Risk of Neurological Disorders in Patients With European Lyme Neuroborreliosis: A Nationwide, Population-Based Cohort Study.

BACKGROUND: Lyme neuroborreliosis (LNB), caused by the tick-borne spirochetes of the Borrelia burgdorferi sensu lato species complex, has been suggested to be associated with a range of neurological disorders. In a nationwide, population-based cohort study, we examined the associations between LNB and dementia, Alzheimer's disease, Parkinson's disease, motor neuron disease, epilepsy, and Guillain-Barré syndrome. METHODS: We used national registers to identify all Danish residents diagnosed during 1986-2016 with LNB (n = 2067), created a gender- and age-matched comparison cohort from the general population (n = 20 670), and calculated risk estimates and hazard ratios. RESULTS: We observed no long-term increased risks of dementia, Alzheimer's disease, Parkinson's disease, motor neuron diseases, or epilepsy. However, within the first year, 8 (0.4%) of the LNB patients developed epilepsy, compared with 20 (0.1%) of the comparison cohort (difference, 0.3%; 95% confidence interval, .02-.6%). In the LNB group, 11 (0.5%) patients were diagnosed with Guillain-Barré syndrome within the first year after LNB diagnosis, compared with 0 (0.0%) in the comparison cohort. After the first year, the risk of Guillain-Barré was not increased. CONCLUSIONS: LNB patients did not have increased long-term risks of dementia, Alzheimer's disease, Parkinson's disease, motor neuron diseases, epilepsy, or Guillain-Barré. Although the absolute risk is low, LNB patients might have an increased short-term risk of epilepsy and Guillain-Barré syndrome.

Genomic investigation of a suspected outbreak of Legionella pneumophila ST82 reveals undetected heterogeneity by the present gold-standard methods, Denmark, July to November 2014.

Between July and November 2014, 15 community-acquired cases of Legionnaires´ disease (LD), including four with Legionella pneumophila serogroup 1 sequence type (ST) 82, were diagnosed in Northern Zealand, Denmark. An outbreak was suspected. No ST82 isolates were found in environmental samples and no external source was established. Four putative-outbreak ST82 isolates were retrospectively subjected to whole genome sequencing (WGS) followed by phylogenetic analyses with epidemiologically unrelated ST82 sequences. The four putative-outbreak ST82 sequences fell into two clades, the two clades were separated by ca 1,700 single nt polymorphisms (SNP)s when recombination regions were included but only by 12 to 21 SNPs when these were removed. A single putative-outbreak ST82 isolate sequence segregated in the first clade. The other three clustered in the second clade, where all included sequences had < 5 SNP differences between them. Intriguingly, this clade also comprised epidemiologically unrelated isolate sequences from the UK and Denmark dating back as early as 2011. The study confirms that recombination plays a major role in L. pneumophila evolution. On the other hand, strains belonging to the same ST can have only few SNP differences despite being sampled over both large timespans and geographic distances. These are two important factors to consider in outbreak investigations.

Anxiety in Hospice Inpatients With Advanced Cancer, From the Perspective of Their Informal Caregivers: A Qualitative Study.

Anxiety is a common symptom in patients with advanced cancer. Early recognition of anxiety is difficult, especially when the physical condition of patients declines and patients are not able to verbally express about their concerns. Under these circumstances, informal caregivers may be a valuable source of information. The aim of this study was to explore anxiety in hospice inpatients with advanced cancer from the perspective of their informal caregivers. Fourteen informal caregivers were interviewed; 64% were women and the median age was 55 years. Informal caregivers assessed patients' anxiety as moderate to severe and identified a negative impact of anxiety on physical, psychological, social, and spiritual dimensions of the patients' lives. They indicated a variety of expressions of anxiety and mentioned physical and mental deterioration as an important source of anxiety. Informal caregivers recognized patients' needs as having a safe environment, presence of people around, and a sense of control over the situation. Although the patients' perspective is the gold standard, informal caregivers can be a valuable source of information in identifying anxiety and providing personalized support. Therefore, informal caregivers should be more involved in the care for anxious patients to improve early recognition of anxiety and to ameliorate anxiety management for this vulnerable patient population.

