[Implementation of a multi-interventional approach to improve medication safety in older hospitalized patients: Feasibility and impact on 30-day rehospitalization rate]. / Mise en place d'une procédure multi-interventionnelle de prise en charge médicamenteuse chez la personne âgée hospitalisée : faisabilité et efficacité sur la réhospitalisation à 30jours.

BACKGROUND: The impact of a multi-interventional approach for medication safety (MIMS) on rehospitalization rate have been inconstant in the literature. This would be due to difficulty in implementing the interventions and insufficient information transmission at discharge. The purpose of this study was to determine the effect of a MIMS on the 30-day rehospitalization rate after discharge from an acute geriatric unit (AGU). METHOD: This was a single-center interventional randomized controlled trial that included patients hospitalized in an AGU and were at least 75 years old. The intervention group benefited from a MIMS including medication reconciliation at admission and at discharge, medication review, and standardized transmission of hospital's medication changes sent to community practitioners (general practitioners and pharmacists) at discharge. The control group benefited from the usual approach applied in the AGU. RESULTS: One hundred nine patients (mean age 87,5±6,1 years) were included. At intention-totreat analysis, the rehospitalization rate was 30% in the intervention group and 15,2% in the control group. The difference was non-significant before and after adjustments (P=0,27 and 0,28 respectively). However, the intervention protocol was not effectively completed in 40% of patients in the intervention group and no intervention was performed in 10%. CONCLUSION: The implementation of a MIMS in an AGU showed a non-significant decrease in the number of rehospitalizations. Other indicators should be analysed, such as the reason for rehospitalisation or the maintenance of treatment at 30 days.

High Versus Low Load Resistance Training: The Effect of 24 Weeks Detraining on Serum Brain Derived-Neurotrophic Factor (BDNF) in Older Adults.

BACKGROUND: Previously we showed that 12 weeks of mixed-low resistance training (LOW+) significantly increased circulating BDNF in older male individuals. OBJECTIVES: To examine the impact of 24 weeks detraining on circulating BDNF. DESIGN: Randomized intervention study. SETTING: Community-dwelling older adults. PARTICIPANTS AND METHODS: Forty-seven out of 56 participants stopped training (detraining) after 12 weeks of resistance exercise (3x/week) at either HIGH-resistance (5 Males, 5 Females, 2x10-15 repetitions at 80%1RM), LOW-resistance (6 Males, 7 Females, 1x80-100 repetitions at 20%1RM), or mixed-low LOW+-resistance (6 Males, 8 Females, 1x60 repetitions at 20%1RM followed by 1x10-20 repetitions at 40%1RM), of whom 37 (aged 68±5 years) provided sufficient serum samples for BDNF analysis at baseline, 12 week and at 36 weeks (24 weeks detraining). RESULTS: BDNF had initially increased by 31% (from 33.4±10.9 ng/mL to 44.5±13.2 ng/mL, p=0.005) after 12 weeks in the LOW+ exercise group in males and decreased by 26% (from 44.5±13.2 ng/mL to 32.9±10.7 ng/mL) after detraining, though not statistically significant (p=0.082). In females, no significant change in BDNF was found in any of the intervention groups (p>0.05), neither after training, nor detraining. At 36 weeks all of the subgroups showed BDNF levels comparable (all p>0.10) to baseline (before the exercise intervention). CONCLUSIONS: Our results show that a 12-weeks LOW+ resistance exercise increases circulating BDNF in older male subjects but that this reduces back to baseline levels after 24 weeks of detraining. Continuous exercise adherence seems to be needed to sustain the training-induced effects on BDNF in older persons. Additional studies are needed to unravel the underlying mechanisms, as well as to confirm the observed sex difference.

Influence of physical development on start and countermovement jump performance in adolescent sprint athletes.

