An association between heart rate variability and incident heart failure in an elderly cohort.

BACKGROUND: Early identification of individuals at risk of developing heart failure (HF) may improve poor prognosis. A dominant sympathetic activity is common in HF and associated with worse outcomes; however, less is known about the autonomic balance before HF. HYPOTHESIS: A low frequency/high frequency (L-F/H-F) ratio, index of heart rate variability, and marker of the autonomic balance predict the development of HF and may improve the performance of the HF prediction model when added to traditional cardiovascular (CV) risk factors. METHODS: Individuals in the PIVUS (Prospective Investigation of the Vasculature in Uppsala Seniors) study (n = 1016, all aged 70 years) were included. Exclusion criteria were prevalent HF, electrocardiographic QRS duration ≥130 millisecond, major arrhythmias, or conduction blocks at baseline. The association between the L-F/H-F ratio and incident HF was assessed using Cox proportional hazard analysis. The C-statistic evaluated whether adding the L-F/H-F-ratio to traditional CV risk factors improved the discrimination of incident HF. RESULTS: HF developed in 107/836 study participants during 15 years of follow-up. A nonlinear, inverse association between the L-F/H-F ratio and incident HF was mainly driven by an L-F/H-F ratio of <30. The association curve was flat for higher values (hazard ratio, HR for the total curve = 0.78 [95% confidence interval, CI: 0.69-0.88, p < .001]; HR = 2 for L-F/H-F ratio = 10). The traditional prediction model improved by 3.3% (p < .03) when the L-F/H-F ratio was added. CONCLUSIONS: An L-F/H-F ratio of <30 was related to incident HF and improved HF prediction when added to traditional CV risk factors.

Interdisciplinary Cooperation in Technical, Medical, and Social Sciences: A Focus on Creating Accessibility.

Accessibility and Universal Design (UD) is an area of professional interest for architects and occupational therapists, but college curricula rarely include both broader and collaborative education in this area. This article presents the experience of the inter-university, interdisciplinary project "Joint Architecture Initiative" (JAI), with the participation of students from the University of Science and Technology, University of Health and Sport Science, and Academy of Fine Arts in Wroclaw (Poland). The JAI project is a response of the university community of Wroclaw to the social-urban campaign "Life Without Barriers" and the needs of residents-the elderly and people with disabilities-for adaptation and modification of housing. The paper presents the theoretical background of the problem, the stages of implementation of the JAI project from the perspective of the model-human-environment-occupation-the tasks of project team members, and the justification for the need to create interdisciplinary teams from the area of technical and health sciences, with particular emphasis on occupational therapy practice (OTP).

A short P-wave duration is associated with incident heart failure in the elderly: a 15 years follow-up cohort study.

BACKGROUND: Early identification of patients at risk of congestive heart failure (HF) may alter their poor prognosis. The aim was therefore to test whether simple electrocardiographic variables, the P-wave and PR-interval, could predict incident HF. METHODS: The PIVUS (Prospective Investigation of the Vasculature in Uppsala Seniors) study (1016 individuals all aged 70 years, 50% women) was used to identify predictors of HF. Subjects with prevalent HF, QRS duration ≥ 130 ms, atrial tachyarrhythmias, implanted pacemaker/defibrillator, second- and third-degree atrioventricular block or delta waves at baseline were excluded. Cox proportional hazard analysis was used to relate the PR interval, P-wave duration (Pdur) and amplitude (Pamp), measured in lead V1, to incident HF. Adjustment was performed for gender, RR-interval, beta-blocking agents, systolic blood pressure, body mass index and smoking. RESULTS: Out of 836 subjects at risk, 107 subjects were diagnosed with HF during a follow-up of 15 years. In the multivariate analysis, there was a strong U-shaped correlation between Pdur in lead V1 and incident HF (P = 0.0001) which was significant for a Pdur < 60 ms [HR = 2.75; 95% CI: 1.87-4.06, at Pdur 40 ms] but not for prolonged Pdur. There was no significant relationship between incident HF and the PR-interval or the Pamp. A Pdur < 60 ms improved discrimination by 3.7% when added to the traditional risk factors including sex, RR-interval, beta-blocking agents, systolic blood pressure, BMI and smoking (P = 0.048). CONCLUSIONS: A short Pdur, an easily measured parameter on the ECG, may potentially be a useful marker of future HF, enabling its early detection and prevention, thus improving outcomes.