Assessment of the Risk of Psychiatric Disorders, Use of Psychiatric Hospitals, and Receipt of Psychiatric Medication Among Patients With Lyme Neuroborreliosis in Denmark.

Importance: The association of Lyme neuroborreliosis with the development of psychiatric disease is unknown and remains a subject of debate. Objective: To investigate the risk of psychiatric disease, the percentage of psychiatric hospital inpatient and outpatient contacts, and the receipt of prescribed psychiatric medications among patients with Lyme neuroborreliosis compared with individuals in a matched comparison cohort. Design, Setting, and Participants: This nationwide population-based matched cohort study included all residents of Denmark who received a positive result on an intrathecal antibody index test for Borrelia burgdorferi (patient cohort) between January 1, 1995, and December 31, 2015. Patients were matched by age and sex to a comparison cohort of individuals without Lyme neuroborreliosis from the general population of Denmark. Data were analyzed from February 2019 to March 2020. Exposures: Diagnosis of Lyme neuroborreliosis, defined as a positive result on an intrathecal antibody index test for B burgdorferi. Main Outcomes and Measures: The 0- to 15-year hazard ratios for the assignment of psychiatric diagnostic codes, the difference in the percentage of psychiatric inpatient and outpatient hospital contacts, and the difference in the percentage of prescribed psychiatric medications received among the patient cohort vs the comparison cohort. Results: Among 2897 patients with Lyme neuroborreliosis (1646 men [56.8%]) and 28 970 individuals in the matched comparison cohort (16 460 men [56.8%]), the median age was 45.7 years (interquartile range [IQR], 11.5-62.0 years) for both groups. The risk of a psychiatric disease diagnosis and the percentage of hospital contacts for psychiatric disease were not higher among patients with Lyme neuroborreliosis compared with individuals in the comparison cohort. A higher percentage of patients with Lyme neuroborreliosis compared with individuals in the comparison cohort received anxiolytic (7.2% vs 4.7%; difference, 2.6%; 95% CI, 1.6%-3.5%), hypnotic and sedative (11.0% vs 5.3%; difference, 5.7%; 95% CI, 4.5%-6.8%), and antidepressant (11.4% vs 6.0%; difference, 5.4%; 95% CI, 4.3%-6.6%) medications within the first year after diagnosis, after which the receipt of psychiatric medication returned to the same level as the comparison cohort. Conclusions and Relevance: In this population-based matched cohort study, patients with Lyme neuroborreliosis did not have an increased risk of developing psychiatric diseases that required hospital care or treatment with prescription medication. The increased receipt of psychiatric medication among patients with Lyme neuroborreliosis within the first year after diagnosis, but not thereafter, suggests that most symptoms associated with the diagnosis subside within a short period.

Utilization of serology for the diagnosis of suspected Lyme borreliosis in Denmark: survey of patients seen in general practice.

BACKGROUND: Serological testing for Lyme borreliosis (LB) is frequently requested by general practitioners for patients with a wide variety of symptoms. METHODS: A survey was performed in order to characterize test utilization and clinical features of patients investigated for serum antibodies to Borrelia burgdorferi sensu lato. During one calendar year a questionnaire was sent to the general practitioners who had ordered LB serology from patients in three Danish counties (population 1.5 million inhabitants). Testing was done with a commercial ELISA assay with purified flagella antigen from a Danish strain of B. afzelii. RESULTS: A total of 4,664 patients were tested. The IgM and IgG seropositivity rates were 9.2% and 3.3%, respectively. Questionnaires from 2,643 (57%) patients were available for analysis. Erythema migrans (EM) was suspected in 38% of patients, Lyme arthritis/disseminated disease in 23% and early neuroborreliosis in 13%. Age 0-15 years and suspected EM were significant predictors of IgM seropositivity, whereas suspected acrodermatitis was a predictor of IgG seropositivity. LB was suspected in 646 patients with arthritis, but only 2.3% were IgG seropositive. This is comparable to the level of seropositivity in the background population indicating that Lyme arthritis is a rare entity in Denmark, and the low pretest probability should alert general practitioners to the possibility of false positive LB serology. Significant predictors for treating the patient were a reported tick bite and suspected EM. CONCLUSIONS: A detailed description of the utilization of serology for Lyme borreliosis with rates of seropositivity according to clinical symptoms is presented. Low rates of seropositivity in certain patient groups indicate a low pretest probability and there is a notable risk of false positive results. 38% of all patients tested were suspected of EM, although this is not a recommended indication due to a low sensitivity of serological testing.

