions

OBJECTIVE: Premature atrial contractions are common in obstetrical practise but there is little information available on recommended management and mode of delivery. DESIGN: The aim of the study was to describe our clinical experience in the management of fetal arrhythmia including the indications for certain time and way of labour. MATERIALS AND METHODS: 128 fetuses with diagnosed supraventricular arrhythmia described as atrial extrasystole were examined. They were divided into 3 main groups: group I (84 fetuses) with single PAC, group II (37 fetuses) with quantitatively significant arrhythmia or accompanied by another kind of arrhythmia and group III (7 fetuses) associated with extracardiac abnormalities. RESULTS: Among 128 fetuses with supraventricular arrhythmia, 44 cases (31%) required systematic monitoring. Quantitatively significant arrhythmia was recognized in 15 cases, blocked bigeminy (2:1) in 2 fetuses, 10 cases were accompanied by another arrhythmias: 4x SVT, 4x sinus bradycardia, 2x premature ventricular contractions (PVC). There were 3 fetuses diagnosed with heart defects and 7 with extracardiac malformations. Fetal echocardiography revealed additional functional circulatory changes in 7 fetuses with premature atrial contractions. Myocarditis was recognized in 2 fetuses. The mode of delivery was analyzed in 128 cases. In the first group 27 patients (32%) underwent caesarean section, in the second group--23 (62%), in the third group 3 patients (43%), respectively. Cardiac indications for caesarean section equalled 22% of all the indications occurring in fetuses suffering from arrhythmia. CONCLUSIONS: Caesarean section is much more commonly performed among fetuses diagnosed with arrhythmia accompanied by another fetal anomalies comparing to the group of fetuses with isolated arrhythmia. Although there are no particular cardiac indications for such way of delivery, total amount of caesarean sections performed in that group is really great. Above all, it may suggest that the obstetrician is under pressure of stress while making decision concerning caesarean section performance, even when there are no other indications and the condition of fetus is stable enough.     

Nursing at ground zero: experiences during and after September 11 World Trade Center attack

The purpose of this study is to discover shared perceptions, feelings, and common experiences of nurses after the September 11th World Trade Center terrorist attack through interpretive analysis of narrative stories of seventeen nurses. Six themes and one constitutive pattern describe the experiences: (a) Loss of a symbol and regaining new meaning, (b) Disaster without patients, (c) Coordinating with and without organizations, (d) Rediscovering the pride in nursing, (e) Traumatic Stress, and (f) Preparing for the future. The constitutive pattern is that nursing enables a humanitarian disaster response.