Abnormal electrocardiographic findings in athletes: Correlation with intensity of sport and level of competition.

INTRODUCTION: Athletes can exhibit abnormal electrocardiogram (ECG) phenotypes that require further evaluation prior to competition. These are apparently more prevalent in high-intensity endurance sports. The purpose of this study was to assess the association between ECG findings in athletes and intensity of sport and level of competition. METHODS: A cohort of 3423 competitive athletes had their ECGs assessed according to the Seattle criteria (SC). The presence of abnormal ECGs was correlated with: (1) intensity of sport (low/moderate vs. at least one high static or dynamic component); (2) competitive level (regional vs. national/international); (3) training volume (≤20 vs. >20 hours/week); (4) type of sport (high dynamic vs. high static component). The same endpoints were studied according to the 'Refined Criteria' (RC). RESULTS: Abnormal ECGs according to the SC were present in 225 (6.6%) athletes, more frequently in those involved in high-intensity sports (8.0% vs. 5.4%; p=0.002), particularly in dynamic sports, and competing at national/international level (7.1% vs. 4.9%; p=0.028). Training volume was not significantly associated with abnormal ECGs. By multivariate analysis, high-intensity sport (OR 1.55, 1.18-2.03; p=0.002) and national/international level (OR 1.50, 95% CI 1.04-2.14; p=0.027) were independent predictors of abnormal ECGs, and these variables, when combined, doubled the prevalence of this finding. According to the RC, abnormal ECGs decreased to 103 (3.0%), but were also more frequent in high-intensity sports (4.2% vs. 2.0%; p<0.001). CONCLUSIONS: There is a positive correlation between higher intensity of sports and increased prevalence of ECG abnormalities. This relationship persists with the use of more restrictive criteria for ECG interpretation, although the number of abnormal ECGs is lower

Het gesprek in 2015:train-de-trainer

Hogeschool Utrecht, Kenniscentrum Sociale Innovatie Gemeenten zijn vanaf 2015 voor een nog grotere groep kwetsbare burgers de toegangspoort tot ondersteuning bij het meedoen in de samenleving. Door de decentralisatie van de AWBZ begeleiding zal de vraag waarmee burgers naar de gemeente komen complexer worden. Gemeenten pakken deze complexe vraagstukken steeds meer op vanuit een brede blik, dat wil zeggen over levensterreinen heen en op het hele sociale domein (werk, inkomen, opvoeding, zorg en ondersteuning) Dit vraagt behoorlijk wat van de gespreksvoerder die het Gesprek voert met de burger. In deze Train-de-trainer bieden de Hanzehogeschool Groningen, Academie voor Sociale Studies – lectoraat Rehabilitatie; Hogeschool Utrecht, kenniscentrum sociale innovatie – lectoraat participatie, zorg en ondersteuning; en Movisie trainingsmateriaal voor de gespreksvoerder, zodat deze in staat is het gesprek op een goede manier te voeren. In deze training besteden we aandacht aan: 1. De context en het kader waarin het gesprek plaatsvindt. 2. Het Gesprek met verschillende doelgroepen. 3. Gesprekstechnieken en contactvaardigheden. 4. Integraal werken en netwerkversterking

Fitness in chronic heart failure : effects of exercise training and of biventricular pacing

In CHF patients exercise capacity is decreased (low physical fitness). The degree of exercise intolerance in CHF is paralleled by an increased mortality, moreover, several studies suggest that increasing exercise capacity in CHF improves prognosis. Therefore, improving exercise capacity is one of the major issues in CHF-related treatment. Besides this decreased exercise capacity CHF patients also have a low autonomic fitness (high neurohumoral activation and a low baroreflex sensitivity (BRS)), which causes structural end-organ damage and increases mortality. The current therapeutic regimen in CHF mainly focuses on the blocking of the neurohumoral activation but not on the removing of neurohumoral activation. In this thesis we have studied the effects of exercise and cardiac resynchronization therapy (CRT) on both physical and autonomic fitness in CHF patients. We found that exercise improves both physical and autonomic fitness. Also, we showed that is possible to increase BRS without actual exercise, by mimicking exercise associated nerve traffic by means of TENS (transcutaneous electrical nerve stimulation). Furthermore, we found that CRT acutely improves BRS, and this improvement had predictive value for the anatomical response after six months of CRT. In conclusion, both exercise and CRT are capable to improve the fitness of CHF patientsNederlandse Hartstichting JE Jurriaanse StichtingUBL - phd migration 201

Return to work policies and practices after total hip or knee arthroplasty in Denmark, Germany, and the Netherlands:an exploratory study

