Effects of aerobic and strength training on depression, anxiety, and health self-perception levels during the COVID-19 pandemic.

OBJECTIVE: This study aimed at comparing the depression and anxiety levels, and health self-perception during the coronavirus disease 2019 pandemic among subjects who practice aerobic, strength, and mixed (aerobic and strength) exercises and nonsports participants. MATERIALS AND METHODS: We included 304 Brazilians of both sexes in this cross-sectional study. All participants were recruited through online advertisement and completed a self-administered questionnaire regarding the personal information, level of restriction adopted, physical activity, and mood state screening (Patient Health Questionnaire-9 and General Anxiety Disorder-7). We divided the participants into four groups: strength sports group (CrossFit or strength training), aerobic/endurance sports groups (running, cycling, triathlon, or swimming), mixed sports groups (individuals who practice endurance and strength sports), and nonsports group. RESULTS: The Kruskal-Wallis test showed a significant effect of the group on the depression and anxiety levels. Meanwhile, the post-hoc comparisons showed a significantly lower depression level in the mixed and aerobic sports groups than in the strength sports and nonsports groups, and a significantly lower anxiety level in the mixed and aerobic sports groups than in the nonsports group. Furthermore, participants in the mixed, strength, and aerobic sports groups presented a better level of health self-assessment than the nonsports group, and those in the mixed sports group had a better level of health self-assessment than the strength or aerobic sports groups. CONCLUSIONS: Individuals practicing aerobic exercises present lower depression and anxiety levels than those practicing strength training and are inactive. However, individuals who practice strength exercises and aerobics have the best levels of health perception.

Effect of two incremental intensity field tests on wellness indices, recovery state, and physical enjoyment in soccer players.

OBJECTIVE: Competitive athletes must undergo fitness testing to monitor athlete progress and to create appropriate, progressive training programs. However, fitness testing adds to training stress; therefore, impacts of testing on wellness and recovery must be considered in test selection. This study investigated the effects of two incremental field tests [VAMEVAL test (T-VAM) and 20-m maximum shuttle test (20-m MST)] on wellness, total quality of recovery (TQR) and physical enjoyment (PE) in competitive soccer players. SUBJECTS AND METHODS: Twenty-two soccer players (20.9±1.5 years) completed two T-VAM and two 20-m MST in a randomized order on separate days with a 1-week interval between tests. TQR and wellness indices (sleep, fatigue, stress and muscle soreness) measures were collected before and 24 hours after each test. Heart rate (HR) was continuously monitored during each test. Rating of perceived exertion (RPE) and PE were assessed after each test. RESULTS: T-VAM resulted in higher PE, TQR and wellness scores than 20-m MST (p<0.05). T-VAM and 20-m MST resulted in similar HR and maximal aerobic speed. For T-VAM, TQR was correlated (p<0.01) with RPE and wellness indices. For 20-m MST, TQR was correlated (p<0.01) with wellness indices. HRmax and RPE were not correlated with wellness indices, TQR or PE. CONCLUSIONS: Overall, T-VAM and 20-m MST produced similar aerobic fitness testing results, but athletes responded more favorably to T-VAM. Coaches can use T-VAM for evaluating aerobic fitness while maximizing well-being and physical enjoyment among soccer players.

A multifaceted intervention: no increase in general practitioners' competence to diagnose skin cancer (minSKIN) - randomized controlled trial.

BACKGROUND: General practitioners (GPs) play crucial roles in early detection of skin cancer. A pilot-study found a positive short-term effect of a 1-day dermatologic education programme on GPs' diagnostic competence. OBJECTIVE: To determine effects of a multifaceted intervention, including technical equipment and continuing feedback by a dermatologist, on GPs' diagnostic skills regarding skin cancer. METHODS: Randomized controlled trial with 78 GPs of the Canton of Zurich, Switzerland. INTERVENTION: GPs in intervention group received a 1-day training, a Lumio (magnifying glass with polarized light, 3Gen), a Nikon digital camera and - during 1 year - feedback on skin lesion pictures sent to the dermatologist. GPs in control group only received the 1-day training. PRIMARY OUTCOME: structured assessment of GP's diagnostic skills in correctly diagnosing images of skin lesions regarding skin cancer. At baseline prior to intervention (T0), after the full-day training course in both groups (T1), and after 1 year of continuing feedback (T2) to the intervention group. MEASURES: Non-parametric unpaired (Wilcoxon-Mann-Whitney) tests were used to compare numbers of correctly classified skin lesions between both groups at T2 and for the change between T1 and T2. RESULTS: At T0, both groups classified a median of 23 skin lesions of the 36 images correctly. This value rose to 28 for both groups at T1 and fell to 24 for both groups at T2. No difference between control and intervention group at T2. Furthermore, we compared differences in the sum scores per GP between T1 and T2 for each group. Also in this comparison, no difference between control and intervention group was found. CONCLUSION AND RELEVANCE: No long-term effect of the multifaceted intervention was found on the competence to diagnose skin cancer by GPs. The positive short-term effect of the 1-day dermatologic education programme did not persist over 12 months.

