Facing the digital frontier: exploring user acceptance of electronic health records in an urban, rural and remote setting in the Philippines.

OBJECTIVES: A thorough understanding of user needs and behavioural intent-to-use underpins the development of a responsive health information system. This study aimed to examine health workers' intent-to-use an electronic health record (EHR) system in an urban, rural and remote setting in the Philippines. METHODS: Following the Unified Theory of Acceptance and Use of Technology framework, user acceptance and the factors influencing intent-to-use the EHR were examined through a self-administered questionnaire. A total of 128 EHR users, comprising physicians, nurses, midwives, barangay health workers and administrative staff, were surveyed. Median scores for each domain were compared across the sites using the Kruskal-Wallis test. Ridge regression analysis was used to identify factors associated with behavioural intent-to-use. RESULTS: Over 94% of users across all sites reported their intent-to-use the EHR in the near future. Of the seven predictor variables examined, only self-efficacy was found to be significantly associated with behavioural intent-to-use. Intent-to-use the EHR increased by 31% (p=0.007) for each unit increase in self-efficacy score among participants. DISCUSSION: Acceptance was high across the three sites, with self-efficacy being a predictor of intent-to-use the technology. This suggests that users are more likely to adopt an EHR if they believe they have the capacity to successfully navigate the technology and perform their designated tasks with it. CONCLUSION: Co-producing interventions with primary care providers is crucial in sustaining EHR systems. Rather than developing a technology based on the surveillance needs of policymakers, an EHR developed from the grassroots was shown to be well-received by end-users.

The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for Revision of the Classification of Residual Tumor After Resection for the Forthcoming (Ninth) Edition of the TNM Classification of Lung Cancer.

INTRODUCTION: The goal of surgical resection is to completely remove a cancer; it is useful to have a system to describe how well this was accomplished. This is captured by the residual tumor (R) classification, which is separate from the TNM classification that describes the anatomic extent of a cancer independent of treatment. The traditional R-classification designates as R0 a complete resection, as R1 a macroscopically complete resection but with microscopic tumor at the surgical margin, and as R2 a resection that leaves gross tumor behind. For lung cancer, an additional category encompasses situations in which the presence of residual tumor is uncertain. METHODS: This paper represents a comprehensive review of evidence regarding these R categories and the descriptors thereof, focusing on studies published after the year 2000 and with adjustment for potential confounders. RESULTS: Consistent discrimination between complete, uncertain, and incomplete resection is revealed with respect to overall survival. Evidence regarding specific descriptors is generally somewhat limited and only partially consistent; nevertheless, the data suggest retaining all descriptors but with clarifications to address ambiguities. CONCLUSION: On the basis of this review, the R-classification for the ninth edition of stage classification of lung cancer is proposed to retain the same overall framework and descriptors, with more precise definitions of descriptors. These refinements should facilitate application and further research.

Promoting equitable and patient-centred care: an analysis of patient satisfaction in urban, rural and remote primary care sites in the Philippines.

OBJECTIVES: This study measured changes in patient satisfaction levels before and after the introduction of primary care system strengthening interventions in urban, rural, and remote sites in the Philippines. METHODS: A previously validated 16-item questionnaire was distributed to 200 patients per site before implementation of interventions and to a different set of 200 patients 1 year after implementation. We compared the percentage change in highly satisfied patients per site before and after implementing interventions using a two-proportion Z-test. RESULTS: The urban site had a significant increase in patient satisfaction in 13 survey items, which corresponded to the domains of healthcare availability, service efficiency, technical competency and health communication. The rural site had a significant increase in six survey items, which corresponded to the domains of service efficiency, environment, location, health communication and handling. The remote site had a decrease in patient satisfaction in 10 survey items, with a significant increase in only 4 items under the domains of healthcare availability and handling. CONCLUSION: Our findings support the 'inverse equity hypothesis', where well-resourced urban communities quickly adopt complex health interventions while rural and remote settings experience delays in effectively meeting patient needs and system demands. Extended intervention periods and targeted strategies may be necessary to impact patient satisfaction in underserved areas considerably.

Feasibility, acceptability and impact of a clinical decision support tool among primary care providers in an urban, rural and remote site in the Philippines.

