Factors contributing to increased workplace violence against nurses during COVID-19 in the healthcare settings of a lower middle-income country- A qualitative study.

PURPOSE: To provide the perceptions of nurses, nursing supervisors, and nursing administrators about factors contributing to increased workplace violence against nurses within the healthcare settings in Pakistan during the first wave of COVID-19 pandemic. METHODS: This study employed a Descriptive Qualitative design, with a purposive sampling technique. From September to December 2021, In-depth Interviews (IDIs) of 45 to 60 minutes, using a semi-structured interview guide, we collected data from a private and a public healthcare setting in Pakistan. Given the travel restrictions during COVID-19, these interviews were conducted online, using Zoom audio features. Bedside nurses, nursing supervisors, and nursing administrators with at least six months of work experience participated in this study. RESULTS: The qualitative data analysis steps suggested by Braun and Clarke (2013) were used for thematic analysis. The overarching theme emerging from the data was "Factors perceived by nurses that contributed to increased workplace violence in their work settings during the first wave of COVID-19, in a lower middle-income country" The sub-themes from the participants' narrations were (a) Highly stressed patients, attendants, and healthcare workers; (b) the financial burden on patients and their families; (c) lack of resources and shortage of staff; (d) restricted visiting policy and a weak security system; (e) lack of awareness about the seriousness of COVID-19; (f) misconceptions about COVID-19 vaccines and nurses' role in disseminating awareness. CONCLUSION: The current pandemic increased the intensity of WPV against nurses in healthcare settings in Pakistan. Despite any supposed reasons for WPV, exposure to violence should never be an acceptable part of nursing. The healthcare system in Pakistan needs to pay equal attention to funding, resource provision, and ensuring a safe working environment for healthcare workers.

Design and Assessment of Bird-Inspired 3D-Printed Models to Evaluate Grasp Mechanics.

Adapting grasp-specialized biomechanical structures into current research with 3D-printed prostheses may improve robotic dexterity in grasping a wider variety of objects. Claw variations across various bird species lend biomechanical advantages for grasping motions related to perching, climbing, and hunting. Designs inspired by bird claws provide improvements beyond a human-inspired structure for specific grasping applications to offer a solution for mitigating a cause of the high rejection rate for upper-limb prostheses. This research focuses on the design and manufacturing of two robotic test devices with different toe arrangements. The first, anisodactyl (three toes at the front, one at the back), is commonly found in birds of prey such as falcons and hawks. The second, zygodactyl (two toes at the front, two at the back), is commonly found in climbing birds such as woodpeckers and parrots. The evaluation methods for these models included a qualitative variable-object grasp assessment. The results highlighted design features that suggest an improved grasp: a small and central palm, curved distal digit components, and a symmetrical digit arrangement. A quantitative grip force test demonstrated that the single digit, the anisodactyl claw, and the zygodactyl claw designs support loads up to 64.3 N, 86.1 N, and 74.1 N, respectively. These loads exceed the minimum mechanical load capabilities for prosthetic devices. The developed designs offer insights into how biomimicry can be harnessed to optimize the grasping functionality of upper-limb prostheses.

Epidemiological cut-off values for Yersina ruckeri disc diffusion data generated by a standardised method.

In order to establish the meaning of data generated in antimicrobial agent susceptibility tests, it is necessary to develop internationally harmonised interpretive criteria. Currently, such criteria have not been developed for data generated in studies of the susceptibility of the fish pathogen Yersinia ruckeri. This work generated the data that would be required to set epidemiological cut-off values for the susceptibility data of this species that had been generated using a standardised disc diffusion method that specified the use of Mueller Hinton agar and incubation at 22°C for 24-28 h. Using this method, sets of inhibition zones data for 4 antimicrobial agents were generated by 3 independent laboratories. The data from these laboratories were aggregated and analysed using the statistically based normalised resistance interpretation. For ampicillin, florfenicol, oxytetracycline and trimethoprim-sulfamethoxazole the cut-off values calculated by this analysis were ≥16, ≥23, ≥24 and ≥30 mm, respectively. Evidence is presented demonstrating that the data for these 4 agents was of sufficient quantity and quality that they could be used by the relevant authorities to set internationally harmonised, consensus epidemiological cut-off values for Y. ruckeri.