Changes in Lyme neuroborreliosis incidence in Denmark, 1996 to 2015.

Lyme neuroborreliosis (LNB) has recently been added to the list of diseases under the European Union epidemiological surveillance in order to obtain updated information on incidence. The goal of this study was to identify temporal (yearly) variation, high risk geographical regions and risk groups, and seasonal variation for LNB in Denmark. This cohort-study investigated Danish patients (n = 2791) diagnosed with LNB (defined as a positive Borrelia burgdorferi sensu lato (s.l.) intrathecal antibody test) between 1996-2015. We calculated incidence and incidence ratios of LNB by comparing 4-yr groups of calendar-years, area of residency, sex and age, income and education groups, and the number of new LNB cases per month. The incidence of LNB was 2.2 per 100,000 individuals and year in 1996-1999, 2.7 in 2004-2007 and 1.1 per 100,000 individuals in 2012-2015. Yearly variations in LNB incidence were similar for most calendar-year groups. LNB incidence was highest in Eastern Denmark and among males and individuals who were 0-14 yrs old, who had a yearly income of >449,000 DKK, and who had a Master's degree or higher education. The number of LNB cases was highest from July to November (p < 0.001). In conclusion, based on Danish nationwide data of patients with positive B. burgdorferi s.l. intrathecal antibody index (1996-2015) the incidence of LNB was found to increase until 2004-2007 but thereafter to decline. European surveillance studies of Lyme borreliosis should be encouraged to monitor the incidence trend.

Long term survival, health, social functioning, and education in patients with European Lyme neuroborreliosis: nationwide population based cohort study.

OBJECTIVE: To estimate long term survival, health, and educational/social functioning in patients with Lyme neuroborreliosis compared with the general population. DESIGN: Nationwide population based cohort study using national registers. SETTING: Denmark. PARTICIPANTS: All Danish residents diagnosed during 1986-2016 as having Lyme neuroborreliosis (n=2067), defined as a positive Borrelia burgdorferi intrathecal antibody test and a clinical diagnosis of Lyme borreliosis, and a comparison cohort from the general population matched on sex and date of birth (n=20 670). MAIN OUTCOME MEASURES: Mortality rate ratios, incidence rate ratios of comorbidities, and differences in educational and social outcomes. RESULTS: Mortality among patients with Lyme neuroborreliosis was not higher than in the general population (mortality rate ratio 0.90, 95% confidence interval 0.79 to 1.03). Lyme neuroborreliosis patients had increased risk of haematological (incidence rate ratio 3.07, 2.03 to 4.66) and non-melanoma skin cancers (1.49, 1.18 to 1.88). At diagnosis, Lyme neuroborreliosis patients had slightly higher employment and lower disability pension rates. After five years, patients and comparison cohort members had similar numbers of hospital contacts (difference -0.22, 95% confidence interval -0.45 to 0.02, in-hospital days/year; 0.37, -0.10 to 0.83, outpatient visits/year), employment rates (difference 1.5%, -2.1% to 5.1%), income (difference -1000, -20 000 to 18 000, Danish kroner), days of sick leave (difference -0.3, -3.5 to 3.0, per year), rates of receipt of a disability pension (difference -0.9%, -3.2% to 1.3%), and number of children (difference -0.10, -0.27 to 0.08). More patients were married (difference 4.8%, 2.2% to 7.4%) and had completed high school education (difference 7%, 1% to 12%). CONCLUSION: A verified diagnosis of Lyme neuroborreliosis had no substantial effect on long term survival, health, or educational/social functioning. Nevertheless, the diagnosis decreased labour market involvement marginally and was associated with increased risk of haematological and non-melanoma skin cancers.