AIM: The aim of the present study was to describe the effect of physical changes during adolescence on sprint start and countermovement jump (CMJ) performance. METHODS: Twenty-eight girls and 25 boys (15.0±1.6 and 14.7±1.9 years at start respectively) were measured twice with a one year interval. Anthropometric data allowed skeletal muscle mass (SMM) estimation. Athletes performed a 10m sprint tracked from behind by a laser sensor, with starting blocks measuring propulsion forces. CMJ's were performed on a Kistler force plate. RESULTS: Between the two measurement occasions both genders increased in body height, weight and SMM. In girls and boys, impulse during the push-off, block leaving velocity and times at 5 and 10 m improved significantly. In both genders CMJ absolute power increased but not power.kg-1. Only in boys a higher CMJ was registered on occasion 2. For both genders on both occasions, impulse during the push-off correlated with body weight, SMM and CMJ power (r from .46 to .84), and in boys also with CMJ height and CMJ power.kg-1 (r from 0.43 to 0.76). Boys showed CMJ height and power to correlate with 5 and 10 m times (r from -0.42 to -0.79) and with block leaving velocity, however only on the first data collection (r=0.61 and 0.59, respectively). CONCLUSION: Sprint start performance is only partly related to muscular development and CMJ could predict start performance in boys only. Sprint start and CMJ rely on technical skills and, therefore, increasing muscularity should be accompanied with sufficient specific training to allow an optimal transfer to start performance.

Sedentary behaviour, physical activity and a continuous metabolic syndrome risk score in adults.

OBJECTIVE: The association of sedentary behaviour and leisure time physical activity with a validated continuous metabolic syndrome risk score was investigated in adults. SUBJECTS/METHODS: A number of 992 adults (559 men) without cardiovascular disease or diabetes. Subjects reported time spent in leisure time physical activity and television watching/computer activities. A validated metabolic syndrome risk score, based on waist circumference, triglycerides, blood pressure, fasting plasma glucose and high-density lipoprotein cholesterol, was used. The metabolic syndrome risk score and time spent in sedentary behaviour and physical activity were analysed as continuous variables using multiple linear regression. RESULTS: Metabolic syndrome risk was positively associated with time spent watching television/computer activities, irrespective of physical activity level, and after adjustment for age, education level, smoking status and dietary intake in women aged > or =45 years (beta=0.184, P<0.05). Independent of the time being sedentary, moderate to vigorous leisure time physical activity was inversely associated with metabolic syndrome risk in men (<45 years: beta=-0.183, P<0.01; > or =45 years: beta=-0.192, P<0.01) and women aged > or =45 years (beta=-0.203, P<0.01). CONCLUSIONS: Although cross-sectional, the present results support inclusion of efforts to decrease sedentary behaviour in metabolic syndrome prevention strategies for women aged > or =45 years, besides promotion of moderate to vigorous physical activity, since both behavioural changes might show additional effects.

Relationship of obesity with physical activity, aerobic fitness and muscle strength in Flemish adults.

AIM: The aim of this study was to analyse differences in physical activity, cardiorespiratory fitness (CRF) and muscle strength between normal weight, overweight and obese adults and to investigate the role of physical activity variables in the analyses of differences in CRF and muscle strength between these groups. METHODS: A total of 807 men and 633 women (age: 18-75 years) were included in this cross-sectional study. Weight, height, waist circumference (WC) and bioelectrical impedance were measured. Different dimensions of physical activity were assessed using a validated questionnaire. CRF (VO(2peak)) was evaluated by a maximal test on a cycle ergometer. Knee strength was measured with a calibrated Biodex System Pro 3 dynamometer. Three methods were used for classification in obesity groups: body mass index (BMI), WC and combined BMI-WC classification. RESULTS: Health-related sports and physical activity level are negatively associated with obesity in men, but not in women. Television viewing is positively associated with obesity, while VO(2peak)/fat free mass (FFM) and knee strength/FFM show a negative association with obesity in both genders. Overall, subjects with normal WC seem to be more physically active and to have somewhat better values for CRF compared to those with high WC within the same BMI category. Lower values for relative CRF and knee strength in obese subjects compared to their lean counterparts remain after adjustment for physical activity. CONCLUSION: This study confirms the lower level of physical activity and the impaired CRF and knee strength in obese adults compared to their lean counterparts. This study also sustains the importance of measuring WC and CRF during clinical examinations.

Polymorphisms in the vitamin D receptor gene are associated with muscle strength in men and women.

