Outpatient treatment of pulmonary embolism.

Over the past decade there has been an increasing trend to manage many conditions traditionally treated during a hospital admission as outpatients. Evidence is increasing to support this approach in patients with pulmonary embolism (PE). In this article, we review the current status of outpatient management of confirmed PE and present a pragmatic approach for clinical healthcare settings.

Multidisciplinary care models for patients with lung cancer.

Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, even though there is a relative lack of consistent evidence that this care model improves outcomes. In this review, we present the available literature regarding how to set up and run an efficient multidisciplinary care model for lung cancer patients with emphasis on team members' roles and responsibilities. Moreover, we present some limited evidence about multidisciplinary care and its impact on lung cancer outcomes and survival. This review provides simple guidance on setting up and running a multidisciplinary service for lung cancer patients. It highlights the importance of defined roles and responsibilities for team members. It also presents concise information based on the literature regarding the impact of multidisciplinary care in lung cancer outcomes (e.g. survival of patients undergoing lung cancer surgery).

Association of Anthropometric and Lifestyle Parameters with Fitness Levels in Greek Schoolchildren: Results from the EYZHN Program.

OBJECTIVE: The aim of the study was to evaluate physical fitness (PF) and identify its anthropometric and lifestyle determinants in a sample of Greek schoolchildren. METHODS: The study sample consisted of 335,810 schoolchildren (♂: 51.3%, 6-18 years old). Students' anthropometric parameters and PF levels-assessed via the Eurofit test battery-were measured by trained physical education teachers and evaluated according to the available norms, while their lifestyle habits were assessed through a questionnaire. RESULTS: In all applied PF tests, students' performance was negatively associated with the presence of obesity and central obesity, defined through international criteria for body mass index and waist to height ratio, respectively. According to multiple logistic regression analysis, the presence of overweight/obesity [odds ratio (OR): 4.43, 95% confidence interval (CI): 3.98-4.93], low adherence to the MD (KIDMED ≤ 3) (OR: 1.27, 95% CI: 1.09-1.48), and increased time spent in sedentary activities (>2 h per day) (OR: 1.16, 95% CI: 1.03-1.29) were positively associated with poor PF, after adjusting for age and sex. In contrast, for every 1 day increase in the weekly frequency of engagement in athletic activity, the probability of poor PF decreased by 26% (OR: 0.74, 95% CI: 0.72-0.77). In a similar model, the presence of central obesity emerged as an even stronger possible predictor of poor PF (OR: 5.20, 95% CI: 4.66-5.78), compared to the presence of general obesity. CONCLUSION: Higher general or abdominal adiposity, as well as the adoption of a low-quality diet and a sedentary lifestyle, is strongly associated with low PF levels during childhood.

Effect of high-intensity interval exercise on basal triglyceride metabolism in non-obese men.

A single bout of high-intensity interval aerobic exercise has been shown to produce the same or greater metabolic benefits as continuous endurance exercise with considerably less energy expenditure, but whether this applies to very low density lipoprotein (VLDL) metabolism is not known. We sought to examine the effect of a single bout of high-intensity interval aerobic exercise on basal VLDL-triglyceride (TG) kinetics 14 and 48 h after exercise cessation to determine the acute and time-dependent effects of this type of exercise on VLDL-TG metabolism. Eight healthy sedentary men (age, 23.6 ± 6.1 years; body mass index, 23.1 ± 2.2 kg·m(-2), peak oxygen consumption (V̇O2peak), 36.3 ± 5.5 mL·kg(-1)·min(-1)) participated in three stable isotopically labeled tracer infusion studies: (i) 14 h and (ii) 48 h after a single bout of high-intensity aerobic interval exercise (60% and 90% of V̇O2peak in 4 min intervals for a total of 32 min; gross energy expenditure ∼500 kcal) and (iii) after an equivalent period of rest, in random order. Fasting plasma VLDL-TG concentration was 20% lower at 14 h (P = 0.046) but not at 48 h (P = 1.000) after exercise compared with the resting trial. VLDL-TG plasma clearance rate increased by 21% at 14 h (P < 0.001) but not at 48 h (P = 0.299) after exercise compared with rest, whereas hepatic VLDL-TG secretion rate was not different from rest at any time point after exercise. We conclude that high-intensity interval exercise reduces fasting plasma VLDL-TG concentrations in non-obese men the next day by augmenting VLDL-TG clearance, just like a single bout of continuous endurance exercise. This effect is short-lived and abolished by 48 h after exercise.

Effect of acute negative and positive energy balance on basal very-low density lipoprotein triglyceride metabolism in women.