INTRODUCTION: Strengthening primary care helps address health inequities that continue to persist in the Philippines. The Philippine Primary Care Studies pilot-tested interventions to improve the primary care system. One intervention was the provision of a free subscription to an electronic decision support application called UpToDate (UTD) for primary care providers (PCPs), including doctors, nurses, midwives and community health workers (CHWs). This study aimed to (1) assess the feasibility of using UTD as information source for PCPs in urban, rural and remote settings, (2) determine the acceptability of UTD as an information source for PCPs and (3) examine the impact of UTD access on PCP clinical decision-making. METHODS: Four focus group discussions (FGDs) and two key informant interviews (KII) were conducted to gather insights from 30 PCPs. Thematic analysis through coding in NVivo V.12 was done using the technology acceptance model (TAM) as a guiding framework. RESULTS: All PCPs had positive feedback regarding UTD use because of its comprehensiveness, accessibility, mobility and general design. The participants relayed UTD's benefit for point-of-contact use, capacity-building and continuing professional development. PCPs across the three sites, including CHWs with no formal medical education, were able to provide evidence-based medical advice to patients through UTD. However, external factors in these settings impeded the full integration of UTD in the PCPs' workflow, including poor internet access, unstable sources of electricity, lack of compatible mobile devices and the need for translation to the local language. CONCLUSION: UTD was a feasible and acceptable clinical decision support tool for the PCPs. Factors affecting the feasibility of using UTD include technological and environmental factors (ie, internet access and the lack of translation to the local language), as well as the organisational structure of the primary care facility which determines the roles of the PCPs. Despite the difference in roles and responsibilities of the PCPs, UTD positively impacted decision-making and patient education for all PCPs through its use as a point-of-contact tool and a tool for capacity-building.

Effect of a brief training program on the knowledge of Filipino primary care providers in a rural and a remote setting: A before and after study

Background and Objective@#Primary care providers are key players in providing quality care to patients and advancing Universal Health Care (UHC). However, effective and quality healthcare delivery may be affected by inadequate knowledge and failure to adhere to evidence-based guidelines among providers. The Philippine Primary Care Studies (PPCS) is a five-year program that pilot tested interventions aimed at strengthening the primary care system in the country. Evidence-based training modules for healthcare providers were administered in Sorsogon and Bataan from the years 2018 to 2021. Module topics were selected based on common health conditions encountered by providers in rural and remote settings. This program aimed to evaluate the effectiveness of training in increasing provider knowledge.@*Methods@#A series of training workshops were conducted among 184 remote- and 210 rural-based primary care providers [nurses, midwives, barangay or village health workers (BHWs)]. They covered four modules: essential intrapartum and newborn care (EINC), integrated management of childhood illness (IMCI), non-communicable diseases (NCD), and geriatrics. A decision support system (UpToDate) was provided as a supplementary resource for all participants. We administered pre-tests and post-tests consisting of multiple-choice questions on common health conditions. Data was analyzed using paired one-tailed t-test, with an alpha of 0.05.@*Results@#The knowledge of nurses, midwives, and BHWs improved after the training workshops were conducted. The largest increase from pre-test to post-test scores were observed among the midwives, with a mean difference (MD) of 32.9% (95% CI 23.9 to 41.9) on the EINC module, MD of 25.0% (95% CI 16.6 to 33.4) in the geriatrics module, and MD of 13.5% (95% CI 6.9 to 20.1) in the NCDs module. The nurses had the greatest improvement in the IMCI module (MD 10.8%, 95% CI 2.5 to 19.1). The knowledge of BHWs improved in all participated modules, with greatest improvement in the NCD module (MD 9.0%, 95% CI 5.77 to 12.14). @*Conclusions@#Primary care workshops, even if conducted as single-sessions and on a short-term basis, are effective in improving short-term knowledge of providers. However, this may not translate to long-term knowledge and application in practice. Furthermore, comparisons across provider categories cannot be made as participant composition for each training workshop varied. Ultimately, this study shows enhancing provider knowledge and competence in primary care will therefore require regular and diverse learning interventions and access to clinical decision support tools.

Assessment of reproductive impact of the aerial parts of Caralluma dalzielii N. E. Br in female Wistar rats.

Caralluma dalzielii N. E. Brown belonging to family Asclepiadaceae, is a popular cactus-shaped plant native to East Africa. The aerial parts are used traditionally for treating various diseases including infertility. The present study evaluated the effects of the aqueous extract of the aerial parts of Caralluma dalzielii (AECD) on reproductive performance of female Wistar rats. Adult female virgin rats were allotted into four major groups namely pre-conception, post-conception, implantation site and ovariectomized rats' groups. Each group was subdivided into 4 groups and treated orally with 125, 250, 500 mg/kg of AECD or distilled water (vehicle). In the pre-conception and post-conception groups, litter sizes, pups' weights, deformities, gestation length and reproductive indices were determined. Number of implantation sites and weights of embryos were assessed in the implantation site group while in the ovariectomised rats' group, uterine weights were determined. AECD produced no difference in litter size and reproductive indices in pre-conception group while in post-conception group the litter size at 500 mg/kg was significantly (p < 0.05) reduced compared to the control. Post-implantation loss index was high, and the other reproductive indices were reduced at 500 mg/kg. Whereas at the dose of 125 mg/kg, post-implantation loss index was reduced, and litter size was increased when compared to the control group. At 500 mg/kg, AECD caused a significant (p < 0.05) decrease in the number of implantation sites and weight of embryos while at 125 mg/kg the implantation sites increased. A significant (p < 0.05) increase in the uterine weight in the ovariectomised rats' group was observed at all dose levels. Our study provides scientific evidence that supports the traditional use of AECD in the treatment of infertility. At a lower dose, AECD acts by increasing the number of implantation sites and litter size of animals but at a higher dose, it may be embryotoxic. AECD increases uterine wet weight in ovariectomised rats suggesting that the plant may be oestrogen-like.