Short P-Wave Duration Is Associated with Incident Atrial Fibrillation.

Atrial fibrillation (AF) is common and increases the risk for stroke and heart failure (HF). The early identification of patients at risk may prevent the development of AF and improve prognosis. This study, therefore, aimed to test the effect of the association between P-wave and PR-interval on the ECG and incident AF.The PIVUS (Prospective Investigation of the Vasculature in Uppsala Seniors) study (1016 individuals all aged 70 years; 50% women) was used to identify whether the ECG variables P-wave duration (Pdur) and PR-duration in lead V1 were related to new-onset AF. Exclusion criteria were prevalent AF, QRS-duration ≥ 130 milliseconds (msec), atrial tachyarrhythmias and implanted pacemaker/defibrillator. Cox proportional-hazards models were used for analyses. Adjustments were made for gender, RR-interval, beta-blocking agents, systolic blood pressure, body mass index, and smoking.Of 877 subjects at risk, 189 individuals developed AF during a 15-year follow-up. There was a U-shaped relationship between the Pdur and incident AF (P = 0.017) following multiple adjustment. Values below 60 msec were significantly associated with incident AF, with a hazard ratio of 1.55 (95% confidence interval 1.15-2.09) for a Pdur ≤ 42 msec. There was no significant relationship between incident AF and the PR-interval.A short Pdur derived from the ECG in V1 may be a useful marker for new-onset AF, enabling the early identification of at-risk patients.

[Cardiac implantable electronic device infections; risk factors, prevention and treatment]. / Ökning av infektioner relaterade till pacemaker och defibrillator.

The infection rate associated with cardiac implantable electronic devices has increased over the past decades. A recent study found the prevalence of infection after cardiac resynchronization therapy to be more than tenfold higher than reported to the national registry. Risk factors for infection can be host-, procedure-, or device-related, the most important being recent manipulation of the device. Perioperative contamination is the most frequent source, but leads can also be secondarily infected from bacteremia, most commonly with staphylococci. Patients with pocket infection often present with erythema and swelling over the pocket, whereas systemic infection usually produces fever and, in its most severe form, endocarditis. Parenteral empiric antimicrobial therapy should be initiated after drawing blood cultures and followed by transesophageal echocardiogram. Management also includes prompt device extraction, followed by a reevaluation of the indication before reimplantation. Education of operators, related personnel, and referring physicians, prevention of modifiable risk factors, and accurate reporting to national registries are critical actions to limit complications.

Prevention of cardiac implantable electronic device infections: guidelines and conventional prophylaxis.

Cardiac implantable electronic devices (CIED) are potentially life-saving treatments for several cardiac conditions, but are not without risk. Despite dissemination of recommended strategies for prevention of device infections, such as administration of antibiotics before implantation, infection rates continue to rise resulting in escalating health care costs. New trials conveying important steps for better prevention of device infection and an EHRA consensus paper were recently published. This document will review the role of various preventive measures for CIED infection, emphasizing the importance of adhering to published recommendations. The document aims to provide guidance on how to prevent CIED infections in clinical practice by considering modifiable and non-modifiable risk factors that may be present pre-, peri-, and/or post-procedure.

Device infections related to cardiac resynchronization therapy in clinical practice-An analysis of its prevalence, risk factors and routine surveillance at a single center university hospital.