Treatment dropout and missed appointments among adults with attention-deficit/hyperactivity disorder: associations with patient- and disorder-related factors.

OBJECTIVE: Knowledge of factors associated with treatment dropout and missed appointments in adults with attention-deficit/hyperactivity disorder (ADHD) is very limited. On the basis of proposed hypotheses that past behavior patterns are more predictive of current behaviors of treatment dropout and missed appointments than are sociodemographic and clinical characteristics, we examined the associations of sociodemographic variables, clinical variables, risk-taking behavior, educational and occupational instability, and behaviors during mandatory schooling with the primary outcome measures of treatment dropout and missed appointments. METHOD: In a naturalistic cohort study of 151 adult outpatients with ADHD initiating assessment in a Danish ADHD unit from September 1, 2010, to September 1, 2011, the Adult ADHD Self-Report Scale v1.1 symptom checklist (ASRS) and a thorough clinical interview were used to assess ADHD according to DSM-IV-TR criteria. Stepwise logistic regression analysis was used to estimate reported associations. RESULTS: A total of 27% of patients dropped out of treatment and a total of 42% had ≥ 3 missed appointments during treatment. Mood and anxiety disorders significantly lowered the odds of treatment dropout (odds ratio [OR] = 0.18; 95% confidence interval [CI], 0.05-0.65), whereas having started but not completed 2 or more educational programs apart from mandatory schooling significantly increased the odds of dropout (OR = 3.01; 95% CI, 1.32-6.89). Variables significantly associated with most missed appointments were low educational level (OR = 2.19; 95% CI, 1.12-4.31), 3 or more employments of less than 3 months' duration (OR = 2.86; 95% CI, 1.30-6.28), and having skipped class often/very often during mandatory schooling (OR = 2.65; 95% CI, 1.29-5.43). Additionally, the predominantly inattentive ADHD (ADHD-I) subtype lowered the odds of missed appointments (OR = 0.17; 95% CI, 0.05-0.62). CONCLUSION: Our results suggest that past behavior in terms of highest dropout rates in the educational and occupational systems and highest rates of skipping class during mandatory schooling is equally associated with current behavior of treatment dropout and missed appointments as are sociodemographic and clinical factors. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02226445.

Radiation-inactivation analysis of the oligomeric structure of the renal sodium/D-glucose symporter.

The radiation-inactivation size (RIS) of the rat renal brush-border membrane sodium/D-glucose cotransporter was estimated from the loss of transport activity in irradiated membrane vesicles. The RIS depended on the electrochemical conditions present when measuring transport activity. A RIS of 294 +/- 40 kDa was obtained when transport was measured in the presence of a sodium electrochemical gradient. Under sodium equilibrium conditions, the RIS was 84 +/- 25 kDa in the presence of a glucose gradient, and 92 +/- 20 kDa in its absence. In the absence of a sodium gradient, but in the presence of an electrical potential gradient, the RIS increased to 225 +/- 49 kDa. The 294 kDa result supports earlier suggestions that the Na+ gradient-dependent glucose transport activity is mediated by a tetramer. Individual monomers appear, however, to carry out glucose transport under equilibrium exchange conditions or when a glucose gradient serves as the only driving force. The electrical potential gradient-driven glucose transport RIS appears to involve three functional subunits.

Different molecular sizes for Na(+)-dependent phosphonoformic acid binding and phosphate transport in renal brush border membrane vesicles.