INTRODUCTION: Vitamin D receptor (VDR) polymorphisms have been associated with fracture risk and muscle strength, although evidence for the latter is limited and conflicting. METHODS: BsmI, TaqI and FokI VDR polymorphisms were genotyped in 253 men (54.9 +/- 10.2 yr) and 240 women (41.5 +/- 13.2 yr). Haplotypes were constructed for BsmI and TaqI. Handgrip, isometric (at 60 degrees , 120 degrees and 180 degrees joint angle) and eccentric torques (60 degrees /s) of knee extension and flexion were analysed using AN(C)OVA. Torque-velocity curves were constructed for concentric torques at 60 degrees /s, 180 degrees /s and 240 degrees /s and analysed using multivariate AN(C)OVA. Age, height and fat-free mass were included as covariates. RESULTS: Quadriceps isometric and concentric strength were higher in female f/f homozygotes compared to F allele carriers. Adjustment for confounding factors rendered results for quadriceps isometric strength at 120 degrees non-significant. No significant association was found with BsmI-TaqI haplotype in women. In contrast, male Bt/Bt homozygotes had higher isometric quadriceps strength at 150 degrees and higher concentric quadriceps strength than bT allele carriers without and with adjustment for confounding factors. No association was observed with FokI in men. In both genders, no interaction effect was present between BsmI-TaqI haplotype and FokI. CONCLUSIONS: Different VDR gene polymorphisms are associated with quadriceps strength in men and women.

Effects of whole body vibration training on muscle strength and sprint performance in sprint-trained athletes.

Despite the expanding use of Whole Body Vibration training among athletes, it is not known whether adding Whole Body Vibration training to the conventional training of sprint-trained athletes will improve speed-strength performance. Twenty experienced sprint-trained athletes (13 male symbol, 7 female symbol, 17-30 years old) were randomly assigned to a Whole Body Vibration group (n=10: 6 male symbol and 4 female symbol) or a Control group (n=10: 7 male symbol, 3 female symbol). During a 5-week experimental period all subjects continued their conventional training program, but the subjects of the Whole Body Vibration group additionally performed three times weekly a Whole Body Vibration training prior to their conventional training program. The Whole Body Vibration program consisted of unloaded static and dynamic leg exercises on a vibration platform (35-40 Hz, 1.7-2.5 mm, Power Plate). Pre and post isometric and dynamic (100 degrees/s) knee-extensor and -flexor strength and knee-extension velocity at fixed resistances were measured by means of a motor-driven dynamometer (Rev 9000, Technogym). Vertical jump performance was measured by means of a contact mat. Force-time characteristics of the start action were assessed using a load cell mounted on each starting block. Sprint running velocity was recorded by means of a laser system. Isometric and dynamic knee-extensor and knee-flexor strength were unaffected (p>0.05) in the Whole Body Vibration group and the Control group. As well, knee-extension velocity remained unchanged (p>0.05). The duration of the start action, the resulting start velocity, start acceleration, and sprint running velocity did not change (>0.05) in either group. In conclusion, this specific Whole Body Vibration protocol of 5 weeks had no surplus value upon the conventional training program to improve speed-strength performance in sprint-trained athletes.

Effects of 24 weeks of whole body vibration training on body composition and muscle strength in untrained females.

The aim of this study was to investigate and to compare the effect of 24 weeks "whole body vibration" training and fitness training on body composition and on muscle strength. Forty-eight untrained females (21.3 +/- 2.0 yr) participated in the study. The whole body vibration group (N = 18) performed unloaded static and dynamic exercises on a vibration platform (35 - 40 Hz, 2.5 - 5.0 mm; Power Plate). The fitness group (N = 18) followed a standard cardiovascular (15 - 40 min) and resistance training program including dynamic leg press and leg extension exercises (20 - 8 RM). Both groups trained 3 times weekly. The control group (N = 12) did not participate in any training. Body composition was determined by means of underwater weighing. Additionally 12 skinfolds were assessed. Isometric (0 degrees /s) and isokinetic (50 degrees /s, 100 degrees /s, 150 degrees /s) knee-extensor strength was measured by means of a motor-driven dynamometer (Technogym). Over 24 weeks there were no significant changes (p > 0.05) in weight, in percentage body fat, nor in skinfold thickness in any of the groups. Fat free mass increased significantly in the whole body vibration group (+ 2.2 %) only. A significant strength gain was recorded in the whole body vibration group (24.4 +/- 5.1 %; 5.9 +/- 2.1 %; 8.3 +/- 4.4 %; 7.6 +/- 1.5 %) and in the fitness group (16.5 +/- 1.7 %; 12.0 +/- 2.7 %; 10.4 +/- 2.3 %; 10.2 +/- 1.9 %), at 0 degrees /s, 50 degrees /s, 100 degrees /s and 150 degrees /s respectively. In conclusion, 24 weeks whole body vibration training did not reduce weight, total body fat or subcutaneous fat in previously untrained females. However, whole body vibration training induces a gain in knee-extensor strength combined with a small increase in fat free mass. The gain in strength is comparable to the strength increase following a standard fitness training program consisting of cardiovascular and resistance training.

