Production of lactic acid by respiratory muscles

We measured blood lactate in normal subjects after 10 minutes of sustained maximum voluntary ventilation (SMVV) with end-tidal Pco₂ kept constant and after breathing against a big added respiratory load for 200 breaths. With SMVV subjects sustained on average 68% of the predicted maximum breathing capacity and achieved final lactate concentrations of 1·9 mmol/l (17·1 mg/100 ml), representing an average increase of about 1·0 mmol/l (9·0 mg/100 ml) over resting values. There was a wide range between individuals, from no increase at all to 2·7 mmol/l, despite similar levels of ventilation. Breathing against added loads produced much smaller changes in blood lactate.     

Pre-deployment stress briefing: does it have an effect?

BACKGROUND: The role of giving information about stress and stress reactions to people about to be exposed to hazardous situations remains unclear. Such information might improve coping and hence resilience. Alternatively, it might increase the expectancy of experiencing adverse psychological consequences following exposure to a hazard. AIM: To determine the effect of a pre-operational stress briefing on health and occupational indices among Naval and Marine personnel who were subsequently deployed to the 2003 Iraq War. METHOD: Controlled, non-randomized, parallel group study. Mental health outcomes post-deployment were compared between those who received a pre-operational stress briefing and those who did not receive such a briefing. RESULTS: Stress briefing attendees were slightly younger, more likely to be marines and to have been exposed to traumatic events than non-attendees. There were no significant differences between the two groups for the health outcomes of common mental health disorders, post-traumatic stress disorder or alcohol misuse. Attendees reported higher morale/cohesion but these differences disappeared following adjustment for demographic and military factors. No differences between the two groups were apparent for experiencing problems during or post-deployment or for marital satisfaction. CONCLUSIONS: We found no evidence that a pre-deployment stress briefing reduced subsequent medium-term psychological distress. On the other hand, we found no evidence of harm either. While only a randomized trial can give genuinely unbiased results, at present stress debriefing must be regarded as an unproven intervention, and it remains a matter of judgement as to whether or not it is indicated.     

Educational needs of eating disorder patients and families

This study examines the expressed interest of 84 consecutively treated eating disorder patients and their relatives/friends in a range of educational topics typically covered in psychoeducation and support groups, and compares clinician estimates of such patient interest. Irrespective of diagnostic and demographic factors, all groups report a high level of interest in educational topics. However, staff consistently under‐predict the interest level actually reported by patients. As only three questionnaire items distinguished between patients with anorexia nervosa (AN) and bulimia nervosa (BN), educational fora involving combined clinical populations are likely to meet the information needs of both groups, and the content of such forma appears just as relevant to their respective relatives/friends. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.     

Dedicated MR receiver coils: a simple design and construction method

We describe a simple method for design and construction of dedicated receiver coils for use in magnetic resonance imaging. We have been successful in constructing dedicated coils for multiple regions of the body using this method.     

The association between PTSD and cardiovascular disease and its risk factors in male veterans of the Iraq/Afghanistan conflicts: a systematic review

Abstract

Military personnel with Post-Traumatic Stress Disorder (PTSD) can experience high levels of mental and physical health comorbidity, potentially indicating a high level of functional impairment that can impact on both military readiness and later ill-health. There is strong evidence to implicate PTSD as a contributory factor to Cardiovascular Disease (CVD) among serving personnel and veterans. This systematic review focusses on the association between PTSD and cardiovascular disease/risk factors in male, military serving and ex-serving personnel who served in the Iraq/Afghanistan conflicts. PUBMED, MEDLINE, PILOTS, EMBASE, PSYCINFO, and PSYCARTICLES were searched using PRISMA guidelines. Three hundred and forty-three records were identified, of which 20 articles were selected. PTSD was positively associated with the development of CVD, specifically circulatory diseases, including hypertension. PTSD was also positively associated with the following risk factors: elevated heart rate, tobacco use, dyslipidaemia, and obesity. Conflicting data is presented regarding heart rate variability and inflammatory markers. Future studies would benefit from a standardized methodological approach to investigating PTSD and physical health manifestations. It is suggested that clinicians offer health advice for CVD at an earlier age for ex-/serving personnel with PTSD.     

