Physical activity, heart rate variability-based stress and recovery, and subjective stress during a 9-month study period.

The aim of this study was to investigate the association between physical activity (PA) and objective heart rate variability (HRV)-based stress and recovery with subjective stress in a longitudinal setting. Working-age participants (n = 221; 185 women, 36 men) were overweight (body mass index, 25.3-40.1 kg/m2 ) and psychologically distressed (≥3/12 points on the General Health Questionnaire). Objective stress and recovery were based on HRV recordings over 1-3 work days. Subjective stress was assessed with the Perceived Stress Scale and PA level with a questionnaire. Data were collected at three time points: baseline, 10 weeks post intervention, and at the 36-week follow-up. We adopted a latent growth model to investigate the initial level and change in PA, objective stress and recovery, and subjective stress at the three measurement time points. The results showed that initial levels of PA (P < 0.001) and objective stress (P = 0.001) and recovery (P < 0.01) were associated with the change in subjective stress. The results persisted after adjustment for intervention group. The present results suggest that high PA and objectively assessed low stress and good recovery have positive effects on changes in subjective stress in the long-term.

Streptococcus dysgalactiae subsp. equisimilis bacteremia: an emerging infection.

The importance of group C and G Streptococcus dysgalactiae subspecies equisimilis (S. dysgalactiae subsp. equisimilis) as a significant pathogen has recently been better recognized. S. dysgalactiae subsp. equisimilis disease can range in severity from milder skin and soft-tissue conditions such as wound infection, erysipelas, and cellulitis, to life-threatening necrotizing fasciitis and streptococcal toxic shock syndrome, thus sharing the clinical picture with S. pyogenes. The most common clinical manifestation of bacteremia is cellulitis. An increase in the incidence of S. dysgalactiae subsp. equisimilis bacteremia has been recognized. Invasive forms of this infection are most commonly found in elderly patients with underlying comorbidities and skin breakdown. The case fatality in bacteremia has been reported to be 15-18%. In this review, the epidemiology, clinical characteristics, and emm types of S. dysgalactiae subsp. equisimilis bacteremia are summarized.

Streptococcus pyogenes bacteraemia, emm types and superantigen profiles.

The aim of this study was to investigate the emm types and superantigen profiles of bacteraemic group A streptococcal (GAS; Streptococcus pyogenes) isolates and to detect possible associations between the molecular characteristics of isolates and the clinical presentations of disease. In this population-based study, 87 bacteraemic GAS isolates from adult patients in Pirkanmaa Health District (HD), Finland, during the period 1995-2004 were emm typed and genotyped for superantigen (SAg) profiles. The epidemiological and clinical data of the patients were analysed with the microbiological characterisation data. Among the 87 isolates, 18 different emm types were found. emm1, emm28 and emm81 were the three most common types, covering 52% of isolates. The prevalence of specific emm types showed high variability during the 10-year study period. We could not find any association between the emm type and clinical features of bacteraemic infection, such as underlying diseases, disease manifestations or case fatality. Of nine superantigen genes examined, speA and speC were identified in 20 and 30% of the strains, respectively. No association was found between disease manifestation and the presence of single superantigen genes. The 26-valent GAS vaccine would have covered only 62% of isolates causing invasive disease in Pirkanmaa HD during the study period.

Clinical presentations and epidemiology of beta-haemolytic streptococcal bacteraemia: a population-based study.

In this population-based study, all 314 episodes of beta-haemolytic streptococcal bacteraemia in adult patients in the Pirkanmaa area, Finland, during the 10-year period 1995-2004 were retrospectively reviewed. Altogether, 92 cases of bacteraemia caused by Lancefield group A beta-haemolytic streptococci (GAS), 76 caused by group B beta-haemolytic streptococci (GBS), 18 caused by group C beta-haemolytic streptococci (GCS) and 128 caused by group G beta-haemolytic streptococci (GGS) were identified. The most important finding was that the incidence of GGS increased during the study period. Disruption of the cutaneous barrier was a very common predisposing factor in GAS and GGS bacteraemias. Skin infections were the presenting clinical manifestations in two-thirds of GAS and GGS bacteraemias.

Correlation between the age at repair and speech outcome in patients with isolated cleft palate.

The effect of the age at primary palatal repair on the speech of 3-year old children with isolated cleft palate was assessed. The group comprised 108 consecutive children whose palates were repaired at the mean ages of 12.9 (n = 45), 18.5 (n = 18) and 22.1 months (n = 45). Signs of cleft palate speech and the degree of speech impairment were recorded. The signs sought were: hypernasality, audible nasal air emission, and misarticulations associated with velopharyngeal insufficiency. The speech impairments were subdivided into three categories by combining the signs of cleft palate speech. The results showed that children who were operated on at the age of about 12-18 months were significantly better speakers than those operated on later. Of these 46 were rated as normal or practically normal speakers (73%), compared with 10 of the children who had their repairs delayed until about 22 months (22%). As a result of the speech evaluations, it was predicted that 5 (11%), 0 and 21 (47%) children in the early, middle, and late closure groups, respectively, required secondary surgery to eliminate signs of cleft palate speech associated with velopharyngeal inadequacy. The numbers who had secondary surgery were 4, 0 and 18 in the three groups.

Cleft palate in diastrophic dysplasia. Morphology, results of treatment and complications.

Forty-one of 95 Finnish patients (43%) with diastrophic dysplasia had open cleft palate (CP). Submucous CP or its microforms were observed in an additional 30 patients (32%). Even though most of the patients have micrognathia, the high frequency of submucous clefts speaks against the role of the interposed tongue in the pathogenesis of CP in the Pierre Robin sequence. There was no hypernasality of speech in 27 of the 30 patients with submucous CP or its microforms, and the spontaneous speech of the other three was good. This is in contrast with observations in isolated submucous CP in general. No operative treatment was indicated in any case. Results after treatment of open CP and speech problems were in good agreement with results from the patients with isolated CP from the same period of time. As newborns 11 of the patients (12%) had severe respiratory difficulties caused by glossoptosis, and a Douglas operation was performed in three patients. Spinal compression due to abnormalities in cervical vertebrae and to dorsiflexion necessitated by intubation and velopharyngeal surgery may be a dangerous operative complication of patients with diastrophic dysplasia.

Secondary palatal repair by the island flap technique. A follow-up study.

The island flap technique was applied to the secondary repair of 57 cleft patients with persisting open nasality and no velopharyngeal closure. A follow-up investigation showed that closure was achieved in about 50%, and the degree of nasality in spontaneous speech diminished in about 70% of the patients. The general quality of speech was postoperatively good in about 50%, but on the other hand fully normal only occasionally. The island flap secondary repair should probably be reserved for selected patients having a tight, short but mobile velum and relatively slight nasality. Failures of this method can still be improved by a traditional upwards based pharyngeal flap.