Influence of strength training on sprint running performance. Current findings and implications for training.

Today, it is generally accepted that sprint performance, like endurance performance, can improve considerably with training. Strength training, especially, plays a key role in this process. Sprint performance will be viewed multidimensionally as an initial acceleration phase (0 to 10 m), a phase of maximum running speed (36 to 100 m) and a transition phase in between. Immediately following the start action, the powerful extensions of the hip, knee and ankle joints are the main accelerators of body mass. However, the hamstrings, the m. adductor magnus and the m. gluteus maximus are considered to make the most important contribution in producing the highest levels of speed. Different training methods are proposed to improve the power output of these muscles. Some of them aim for hypertrophy and others for specific adaptations of the nervous system. This includes general (hypertrophy and neuronal activation), velocity specific (speed-strength) and movement specific (sprint associated exercises) strength training. In developing training strategies, the coach has to keep in mind that strength, power and speed are inherently related to one another, because they are all the output of the same functional systems. As heavy resistance training results in a fibre type IIb into fibre type IIa conversion, the coach has to aim for an optimal balance between sprint specific and nonspecific training components. To achieve this they must take into consideration the specific strength training demands of each individual, based on performance capacity in each specific phase of the sprint.

Influence of high-resistance and high-velocity training on sprint performance.

The purpose of this study is to analyze the effect of high-resistance (HR) and high-velocity (HV) training on the different phases of 100-m sprint performance. Two training groups (HR and HV) were compared with two control groups (RUN and PAS). The HR (N = 22) and HV group (N = 21) trained 3 d.wk-1 for 9 wk: two strength training sessions (HR or HV) and one running session. There was a run control group (RUN, N = 12) that also participated in the running sessions (1 d.wk-1) and a passive control group (PAS, N = 11). Running speed over a 100-m sprint was recorded every 2 m. By means of a principal component analysis on all speed variables, three phases were distinguished: initial acceleration (0-10 m), building-up running speed to a maximum (10-36 m), and maintaining maximum speed in the second part of the run (36-100 m). HV training resulted in improved initial acceleration (P < 0.05 compared with RUN, PAS, and HR), a higher maximum speed (P < 0.05 compared with PAS), and a decreased speed endurance (P < 0.05 compared to RUN and PAS). The HV group improved significantly in total 100 m time (P < 0.05 compared with the RUN and PAS groups). The HR program resulted in an improved initial acceleration phase (P < 0.05 compared with PAS).

[Effect of vitamin D on skin metabolism (author's transl)]. / Etude de l'activité biologique de la vitamine D sur l'épiderme.

To examine for a possible local action of vitamin D on skin, its histology DNA content, melanogenetic response to UV and proliferative activity (incorporation of 3H thymidine into DNA) were studied on vitamin D deficient and vitamin D fed rats. The skin thickness DNA content and melanogenetic response to UV (assessed as the activity of skin tyrosinase) were greater in vitamin D fed than in vitamin deficient rats. In keratinocyte cell cultures vitamin D (10-9 M-10-12 M) increased DNA synthesis in suprabasal cells whereas it had no effect on DNA synthesis in basal cells. The influence of vitamin D on skin thickness and melanogenetic response to UV could provide an effective feed-back control for protection against UV penetration and vitamin D intoxication.

Dibutyryl cyclic AMP-induced differentiation of epidermal cells in tissue culture.

Histochemical and biochemical techniques have been used to compare the effects of dibutyryl cyclic AMP on epidermal cells and dermal cells in primary tissue culture. Rhodamin B staining showed only scattered positive cells in nontreated epidermal cells and a few contaminating keratinizing cell foci in both nontreated and treated dermal cell cultures. In contrast, treated epidermal cells stained strongly and had many keratinizing cell foci. A significant increase in histidine, cystine, and arginine incorporation was noted in epidermal cells treated with dibutyryl cyclic AMP as compared to untreated epidermal cells and to dermal cell cultures both treated and untreated. Dibutyryl cyclic AMP had no significant effect on leucine and phenylalanine incorporation. These results seem to suggest that the intracellular level of cyclic AMP not only controls the synthesis of DNA by epidermal cells in culture but also induces the process of differentiation toward keratinization.