RESUMO
Dysfunctional breathing is characterised by an abnormal breathing pattern leading to respiratory symptoms. The 25-item Self Evaluation of Breathing Questionnaire (SEBQ) has been developed to measure breathing-related symptoms and their severity but lacks thorough evaluation. To determine reproducibility, internal consistency and predictors of SEBQ score, 180 participants completed an online SEBQ with additional demographic and lifestyle questions. Two weeks later, 155 of those repeated SEBQ. Test-retest correlation of the SEBQ was high [intraclass correlation coefficient (3, 1) = 0.89; 95 % CI 0.85-0.92]. There was no difference in SEBQ score between test and retest (15.1 (11.6) [mean (SD)] versus 14.7 (12.4); P = 0.4) and the score showed a typical error (standard error of measurement) of 4.0. Internal consistency was high (Cronbach's α = 0.93), and a single factor structure for items was shown. Smoking status, reported respiratory disease, recent respiratory illness and female gender were positively-associated predictors of SEBQ score, and together explained 25.6 % of score variance (P ≤ 0.001). The SEBQ has high test-retest reproducibility and its score may be predicted by current smoking, chronic respiratory disease, recent respiratory illness and female gender, thus may be a useful clinical screening tool for dysfunctional breathing.
Assuntos
Autoavaliação Diagnóstica , Psicometria/instrumentação , Transtornos Respiratórios/diagnóstico , Inquéritos e Questionários/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores Sexuais , FumarRESUMO
AIM: Past research indicates that endurance is improved when exercise movements are synchronised with a musical beat, however it is unclear whether such benefits are associated with reduced metabolic cost. We compared oxygen consumption (.VO2) and related physiological effects of exercise conducted synchronously and asynchronously with music. METHODS: Three music tracks, each recorded at three different tempi (123, 130, and 137 beats.min-1), accompanied cycle ergometry at 65 pedal revolutions.min-1. Thus three randomly-assigned experimental conditions were administered: slow tempo asynchronous, synchronous, and fast tempo asynchronous. Exercise response of .VO2, HR, and ratings of perceived exertion (RPE), to each condition was monitored in 10 untrained male participants aged 21.7±0.8 years (mean±SD) who cycled for 12 min at 70% maximal heart rate (HR). RESULTS: Mean .VO2 differed among conditions (P=0.008), being lower in the synchronous (1.80±0.22 L.min-1) compared to the slow tempo asynchronous condition (1.94±0.21 L.min-1; P<0.05). There was no difference in HR or RPE among conditions, although HR showed a similar trend to .VO2. CONCLUSION: The present results indicate that exercise is more efficient when performed synchronously with music than when musical tempo is slightly slower than the rate of cyclical movement.
Assuntos
Ciclismo/fisiologia , Música , Consumo de Oxigênio , Adulto , Teste de Esforço , Frequência Cardíaca , Humanos , Masculino , Esforço Físico , Adulto JovemRESUMO
UNLABELLED: Optimal levels of 25-hydroxyvitamin D [25(OH)D] were investigated in premenopausal Chinese women. Parathyroid hormone (PTH) change at 3 months was associated with change in 25(OH)D but not with baseline levels, and PTH fell even when starting levels of 25(OH)D were >40 nmol/L, consistent with optimal values for 25(OH)D of ≥40 nmol/l. INTRODUCTION: The upper level of 25-hydroxyvitamin D [25(OH)D] which constitutes a long-term bone health risk by causing elevated PTH levels is uncertain. Although many studies have addressed this question using cross-sectional data, the present study is one of few employing a prospective approach to determine 25(OH)D levels required to minimize PTH. METHODS: Relationships among baseline values and 3-month changes (Δ) in PTH and 25(OH)D were assessed in 221 Chinese women, aged 28.0±4.4 years (mean±SD), taking part in a placebo-controlled dairy product intervention delivering 200 IU vitamin D(3)/day. RESULTS: Baseline 25(OH)D was 34±11 nmol/L and was inversely related to baseline PTH (r=-0.18, P=0.007), with a plateau in PTH levels when 25(OH)D was >40 nmol/L. After 3 months intervention, PTH fell 11% and neither Δ25(OH)D nor ΔPTH differed between treatment and control groups. ΔPTH was inversely related to Δ25(OH)D (P<0.001) but not to baseline 25(OH)D. Similarly, ΔPTH differed between quartiles of Δ25(OH)D (P<0.001), but not between quartiles of baseline 25(OH)D and no interaction was observed between quartiles of baseline 25(OH)D and Δ25(OH)D. Even in the highest quartile of baseline 25(OH)D (>40 nmol/L), PTH fell 0.4±0.1 pmol/L (mean±SEM; P=0.008). CONCLUSIONS: We conclude that vitamin D deficiency is common in young women in Hong Kong. The cross-sectional analysis indicates that optimal 25(OH)D is >40 nmol/L, and the longitudinal data is consistent with a higher optimal value which is not defined in this study's results.