Inferring Consciousness in Phylogenetically Distant Organisms.

The neural dynamics of subjectivity approach to the biological explanation of consciousness is outlined and applied to the problem of inferring consciousness in animals phylogenetically distant from ourselves. The neural dynamics of subjectivity approach holds that consciousness or felt experience is characteristic of systems whose nervous systems have been shaped to realize subjectivity through a combination of network interactions and large-scale dynamic patterns. Features of the vertebrate brain architecture that figure in other accounts of the biology of consciousness are viewed as inessential. Deep phylogenetic branchings in the animal kingdom occurred before the evolution of complex behavior, cognition, and sensing. These capacities arose independently in brain architectures that differ widely across arthropods, vertebrates, and cephalopods, but with conservation of large-scale dynamic patterns of a kind that have an apparent link to felt experience in humans. An evolutionary perspective also motivates a strongly gradualist view of consciousness; a simple distinction between conscious and nonconscious animals will probably be replaced with a view that admits differences of degree, perhaps on many dimensions.

Using unsupervised clustering approaches to identify common mental health profiles and associated mental healthcare service use patterns in Ontario, Canada.

Mental health is a complex, multidimensional concept that goes beyond clinical diagnoses, including psychological distress, life stress and well-being. This study aims to use unsupervised clustering approaches to identify multidimensional mental health profiles that exist in the population, and their associated service use patterns. The data source for this study is the 2012 Canadian Community Health Survey- Mental Health linked to administrative healthcare data holdings, included were all Ontario adult respondents. We used a Partioning Around Medoids clustering algorithm with Gower's proximity to identify groups with distinct combinations of mental health indicators and described them by their sociodemographic and service use characteristics. We identified four groups with distinct mental health profiles, including one group who met the clinical threshold for a depressive diagnosis, with the remaining three groups expressing differences in positive mental health, life stress and self-rated mental health. The four groups had different age, employment and income profiles and exhibited differential access to mental healthcare services. This study represents the first step in identifying complex profiles of mental health at the population level in Ontario, Canada. Further research is required to better understand the potential causes and consequences of belonging to each of the mental health profiles identified.

The adequacy of workplace accommodation and the incidence of permanent employment separations after a disabling work injury or illness.

OBJECTIVE: This study aimed to estimate the influence of the adequacy of employer accommodations of health impairments in predicting permanent separation from the employment relationship in a cohort of workers disabled by a work-related injury or illness. METHODS: The study used data from a retrospective, observational cohort of 1793 Ontario workers who participated in an interviewer-administered survey 18 months following a disabling injury or illness. The relative risks (RR) of a permanent employment separation associated with inadequate employer accommodations were estimated using inverse probability of treatment weights to reduce confounding. RESULTS: Over the 18-month follow-up, the incidence of permanent separation was 30.1/100, with 49.2% of separations related to health status. Approximately 51% of participants experiencing a separation were exposed to inadequate workplace accommodations, compared to 27% of participants in continuing employment. The propensity score adjusted RR of a health-related separation associated with inadequate accommodation was substantial [RR 2.72; 95% confidence interval (CI) 2.20-3.73], greater than the RR of separations not related to health (RR 1.68; 95% CI 1.38-2.21). CONCLUSIONS: Incidence of permanent separation in this cohort of Ontario labor force participants was approximately two times more frequent than would be expected. The adequacy of employer accommodation was a strong determinant of the risk of permanent separation. These findings emphasize the potential for strengthened workplace accommodation practices in this setting.

Bullying in the Arab World: Definition, Perception, and Implications for Public Health and Interventions.