PURPOSE: To explore return-to-work (RTW) policies and practices for total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients in three European countries.MATERIALS AND METHODS: An exploratory study in Denmark, Germany, and the Netherlands consisting of three aspects: (1) description of the healthcare and social security systems; (2) identification of national RTW guidelines; (3) a survey to gain insight into RTW practices and perceptions of orthopaedic surgeons, including barriers, facilitators, and needs.RESULTS: Healthcare and social security systems differed (e.g. fast-track vs longer postoperative stay; coverage of rehabilitation costs). National guidelines were available in Germany (THA, TKA) and the Netherlands (TKA), containing limited RTW information. The survey was completed by 168 orthopaedic surgeons (Denmark n = 51; Germany n = 39; the Netherlands n = 78). Overall, orthopaedic surgeons reported being in need of more knowledge and better collaboration with other healthcare practitioners.CONCLUSION: We found considerable variation in healthcare and social security systems. When available, national guidelines contained limited information. In all three countries surgeons need more knowledge and better collaboration with other healthcare practitioners. We advise that RTW multidisciplinary recommendations post THA/TKA be established by the national associations of the healthcare practitioners involved.</p

Data quality assessment of interventional trials in public trial databases

ObjectiveHigh-quality data entry in clinical trial databases is crucial to the usefulness, validity, and replicability of research findings, as it influences evidence-based medical practice and future research. Our aim is to assess the quality of self-reported data in trial registries and present practical and systematic methods for identifying and evaluating data quality.Study Design and SettingWe searched ClinicalTrials.Gov (CTG) for interventional total knee arthroplasty (TKA) trials between 2000 and 2015. We extracted required and optional trial information elements and used the CTG's variables' definitions. We performed a literature review on data quality reporting on frameworks, checklists, and overviews of irregularities in healthcare databases. We identified and assessed data quality attributes as follows: consistency, accuracy, completeness, and timeliness.ResultsWe included 816 interventional TKA trials. Data irregularities varied widely: 0%–100%. Inconsistency ranged from 0% to 36%, and most often nonrandomized labeled allocation was combined with a “single-group” assignment trial design. Inaccuracy ranged from 0% to 100%. Incompleteness ranged from 0% to 61%; 61% of finished TKA trials did not report their outcome. With regard to irregularities in timeliness, 49% of the trials were registered more than 3 months after the start date.ConclusionWe found significant variations in the data quality of registered clinical TKA trials. Trial sponsors should be committed to ensuring that the information they provide is reliable, consistent, up-to-date, transparent, and accurate. CTG's users need to be critical when drawing conclusions based on the registered data. We believe this awareness will increase well-informed decisions about published articles and treatment protocols, including replicating and improving trial designs.Orthopaedics, Trauma Surgery and Rehabilitatio

Recovery and the use of postoperative physical therapy after total hip or knee replacement

BACKGROUND: Total hip or knee arthroplasties (THA/TKA) show favorable long-term effects, yet the recovery process may take weeks to months. Physical therapy (PT) following discharge from hospital is an effective intervention to enhance this recovery process. To investigate the relation between recovery and postoperative PT usage, including the presence of comorbidities, 6 months after THA/TKA. METHODS: Multicenter, observational study in primary THA/TKA patients who completed preoperative and 6 months postoperative assessments. The assessments included questions on PT use (yes/no and duration; long term use defined as ≥ 12 weeks), comorbidities (musculoskeletal, non-musculoskeletal, sensory comorbidities and frequency of comorbidities). Recovery was assessed with the HOOS/KOOS on all 5 subdomains. Logistic regression with long term PT as outcome was performed adjusted for confounding including an interaction term (comorbidity*HOOS/KOOS-subdomain). RESULTS: In total, 1289 THA and 1333 TKA patients were included, of whom 95% received postoperative PT, 56% and 67% received postoperative PT ≥ 12 weeks respectively. In both THA and TKA group, less improvement on all HOOS/KOOS domain scores was associated with ≥ 12 weeks of postoperative PT (range Odds Ratios 0.97–0.99). In the THA group the impact of recovery was smaller in patient with comorbidities as non- musculoskeletal comorbidities modified all associations between recovery and postoperative PT duration (Odds Ratios range 1.01–1.05). Musculoskeletal comorbidities modified the associations between Function-in-Daily-Living-and Sport-and-recreation recovery and postoperative PT. Sensory comorbidities only had an effect on Sport-and-recreation recovery and postoperative PT. Also the frequency of comorbidities modified the relation between Function-in-Daily-Living, pain and symptoms recovery and postoperative PT. In the TKA group comorbidity did not modify the associations. CONCLUSION: Worse recovery was associated with longer duration of postoperative PT suggesting that PT provision is in line with patients’ needs. The impact of physical recovery on the use of long-term postoperative PT was smaller in THA patients with comorbidities. TRIAL REGISTRATION: Registered in the Dutch Trial Registry on March 13, 2012. TRIAL ID NTR3348; registration number: P12.047. https://www.trialregister.nl/trial/3197. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-022-05429-z

The effect of exercise on prescription on physical activity and wellbeing in a multi-ethnic female population: A controlled trial