[How do Swiss family physicians treat subclinical hypothyroidism?]. / Comment tes médecins de famille prennent-ils en charge l'hypothyroïdie infraclinique?

Subclinical hypothyroidism is a common condition, and its prevalence increases with age. Currently, guidelines regarding the screening and treatment of subclinical hypothyroidism are controversial. An international survey of general practitioners (GPs), to which Swiss GPs also contributed, showed large inter-country variations in treatment strategies for subclinical hypothyroidism. These differences are mainly explained by the lack of strong evidence for the management of this condition. The European randomized-controlled clinical trial TRUST should help clarify recommendations for screening and thyroxin replacement for the elderly with subclinical hypothyroidism. Working in close collaboration with GPs in Switzerland for the recruitment of patients will ensure that the findings from this study will be applicable to primary care settings.

Swiss quality and outcomes framework: quality indicators for diabetes management in Swiss primary care based on electronic medical records.

BACKGROUND: Most industrialized countries are faced with a growing population of patients with chronic diseases and multimorbidity. Evidence performance gaps have been recognized in the treatment of this vulnerable patient group. In England, the Quality and Outcomes Framework (QOF) - based on incentivized quality indicators - has been established to narrow the gap. OBJECTIVE: We evaluated to what extent clinical data, extracted from electronic medical records (EMRs) of Swiss general practitioners, can be used as quality indicators in terms of a Swiss Quality and Outcomes Framework (SQOF) for diabetes care adopted from the QOF of the UK National Health Service (NHS). METHODS: We searched the FIRE database (Family Medicine ICPC Research Using Electronic Medical Records) for patients suffering from diabetes type 1 or type 2. Eligible data were matched with the diabetes indicator set of the NHS QOF and compared with the results in England. RESULTS: A total of 11 out of 17 diabetes indicators could be adopted for the SQOF; 46 practices with 1,781 diabetes patients were included. The practices fulfilled the SQOF diabetes indicator set with 46.9% overall, with highest compliance for blood pressure measurements (97.8% of all practices) and lowest compliance for influenza immunization (45.7%). Our study practices showed higher variation across all indicators and between practices compared to England, but lacking structured data limited calculation of scores and comparability. CONCLUSIONS: Our results show that it is technically feasible to establish a diabetes QOF in Swiss primary care based on EMRs. However, a high amount of missing data made it impossible to evaluate the actual quality of care. For a nationwide introduction, standards for electronic medical documentation and EMR use need to be set. It should also be acknowledged that important dimensions of suffering from one or more chronic diseases such as health-related quality of life are not reflected within a system focusing only on somatic aspects of a disease.

The age-related decline in Olympic distance triathlon performance differs between males and females.

AIM: The aim of this cross-sectional study was to compare the age-related declines in swimming, cycling, and running and overall race times between males and females in an Olympic distance triathlon, the 'Zürich Triathlon' in Switzerland. METHODS: Swimming (1.5 km), cycling (40 km), running (10 km) and overall race times of 7939 total finishers (1666 females and 6273 males) from 2000 to 2010 in the "Zürich Triathlon" were analysed. RESULTS: There was a significant (P<0.001) age effect on performance for both males and females independently of the discipline. No significant difference in the overall race time was observed between 18 and 34 years for both genders. There was an interaction (P<0.001) of age and gender for swimming, cycling and overall race times, but not for running times. The age-related declines in performance were significantly less pronounced for males compared with females for swimming (>50 years), for cycling (>40 years) and for overall race time (>40 years). CONCLUSION: These data suggest that the age and gender interactions in an Olympic distance triathlon performance differ between the three locomotion modes. Further studies investigating training regimes, competition experience or socio-demographic factors are needed to get a better insight in the phenomenon of the gender specific age-related declines in endurance performance.

Male swimmers cross the English Channel faster than female swimmers.