Assuntos
Hormônio Paratireóideo/sangue , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Adulto , Colecalciferol/administração & dosagem , Laticínios , Feminino , Seguimentos , Alimentos Fortificados , Humanos , Pré-Menopausa/sangue , Estudos Prospectivos , Vitamina D/sangue , Vitamina D/fisiologia , Deficiência de Vitamina D/dietoterapia , Adulto JovemRESUMO
BACKGROUND: Breathing retraining and manual therapy (MT), delivered independently or together, influence autonomic activity, and improve symptoms in patients with chronic conditions. This study evaluated the effects of breathing retraining and osteopathic MT on cardiac autonomic measures and breathing symptoms during spontaneous breathing in healthy active adults. METHODS: Participants (n = 18) received breathing retraining and four, weekly manual therapy sessions, randomised to start immediately, or after 6-week delay. Heart-rate (HR) variability was assessed as a 7-day average of waking 6-min electrocardiograms, using time (logarithm of root-mean-square of successive differences; LnRMSSD) and frequency domain (logarithm of high-frequency; LnHF) measures. Recordings were taken before, one week following intervention or delay, and then following the later intervention for those with delayed starts. Changes were compared between those who received and had yet to receive the intervention, and before and after treatment for the whole cohort. RESULTS: Following the intervention, HR-variability measures increased 4% overall (Effect Sizes: 1.0-1.1) for the whole cohort. Between-group analyses showed that the immediate-start group increased more than the delayed start group: LnRMSSD 0.27 (0.02-0.52; 95%CI) ln.ms, and LnHF 0.41 (-0.01-0.84) ln.ms2 for immediate start; compared with LnRMSSD -0.09 (-0.29-0.11) ln.ms, and LnHF -0.19 (-0.59-0.22) ln.ms2 (P = 0.02-0.03 for interaction) for delayed start. Resting HR decreased following intervention in the whole cohort (Effect Size -0.8; P = 0.02). CONCLUSION: A 6-week osteopathic treatment consisting of breathing retraining and MT is beneficial in raising HR-variability compared to no treatment, and may induce favourable (parasympathetic over sympathetic) autonomic modulation. TRIAL REGISTRATION: ACTRN12614001119684.