We compared several features of Na(+)-dependent phosphono[14C]formic acid (PFA) binding and Na(+)-dependent phosphate transport in rat renal brush border membrane vesicles. From kinetic analyses, we estimated an apparent Km for PFA binding of 0.86 mM, an order of magnitude greater than that for phosphate and the high-affinity phosphate transport system. A hyperbolic Na(+)-saturation curve for PFA binding and a sigmoidal Na(+)-saturation curve for phosphate transport were demonstrated; based on these data, we estimated stoichiometries of 1:1 for Na+/PFA and 2:1 for Na+/phosphate. By radiation inactivation analysis, target sizes for brush border membrane protein(s) mediating Na(+)-dependent PFA binding and Na(+)-dependent phosphate transport corresponded to molecular masses of 555 +/- 32 kDa and 205 +/- 36 kDa, respectively. Similar analysis of the phosphate-inhibitable component of Na(+)-dependent PFA binding gave a target size of 130 +/- 28 kDa. We also demonstrated that phosphate deprivation, which elicits a 2.6-fold increase in brush border membrane Na(+)-dependent phosphate transport, had no effect on either Na(+)-dependent PFA binding or on the target size for PFA binding. However, phosphate deprivation appeared to increase the target size for phosphate transport (from 255 +/- 32 to 335 +/- 75 kDa (P less than 0.01]. In summary, we present evidence for several differences between Na(+)-dependent PFA binding and Na(+)-dependent phosphate transport in rat renal brush border membrane vesicles and suggest that PFA may not interact exclusively with the proteins mediating Na(+)-phosphate co-transport.

The renal brush border membrane sodium/sulfate cotransporter functions in situ as a homotetramer.

The functional molecular size of the renal Na+/SO4(2-) cotransporter was analysed with the radiation inactivation and fragmentation method. Purified brush border membrane vesicles preserved in a cryoprotective medium were exposed to gamma-radiations. Initial rates of SO4(2-) influx into these vesicles were estimated with membranes irradiated with 0, 4 and 8 Mrad. In each case, SO4(2-) uptake by irradiated membranes was significantly reduced but remained linear during the first 5 sec of incubation. To avoid artifacts arising from a decrease in the driving force caused by modifications in membrane permeability, this incubation period was chosen to measure the effect of irradiation on the SO4(2-) transport activity. Increasing irradiation doses resulted in a monoexponential decrease in transport activity allowing the molecular size to be estimated at 238 +/- 6 kDa (SD, n = 3). Recently, a cDNA for the Na+/SO4(2-) cotransporter was cloned and expressed in Xenopus laevis oocytes (Markovich D. et al. (1993) Proc. Natl Acad. Sci. U.S.A. 90, 8073-8077). The deduced amino acid sequence of this cotransporter predicts a molecular weight of 66 kDa. We suggest that the in situ activity of the renal brush border membrane Na+/SO4(2-) cotransporter requires the presence of four intact and identical subunits arranged as a homotetramer.

The nutritional and metabolic effects of a carbohydrate-rich diet in a glycogen supercompensation training regimen.

It has been suggested that glycogen depletion followed by a protein-fat diet and a carbohydrate-rich diet improves performance. This study was designed to determine the nutritional and metabolic effects of a carbohydrate-rich diet in a glycogen supercompensation training regimen. Four male subjects participated in a 5-week protocol of which the first 3 weeks were devoted to a control period and the last 2 weeks to the experimental phase of the study. The variables measured before, during, and following the experimental phase included anthropometric and basal metabolic rate measurements, urinary and serum analysis for vitamins, SMA 12/60 blood profile and aerobic performance (VO2max). Results indicated an appreciable modification of the metabolic and nutritional profile of the subjects as a result of the diets. During the protein-fat diet there was a decrease in serum glucose and resting respiratory quotient and an increase in cholesterol, blood urea nitrogen, riboflavin, and N1-methylnicotinamide excretion. Subsequent to the carbohydrate-rich diet there was an increase in triglycerides and vitamin C, riboflavin, and thiamin excretion while there was a decrease in serum blood urea nitrogen, and N1-methylnicotinamide excretion. Aerobic performance was slightly decreased and the mean postexercise lactate levels were slightly higher after the carbohydrate-rich diet. It was hypothesized that the reduced niacin intake during the carohydrate-rich diet may hamper the aerobic oxidative pathways.

Health and gender differences between middle and senior managers in the Canadian Public Service.