We examined the gender difference in performance of open-water ultra-swimmers crossing the English Channel between 1875 and 2011. A total of 1606 swimmers (1120 males and 486 females) crossed the English Channel within a mean time of 809.6 ± 175.6 min. The overall female swim time of 796.3 ± 188.7 min was not different compared with the overall male swim time of 815.4 ± 169.4 min (P > 0.05). The fastest male swim time ever of 417 min was 6.7% faster than the fastest female swim time ever with 445 min. The gender difference in performance of the top three times ever was 8.9 ± 2.3%. Over the last 36 years, the performance of the annual top three swimmers showed no changes for both females and males. The top three males (564.3 ± 63.8 min) were significantly faster than the top three females (602.1 ± 58.7 min; P < 0.01). The gender difference remained unchanged at 12.5 ± 9.6% over the years. To summarize, the top three male swimmers in the English Channel were ∼12% faster than the females in the last 36 years. It seems unlikely that female open-water ultra-swimmers will overtop males in the near future in the English Channel.

[Will foam sclerotherapy and endovenous thermal ablation replace varicose vein stripping?]. / Können Schaumverödung und Thermoablation das chirurgische Venenstripping ersetzen?

Minimally invasive treatments of varicosis are increasingly establishing. Short and intermediate-term outcomes of endovenous treatments are satisfying: success rates are comparable with conventional surgery, whereas recovery is faster and complication rates are lower. Success rates are highest for endovenous laser ablation (EVLA). However, endovenous radiofrequency ablation (RFA) has advanced. Its short term outcomes are now comparable to EVLA, but with less side-effects. Ultrasound guided foam sclerotherapy (UGFS) replaced other forms of liquid sclerotherapy. In principle, this treatment can be combined with every other treatment for varicosis, but it loses its position as a monotherapy, due to poorer intermediate-term outcomes compared with EVLA and RFA. More prospective randomized controlled trials are needed in order to state an evidence based hierarchy of treatments for varicosis. With the minimally invasive treatments it is possible to treat patients on an outpatient basis. It will have to be assessed whether this will lead to higher cost-effectiveness.

Regulation of electrolyte and fluid metabolism in multi-stage ultra-marathoners.

The purposes of this study were (i) to determine the prevalence of exercise-associated hyponatremia (EAH) in multi-stage ultra-marathoners and (ii) to gain more insight into fluid and electrolyte regulation during a multi-stage race. Body mass, sodium concentration ([Na⁺]), potassium concentration ([K⁺]), creatinine, urea, specific gravity, and osmolality in urine were measured in 25 male ultra-marathoners in the 'Swiss Jura Marathon' 2008 with 11,000 m gain of altitude over 7 stages covering 350 km, before and after each stage. Haemoglobin, haematocrit, creatinine, urea, [Na⁺], [K⁺], and osmolality were measured in plasma before stage 1 and after stages 1, 3, 5, and 7. Two athletes (8%) showed plasma [Na⁺] <135 mmol/l. Body mass, plasma [Na⁺], and plasma [K⁺] remained unchanged (p>0.05). Urine specific gravity (p<0.001) and osmolality in both plasma (p<0.01) and urine (p<0.001) were increased and haematocrit (p<0.0001), haemoglobin (p<0.0001) and plasma albumin were decreased (p<0.001). Plasma volume (p<0.01) and plasma urea (p<0.001) were increased. The K⁺/Na⁺ ratio in urine increased >1.0 after each stage and returned to <1.0 the morning of the next stage (p<0.001). To summarize, more sodium than potassium was excreted during rest. The increased urinary sodium losses during rest are compatible with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) or the cerebral salt-wasting syndrome (CSWS). Further studies are needed to determine the antidiuretic hormone (ADH) and both the atrial natriuretic peptide (ANP) and the brain natriuretic peptide (BNP) during multi-stage races.

Effect of a multistage ultraendurance triathlon on aldosterone, vasopressin, extracellular water and urine electrolytes.

Prolonged endurance exercise over several days induces increase in extracellular water (ECW). We aimed to investigate an association between the increase in ECW and the change in aldosterone and vasopressin in a multistage ultraendurance triathlon, the 'World Challenge Deca Iron Triathlon' with 10 Ironman triathlons within 10 days. Before and after each Ironman, body mass, ECW, urinary [Na(+)], urinary [K(+)], urinary specific gravity, urinary osmolality and aldosterone and vasopressin in plasma were measured. The 11 finishers completed the total distance of 38 km swimming, 1800 km cycling and 422 km running within 145.5 (18.8) hours and 25 (22) minutes. ECW increased by 0.9 (1.1) L from 14.6 (1.5) L prerace to 15.5 (1.9) L postrace (P < 0.0001). Aldosterone increased from 70.8 (104.5) pg/mL to 102.6 (104.6) pg/mL (P = 0.033); vasopressin remained unchanged. The increase in ECW was related neither to postrace aldosterone nor to postrace vasopressin. In conclusion, ECW and aldosterone increased after this multistage ultraendurance triathlon, but vasopressin did not. The increase in ECW and the increase in aldosterone were not associated.

