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1.
Cardiovasc Revasc Med ; 20(8): 642-648, 2019 08.
Article in English | MEDLINE | ID: mdl-31171470

ABSTRACT

BACKGROUND: Patients with peripheral arterial disease (PAD) often have walking impairment due to insufficient oxygen supply to skeletal muscle. In aged rats, we have shown that daily stretching of calf muscles improves endothelium-dependent dilation of arterioles from the soleus muscle and increases capillarity and muscle blood flow during exercise. Therefore, we hypothesized that daily muscle stretching of calf muscles would improve endothelium-dependent vasodilation of the popliteal artery and walking function in PAD patients. METHODS: We performed a randomized, non-blinded, crossover study whereby 13 patients with stable symptomatic PAD were randomized to undergo either 4 weeks of passive calf muscle stretching (ankle dorsiflexion applied 30 min/d, 5 days/wk) followed by 4 weeks of no muscle stretching and vice versa. Endothelium-dependent flow-mediated dilation (FMD) and endothelium-independent nitroglycerin-induced dilation of the popliteal artery and 6 minute walk test (6MWT) were evaluated at baseline and after each 4 week interval. RESULTS: After 4 weeks of muscle stretching, FMD and 6MWT improved significantly in the muscle stretching group vs. the control (FMD: 5.1 ±â€¯0.5% vs. 3.7 ±â€¯0.3%, P = 0.005; 6MWT continuous walking distance: 304 ±â€¯43 m vs. 182 ±â€¯34 m; P = 0.0006). No difference in nitroglycerin-induced dilation was found between groups (10.9 ±â€¯1.2 vs. 9.9 ±â€¯0.4%, P = 0.48). Post-stretching, 6MWT total walking distance was positively correlated with normalized FMD (R = 0.645, P = 0.02). CONCLUSIONS: Passive calf muscle stretching enhanced vascular endothelial function and improved walking function in elderly patients with stable symptomatic PAD. These findings merit further investigation in a prospective randomized trial.


Subject(s)
Endothelium, Vascular/physiopathology , Exercise Tolerance , Intermittent Claudication/therapy , Muscle Stretching Exercises , Muscle, Skeletal/blood supply , Peripheral Arterial Disease/therapy , Popliteal Artery/physiopathology , Vasodilation , Walk Test , Aged , Aged, 80 and over , Cross-Over Studies , Female , Florida , Humans , Intermittent Claudication/diagnostic imaging , Intermittent Claudication/physiopathology , Male , Middle Aged , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/physiopathology , Popliteal Artery/diagnostic imaging , Predictive Value of Tests , Prospective Studies , Recovery of Function , Regional Blood Flow , Time Factors , Treatment Outcome
2.
JAAPA ; 31(5): 12-18, 2018 May.
Article in English | MEDLINE | ID: mdl-29701616

ABSTRACT

Coronary artery disease (CAD) is the leading cause of death among adults in the United States. Despite advances in cardiac care, patients who have CAD and a diagnosis of depression have higher rates of morbidity and mortality. This article examines the epidemiology, clinical presentation, screening tools, and treatment recommendations for these patients.


Subject(s)
Coronary Artery Disease/psychology , Depression/diagnosis , Depression/therapy , Adult , Antidepressive Agents/therapeutic use , Depression/etiology , Disease Management , Female , Humans , Male , Mass Screening/methods , Middle Aged , Psychiatric Status Rating Scales , Risk Factors , United States/epidemiology
3.
J Environ Health ; 69(10): 27-32, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17583293

ABSTRACT

Food handler focus groups in two Oregon counties discussed knowledge, practices, and barriers related to handwashing in the restaurant environment. Current knowledge-based handwashing training programs do not address the internal and external barriers that affect handwashing practice. According to the focus groups, important barriers were time pressure, inadequate facilities and supplies, lack of accountability, lack of involvement of managers and coworkers, and organizations that were not supportive of handwashing. Because barriers to handwashing are multi-dimensional in nature, the authors recommend that future educational and training programs include 1) a hands-on training program that orients new employees to correct handwashing practice and more advanced education about foodborne illness; 2) involvement of both managers and coworkers in the training; 3) easily accessible hand-washing facilities stocked with necessary supplies; 4) continued handwashing training and support involving the food service industry, managers, and coworkers; and 5) involvement of health departments and inspectors in providing managers and food workers with advice and consultation on improvement of handwashing practice.


Subject(s)
Food Handling/standards , Hand Disinfection/standards , Health Knowledge, Attitudes, Practice , Restaurants/standards , Adult , Aged , Female , Focus Groups , Food Contamination/prevention & control , Foodborne Diseases/etiology , Foodborne Diseases/prevention & control , Hand Disinfection/methods , Health Education/methods , Humans , Hygiene/education , Male , Middle Aged , Oregon
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