The present research aimed to examine bullying among diverse Arab nationalities residing in Qatar across two separate studies. Study 1 examined how Arabic-speaking adolescents and adults describe and perceive bullying, participants (N = 36) from different Arab nationalities (i.e., Egyptians, Qataris, Syrians, and other Arabs) were presented with three tasks in a focus group where they were asked questions about how they describe and perceive three scenarios without reference to the term "bullying". Findings indicated that (1) the majority of participants referred to the intention to cause harm and the imbalance of power in their descriptions, and (2) differences in describing the behaviours in the scenarios were notable when comparing Egyptians with the three other nationalities. Overall, participants frequently chose different Arabic terms (e.g., Ta'adi (تعدي)) in their descriptions of the scenarios. Interestingly, the term Tanammor (تنمُّر), which has been used in previous studies as the Arabic term for bullying, was chosen the least by the current sample. Study 2 examined how Arab-speaking students (N = 117) describe bullying behaviour in seven scenarios using Arabic and English terms. The procedure was administered in English in the international schools, and Arabic in the independent schools. English-speaking students often used the term "bullying", whereas Arabic-speaking students often used behavioural descriptions (e.g., the term "solok sayea" (سلوك سيء) which translates to "bad behaviour"). These findings are discussed in relation to the definition and perspective of bullying among Arabic speakers. There is a need for further investigations to introduce a novel term for bullying within the Arabic language while considering cultural values, norms, and beliefs. This has the potential to promote heightened awareness and comprehension, enabling the formulation of customised intervention approaches, policies, and educational initiatives intended to prevent and alleviate bullying behaviours.

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With and Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials.

BACKGROUND: Diabetes may be associated with differential outcomes in patients undergoing left main coronary revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The aim of this study was to investigate outcomes in patients with left main disease with and without diabetes randomized to PCI versus CABG. METHODS: Individual patient data were pooled from 4 trials (SYNTAX [Synergy Between PCI With Taxus and Cardiac Surgery], PRECOMBAT [Premier of Randomized Comparison of Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease], NOBLE [Nordic-Baltic-British Left Main Revascularisation Study], and EXCEL [Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization]) that randomized patients with left main disease to PCI or CABG. Patients were considered suitable for either approach. Patients were categorized by diabetes status. Kaplan-Meier event rates, Cox model hazard ratios, and interactions were assessed. RESULTS: Among 4393 patients, 1104 (25.1%) had diabetes. Patients with diabetes experienced higher rates of 5-year death (158/1104 [Kaplan-Meier rate, 14.7%] versus 297/3289 [9.3%]; P<0.001), spontaneous myocardial infarction (MI; 67/1104 [6.7%] versus 114/3289 [3.7%]; P<0.001), and repeat revascularization (189/1104 [18.5%] versus 410/3289 [13.2%]; P<0.001). Rates of all-cause mortality did not differ after PCI versus CABG in those with (84/563 [15.3%] versus 74/541 [14.1%]; hazard ratio, 1.11 [95% CI, 0.82-1.52]) or without (155/1634 [9.7%] versus 142/1655 [8.9%]; hazard ratio, 1.08 [95% CI, 0.86-1.36; PintHR=0.87) diabetes. Rates of stroke within 1 year were lower with PCI versus CABG in the entire population, with no heterogeneity based on diabetes status (PintHR=0.51). The 5-year rates of spontaneous MI and repeat coronary revascularization were higher after PCI regardless of diabetes status (spontaneous MI: 45/563 [8.9%] versus 22/541 [4.4%] in diabetes and 82/1634 [5.3%] versus 32/1655 [2.1%] in no diabetes, PintHR=0.47; repeat revascularization: 127/563 [24.5%] versus 62/541 [12.4%] in diabetes and 254/1634 [16.3%] versus 156/1655 [10.1%] in no diabetes, PintHR=0.18). For spontaneous MI and repeat revascularization, there were greater absolute risk differences beyond 1 year in patients with diabetes (4.9% and 9.9%) compared with those without (2.1% and 4.3%; PintARD=0.047 and 0.016). CONCLUSIONS: In patients with left main disease considered equally suitable for PCI or CABG and with largely low to intermediate SYNTAX scores, diabetes was associated with higher rates of death and cardiovascular events through 5 years. Compared with CABG, PCI resulted in no difference in the risk of death and a lower risk of early stroke regardless of diabetes status, and a higher risk of spontaneous MI and repeat coronary revascularization, with larger late absolute excess risks in patients with diabetes. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01205776, NCT0146651, NCT00422968, and NCT00114972.

