Long-term effectiveness of the New Zealand Green Prescription primary health care exercise initiative.

OBJECTIVES: The rising incidence of non-communicable diseases in western countries is being driven by poor lifestyle choices, including increasingly inadequate physical activity. The aim of this study was to quantify the effectiveness of a physical activity primary care intervention named the 'Green Prescription' on changes in physical activity levels 2-3 year's following original prescription. STUDY DESIGN: A retrospective study design using a telephone interview. METHODS: Physical activity and health information was gathered from participants in June-September 2015, who were originally prescribed a primary care physical activity intervention 2-3 years ago. Respondents were classified as either having completed the programme (adherence group, n = 91) or having not completed the programme (non-adherence group, n = 56). RESULTS: Participants who had completed the programme within the past 2-3 years reported an additional 64 min (95% CI = 16-110) of total physical activity per week compared to those who had dropped out. Forty-two percent of participants in the adherence group reported increased physical activity levels after receiving the Green Prescription compared to 29% in the non-adherence group. The adherence group were less likely to be sedentary (odds ratio 0.7, 95% CI = 0.5-0.9) and more likely to meet the current physical activity guidelines of at least 150 min of physical activity per week (OR = 1.1, 95% CI = 1.0-1.3). CONCLUSIONS: The findings indicate a long-term benefit is likely to participants who completed Green Prescription.

The effect of short-term intermittent hypoxic exposure on heart rate variability in a sedentary population.

While the effects of instantaneous, single-bout exposure to hypoxia have been well researched, little is known about the autonomic response during, or as an adaptation to, repeated intermittent hypoxic exposure (IHE) in a sedentary population. Resting heart rate variability (HRV) and exercise capacity was assessed in 16 participants (8 receiving IHE, [Hyp] and 8 receiving a placebo treatment [C]) before and after a 4-week IHE intervention. Heart rate variability was also measured during an IHE session in the last week of the intervention. Post-intervention, the root mean squared successive difference (rMSSD) increased substantially in Hyp (71.6 ± 52.5%, mean change ± 90% confidence limits) compared to C suggesting an increase in vagal outflow. However, aside from a likely decrease in submaximal exercise heart rate in the Hyp group (-5.0 ± 6.4%) there was little evidence of improved exercise capacity. During the week 4 IHE measurement, HRV decreased during the hypoxic exposure (reduced R-R interval: -7.5 ± 3.2%; and rMSSD: -24.7 ± 17.3%) suggesting a decrease in the relative contribution of vagal activity. In summary, while 4 weeks of IHE is unlikely to improve maximal exercise capacity, it may be a useful means of increasing HRV in people unable to exercise.

Chronic subdural haematomas are more common on the left than on the right.

Subdural haematomas (SDHs), and in particular chronic subdural haematomas (CSDHs), are commonly encountered in a neurosurgical practice. The aetiology, presentation, management and prognosis of these are well documented but there are few publications that report on their side prevalence (laterality). We report an analysis of all patients (both operated on and conservatively managed) who presented to the Neurosurgical Service at Christchurch Hospital with SDHs between 1 January 1996 and 30 June 2006. A total of 413 patients presented with a total of 450 SDHs, of which 150 (33.3%) were acute, 38 were (8.4%) subacute and 262 (58.2%) were chronic. The patients ranged in age from 3 months to 95 years. The mean (+/-standard deviation, SD) age of patients with acute SDH was 50.9+/-25.8 years, 65.4+/-19.8 years for subacute SDH and 68.9+/-19.7 years for chronic SDH. A total of 275 (67%) patients were male and 138 (33%) female, with the male predominance occurring in all subgroups. The SDHs were distributed unilaterally in the acute and subacute groups; however, CSDHs occurred more frequently on the left side (57.2% compared to 42.7% on the right; p=0.0345). We discuss the likely reasons behind the increased rate of CSDHs diagnoses on the left side.

Primary falcine chondrosarcoma.

Non-skull-base intracranial chondrosarcomas are extremely rare. We present a patient with a classic falcine chondrosarcoma and review the radiological features that may aid in a pre-operative diagnosis, as well as the adjuvant treatment options. A 32-year-old woman presented with a 5-year history of progressive weakness in her right leg. MRI scan demonstrated a 4.9 x 4.3 x 2.7 cm irregular parasaggital mass in the left frontoparietal region that was in contact with the falx. A left fronto-parietal craniotomy was performed and gross total excision was achieved. Intracranial chondrosarcomas that occur above the skull base tend to be of the mesenchymal variety. Classic chondrosarcomas of the falx are rare. The management of these tumours is surgery, with adjuvant radiotherapy for incompletely excised lesions.