Most studies of the relationship between socioeconomic status (SES) and health have concentrated on disparities between the richest and poorest men; few studies have examined such relationships for women due to difficulties in measuring SES for women. For the present study, data collected from Canadian Public Service middle and senior managers provided an opportunity to examine associations between SES and health within the upper end of the SES spectrum for both genders, since women managers can be assumed to have a relatively high SES. Demographic, health and lifestyle characteristics are compared for middle and senior managers for each gender separately to determine whether women experience the health benefits associated with higher SES that have been previously observed for men. The results support the hypothesis that achieving a higher SES through work is a more stressful process for women than for men and that women's upward mobility is restricted compared to that of men. Despite these findings, there is little evidence that women's health has been adversely affected. Compared to male managers, fewer female managers smoke or drink and fewer have high body mass index, high blood pressure or high cholesterol levels. Female managers are also more likely to report being in good health.

Relationship between stature and coronary heart disease in a German male population.

Short stature in men has previously been associated with a higher risk of coronary heart disease. In order to further investigate this observation, the physical characteristics of 4470 German men admitted to the Klinik Roderbirken between 1978 and 1989 with a documented myocardial infarction and with a stenosis greater than or equal to 75% in at least one vessel were compared to those of 711 male controls. Results indicated that the myocardial infarct group was significantly shorter by 1.8 cm than the control group (p less than 0.001). However, discriminant function analysis indicated that height accounted for only 1% of the variance between the cardiac and control patients. Classification analysis further indicated that on the basis of height, the percentage of subjects correctly classified for grouping was no better than 54% for the myocardial infarct patients and 57% for the controls. It was concluded that height exerted a minimal influence on coronary heart disease in this population.

The effects of simulated akinetic and dyskinetic aneurysms on left ventricular systolic function: clinical implications.

OBJECTIVE: Scant attention has been directed towards quantifying the degree of mechanical disadvantage produced by akinetic and dyskinetic aneurysms. The purpose of this study was to evaluate the mechanical disadvantages of simulated akinetic and dyskinetic aneurysms on left ventricular function. METHODS: An elaborate experimental apparatus consisting of a computer-controlled water pressure chamber in which is suspended a model rubber ventricle was developed. The system has been shown to reproduce accurately the ventricular and aortic pressures found in vivo. In this study, a procedure was designed to simulate akinetic and dyskinetic aneurysms of various sizes on ventricular function. RESULTS: The results indicated that an akinetic aneurysm produces little or no mechanical disadvantage with respect to ventricular pressure since systolic paradox is minimal. However, a dyskinetic aneurysm, irrespective of size, will usually compromise ventricular function due to paradoxical systolic expansion in the bulging aneurysmic sac. In vivo, other factors, such as blood coagulation and rhythm disturbances, may influence these results. CONCLUSIONS: An akinetic aneurysm causes little or no mechanical disadvantage while the dyskinetic aneurysm, irrespective of size. will restrict ventricular function. The experimental simulation system, notwithstanding its limitations, thus provides a unique procedure to quantify akinetic and dyskinetic aneurysms.

Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity.

One metabolic equivalent (MET) is defined as the amount of oxygen consumed while sitting at rest and is equal to 3.5 ml O2 per kg body weight x min. The MET concept represents a simple, practical, and easily understood procedure for expressing the energy cost of physical activities as a multiple of the resting metabolic rate. The energy cost of an activity can be determined by dividing the relative oxygen cost of the activity (ml O2/kg/min) x by 3.5. This article summarizes and presents energy expenditure values for numerous household and recreational activities in both METS and watts units. Also, the intensity levels (in METS) for selected exercise protocols are compared stage by stage. In spite of its limitations, the MET concept provides a convenient method to describe the functional capacity or exercise tolerance of an individual as determined from progressive exercise testing and to define a repertoire of physical activities in which a person may participate safely, without exceeding a prescribed intensity level.

Electrocardiographic responses to jogging in middle-aged and older men and women.

