Sternal precautions are intended to prevent complications after median sternotomy, but little data exist to support the consensus recommendations. To better characterize the forces on the sternum ...that can occur during everyday events, we conducted a prospective nonrandomized study of 41 healthy volunteers that evaluated the force exerted during bench press resistance exercise and while sneezing. A balloon-tipped esophageal catheter, inserted through the subject's nose and advanced into the thoracic cavity, was used to measure the intrathoracic pressure differential during the study activities. After the 1 repetition maximum (1-RM) was assessed, the subject performed the bench press at the following intensities, first with controlled breathing and then with the Valsalva maneuver: 40% of 1-RM (low), 70% of 1-RM (moderate), and 1-RM (high). Next, various nasal irritants were used to induce a sneeze. The forces on the sternum were calculated according to a cylindrical model, and a 2-tailed paired t test was used to compare the mean force exerted during a sneeze with the mean force exerted during each of the 6 bench press exercises. No statistically significant difference was found between the mean force from a sneeze (41.0 kg) and the mean total force exerted during moderate-intensity bench press exercise with breathing (41.4 kg). In conclusion, current guidelines and recommendations limit patient activity after a median sternotomy. Because these patients can repeatedly withstand a sneeze, our study indicates that they can withstand the forces from more strenuous activities than are currently allowed.
We designed a study to measure the functional capacity requirements of firefighters to aid in the development of an occupation-specific training program in cardiac rehabilitation; 23 healthy male ...firefighters with no history of heart disease completed a fire and rescue obstacle course that simulated 7 common firefighting tasks. They wore complete personal protective equipment and portable metabolic instruments that included a data collection mask. We monitored each subject's oxygen consumption (VO2 ) and working heart rate, then calculated age-predicted maximum heart rates (220 − age) and training target heart rates (85% of age-predicted maximum heart rate). During performance of the obstacle course, the subjects' mean working heart rates and peak heart rates were higher than the calculated training target heart rates ( t22 = 5.69 working vs target, p <0.001 and t22 = 15.14 peak vs target, p <0.001). These findings, with mean results for peak VO2 (3,447 ml/min) and metabolic equivalents (11.9 METs), show that our subjects' functional capacity greatly exceeded that typically attained by patients in traditional cardiac rehabilitation programs (5 to 8 METs). In conclusion, our results indicate the need for intense, occupation-specific cardiac rehabilitation training that will help firefighters safely return to work after a cardiac event.
Abstract For surgical patients' family members, the wait during surgery can cause anxiety that can be exacerbated if staff members provide inadequate or inconsistent information about the patient's ...status. Educational interventions and other staff-intensive measures to help reduce family members' anxiety can be time consuming for staff members and impractical in a high-volume facility. To improve communication with patients' families, nurses at a heart and vascular hospital in Dallas, Texas, designed and distributed a card containing estimated procedure times, helpful telephone numbers, and other information. A survey of family members indicated that receiving the card reduced anxiety in a significant proportion of the respondents.
•Pregnant women misusing opioids report significant depression, anxiety, and stress.•Symptoms are higher compared to women with other medically high-risk pregnancies.•High maternal anxiety and low ...stress predict neonatal opioid withdrawal syndrome.
Diagnoses of anxiety and depressive disorders are prevalent among women who misuse opioids during pregnancy and have been linked to the development of neonatal opioid withdrawal syndrome (NOWS) in infants. The role of stress in NOWS, however, has not been studied, despite its relationship to anxiety and depression. Moreover, anxiety and depression have only been assessed at the level of diagnoses, limiting our understanding of the effects of symptoms along a continuum of severity on opioid misuse in pregnancy and NOWS.
We first compared symptoms of anxiety, depression, and stress assessed along a continuum in women who misused opioids during pregnancy (n = 53) who chose to receive medication assisted treatment (MAT) or to detoxify from opioids, and women with high-risk pregnancies for medical reasons unrelated to drug use (n = 37). We then examined whether depression, anxiety, and stress symptoms during pregnancy predicted NOWS.
Findings revealed significantly higher depression, anxiety, and stress among pregnant women who misused opioids than among the comparison group. Furthermore, results indicated that higher anxious symptoms as hypothesized (but not depressive symptoms), and lower stress symptoms contributed to a greater likelihood of infants developing NOWS after delivery beyond the type of treatment (i.e., MAT or tapering/detoxification) they received for opioid use.
The present study used a small sample size and had some measurement limitations.
Findings suggest important opportunities for effective integrated psychological and medical interventions for pregnant women misusing opioids to improve their own health and that of their infants.
Objective Bone marrow lesions (BML) have been implicated in the pathogenesis of osteoarthritis, yet their exact role, etiology, and natural history remain unclear. The aim of this study was to ...examine the natural history of BML in a healthy population and identify risk factors associated with their persistence and incidence. Methods One hundred forty-eight healthy middle-aged women had magnetic resonance imaging performed on their dominant knee at baseline and 2 years later to assess the presence, natural history, and risk factors for persistence and incidence of BML. Results Approximately 46% of BML present at baseline completely resolved over 2 years. “Large” BML had the potential to improve, while the majority of “very large” remained stable. In those women with no BML at baseline, approximately 9% developed a BML over 2 years, the majority in the medial compartment. There was a trend toward weight being a risk factor for the development of “very large” BML ( P = 0.08). Conclusions The natural history of BML may be different in healthy persons compared with diseased states. The trend for weight as a risk factor for development of a “very-large” BML suggests there is potential to identify modifiable risk factors for BML in asymptomatic people and warrants further investigation.
Family history is a simple yet powerful genomic tool that can identify individuals and entire populations at risk for diseases such as heart disease, cancer, and diabetes. Despite its use for ...predicting disease, family history has traditionally been underused in the public health setting.
A program for identifying families at risk for a variety of chronic diseases was implemented in Utah. Utah has population characteristics that are unique among the United States. Although the land area is large, most residents live within a relatively small geographic area. The religion of 70% of the residents encourages the recording of detailed family histories, and many families have access to records dating back to the 1800s.
From 1983 through 1999, the Utah Department of Health, local health departments, school districts, the University of Utah, and the Baylor College of Medicine implemented and conducted the Family High Risk Program, which identified families at risk for chronic diseases using the Health Family Tree Questionnaire in Utah high schools.
The collection of family history is a cost-effective method for identifying and intervening with high-risk populations. More than 80% of eligible families consented to fully participate in the program. A total of 80,611 usable trees were collected. Of the 151,188 Utah families who participated, 8546 families identified as high-risk for disease(s) were offered follow-up interventions.
The program was revolutionary in design and demonstrated that family history can bridge the gap between genetic advances and public health practice.
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