Assuntos
Sistema Nervoso Autônomo , Manipulações Musculoesqueléticas , Adulto , Eletrocardiografia , Frequência Cardíaca , Humanos , RespiraçãoRESUMO
SUMMARY: Daily dosing with vitamin D often fails to achieve optimal outcomes, and it is uncertain what the target level of 25-hydroxyvitamin D should be. This study found that large loading doses of vitamin D(3) rapidly and safely normalize 25OHD levels, and that monthly dosing is similarly effective after 3-5 months. With baseline 25OHD > 50 nmol/L, vitamin D supplementation does not reduce PTH levels. INTRODUCTION: There is concern that vitamin D supplementation doses are frequently inadequate, and that compliance with daily medication is likely to be suboptimal. METHODS: This randomized double-blind trial compares responses to three high-dose vitamin D(3) regimens and estimates optimal 25-hydroxyvitamin D (25OHD) levels, from changes in parathyroid hormone (PTH), and procollagen type I amino-terminal propeptide (P1NP) in relation to baseline 25OHD. Sixty-three elderly participants were randomized to three regimens of vitamin D supplementation: a 500,000-IU loading dose; the loading dose plus 50,000 IU/month; or 50,000 IU/month. RESULTS: The Loading and Loading + Monthly groups showed increases in 25OHD of 58 +/- 28 nmol/L from baseline to 1 month. Thereafter, levels gradually declined to plateaus of 69 +/- 5 nmol/L and 91 +/- 4 nmol/l, respectively. In the Monthly group, 25OHD reached a plateau of ~80 +/- 20 nmol/L at 3-5 months. There were no changes in serum calcium concentrations. PTH and P1NP were only suppressed by vitamin D treatment in those with baseline 25OHD levels <50 and <30 nmol/L, respectively. CONCLUSIONS: Large loading doses of vitamin D(3) rapidly and safely normalize 25OHD levels in the frail elderly. Monthly dosing is similarly effective and safe, but takes 3-5 months for plateau 25OHD levels to be reached.
Assuntos
Colecalciferol/administração & dosagem , Suplementos Nutricionais , Vitaminas/administração & dosagem , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Idoso Fragilizado , Força da Mão , Humanos , Masculino , Hormônio Paratireóideo/sangue , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue , Vitamina D/análogos & derivados , Vitamina D/sangueRESUMO
AIM: To determine whether the terms used by pathologists in reporting on sudden infant deaths are applied consistently. METHOD: Postal survey. RESULTS: Replies were received from 63 pathologists who carry out necropsies after sudden infant deaths. There was a pronounced variation in their use of the terms "sudden infant death syndrome" and "unascertained", with the last term being applied not only when there were apparently suspicious features but also in various other circumstances. Opinions were divided as to whether the term "sudden infant death syndrome" still serves a useful purpose. Deaths that had occurred while bed sharing were categorised in several different ways. Many pathologists commented on the inadequacy of the history available to them at the time of their report. CONCLUSIONS: There is a serious need for greater consistency in the way pathologists report on sudden death in infants. Pathologists should be provided with a full history before they carry out the necropsy.
Assuntos
Morte Súbita do Lactente , Terminologia como Assunto , Autopsia , Humanos , Recém-Nascido , Patologia Clínica , Inquéritos e QuestionáriosRESUMO
Post-perinatal infant mortality in Yorkshire 1991-1993 was higher among non-whites (mainly Pakistanis) than among whites (5.7/1000 vs. 4.9/1000 live births). Pakistani families had more deaths from congenital or metabolic abnormalities, and from perinatal factors, but far fewer than sudden infant death syndrome.
Assuntos
Etnicidade , Mortalidade Infantil , Humanos , Lactente , Paquistão/etnologia , Morte Súbita do Lactente/etnologia , Reino Unido/epidemiologiaAssuntos
Morte Súbita do Lactente/patologia , Autopsia , Atestado de Óbito , Humanos , Lactente , Recém-Nascido , Exame FísicoRESUMO
Recurrence of sudden infant death syndrome (SIDS) is rare but may give rise to confusion and controversy because of the differential diagnoses of familial disease or covert homicide. We examine eight studies of recurrent SIDS published in English since 1970. These studies reported relative risks of recurrence, as compared with the population or with controls, ranging from 1.7 to 10.1. We assess the validity of the studies by three main criteria: accuracy of ascertainment, adequacy of investigation and matching of controls. We found that all the studies failed to meet these criteria, and we think that their flaws would have resulted mainly in overestimation of recurrence risk. We conclude that, although an increase in risk is probable on theoretical grounds, this risk cannot be quantified from the available evidence. We suggest that professionals should be cautious in their pronouncements on the chances of recurrence, and that parents who have lost a baby to SIDS can, with the exception of particularly vulnerable families, be reassured that the risk of recurrence is small.
