What is the most appropriate age for the first cardiac screening of athletes?

For sporting organisations that conduct screening of athletes, there are very few consistent guidelines on the age at which to start. Our review found the total rate of sudden cardiac arrest or death is very low between the ages of 8-11 years (less than 1/100,000/year), increasing to 1-2/100,000/year in both elite athletes and community athletes aged 12-15 years and then steadily increases with age. The conditions associated with sudden cardiac death in paediatric athletes and young adult athletes are very similar with some evidence that death from coronary artery abnormalities occurs more frequently in athletes 10-14 years old. The decision when to begin a screening program involves a complex interplay between requirements and usual practices in a country, the rules of different leagues and programs, the age of entry into an elite program, the underlying risk of the population and the resources available. Given the incidence of sudden cardiac arrest or death in young people, we recommend beginning cardiac screening no earlier than 12 years (not later than 16 years). The risk increases with age, therefore, starting a program at any point after age 12 has added value. Importantly, anyone with concerning symptoms (e.g. collapse on exercise) or family history of an inherited cardiac condition should see a physician irrespective of age. Finally, no screening program can capture all abnormalities, and it is essential for organisations to implement a cardiac emergency plan including training on recognition and response to sudden cardiac arrest and prompt access to resuscitation, including defibrillators.

Necesidad de variaciones en las estructuras hospitalarias de los servicios de geriatría / Need for variations in the hospital structures of the geriatrics services

El envejecimiento conlleva a variaciones en las estructuras hospitalarias. La experiencia del autor durante más de 20 años en la atención hospitalaria a adultos mayores reservistas y veteranos de la defensa, permite afirmar que debemos continuar trabajando por mejorar las capacidades estructurales y la asistencia geriátrica. Una investigación realizada en adultos mayores veteranos de la defensa mostró la existencia de elevada prevalencia de diversas deficiencias y enfermedades crónicas que afectan la salud. Los Hospitales Militares Centrales y de Ejércitos deben de disponer de un Servicio de Geriatría donde los adultos mayores serán evaluados integralmente. Preparar las instituciones de salud para enfrentar el reto que impone el envejecimiento poblacional constituye una proyección estratégica de trabajo concebida en los Lineamientos del Partido(AU)

Aging leads to variations in hospital structures. The author's experience for more than 20 years in hospital care for elderly reservists and veterans allows us to affirm that we must continue working to improve structural capacities and geriatric care. An investigation in elderly veterans of the defense showed the existence of high prevalence of diverse deficiencies and chronic diseases that affect health. Central Military Hospitals and Army Hospitals must have a Geriatrics Service where the elderly will be fully evaluated. Preparing health institutions to meet the challenge of aging population is a strategic projection of work conceived in the Cuban Communist Party Guidelines(AU)

Prevalência de sintomas osteomusculares em professores de escolas públicas e privadas do ensino fundamental / Prevalence of musculoskeletal symptoms in the faculty of public schools and the private school

Objetivos: Diante da preocupação com a saúde e as condições de trabalho dos professores, este artigo objetivou verificar a prevalência de sintomas osteomusculares em professores do ensino fundamental de escolas públicas e privadas. Métodos: A amostra foi composta por 320 professores de seis escolas. Para a pesquisa, fez-se uso de um questionário sociodemográfico, de um check-list para avaliação ergonômica, e do questionário nórdico para avaliar os sintomas osteomusculares. Para análise dos dados utilizou-se o programa SPSS® 10.0. Resultados: Dos participantes, 89,7% referiram algum sintoma nos últimos 12 meses. As áreas mais acometidas por estes sintomas foram: coluna dorsal 54,1% (173), pescoço 50,9% (163) coluna lombar 49,1% (157). Os sintomas impossibilitaram 36,6% dos professores de exercer suasatividades normais. Observou-se também que a condição ergonômica do local de trabalho é considerada ruim pelos professores. Conclusão: concluímos que a prevalência de sintomas osteomusculares nos professores é alta e as condições ergonômicas são consideradas inapropriadas, podendo interferir diretamente em sua saúde.

