Symptoms characteristic of heart failure among CKD patients without diagnosed heart failure.

BACKGROUND: Epidemiological studies typically diagnose heart failure (HF) at the time of hospitalization, and have not evaluated the prevalence of HF symptoms in CKD patients without a prior HF diagnosis. METHODS AND RESULTS: We modified the Kansas City Cardiomyopathy Questionnaire (KCCQ) to detect and quantify symptoms characteristic of HF (dyspnea, edema, and fatigue) among 2883 chronic kidney disease (CKD) patients without diagnosed heart failure in the Chronic Renal Insufficiency Cohort (CRIC). The KCCQ is a 23-item instrument that quantifies the impact of dyspnea, fatigue, and edema on physical, social, and emotional functions (scored 0 to 100). The median KCCQ score was 92, and 25% had KCCQ scores <75. Compared with cystatin C­based estimated glomerular filtration rate >50 mL·min·1.73 m(2) (reference), estimated glomerular filtration rate 40 to 50, 30 to 40, and <30 were independently associated with lower KCCQ scores (<75); adjusted odds ratios and (95% CI): 1.38 (1.06-1.78), 1.39 (1.09-1.82), and 2.15 (1.54-3.00), respectively. Lower hemoglobin (Hb) levels also had independent associations with KCCQ <75: Hb >14 g/dL (reference), Hb 13 to 14 g/dL (1.03; 0.76-1.40), Hb 12 to 13 g/dL (1.41; 1.04-1.91), Hb 11 to 12 g/dL (1.56; 1.12-2.16); and Hb <1 g/dL (1.65; 1.15-2.37). CONCLUSION: CKD patients without diagnosed HF have a substantial burden of symptoms characteristic of HF, particularly among those with lower estimated glomerular filtration rate and hemoglobin levels.

Implementation of an Internet-based geographic information system: the Florida experience.

Increasingly, Web-based data dissemination systems are being used to provide public health information. This article describes Florida's experience in augmenting a Web-based data query system, Florida CHARTS, with a geographic information system component. As with any systems development, users' needs guide the product. With a focus on community health assessment and improvement planning, several methods of data display have been established. A variety of issues are explored including the impact of small numbers of events on data display and data confidentiality, the selection of geographic units of analysis, and techniques for geographically coding data.

Albuterol helps resistance exercise attenuate unloading-induced knee extensor losses.

INTRODUCTION: While resistance exercise (REX) attenuates knee extensor (KE) mass and strength deficits during short-term unloading, additional treatments concurrently administered with REX are required to reduce the greater losses seen with longer periods of unloading. METHODS: To determine whether albuterol helps REX attenuate unloading-induced KE losses, two groups of subjects strength trained their left thigh three times per week, and otherwise refrained from ambulatory and weight-bearing activity for 40 d while receiving a capsule dosing treatment (albuterol, placebo) with no crossover. A third group served as unloaded controls (CTRL). On days 0, 20, and 40, the following data were collected from the nonweight-bearing (left) thigh: cross-sectional area (CSA); integrated electromyography (IEMG); and concentric and eccentric KE strength measures. Thigh CSA was estimated using anthropometric methodology. IEMG was used to provide root mean square (RMS) values from submaximal (100 nm) and maximal isometric contractions. Concentric and eccentric strength were measured from eight-repetition unilateral leg press sets. RESULTS: Repeated-measures mixed-factorial 3 x 3 ANCOVAs with day 0 values as a covariate showed group by time interactions for concentric and eccentric total work (CTW, ETW). Tukey's post hoc test showed REX-albuterol evoked significant (p < 0.05) day 40 CTW and ETW gains vs. within-group day 0 and within-time REX-placebo and CTRL values. By days 20 and 40, CTRL subjects incurred significant decrements. CONCLUSIONS: Albuterol augmented the effects of REX to increase CTW and ETW. Research identifying possible mechanisms responsible for such changes, as well as the safety of REX-albuterol administration in other models, is warranted.