Assuntos
Morte Súbita do Lactente/epidemiologia , Medicina Baseada em Evidências , Humanos , Lactente , Recém-Nascido , Recidiva , Projetos de Pesquisa , Medição de Risco , Morte Súbita do Lactente/etiologiaRESUMO
Twenty-four infants under 6 months infected with echovirus 19 are described, They were the youngest of the many children admitted to hospitals in Newcastle and Gateshead during an epidemic in the north-east of England in 1974. Generally, the younger the child the more severe the illness, which affected the upper respiratory tract, the gut, the skin, and the meninges, and sometimes caused as state of collapse resembling septicaemic shock. Polymorphonuclear pleocystosis of the cerebrospinal fluid (CSF) sometimes suggested bacterial meningitis, so that antibiotics were given in 38% of cases. The virus was recovered with a high success rate from nasopharyngeal secretions, CSF, and stool.
Assuntos
Infecções por Echovirus/epidemiologia , Fatores Etários , Antibacterianos/uso terapêutico , Surtos de Doenças , Infecções por Echovirus/tratamento farmacológico , Inglaterra , Humanos , Lactente , Recém-NascidoRESUMO
It is impossible to be certain, but it is estimated that each year in England and Wales there may be about 30-40 infant deaths from covert homicide, which represents about 10% of the current annual total of sudden unexpected deaths in infancy. This paper reviews the features that have been suggested as possible indicators of covert homicide, describes the difficulties in its identification and the need for better evidence, and emphasises the importance of thorough medical investigation of all sudden infant deaths.
Assuntos
Infanticídio/estatística & dados numéricos , Morte Súbita do Lactente/epidemiologia , Distribuição por Idade , Causas de Morte , Inglaterra/epidemiologia , Medicina Legal , Humanos , Incidência , Lactente , Fatores de Tempo , País de Gales/epidemiologiaRESUMO
The aetiopathogenesis of haemorrhagic shock encephalopathy syndrome (HSES) remains unclear and after concern that a novel environmental agent was the cause, the British Paediatric Association and the Public Health Laboratory Service Communicable Disease Surveillance Centre in 1983 initiated surveillance of this condition in the British Isles. After 1986 cases were ascertained via the British Paediatric Surveillance Unit 'active' reporting scheme; this report presents the findings for 1985-8. Sixty five patients were reported, of whom 52 satisfied the criteria for inclusion. Of those whose outcome was known, 24 (46%) died, 18 had severe neurological damage, and six survived apparently intact. Epidemiological features of note were: the median age of 15 weeks (range 3-140); statistically significant clustering of admission times suggesting a peak onset period at night; lack of geographic clusters, of secular trends and, except for a slight excess in winter months, of seasonality. Clinical and pathological features followed a highly consistent pattern, suggesting that HSES is an individual clinical entity distinguishable from conditions with similar presentations, such as septicaemia and Reye's syndrome. There was no microbiological or epidemiological evidence to support the emergence of a novel environmental agent. Many of the features of HSES were, however, the same as those described in heat stroke and we suggest that the two conditions are the same even though there is usually no history of overt overheating.
Assuntos
Encefalopatias/epidemiologia , Choque Hemorrágico/epidemiologia , Fatores Etários , Encefalopatias/diagnóstico , Encefalopatias/patologia , Criança , Hemoglobinas/análise , Humanos , Incidência , Vigilância da População , Estações do Ano , Fatores Sexuais , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/patologia , Síndrome , Reino Unido/epidemiologiaRESUMO
Two-hundred successively delivered mothers were asked about their attitudes towards feeding their babies, the influences on them, and their personal and social backgrounds. Initially 39% intended to breast-feed, though in the first few weeks many gave up. Choosing to breast-feed, and success in doing so, were strongly associated with higher social class. The commonest reason given by those who chose the bottle was the embarrassment of breast-feeding. Efforts to increase the numbers of mothers choosing to breast-feed should concentrate on those mothers who remain undecided on their method of feeding. If they are to breast-feed their babies successfully they will need careful advice and support both before and after delivery.