Nonallergic Rhinopathy: A Comprehensive Review of Classification, Diagnosis, and Treatment.

Chronic nonallergic rhinitis syndromes encompass various conditions, of which vasomotor rhinitis is the most common form, representing approximately 80% of patients, also referred to as nonallergic rhinopathy (NAR), nasal hyperreactivity, neurogenic rhinitis, or idiopathic rhinitis. Expert panels have recommended replacing vasomotor rhinitis terminology because it is more descriptive of this condition that is characterized by symptoms triggered by chemical irritants and weather changes through chemosensors, mechanosensors, thermosensors, and/or osmosensors activated through different transient receptor potential calcium ion channels. Elucidating the specific role of transient receptor potential vanilloid 1, triggered by capsaicin, has been an important advancement in better understanding the pathophysiology of NAR because it has now been shown that downregulation of transient receptor potential vanilloid 1 receptors by several therapeutic compounds provides symptomatic relief for this condition. The classification of NAR is further complicated by its association with allergic rhinitis referred to as mixed rhinitis, which involves both immunoglobulin E-mediated and neurogenic mechanistic pathways. Comorbidities associated with NAR, including rhinosinusitis, headaches, asthma, chronic cough, and sleep disturbances, underscore the need for comprehensive management. Treatment options for NAR include environmental interventions, pharmacotherapy, and in refractory cases, surgical options, emphasizing the need for a tailored approach for each patient. Thus, it is extremely important to accurately diagnose NAR because inappropriate therapies lead to poor clinical outcomes and unnecessary health care and economic burdens for these patients. This review provides a comprehensive overview of NAR subtypes, focusing on classification, diagnosis, and treatment approaches for NAR.

BDNF in Neuropathic Pain; the Culprit that Cannot be Apprehended.

In males but not in females, brain derived neurotrophic factor (BDNF) plays an obligatory role in the onset and maintenance of neuropathic pain. Afferent terminals of injured peripheral nerves release colony stimulating factor (CSF-1) and other mediators into the dorsal horn. These transform the phenotype of dorsal horn microglia such that they express P2X4 purinoceptors. Activation of these receptors by neuron-derived ATP promotes BDNF release. This microglial-derived BDNF increases synaptic activation of excitatory dorsal horn neurons and decreases that of inhibitory neurons. It also alters the neuronal chloride gradient such the normal inhibitory effect of GABA is converted to excitation. By as yet undefined processes, this attenuated inhibition increases NMDA receptor function. BDNF also promotes the release of pro-inflammatory cytokines from astrocytes. All of these actions culminate in the increase dorsal horn excitability that underlies many forms of neuropathic pain. Peripheral nerve injury also alters excitability of structures in the thalamus, cortex and mesolimbic system that are responsible for pain perception and for the generation of co-morbidities such as anxiety and depression. The weight of evidence from male rodents suggests that this preferential modulation of excitably of supra-spinal pain processing structures also involves the action of microglial-derived BDNF. Possible mechanisms promoting the preferential release of BDNF in pain signaling structures are discussed. In females, invading T-lymphocytes increase dorsal horn excitability but it remains to be determined whether similar processes operate in supra-spinal structures. Despite its ubiquitous role in pain aetiology neither BDNF nor TrkB receptors represent potential therapeutic targets.

Variation in occupational exposure risk for COVID-19 workers' compensation claims across pandemic waves in Ontario.