BACKGROUND: The implantation rates of cardiac implantable electronic devices have steadily increased, accompanied by a steeper rise of device related infections (DRI). HYPOTHESIS: The prevalence of DRI for cardiac resynchronization therapy (CRT) is higher in clinical practice than reported previously, even at a university hospital, and likely higher than reported to the national device registry. METHODS: Electronic medical records of consecutive patients undergoing a CRT procedure between January 2016 and December 2017 were analyzed. Clinical history, procedure related variables and complications were reviewed by specialists in cardiology and infectious diseases. RESULTS: A total of 171 patients, mean aged 74 years, 138 males (80.7%) were included. Twelve DRI occurred in 10 patients during mean 2.5 years follow-up, giving a prevalence of 7% (incidence of 29/1000 person-years). Reoperation, pocket haematoma, ≥3 procedures, previous device infection and indwelling central venous line were the strongest predictive factors according to univariate analysis. Out of 63/171 (36.8%) major complications, 31(49.2%) were lead-related. There were 49/171 (28.7%) reoperations and 15/171 (8.8%) minor complications. The number major complications and DRI reported to the national device registry were 7/171 (4.1%) and 2/171 (0.6%), respectively, reflecting a 5-fold underreporting. CONCLUSIONS: The high rate of CRT device infections is in sharp contrast to those reported by others and to the national device registry. Although a center specific explanation cannot be excluded, the high rates highlight a major issue with registries, reinforcing the need for better surveillance and automatic reporting of device related complications.

Disability of Dialysis Patients and the Condition of Blood Vessels.

The number of elderly hemodialysis patients is constantly increasing worldwide. This population has a high burden of comorbid conditions, which impair daily activities. The aim of the study was to analyze problems of disability in hemodialysis patients in the context of cardiovascular (CV) complications and vascular condition. In this cross-sectional study, 129 patients (mean age 64.5) were enrolled. The degree of disability in Barthel index (Bi) and 10-year cardiovascular risk (QRISK®3) were assessed. A Mobil-O-Graph monitor was used for measuring hemodynamic parameters. Only 6.2% of patients were professionally active, 19% used a wheelchair for transport, and 16% used crutches. More than half (51%) were independent in everyday activities reaching 80-100 points on Bi. The rest, with Bi < 80, were considered as dependent. The most common causes of disability were CV complications. The independent group (80-100 points) was characterized by significantly lower pulse wave velocity (PWV) and lower QRISK®3 compared to dependent patients. The degree of disability negatively correlated with age, PWV, and QRISK®3. Multivariate logistic regression revealed that disability (Bi < 80) was independently associated with CV events in the past adjusted odds ratio (adj.OR) 4.83 (95% confidence interval (95% CI): 1.74-13.41) and higher PWV adj.OR 1.45 (95% CI: 1.15-1.82). Our results indicate that CV diseases are the most important cause of functional impairment.

The Effects of Active Self-correction on Postural Control in Girls with Adolescent Idiopathic Scoliosis: The Role of an Additional Mental Task.

Due to balance deficits that accompany adolescent idiopathic scoliosis (AIS), the potential interaction between activities of daily living and active self-correction movements (ASC) on postural control deserves particular attention. Our purpose was to assess the effects of ASC movements with or without a secondary mental task on postural control in twenty-five girls with AIS. It is a quasi-experimental within-subject design with repeated measures ANOVA. They were measured in four 20-s quiet standing trials on a force plate: no task, ASC, Stroop test, and both. Based on the center-of-pressure (COP) recordings, the COP parameters were computed. The ASC alone had no effect on any of the postural sway measures. Stroop test alone decreased COP speed and increased COP entropy. Performing the ASC movements and Stroop test together increased the COP speed and decreased COP entropy as compared to the baseline data. In conclusion, our results indicate that AIS did not interfere with postural control. The effects of the Stroop test accounted for good capacity of subjects with AIS to take advantage of distracting attentional resources from the posture. However, performing both tasks together exhibited some deficits in postural control, which may suggest the need for therapeutic consultation while engaging in more demanding activities.