Assuntos
Atitude , Aleitamento Materno , Emoções , Inglaterra , Feminino , Humanos , Recém-Nascido , Gravidez , Classe Social , Fatores de TempoRESUMO
Details of room temperature, clothing, and bedding used by night and by day and in winter and in summer were recorded for 649 babies aged 8 to 26 weeks. Room temperature at night was significantly related to outside temperature and duration of heating. Total insulation was significantly related to outside temperature and to minimum room temperature, but there was wide variation in insulation at the same room temperature. High levels of insulation for a given room temperature were found particularly at night and in winter, and were associated with the use of thick or doubled duvets and with swaddling. At least half the babies threw off some or all of their bedding at night, and at least a quarter sweated. Younger mothers and mothers in the lower social groups put more bedclothes over their babies, and the latter also kept their rooms warmer. Many mothers kept their babies warmer during infections.
Assuntos
Meio Ambiente , Temperatura Alta , Cuidado do Lactente , Adulto , Roupas de Cama, Mesa e Banho , Peso ao Nascer , Vestuário , Febre/terapia , Humanos , Lactente , Recém-Nascido , Idade Materna , Estações do Ano , Classe Social , Fatores Socioeconômicos , Sudorese/fisiologia , Temperatura , Condutividade Térmica , Fatores de TempoRESUMO
The purpose of the study was to investigate whether the thermal environment in which babies slept before developing haemorrhagic shock encephalopathy syndrome (HSES) differed from that of other babies. Data were collected by standardised interview from parents of 31 babies who had had HSES before the age of 7 months and compared with equivalent data for 124 control babies, with matching for outside temperature on the relevant night and for age. Multivariate analysis showed a strong association between HSES and covering of the baby's head by bedding, the odds ratio being 30.7 (95% confidence interval, 2.5 to 384). There were weaker associations with other aspects of the thermal environment. This suggests a link between HSES and some cases of cot death, supports the suggestion that HSES may be caused by overheating, and reinforces advice that babies should be placed to sleep in such a way that they are less likely to become totally covered.
Assuntos
Encefalopatias/etiologia , Temperatura Alta/efeitos adversos , Choque Hemorrágico/etiologia , Estudos de Casos e Controles , Feminino , Febre/complicações , Humanos , Lactente , Modelos Logísticos , Masculino , Análise Multivariada , SíndromeRESUMO
1 Apparent Vmax and Km for phenytoin were estimated in 40 children (aged 8--33 months) and 21 adults (aged 18--66 years). 2 The derived values of Vmax and Km were used to predict the plasma and salivary concentrations of phenytoin following a change in dose. There was a highly significant correlation between observed and predicted steady-state concentration in both children and adults (P less than 0.001). 3 The apparent Km was similar in children (7.5 +/- 1.2 mg/l) and adults (9.4 +/- 2.3 mg/l). 4 Vmax differed significantly (P less than 0.001) between children (20.4 +/- 2.1 mg kg-1 day-1) and adults (8.7 +/- 0.7 mg kg-1 day-1). 5 After correction for differences in the ratio of liver weight to body weight in children and adults, Vmax was similar in the two groups.
Assuntos
Fenitoína/metabolismo , Peso Corporal , Pré-Escolar , Feminino , Humanos , Lactente , Cinética , Fígado/anatomia & histologia , Masculino , Tamanho do ÓrgãoRESUMO
Mothers of 56 children under 2 years old taking phenobarbitone and mothers of 55 children taking phenytoin recorded on questionnaires changes they had noted in the children's behaviour 3 and 9 weeks after starting the drug. Severe behavioural disturbance was noted by many, but the pattern and incidence was similar to that recorded by the mothers of 50 children starting a placebo, and we attribute it to the effect of a recent hospital admission. There was a small improvement in the behaviour of 20% of children who had been taking phenobarbitone for a year when they stopped it, but in this age group the disturbance caused by phenobarbitone did not appear to have been great.