OBJECTIVES: To understand rates of work-related COVID-19 (WR-C19) infection by occupational exposures across waves of the COVID-19 pandemic in Ontario, Canada. METHODS: We combined workers' compensation claims for COVID-19 with data from Statistics Canada's Labour Force Survey, to estimate rates of WR-C19 among workers spending the majority of their working time at the workplace between 1 April 2020 and 30 April 2022. Occupational exposures, imputed using a job exposure matrix, were whether the occupation was public facing, proximity to others at work, location of work and a summary measure of low, medium and high occupational exposure. Negative binomial regression models examined the relationship between occupational exposures and risk of WR-C19, adjusting for covariates. RESULTS: Trends in rates of WR-C19 differed from overall COVID-19 cases among the working-aged population. All occupational exposures were associated with increased risk of WR-C19, with risk ratios for medium and high summary exposures being 1.30 (95% CI 1.09 to 1.55) and 2.46 (95% CI 2.10 to 2.88), respectively, in fully adjusted models. The magnitude of associations between occupational exposures and risk of WR-C19 differed across waves of the pandemic, being weakest for most exposures in period March 2021 to June 2021, and highest at the start of the pandemic and during the Omicron wave (December 2021 to April 2022). CONCLUSIONS: Occupational exposures were consistently associated with increased risk of WR-C19, although the magnitude of this relationship differed across pandemic waves in Ontario. Preparation for future pandemics should consider more accurate reporting of WR-C19 infections and the potential dynamic nature of occupational exposures.

Prior Influenza Infection Mitigates SARS-CoV-2 Disease in Syrian Hamsters.

Seasonal infection rates of individual viruses are influenced by synergistic or inhibitory interactions between coincident viruses. Endemic patterns of SARS-CoV-2 and influenza infection overlap seasonally in the Northern hemisphere and may be similarly influenced. We explored the immunopathologic basis of SARS-CoV-2 and influenza A (H1N1pdm09) interactions in Syrian hamsters. H1N1 given 48 h prior to SARS-CoV-2 profoundly mitigated weight loss and lung pathology compared to SARS-CoV-2 infection alone. This was accompanied by the normalization of granulocyte dynamics and accelerated antigen-presenting populations in bronchoalveolar lavage and blood. Using nasal transcriptomics, we identified a rapid upregulation of innate and antiviral pathways induced by H1N1 by the time of SARS-CoV-2 inoculation in 48 h dual-infected animals. The animals that were infected with both viruses also showed a notable and temporary downregulation of mitochondrial and viral replication pathways. Quantitative RT-PCR confirmed a decrease in the SARS-CoV-2 viral load and lower cytokine levels in the lungs of animals infected with both viruses throughout the course of the disease. Our data confirm that H1N1 infection induces rapid and transient gene expression that is associated with the mitigation of SARS-CoV-2 pulmonary disease. These protective responses are likely to begin in the upper respiratory tract shortly after infection. On a population level, interaction between these two viruses may influence their relative seasonal infection rates.

Changing the liver transplant assessment process from inpatient to a day-case and outpatient approach to reduce inpatient bed utlisation.

The liver transplant assessment process involves a complex set of tests and clinical reviews to determine suitability for liver transplantation. We had an assessment process involving a 3-day inpatient stay and often experienced difficulties admitting patients to the prebooked bed due to a lack of inpatient bed availability.We aimed to change the process from a 3-day and 2-night inpatient stay to a 1-day day-case stay to reduce the demand for inpatient beds.Planning the new assessment process involved negotiations with many department staff to establish prebooked timeslots in 1 day. The improvement project was tested and refined through Plan-Do-Study-Act cycles. The liver transplant assessment team used their established once-a-week meeting to learn what went well and to agree on revisions to the process for further testing. The process involved several adaptations, such as the removal and changing of individual time slots, reinforcement of early notification once patients had finished their tests and scheduling a separate outpatient appointment to provide time for junior doctor clerking and blood tests.The new day-case and outpatient coordinated liver transplant assessment process resulted in a reduction of inpatient hospital bed utilisation from an average of 257-20 inpatient bed days per annum. This reduction in inpatient bed utilisation was maintained for 3 years with a similar level of patient satisfaction. The cost avoidance was calculated at £381.96 per patient, which is a 63% reduction in cost. Assuming an average number of patients being assessed per annum of 110, this would result in an average cost avoidance of £42 016 per annum. The carbon footprint was calculated with an average reduction per patient from 618 kilograms of carbon dioxide equivalent (kgCO2e) to 179 kgCO2e.This project has highlighted how to change a complex inpatient assessment process to an alternative day-case and outpatient approach and could be considered useful learning for other inpatient assessment services, not just liver transplantation.