Evaluación de la relación beneficio/riesgo en la terapéutica de pacientes geriátricos / Evaluation of benefit/risk relationship in the therapeutics of geriatric patients

Se realizó un estudio descriptivo de una muestra de 123 pacientes ingresados en el Kurhotel Escambray, Tope de Collantes, por el Programa Geriátrico-Revitalizador durante el período 1998-1999. Los grupos etáreos de mayor porcentaje fueron los comprendidos entre 60 y 65 y 66 y 70 años (26,8 y 23,6 porciento respectivamente). El sexo femenino fue ligeramente predominante (54,4 porciento) y la raza blanca fue la más frecuente (84 porciento). La polifarmacia se presentó en el 24,4 porciento de los casos, las reacciones adversas medicamentosas estuvieron presentes en el 7,4 porciento de los pacientes, siendo la nifedipina y el ácido acetil salicílico (ASA) los fármacos que con mayor frecuencia las ocasionaron. Las interacciones medicamentosas ocuparon el 41 porciento de la muestra y solo el 2 porciento fue clasificado, según gravedad, en mayor. La relación beneficio/riesgo se consideró favorable para nuestros pacientes

Effect of low temperature on tracheal smooth muscle contractile and relaxing responses evoked by electrical field stimulation

OBJECTIVE: The aim of this work was to evaluate the effect of low temperature (LT) on the contractile and relaxing responses of rat tracheas (RTs) after electrical field stimulation (EFS). METHODS: Voltage-dependent (10-60 V, 40 Hz) and frequency-dependent (0.1-60 Hz, 40 V) response curves were constructed at 37 and 18 degrees C after the activation of tracheal intramural nerves with a Grass S88 stimulator. The EFS that produced half of the maximum contractile response (ES50) at 37 or 18 degrees C was determined and considered as the dependent variable. The relaxation of pre-contracted RTs (EFS; 5 Hz, 40 V) to sodium nitroprusside (SNP; 1 x 10(-7) - 1 x 10(-3) M) isoproterenol (ISP; 1 x 10(-9) - 1 x 10(-5) M) and to 20 mM potassium chloride (KCl) after low-K+ inhibition of the Na+/K+ pump at 18 and 37 degrees C were determined. RESULTS: We found that the tracheal responses elicited by EFS at 37 and 18 degrees C were completely blocked with 1 microM atropine. LT slightly increases the voltage-dependent ES50, from 33.7 +/- 4.0 to 37.8 +/- 4.8 V, n = 5 but decreases the frequency-dependent ES50 from 19.3 +/- 4.3 to 1.0 +/- 0.28 Hz, n = 5, p < 0.05. Relaxing responses to SNP, ISP and KCl at 37 degrees C correspond to 43.5 +/- 6, 36.7 +/- 12 and 12.1 +/- 1.5 respectively. No significant tracheal relaxations were elicited at 18 degrees C. Our results indicate that in RTs, LT enhances tracheal sensitivity to EFS and decreases it in response to bronchorelaxants. The LT-dependent enhanced contractile response is observed only after a low frequency stimulation range (0.1-20 Hz), that is very close to the frequency of vagal stimuli required for inducing bronchoconstriction in vivo. Furthermore, LT abolishes the sensitivity of RTs to exogenously added bronchorelaxants (NO and ISP). In addition, LT appears to decrease the Na(+)-K+ pump activity; this effect has been associated with increased tracheal hyperreactivity in vitro. ACH appears to be the main endogenous neurotransmitter involved on neurally mediated contractile responses at 37 and 18 degrees C. CONCLUSION: Low temperature enhances the contractile response of rat tracheas in response to endogenous ACH release. The effect of LT is limited to frequencies below 20 Hz, which are within the physiological range required for bronchoconstriction. Furthermore, LT severely impairs the sensitivity of RTs to relaxant stimuli, either of endogenous of exogenous origin.

Differential antagonism by amiloride and pirenzepine of the muscarinic receptors of rat tracheal smooth muscle

Amiloride (AM) is a well known potassium sparing diuretic. The effects of AM at the cellular level include blockade of Na+/H+ exchange in several tissues and inhibition of passive sodium flux in epithelial cells. In this study we have explored the interactions of amiloride with muscarinic receptors, using isolated rat tracheal rings and compared its effects to those of the muscarinic receptor subtype-selective antagonist pirenzepine (PZ). The results obtained demonstrate the ability of AM (100 uM to 1mM) to inhibit the ACh induced rat tracheall contractions. The inhibition resulted in the reduction of the Emax values of ACh in this preparation, and the apparent Ki for AM was of 478 uM. This effect was also observed in a sodium-free choline medium, indicating that it is independent from sodium transport mechanisms sensitive to AM. In contrast to AM, PZ displayed a surmountable type of antagonism with a pA2 value of 6.52. The results demonstrate a differential antagonism by AM and PZ of the muscarinic receptors present in the smooth muscle of the rat trachea