Patient Knowledge on Malaria Symptoms Is a Key to Promoting Universal Access of Patients to Effective Malaria Treatment in Palawan, the Philippines.

INTRODUCTION: Palawan, where health care facilities are still limited, is one of the most malaria endemic provinces in the Philippines. Since 1999, microscopists (community health workers) have been trained in malaria diagnosis and feasibility of early diagnosis and treatments have been enhanced throughout the province. To accelerate the universal access of malaria patients to diagnostic testing in Palawan, positive health seeking behavior should be encouraged when malaria infection is suspected. METHODS: In this cross-sectional study, structured interviews were carried out with residents (N = 218) of 20 remote malaria-endemic villages throughout Palawan with a history of suspected malaria from January to February in 2012. Structural equation modeling (SEM) was conducted to determine factors associated with appropriate treatment, which included: (1) socio-demographic characteristics; (2) proximity to a health facility; (3) health seeking behavior; (4) knowledge on malaria; (5) participation in community awareness-raising activities. RESULTS: Three factors independently associated with appropriate treatment were identified by SEM (CMIN = 10.5, df = 11, CFI = 1.000, RMSEA = .000): "living near microscopist" (p < 0.001), "not living near private pharmacy" (p < 0.01), and "having severe symptoms" (p < 0.01). "Severe symptoms" were positively correlated with more "knowledge on malaria symptoms" (p < 0.001). This knowledge was significantly increased by attending "community awareness-raising activities by microscopists" (p < 0.001). CONCLUSIONS: In the resource-limited settings, microscopists played a significant role in providing appropriate treatment to all participants with severe malaria symptoms. However, it was considered that knowledge on malaria symptoms made participants more aware of their symptoms, and further progressed self-triage. Strengthening this recognition sensitivity and making residents aware of nearby microscopists may be the keys to accelerating universal access to effective malaria treatment in Palawan.

Pregnancy outcome in chronic myeloid leukemia patients on imatinib therapy.

INTRODUCTION: Imatinib is a first-line therapy to treat chronic myeloid leukemia (CML) patients. MATERIALS AND METHODS: We selected 22 CML cases of pregnancies and reported 9 accidental and 13 planned pregnancies that were on imatinib therapy. Willing female patients remaining in complete hematological, cytogenetic and major molecular responses for at least 2 years planned for pregnancy and were advised to stop imatinib for 1 month prior to conception and 3 months after conception (first trimester). Willing male patients stopped therapy 1 month prior to conception of their wives. In unplanned cases, all patients were in exposure to imatinib during conception. Twenty-two pregnancies resulted in seven male children and eight female children. There were three spontaneous abortions and four elective abortions along with one case of hypospadia and another one of mild hydrocephalus. CONCLUSION: We may suggest that planned pregnancy during therapy may be encouraged but imatinib therapy in unplanned pregnancy can cause spontaneous abortion or congenital anomaly.

Determining the impact of community awareness-raising activities on the prevention of malaria transmission in Palawan, the Philippines.

Palawan has the highest malaria endemicity in the Philippines, and malaria remains a major health burden in the region. In 1999, 344 microscopists were trained in Palawan. This allowed for early diagnosis and prompt treatment throughout the island. To take a significant step toward the elimination of malaria on the island, microscopists implemented community awareness-raising activities aimed at preventing transmission of malaria. The objective of the present study was to determine the impact of these activities on the self-implemented preventive measures against malaria by the ex-patients of the microscopists. Structured interviews were carried out from January to February in 2012, in 20 remote malaria-endemic villages throughout Palawan. In total, 141 ex-patients who had previously been diagnosed malaria-positive by the microscopists, volunteered to participate in the present study. Structural equation modeling was conducted to determine factors associated with self-implemented preventive measures against malaria, which included: (1) place of residence; (2) socio-demographic characteristics; (3) knowledge on malaria; (4) participation in community awareness-raising activities for malaria prevention; and (5) satisfaction with microscopists. Structural equation modeling identified six significant factors independently associated with self-implemented preventive measures against malaria; ethnicity, knowledge on malaria transmission, knowledge on vector species, knowledge on vector's most active time, participation in awareness-raising activities for malaria prevention by microscopists, and satisfaction with microscopists. Tagalog ethnicity (the predominant ethnic group) was positively related to better self-implemented preventive measures. In conclusion, aside from providing early diagnosis and treatment, microscopists played a significant role in self-implemented preventive measures against malaria. The strengthening of awareness-raising activities by microscopists was suggested to be an effective strategy for reducing malaria re-infection in Palawan. These activities should be strengthened to improve preventive measures implemented by ex-patients traveling to mountain areas and to enhance the knowledge on malaria transmission particularly among indigenous residents.