A Retrospective Cohort Analysis of Mental Health-Related Emergency Department Visits Among Veterans and Non-Veterans Residing in Ontario, Canada: Une analyse de cohorte rétrospective des visites au service d'urgence liées à la santé mentale parmi les vétérans et non-vétérans résidant en Ontario, Canada.

OBJECTIVES: Emergency departments (EDs) are a vital part of healthcare systems, at times acting as a gateway to community-based mental health (MH) services. This may be particularly true for veterans of the Royal Canadian Mounted Police who were released prior to 2013 and the Canadian Armed Forces, as these individuals transition from federal to provincial healthcare coverage on release and may use EDs because of delays in obtaining a primary care provider. We aimed to estimate the hazard ratio (HR) of MH-related ED visits between veterans and non-veterans residing in Ontario, Canada: (1) overall; and by (2) sex; and (3) length of service. METHODS: This retrospective cohort study used administrative healthcare data from 18,837 veterans and 75,348 age-, sex-, geography-, and income-matched non-veterans residing in Ontario, Canada between April 1, 2002, and March 31, 2020. Anderson-Gill regression models were used to estimate the HR of recurrent MH-related ED visits during the period of follow-up. Sex and length of service were used as stratification variables in the models. RESULTS: Veterans had a higher adjusted HR (aHR) of MH-related ED visits than non-veterans (aHR, 1.97, 95% CI, 1.70 to 2.29). A stronger effect was observed among females (aHR, 3.29; 95% CI, 1.96 to 5.53) than males (aHR, 1.78; 95% CI, 1.57 to 2.01). Veterans who served for 5-9 years had a higher rate of use than non-veterans (aHR, 3.76; 95% CI, 2.34 to 6.02) while veterans who served for 30+ years had a lower rate compared to non-veterans (aHR, 0.60; 95% CI, 0.42 à 0.84). CONCLUSIONS: Rates of MH-related ED visits are higher among veterans overall compared to members of the Ontario general population, but usage is influenced by sex and length of service. These findings indicate that certain subpopulations of veterans, including females and those with fewer years of service, may have greater acute mental healthcare needs and/or reduced access to primary mental healthcare.

Immune Mechanisms Underpinning Long COVID: Collegium Internationale Allergologicum Update 2024.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can result in a prolonged multisystem disorder termed long COVID, which may affect up to 10% of people following coronavirus disease 2019 (COVID-19). It is currently unclear why certain individuals do not fully recover following SARS-CoV-2 infection. SUMMARY: In this review, we examine immunological mechanisms that may underpin the pathophysiology of long COVID. These mechanisms include an inappropriate immune response to acute SARS-CoV-2 infection, immune cell exhaustion, immune cell metabolic reprogramming, a persistent SARS-CoV-2 reservoir, reactivation of other viruses, inflammatory responses impacting the central nervous system, autoimmunity, microbiome dysbiosis, and dietary factors. KEY MESSAGES: Unfortunately, the currently available diagnostic and treatment options for long COVID are inadequate, and more clinical trials are needed that match experimental interventions to underlying immunological mechanisms.

The Known Biology of Neuropathic Pain and Its Relevance to Pain Management.

Patients with neuropathic pain are heterogeneous in pathophysiology, etiology, and clinical presentation. Signs and symptoms are determined by the nature of the injury and factors such as genetics, sex, prior injury, age, culture, and environment. Basic science has provided general information about pain etiology by studying the consequences of peripheral injury in rodent models. This is associated with the release of inflammatory cytokines, chemokines, and growth factors that sensitize sensory nerve endings, alter gene expression, promote post-translational modification of proteins, and alter ion channel function. This leads to spontaneous activity in primary afferent neurons that is crucial for the onset and persistence of pain and the release of secondary mediators such as colony-stimulating factor 1 from primary afferent terminals. These promote the release of tertiary mediators such as brain-derived neurotrophic factor and interleukin-1ß from microglia and astrocytes. Tertiary mediators facilitate the transmission of nociceptive information at the spinal, thalamic, and cortical levels. For the most part, these findings have failed to identify new therapeutic approaches. More recent basic science has better mirrored the clinical situation by addressing the pathophysiology associated with specific types of injury, refinement of methodology, and attention to various contributory factors such as sex. Improved quantification of sensory profiles in each patient and their distribution into defined clusters may improve translation between basic science and clinical practice. If such quantification can be traced back to cellular and molecular aspects of pathophysiology, this may lead to personalized medicine approaches that dictate a rational therapeutic approach for each individual.