Gender-specific responses of lean body composition and non-gender-specific cardiac function improvement after GH replacement in GH-deficient adults

GH deficiency (GHD) in adulthood is accompanied by physical and psychological impairments. One hundred fifteen patients (67 male, 48 female) with pronounced GHD were enrolled in a randomized, double-blind, placebo-controlled study with objectives that included effects on body composition, cardiac structure, and function and safety of replacement therapy with recombinant human GH (Saizen). Sixty patients (31 male, 29 female) received GH at a dose of 0.005-0.010 mg/kg.d, and 55 patients (36 male, 19 female) received placebo for 6 months. Assessment of body composition by dual-energy x-ray absorptiometry demonstrated a treatment difference in lean body mass increase of 2.1 kg (between-group comparison, P < 0.0001), which was significantly greater among males than females (P < 0.0001) [males: GH, +3.13 kg (2.42, 3.84); placebo, +0.11 kg (-0.60, 0.82); and females: GH, +0.64 kg (-0.15, 1.44); placebo: -0.90 kg (-2.20, 0.39)] [mean change 0-6 months (95% confidence limits)] and was associated with IGF-I changes. The decrease in fat mass of 2.8 kg (between-group comparison, P < 0.0001) noted by DEXA was also evident from bioelectric impedance and anthropometric measurements. Echocardiography showed comparable improvement in left ventricular systolic function after GH treatment in both genders. End-systolic volume decreased by 4.3 +/- 10.5 ml (from 35.8 +/- 17.6 ml; between-group comparison, P = 0.035) and ejection fraction increased by 5.1 +/- 10.0% (from 55.0 +/- 11.2%; between-group comparison, P = 0.048), approaching normalcy. Diastolic function did not change as assessed by isovolumic relaxation time, early diastolic flow, diastolic flow secondary to atrial contraction, or ratio of peak mitral early diastolic and atrial contraction velocity. GH treatment was well tolerated, with adverse events primarily related to effects on fluid balance. No apparent relationship between IGF-I levels and the occurrence or severity of adverse events was identified. In conclusion, GH replacement therapy in adults with GHD demonstrated beneficial effects on lean body mass composition that was more pronounced in males than females. In contrast, cardiac function improvement appears to benefit both genders equally.     

Effective peer-to-peer support for young people with end-stage renal disease: a mixed methods evaluation of Camp COOL

Background

The Camp COOL programme aims to help young Dutch people with end-stage renal disease (ESRD) develop self-management skills. Fellow patients already treated in adult care (hereafter referred to as ‘buddies’) organise the day-to-day program, run the camp, counsel the attendees, and also participate in the activities. The attendees are young people who still have to transfer to adult care. This study aimed to explore the effects of this specific form of peer-to-peer support on the self-management of young people (16–25 years) with ESRD who participated in Camp COOL (CC) (hereafter referred to as ‘participants’).

Methods

A mixed methods research design was employed. Semi-structured interviews (n?=?19) with initiators/staff, participants, and healthcare professionals were conducted. These were combined with retrospective and pre-post surveys among participants (n?=?62), and observations during two camp weeks.

Results

Self-reported effects of participants were: increased self-confidence, more disease-related knowledge, feeling capable of being more responsible and open towards others, and daring to stand up for yourself. According to participants, being a buddy or having one positively affected them. Self-efficacy of attendees and independence of buddies increased, while attendees’ sense of social inclusion decreased (measured as domains of health-related quality of life). The buddy role was a pro-active combination of being supervisor, advisor, and leader.

Conclusions

Camp COOL allowed young people to support each other in adjusting to everyday life with ESRD. Participating in the camp positively influenced self-management in this group. Peer-to-peer support through buddies was much appreciated. Support from young adults was not only beneficial for adolescent attendees, but also for young adult buddies. Paediatric nephrologists are encouraged to refer patients to CC and to facilitate such initiatives. Together with nephrologists in adult care, they could take on a role in selecting buddies.