Postural control in girls with adolescent idiopathic scoliosis while wearing a Chêneau brace or performing active self-correction: a pilot study.

BACKGROUND: It is known that adolescent idiopathic scoliosis (AIS) is often accompanied by balance deficits. This reciprocal relationship must be taken into account when prescribing new therapeutic modalities because these may differently affect postural control, interacting with therapy and influencing its results. OBJECTIVE: The purpose was to compare postural control in girls with AIS while wearing the Chêneau brace (BRA) or performing active self-correction (ASC) with their postural control in a quiet comfortable stance. METHODS: Nine subjects were evaluated on a force plate in three series of two 20-s quiet standing trials with eyes open or closed; three blocks were randomly arranged: normal quiet stance (QST), quiet stance with BRA, and quiet stance with ASC. On the basis of centre-of-pressure (COP) recordings, the spatial and temporal COP parameters were computed. RESULTS AND DISCUSSION: Performing ASC was associated with a significant backward excursion of the COP mean position with eyes open and closed (ES = 0.56 and 0.65, respectively; p < 0.05). This excursion was accompanied by an increase in the COP fractal dimension (ES = 1.05 and 0.98; p < 0.05) and frequency (ES = 0.78; p = 0.10 and ES = 1.14; p < 0.05) in the mediolateral (ML) plane. Finally, both therapeutic modalities decreased COP sample entropy with eyes closed in the anteroposterior (AP) plane. Wearing BRA resulted in ES = 1.45 (p < 0.05) while performing ASC in ES = 0.76 (p = 0.13). CONCLUSION: The observed changes in the fractal dimension (complexity) and frequency caused by ASC account for better adaptability of patients to environmental demands and for their adequate resources of available postural strategies in the ML plane. These changes in sway structure were accompanied by a significant (around 25 mm) backward excursion of the mean COP position. However, this improvement was achieved at the cost of lower automaticity, i.e. higher attentional involvement in postural control in the AP plane. Wearing BRA may have an undesirable effect on some aspects of body balance.

Postural instability in cognitively impaired elderly during forward and backward body leans.

[Purpose] The aim of this study was to determine whether there are differences in postural stability control while leaning forward and backward between healthy elderly participants and elderly participants with cognitive impairment. [Participants and Methods] Postural stability was analyzed in 36 participants. According to the Mini-Mental State Examination results, participants were divided into the cognitive impairment group and the control group. A force plate was used to register the center of pressure in the sagittal and frontal plane, during two trials of maximum forward and backward body leaning. [Results] Significant differences were shown in both forward and backward leaning between the control and cognitive impairment groups. [Conclusion] The control of stability in the sagittal plane during maximum forward and backward lean of the body in cognitively impaired patients is similar to the results obtained by their healthy peers. However, individuals with cognitive impairment demonstrated larger lateral oscillations, which may be the reason for postural instability in this group, leading to an increased occurrence of falls.

The effect of a single massage based on the tensegrity principle on postural stability in young women.

OBJECTIVE: The aim of this study was to investigate the effects of normalized muscle tension via tensegrity-based massage on postural stability in a sample of female young adults. METHODS: Nineteen females aged 21.8 ± 1.9 years were recruited presenting abnormal tension at muscles adhering to any of the following structural sites: superior iliac spine, lateral sacropelvic surface, linea aspera at 1/2 of femur length, and superior nuchal line of the occiput. Balance and postural control were assessed during bipedal stance using a force platform in multiple conditions: hard surface or soft foam surface with the head in either a neutral posture or tilted backward. Baseline and 3-min and 15-min post-treatment measures were collected while barefoot and eyes closed. Main outcomes measures included center of pressure variability, range, radius, and velocity in the anteroposterior (AP) mediolateral (ML) dimensions. RESULTS: In the solid surface with neutral head posture condition only AP COP measures decreased significantly (p< 0.05). In the soft surface condition, significant differences were observed in the AP and ML dimensions among most measures (p< 0.05). CONCLUSIONS: A single application of tensegrity-based massage positively influenced postural control in young adult females, particularly in the AP direction.