Associations between occupational physical activity and left ventricular structure and function over 25 years in CARDIA.

AIMS: Leisure time physical activity (LTPA) confers cardiovascular health benefits, while occupational physical activity (OPA) may have paradoxically negative health associations. This study tested the explanatory hypothesis that unfavourable cardiac remodelling may result from chronic OPA-induced cardiovascular strain. METHODS AND RESULTS: Longitudinal associations of OPA and left ventricular (LV) structure and function were examined in 1462 participants {50.0% female, 56.4% White, aged 30.4 ± 3.4 years at baseline [Year 5 exam (1990-91)]} from the Coronary Artery Risk Development in Young Adults study. Left ventricular structure and function were measured as LV mass (LVMi), end-diastolic volume (LVEDVi), end-systolic volume (LVESVi), ejection fraction (LVEF), stroke volume (LVSVi), and e/a-wave ratio (EA ratio) via echocardiography at baseline and 25 years later. Occupational physical activity was reported at seven exams during the study period as months/year with 'vigorous job activities such as lifting, carrying, or digging' for ≥5 h/week. The 25-year OPA patterns were categorized into three trajectories: no OPA (n = 770), medium OPA (n = 410), and high OPA (n = 282). Linear regression estimated associations between OPA trajectories and echocardiogram variables at follow-up after adjusting for baseline values, individual demographic/health characteristics, and LTPA. Twenty-five-year OPA exposure was not significantly associated with LVMi, LVEDVi, LVSVi, or EA ratio (P > 0.05). However, higher LVESVi (ß = 1.84, P < 0.05) and lower LVEF (ß = -1.94, P < 0.05) were observed at follow-up among those in the high- vs. no-OPA trajectories. CONCLUSION: The paradoxically adverse association of OPA with cardiovascular health was partially supported by null or adverse associations between high OPA and echocardiogram outcomes. Confirmation is needed using more precise OPA measures.

This study tested the paradoxical notion that physical activity done for work may not have the same heart health benefits as expected for physical activity done during leisure time. Those who completed high amounts of physical activity at work had no beneficial changes and, in some cases, adverse changes to the structure and function of their hearts compared with those doing no activity at work during the same period. The adverse changes associated with physical activity at work were more apparent among men, those with greater than high school education levels, and those with low levels of physical activity outside of work.

Utilizing Electromyographic Video Games Controllers to Improve Outcomes for Prosthesis Users.

A study was developed for a limb-different accessible video game controller that utilizes an electromyographic sensor to control gameplay actions. Data was collected from 50 college-aged student participants. This biofeedback-based serious game trains users in a virtual capacity, through the visualization of muscle contraction, via the movement of the video game character. The training platform has been developed to accompany the corresponding electromyographic actuated prosthetic arm device, leveraging the same control scheme to enable the translation of hand gesture states. This study evaluated the controller, user interface, and gameplay to identify training improvement outcomes and user satisfaction. Study participants were divided into two cohorts that differed in their intervention between the pre-test and post-test challenge course. Cohort one had a free play environment that encouraged learning through algorithmically generated track patterns and the use of powerups. In contrast, cohort two repeated the challenge mode, which was made up of a course of rings to jump through and focused on targeted muscle discretization via character jump heights correlated to muscle output. Data were collected to develop and validate training methods and identify overall game satisfaction and usability. The results of this study indicated an increase in the user's ability to be successful based on time on task with the intervention. The study also evaluated the usability and participant experience with the intervention.