BACKGROUND: Acute reduction in dietary energy intake reduces very low-density lipoprotein triglyceride (VLDL-TG) concentration. Although chronic dietary energy surplus and obesity are associated with hypertriglyceridemia, the effect of acute overfeeding on VLDL-TG metabolism is not known. OBJECTIVE: The aim of the present study was to investigate the effects of acute negative and positive energy balance on VLDL-TG metabolism in healthy women. DESIGN: Ten healthy women (AGE: 22.0±2.9 years, BMI: 21.2±1.3 kg/m(2)) underwent a stable isotopically labeled tracer infusion study to determine basal VLDL-TG kinetics after performing, in random order, three experimental trials on the previous day: i) isocaloric feeding (control) ii) hypocaloric feeding with a dietary energy restriction of 2.89±0.42 MJ and iii) hypercaloric feeding with a dietary energy surplus of 2.91±0.32 MJ. The three diets had the same macronutrient composition. RESULTS: Fasting plasma VLDL-TG concentrations decreased by ∼26% after hypocaloric feeding relative to the control trial (P = 0.037), owing to decreased hepatic VLDL-TG secretion rate (by 21%, P = 0.023) and increased VLDL-TG plasma clearance rate (by ∼12%, P = 0.016). Hypercaloric feeding increased plasma glucose concentration (P = 0.042) but had no effect on VLDL-TG concentration and kinetics compared to the control trial. CONCLUSION: Acute dietary energy deficit (∼3MJ) leads to hypotriglyceridemia via a combination of decreased hepatic VLDL-TG secretion and increased VLDL-TG clearance. On the other hand, acute dietary energy surplus (∼3MJ) does not affect basal VLDL-TG metabolism but disrupts glucose homeostasis in healthy women.

Acute effects of exercise and calorie restriction on triglyceride metabolism in women.

PURPOSE: The mechanisms by which exercise reduces fasting plasma triglyceride (TG) concentrations in women and the effect of negative energy balance independent of muscular contraction are not known.The aim of this study was to evaluate the effects of equivalent energy deficits induced by exercise or calorie restriction on basal VLDL-TG metabolism in women. METHODS: Eleven healthy women (age = 23.5 ± 2.7 yr, body mass index = 21.6 ± 1.4 kg·m-2; mean ± SD) underwent a stable isotopically labeled tracer infusion study to determine basal VLDL-TG kinetics after performing, in random order, three experimental trials on the previous day: (i) a single exercise bout (brisk walking at 60% of peak oxygen consumption for 123 ± 18 min, with a net energy expenditure of 2.06 ± 0.39 MJ, ∼500 kcal), (ii) dietary energy restriction of 2.10 ± 0.41 MJ, and (iii) a control day of isocaloric feeding and rest (zero energy balance). RESULTS: Fasting plasma VLDL-TG concentration was approximately 30% lower after the exercise trial compared with the control trial (P < 0.001), whereas no significant change was detected after the calorie restriction trial (P = 0.297 vs control). Relative to the control condition, exercise increased the plasma clearance rate of VLDL-TG by 22% (P = 0.001) and reduced hepatic VLDL-TG secretion rate by approximately 17% (P = 0.042), whereas hypocaloric diet had no effect on VLDL-TG kinetics (P > 0.2). CONCLUSION: (i) Exercise-induced hypotriglyceridemia in women manifests through a different mechanism (increased clearance and decreased secretion of VLDL-TG) than that previously described in men (increased clearance of VLDL-TG only), and (ii) exercise affects TG homeostasis by eliciting changes in VLDL-TG kinetics that cannot be reproduced by an equivalent diet-induced energy deficit, indicating that these changes are independent of the exercise-induced negative energy balance but instead are specific to muscular contraction.

Changes in body composition following a dietary and lifestyle intervention trial: the postmenopausal health study.

OBJECTIVE: To examine whether dietary changes and the consumption of dairy products fortified with calcium and vitamin D3 versus the use of a calcium supplement alone could have any effect on anthropometric and body composition indices of postmenopausal women over a 12-month period. METHODS: 101 healthy postmenopausal women were randomized to a dietary intervention group (DG: n=39), receiving approximately 1200 mg of calcium and 7.5 microg of vitamin D3 per day via fortified dairy products and attending biweekly dietary and lifestyle intervention sessions; a calcium supplemented group (CaG: n=26) receiving a total of 1200 mg calcium per day; and a control group who continued with their usual diet (CG: n=36). Dietary, physical activity, anthropometric, body composition and distribution (based on DXA) data were collected at baseline and after 12 months of intervention. RESULTS: No significant differences were observed in the mean 12-month changes in certain anthropometric (i.e. weight, BMI) and DXA (i.e. total body fat and lean mass) indices between groups. However, the DG was found to have a lower decrease in mid-arm muscle circumference (P<0.001) and a lower increase in the sum of skinfolds' thickness (P=0.042) compared with the CaG and the CG. Furthermore, the DG was also found to have a greater decrease in the percentage of legs' fat mass (P=0.025) and a higher increase in the percentage of legs' lean mass (P=0.012) compared with the two other groups. CONCLUSION: The application of a holistic intervention approach combining nutrition and lifestyle counseling with consumption of fortified dairy products for 12 months was found to have favourable changes in certain anthropometric and body composition indices compared to calcium supplementation alone.