Repeated cryostimulation improves position sense and simple reaction time.

[Purpose] Whole body cryotherapy has been shown to have many benefits, yet nothing is known if and how this modality can improve neuromuscular performance and retain those improvements. [Subjects and Methods] Joint position sense based on the bilateral knee joint matching test and simple reaction time was investigated in 25 young healthy adults who underwent an extended period of whole body cryostimulation. The measurements were taken at baseline and after 10, 20, and 30 whole body cryotherapy sessions, with three days elapsing after the last treatment, and comparing the results with 24 control subjects. [Results] Only when 20 sessions were completed did joint position sense and simple reaction time improve in the intervention group. After 30 sessions, the outcome was similar. Equal results were found at baseline and after 10 sessions in both groups, but the intervention group outstripped controls after 20 and 30 sessions in both joint position sense and simple reaction time. [Conclusion] These results indicate that the common standard of 10 sessions is insufficient, while approximately 20 sessions of whole body cryotherapy may efficiently enhance neuromuscular performance with an ability to sustain the effects for at least three days.

Effect of frequent WBC treatments on the back pain therapy in elderly men.

Cryotherapy is the application of a stimulus of a cryotherapeutic temperature below -100 °C in a period of 1-3 min in order to stimulate and use physiological reactions of human body to cold. It can be applied to specific body parts or to a whole body. Whole-body cryotherapy is a treatment method applied in treatment of motor organ issues, nervous system diseases, psychiatry, dermatology and laryngology. The research group consisted of 80 male in the age range of 65-77 suffering from chronic, lasting more than 3 months, lower back pain. The subjects qualified to the research were divided into two groups. Group A consisted of 40 patients who participated in whole-body cryotherapy (WBC) twice a week. Group B also contained 40 patients who participated in WBC whole week. Examinations were conducted twice. The first one was conducted before the commencement of the treatment while the second one after the therapy was over. The results of the research did not show any statistically significant improvement in patients from Group A. However, the results obtained by Group B have proven significant condition improvement and enable the researchers to conclude that WBC is effective in treating patients with lower back pain.

Effect of cryotherapy on the lumbar spine in elderly men with back pain.

Whole-body cryotherapy (WBC) is a procedure which is more and more often successfully applied in medicine. Used in physiotherapy programs improves the efficiency of physiotherapeutic exercises applied in different aliments. The aim of the research was to determine the influence of WBC treatment on the improvement of spine activity in elderly men. The evaluation was based on subjects suffering from chronic lower back pain. The research was conducted on 96 male in the age of 65-75 years suffering from chronic pain in the lumbar spine, lasting >3 months. All the subjects performed physical exercises at a gym. Half of the examined patients performed only physical exercises while the second half of the group participated in WBC before performing the same exercises. The research evaluated the mobility of lumbar spine at all movement planes and examined the values of active potentials of erector spinae in the lumbar part of the spine. The group of men who participated in WBC showed significantly lower values of active potentials of erector spinae muscles in the lumbar part of the spine and a significant increase in the range of the lumbar spine mobility, in comparison to the group which did not use WBC.

Comparison of massage based on the tensegrity principle and classic massage in treating chronic shoulder pain.