[The diabetes traffic light scheme - development of an instrument for the case management in patients with diabetes mellitus in primary care]. / Das Diabetes-Ampelschema - Entwicklung eines Instruments für das hausärztliche Case Management bei Patienten mit Diabetes mellitus.

In order to sustain the continuity and quality of treatment in diabetic primary care patients, it is necessary to introduce structured and regularly performed monitoring system into the practice team. The monitoring aims at early and valid recognition of potential complications resulting from a chronic disease. Ideally the practice nurse is in charge of the case management. The central element of the case management is a colour coded instrument, the diabetes traffic light scheme, by which means the most important clinical parameters and patient adherence can be screened in regular intervals. Additionally, the instrument regulates in-practice communication by means of stratified action plans and enables ideal treatment continuity also in larger teams. The experiences resulting from the development of this diabetes-specific traffic light scheme can be beneficial for the future development of similar instruments in other chronic diseases.

Maintained serum sodium in male ultra-marathoners--the role of fluid intake, vasopressin, and aldosterone in fluid and electrolyte regulation.

Exercise-associated hyponatremia (EAH) is a well know electrolyte disorder in endurance athletes. Although fluid overload is the most like etiology, recent studies, however, argued whether EAH is a disorder of vasopressin secretion. The aims of the present study were to investigate (i) the prevalence of EAH in male ultra-marathoners and (ii) whether fluid intake, aldosterone or vasopressin, as measured by copeptin, were associated with post-race serum sodium concentration ([Na+]). In 50 male ultra-marathoners in a 100 km ultra-marathon, serum [Na+], aldosterone, copeptin, serum and urine osmolality, and body mass were measured pre- and post-race. Fluid intake, renal function parameters and urine excretion were measured. No athlete developed EAH. Copeptin and aldosterone increased; a significant correlation was found between the change in copeptin and the change in serum [Na+], no correlation was found between aldosterone and serum [Na+]. Serum [Na+] increased by 1.6%; body mass decreased by 1.9 kg. The change in serum [Na+] and body mass correlated significantly and negatively. The fluid intake of ~ 0.58 l/h was positively related to the change in body mass and negatively to both post-race serum [Na+] and the change in serum [Na+]. We conclude that serum [Na+] was maintained by both the mechanisms of fluid intake and the hormonal regulation of vasopressin.

[Post hip fracture care]. / Nachsorge Schenkelhalsfraktur.

Hip fractures are common and associated with high mortality and morbidity. Patients with hip fractures have a high risk of refractures. Osteoporosis is the underlying cause. A therapy with bisphosphonates is indicated without the need of further diagnostic testing with a bone marrow densitometry.

[Vocational training of future GPs in Swiss hospitals: the view of chief physicians]. / Weiterbildung von angehenden Hausärzten an stationären Weiterbildungsstellen: Sicht der Chefärzte.

BACKGROUND: We sought to assess the way future general practitioners are promoted by their chief physicians. METHODS: Semi quantitative questionnaires sent to 54 chief physicians (hospitals in cantons Zurich and Berne). RESULTS: 42 (77.8%) questionnaires were returned. 41 (97.6%) chief physicians asked the assistant physicians about their intended career. 23 (54.8%) discussed with future general practitioners (GPs) specific learning objectives. 32 (76.2%) chief physicians would have appreciated an official catalogue of learning objectives for future GPs. A GP-specific traineeship was lacking in most of the hospitals. CONCLUSIONS: The upcoming shortage of future GPs could be inhibited by an appropriate GP curriculum during the vocational training.

[Vocational training of future GPs in Swiss hospitals: the view of assistant physicians]. / Weiterbildung von angehenden Hausärzten an stationären Weiterbildungsstellen: Sicht der Assistenzärzte.

BACKGROUND: We sought to assess views of young physicians, performing vocational training in hospitals, regarding primary care. METHODS: Semi quantitative questionnaires sent to 535 assistant physicians (hospitals in cantons Zurich and Berne). RESULTS: 318 (62.4%) questionnaires were returned. 143 (45.0%) of the assistant physicians considered becoming a general practitioner (GP). There from, 58 (40.3%) decided in their undergraduate phase, 56 (38.9%) decided postgraduate. They felt generally supported by supervisors. A lack of specific learning objectives and hospital GP-traineeships were revealed. CONCLUSIONS: Our study shows that the decision for a career in primary care is made in equal parts undergraduate and postgraduate. These future and potential GPs should be attracted by an appropriate GP curriculum during their vocational training.