Recent jogging-related sudden deaths rekindled the concern among health professionals as to the hazards of strenuous exercise. The purpose of this study was to evaluate the extent of rhythm disturbances and myocardial ischemia in older men and women during a typical strenuous jogging session. Twenty-two members of a local jogging club (11 men and 11 women) between the ages of 50 and 66 years participated in the study. The CardioData PR3/ST monitor was employed to record heart rate, rhythm disturbances, J point and ST slope during the course of the run. The men ran a 10 km run and the women a 6 km run at a competitive pace. The mean maximal heart rate during the run was 170 +/- 15 beats/min for the males and 176 +/- 14 beats/min for the females. The mean J point during the run was -3.39 +/- 1.21 mV for the males and -2.97 +/- 0.96 mV for the females. Females showed a significantly lower mean ST slope (3.95 +/- 0.91 mV) during the run than the males (5.56 +/- 1.37 mV, p < 0.05). A number of episodes of premature ventricular beats, both uni- and multifocal, were observed. Exercise testing of sufficient intensity is recommended to detect those persons susceptible to developing serious arrhythmias during strenuous exercise.

The benefits and challenges of a fitness and lifestyle enhancement program for correctional officers.

This paper documents the benefits and difficulties encountered in the development of an on-site exercise and lifestyle enhancement program for correctional officers. 25 male correctional officers participated in a 6.5-week strength and aerobic training program integrated with penitentiary duties. 21 officers were available for retesting. The program was associated with decreases in body weight, skinfold thickness, cholesterol levels and increases in HDL-cholesterol, chest girth, strength scores and muscular endurance. Resting heart rates and systolic blood pressures were reduced but there was no significant change in maximal oxygen consumption. Furthermore, there were favourable changes in smoking and alcohol consumption, sleeping patterns, nutritional habits and tolerance of stress. These results are probably typical of what can be expected from a program of this type. We conclude that a brief at-work exercise and health enhancement program can exert positive but modest influences on the fitness, health and lifestyle of correctional officers, without undermining security of the institution. However, if this type of program is to achieve beneficial effects on health and fitness, a number of difficulties must be addressed.

Blood pressure response to the Canadian Aerobic Fitness Test.

Persons who are normotensive or borderline hypertensive at rest but who have an exaggerated blood pressure response to exercise incur a higher risk of developing sustained hypertension. Our purpose was to develop provisional norms for immediate post-exercise blood pressure responses to the Canadian Aerobic Fitness Test (CAFT) for men and women 20-69 years and to recommend threshold values for exercise hypertension. We studied 986 males and females. Blood pressure criteria for inclusion were less than 150/100 mmHg for men and less than 160/100 mmHg for women. The blood pressure values for the 3 stages of the CAFT specific to each age group and sex were appropriately summarized for each workload. An exaggerated blood pressure to exercise was defined as the mean + 1 SD while a grossly exaggerated blood pressure was defined as the mean + 2 SD. As such, the following values are recommended as criteria for the first stage of the CAFT regardless of age: Men: exaggerated response greater than or equal to 170 mmHg, grossly exaggerated, greater than or equal to 190 mmHg; women greater than or equal to 160 mmHg and 180 mmHg respectively. The delta SBP (exercise SBP minus resting SBP) at the first stage of the CAFT could also be utilized to identify persons who demonstrate an abnormal pressure response to exercise. An increase of 10 mmHg above resting diastolic pressure at any stage of exercise should also be cause for concern and counselling.

Characteristics of women performing strength training: comparison of participants and dropouts.

The physiological, anthropometric, personality and lifestyle characteristics of 122 women volunteering for a seven-week program of heavy resistance weight training were studied relative to adherence rates. Initially, volunteers were above-average in body mass and grip strength, but were below-average in chest girth and bicristal diameter. They were also physically active and only 20% smoked. Regular (R) attenders (attendance greater than 80%; 72% of the sample) were physically smaller in terms of stature, mass, girths and dimensions, but had greater strength per kg of mass or LBM compared to participants classified as infrequent (I; 24-76%) and dropout (DO; less than 20%). Conversely, I and DO members were more likely to smoke, to smoke more heavily, to drink coffee and to not eat breakfast. Most dropouts quit during the first week; among volunteers who continued, differences in assigned training intensity had no effect on adherence. Adherence was also unrelated to strength gains, anthropometric adaptations, or injury.