OBJECTIVE: The purpose of this study was to compare the clinical outcomes of classic massage to massage based on the tensegrity principle for patients with chronic idiopathic shoulder pain. METHODS: Thirty subjects with chronic shoulder pain symptoms were divided into 2 groups, 15 subjects received classic (Swedish) massage to tissues surrounding the glenohumeral joint and 15 subjects received the massage using techniques based on the tensegrity principle. The tensegrity principle is based on directing treatment to the painful area and the tissues (muscles, fascia, and ligaments) that structurally support the painful area, thus treating tissues that have direct and indirect influence on the motion segment. Both treatment groups received 10 sessions over 2 weeks, each session lasted 20 minutes. The McGill Pain Questionnaire and glenohumeral ranges of motion were measured immediately before the first massage session, on the day the therapy ended 2 weeks after therapy started, and 1 month after the last massage. RESULTS: Subjects receiving massage based on the tensegrity principle demonstrated statistically significance improvement in the passive and active ranges of flexion and abduction of the glenohumeral joint. Pain decreased in both massage groups. CONCLUSIONS: This study showed increases in passive and active ranges of motion for flexion and abduction in patients who had massage based on the tensegrity principle. For pain outcomes, both classic and tensegrity massage groups demonstrated improvement.

Postural stability and body posture in older women: comparison between fallers and non-fallers.

BACKGROUND: The study aimed to compare characteristics of postural sway and shape of anteroposterior spinal curvatures in faller and non-faller elderly women. MATERIAL AND METHODS: The study enrolled 265 women aged 51-82 years (mean: 66.2) who were physically fit and free from conditions affecting sensorimotor function. Balance was assessed by stabilographic method. Changes in the location of the centre of the force of foot pressure on the ground were registered over 20-second periods with the subjects standing still with eyes open and closed. Measures of variability in the COP signal were analysed together the viscoelastic parameters of the mathematical model in the standing position. Assessment of the shape of anteroposterior spinal curvatures was conducted by photogrammetric method. Indices of the degree of thoracic kyphosis and lumbar lordosis were analysed. RESULTS: The group of women who had experienced at least one fall during the year displayed: a) with regard to body balance, a significantly larger range, variability and velocity of body sway in the sagittal plane and increased suppression of postural oscillations in the frontal plane; b) with regard to body posture, more pronounced forward inclination of the trunk, more marked thoracic kyphosis and a smaller degree of lumbar lordosis. CONCLUSIONS: Fallers demonstrate poorer body balance in the standing position and poorer body posture than non-fallers.

Does osteoarthritis further compromise the postural stability of women with osteoporosis?

BACKGROUND: It is known that women with osteoporosis display only slight deficits in postural control. However, a condition that often co-exists with OP is osteoarthritis (OA), which has been shown to significantly compromise balance. To establish reasonable inclusion criteria for balance assessment of women with OP and investigate if specific treatment regimens are necessary for those subjects, it is important to evaluate the differences in postural control and postural strategies between the two groups. MATERIAL AND METHOD: We compared postural sway in quiet standing measured by the parameters of the center-of-pressure (COP) signals, recorded on a force plate, of 30 women with osteoporosis and 27 women with coexisting mild osteoarthritis. RESULTS: Our results indicated that the latter subjects had higher COP sway in the sagittal compared with the frontal plane, while the former subjects had similar sway in both planes. Subjects with both conditions relied more on vision to preserve postural stability compared with subjects with osteoporosis alone, and they also appeared to compensate further with a higher frequency of their body oscillations. CONCLUSIONS: 1. Even mild symptoms of osteoarthritis may affect balance and misrepresent the observed postural behavior in stabilographic studies. 2. The indications for the treatment regimens of.

The effect of physiotherapy training programme on postural stability in men with hip osteoarthritis.

This study presents the influence of a physiotherapy training programme over the standing balance in elderly hip osteoarthritis (OA) patients. The aim of this study was to analyse the standing balance in elderly male hip OA patients, and to investigate how the physiotherapy training programme could significantly improve the balance. The tests were performed on a group of selected OA patients as well as on a group of age- and sex-matched healthy control subjects before and after the physiotherapy training programme. The significant differences were observed between the results of tests performed before and after the physiotherapy training programme, and also between the hip OA patients and the control subjects in all CPF parameters, in both sagittal and frontal planes. In conclusion, the hip OA has an effect on the process of maintaining the standing balance. Moreover the physiotherapy training programme significantly improves the postural stability in male hip OA patients.