Interventions in primary care to improve cardiovascular risk factors and glycated haemoglobin (HbA1c) levels in patients with diabetes: a systematic review.

Most patients with diabetes are treated in primary care (PC). We performed a systematic review to assess the effect of single and combined interventions on cardiovascular risk factors (CVRFs) and glycated haemoglobin (HbA1c) levels in patients with diabetes in PC settings. We searched the MEDLINE database from January 1990 to October 2008. According to the Cochrane Effective Practice and Organization of Care Group (EPOC) criteria, (cluster-)randomized control studies and controlled before-and-after studies were selected and reviewed. Identified interventions were classified according to a modified EPOC intervention taxonomy. We included 68 studies. Forty-five studies evaluated the effect of any intervention on HbA1c. Seventeen studies presented a significant improvement in HbA1c. Nine out of 27 studies evaluating CVRFs [cholesterol, blood pressure (BP)] and HbA1c showed a significant improvement in at least two of these factors. Audit and feedback on performance, clinical decision support systems, multi-professional teams and patient education seemed to be successful strategies. The increasing evidence regarding the treatment of persons with chronic illnesses, summarized in the Chronic Care Model (CCM), is not reflected in most recent studies about diabetes treatment in PC. Most interventions still seem only partly adapted to the CCM. The methodological quality of many studies is still poor and often the pivotal outcomes, CVRFs and HbA1c, are not appropriately addressed. As a consequence, the potential of PC in the care of patients with diabetes may still be underestimated.

Upper body skinfold thickness is related to race performance in male Ironman triathletes.

We investigated the association between skinfold thickness and race performance in male and female Ironman triathletes. Skinfold thicknesses at 8 sites and percent body fat were correlated to total race time including the split times for the 3 sub disciplines, for 27 male and 16 female Ironman athletes. In the males, percent body fat (r=0.76; p<0.0001), the sum of upper body skinfolds (r=0.75; p<0.0001) and the sum of all 8 skinfolds (r=0.71; p<0.0001) were related to total race time. Percent body fat (r=-0.67; p<0.001), the sum of upper body skinfolds (r=-0.63, p=0.0004) and the sum of all 8 skinfolds (r=-0.59; p<0.001) were also associated with speed in cycling during the race. In the females, none of the skinfold thicknesses showed an association with total race time, average weekly training volume or speed in the sub disciplines in the race. The results of this study indicate that low skinfold thicknesses of the upper body are related to race performance in male Ironman triathletes, but not in females.

The Patient Assessment of Chronic Illness Care questionnaire: evaluation in patients with mental disorders in primary care.

The Chronic Care Model provides evidence-based recommendations to improve the care for patients with chronic conditions. The Patient Assessment of Chronic Illness Care questionnaire (PACIC) is an instrument to evaluate the patient's perspective on receipt of care delivered in the five domains patient activation, delivery system, goal setting, problem solving, and follow-up. The aim of this study was to assess the psychometric characteristics of the PACIC in 442 primary care patients with major depression. The psychometric properties were good. We found possible ceiling effects in the two subscales 'patient activation' (12.9%) and 'problem solving/contextual' (8.9%), as well as floor effects in 'goal setting/tailoring' (4.6%). The Cronbach's α coefficient for the total scale was excellent (0.91). We found two major factors, which we labeled according to the PACIC domains as composite factors 'patient activation and problem solving' as well as 'goal setting and coordination'. The perspective of patients with mental disorders, such as depression, on primary chronic illness care can be assessed adequately by the PACIC.

Do ultra-runners in a 24-h run really dehydrate?

BACKGROUND: Loss of body mass during a 24-h run was considered to be a result of dehydration. AIMS: We intended to quantify the decrease in body mass as a loss in fat mass or skeletal muscle mass and to quantify the change in hydration status. METHODS: Body mass, fat mass, skeletal muscle mass, haematocrit, plasma sodium and urinary specific gravity were measured in 15 ultra-marathoners in a 24-h run. RESULTS: Body mass decreased by 2.2 kg (p = 0.0009) and fat mass decreased by 0.5 kg (p = 0.0084). The decrease in body mass correlated to the decrease in fat mass (r = 0.72, p = 0.0024). Urinary specific gravity increased from 1.012 to 1.022 g/mL (p = 0.0005). CONCLUSIONS: The decrease in body mass and the increase in urinary specific gravity indicate dehydration. The decrease in body mass was correlated to the decrease in fat mass and therefore not only due to dehydration.