BACKGROUND: In Western countries, individuals from multi-ethnic disadvantaged populations are less physically active than the Western population as a whole. This lack of physical activity (PA) may be one of the factors explaining disparities in health. Exercise on Prescription” (EoP), is an exercise program to which persons are referred by primary care. It has been developed to suit the needs of physically inactive women from diverse ethnic backgrounds living in deprived neighborhoods in the Netherlands. The effectiveness of this program has however, not yet been proven. METHODS: A total of 514 women from diverse ethnic backgrounds were included in this study (192 EoP, 322 control group). Women in the EoP group participated in 18 sessions of supervised PA. The control group received care as usual. At baseline, 6 and 12 months the women attended an interview and a physical examination. Outcome measures were PA, BMI, weight circumference, fat percentage, oxygen uptake, mental well-being, subjective health and use of care. RESULTS: Of the participants 59% had a low educational level and 90% of the women were overweight or obese. Compliance was high, only 14% dropped out during the course of the program. Total PA did not change, PA during leisure time increased at 6 and at 12 months and PA during household activities increased at 12 months (P(EoPvsControl) < 0.05). EoP had no significant effect on the other outcome variables. CONCLUSIONS: EoP was successful in recruiting its target population and compliance was high. The effect of EoP on PA, health and mental well-being was limited. In this format EoP does not seem to be effective for increasing PA and the health status of non-Western migrant women. TRIAL REGISTRATION: Dutch Trial register: NTR129

Three out of four working-age patients have fulfilled expectations towards paid employment six months after total hip or knee arthroplasty:a multicentre cohort study

To investigate factors associated with fulfilment of expectations towards paid employment after total hip/knee arthroplasty (THA/TKA). Cohort study including preoperatively employed patients aged 18-64 scheduled for THA/TKA. Expectations were collected preoperatively, and 6 and 12 months postoperatively with the paid employment item of the Hospital-for-Special-Surgery Expectations Surveys (back-to-normal = 1; large improvement = 2; moderate improvement = 3; slight improvement = 4; not applicable = 5). Patients scoring not applicable were excluded. Fulfilment was calculated by subtracting preoperative from postoperative scores (&lt; 0: unfulfilled; ≥ 0: fulfilled). Multivariable logistic regression analyses were conducted separately for THA/TKA at 6 and 12 months postoperatively. Six months postoperatively, 75% of THA patients (n = 237/n = 316) and 72% of TKA patients (n = 211/n = 294) had fulfilled expectations. Older age (TKA:OR 1.08, 95% CI 1.01-1.15) and better postoperative physical functioning (THA:OR 1.10, 95% CI 1.06-1.14; TKA:OR 1.03, 95% CI 1.01-1.06) increased the likelihood of fulfilment. Physical work tasks (THA:OR 0.12, 95% CI 0.03-0.44), preoperative sick leave (TKA:OR 0.33, 95% CI 0.17-0.65), and difficulties at work (THA:OR 0.10, 95% CI 0.03-0.35; TKA:OR 0.41, 95% CI 0.17-0.98) decreased the likelihood of fulfilment. Twelve months postoperatively similar risk factors were found. Three out of four working-age THA/TKA patients had fulfilled expectations towards paid employment at 6 months postoperatively. Preoperative factors associated with fulfilment were older age, mental work tasks, no sick leave, postoperative factors were better physical functioning, and no perceived difficulties at work.</p

Does forced or compensated turnout lead to musculoskeletal injuries in dancers? A systematic review on the complexity of causes

Injury prevalence in dancers is high, and misaligned turnout (TO) is claimed to bear injury risk. This systematic review aimed to investigate if compensating or forcing TO leads to musculoskeletal injuries.A systematic literature review was conducted according to the PRISMA Guidelines using the databases of PubMed, Embase, Emcare, Web of Science, Cochrane Library, Academic Search Premier, and ScienceDirect. Studies investigating the relationship between compensated or forced TO and injuries in all genders, all ages, and levels of dancers were included. Details on misaligned TO measurements and injuries had to be provided. Screening was performed by two researchers, data extraction and methodological quality assessment executed by one researcher and checked by another.7 studies with 1293 dancers were included. Methodological quality was low due to study designs and a general lack of standardised definition of pathology and methods of assessment of misaligned TO. The studies investigating the lower extremities showed a hip-focus only. Non-hip contributors as well as their natural anatomical variations were not accounted for, limiting the understanding of injury mechanisms underlying misaligned TO. As such no definite conclusions on the effect of compensating or forcing TO on musculoskeletal injuries could be made.Total TO is dependent on complex motion cycles rather than generalised (hip) joint dominance only. Objective dual assessment of maximum passive joint range of motion through 3D kinematic analysis in combination with physical examination is needed to account for anatomical variations, locate sites prone to (overuse)injury, and investigate underlying injury mechanisms. (C) 2020 Elsevier Ltd. All rights reserved.Clinical epidemiolog