Determining the active role of microscopists in community awareness-raising activities for malaria prevention: a cross-sectional study in Palawan, the Philippines.

BACKGROUND: Malaria remains one of the most prevalent and fatal diseases among the inhabitants of Palawan in the Philippines. Palawan, where healthcare services remain limited, has the highest malaria endemicity in the country. To eliminate malaria, effective prevention measures should be conducted alongside early diagnosis and prompt treatment, which are the major tasks of the trained microscopists in Palawan. However, while the microscopists have implemented community awareness-raising activities aimed at preventing transmission of malaria, the nature and quality of these activities have not been evaluated. The present study identified the factors associated with the strengthening of community awareness-raising activities for malaria prevention implemented by microscopists in Palawan. METHODS: A cross-sectional study was conducted among 127 microscopists in Palawan. Data were collected using self-administered questionnaires from November 2010 to February 2011. For data analysis, structural equation modelling was conducted, based on the questionnaire results, to identify the impact of factors associated with the number of community malaria awareness-raising activities implemented by microscopists using the following assessment indicators: (1) place of assignment; (2) annual parasite index; (3) microscopists' capacity (service quality, knowledge on malaria, and ability in malaria microscopy); (4) self-preventive measures against malaria; and (5) job satisfaction. RESULTS: High microscopists' capacity was found to be a significant factor for a greater number of community awareness-raising activities for malaria prevention. High microscopists' capacity was significantly explained by its two sub-components: high service quality (active detection, diagnosis and treatment, prescription of anti-malarial, and follow-up) and high ability in malaria microscopy (preparation and documentation, slide preparation and observation, safe handling and disposal, and knowledge on the morphology of infected red blood cells). CONCLUSIONS: Microscopists' capacity was identified as a significant factor in community awareness-raising activities for malaria prevention. Thus, the strengthening of service quality and ability in malaria microscopy should be of the highest priority.

Vocal acoustic measures of asymptomatic Filipino young adults at a private tertiary hospital in Quezon City - A pilot study

Objective@#To describe the vocal acoustic measures of nonsmoking Filipino young adults without voice complaints at a private tertiary hospital in Quezon City; to determine if our baseline values are distributed normally and comparable to data in similar studies done abroad; and to recommend normative voice parameters which may be used as baseline data in our institution and for comparison in future studies.@*Methods@#Design: Cross-sectional study Setting: Private tertiary hospital Participants: A total of 70 subjects were recruited at random.@*Results@#Values extracted for f0, Jitter %, Jitter dB, Shimmer %, Shimmer dB and NHR showed normal distribution of results. The average vocal acoustic values found in the present study for male voices producing the vowel /a/ were fo = 130.6 ± 13.65Hz, jitter = 0.0.46 % ± 0.184, jitter dB: 37.62dB ± 16.664, shimmer %= 0.23%, shimmer dB=0.23 ± 0.67 and NHR = 0.13 ± 0.010. The average values found for female voices, producing the vowel /a/ were fo = 218.38 ± 26.192Hz, jitter = 0.87% ± 0.61, jitter dB: 34.82 ± 22.5, shimmer %= 2.72 ± 1.07 shimmer dB=0.23db ± 0.67 and NHR = 0.12dB ± 0.016. Values retrieved from this study show similar trends with other papers abroad.@*Conclusions@#Voice acoustic systems are composed of different recording criteria, recording instrumentations and algorithms which primarily cause the differences in the results obtained in various studies, thus precluding a single normalization. Following international recommendations for individual normalization per institution, we have obtained our own values. Our data was comparable to the results of other international studies. However further investigation is recommended in areas where possibilities of interdialectic variation may produce an effect on the outcome of the study.

Antioxidant and redox status after maximal aerobic exercise at high altitude in acclimatized lowlanders and native highlanders.

Exercise-induced increase in oxygen consumption leads to oxidative stress. On the contrary, hypoxia triggers oxidative stress despite decreased oxygen flux. Therefore, exercise under hypoxia may aggravate oxidative damage. Highlanders are expected to have better antioxidant capacity than lowlanders as a result of adaptation to hypoxia. The present study was undertaken to investigate the effect of exercise on antioxidant system in lowlanders and highlanders at high altitudes (HA). This study was conducted on active male volunteers, randomly selected and categorized into three groups, i.e., lowlanders tested at sea level (LL-SL, n = 35), lowlanders tested at altitude of 4560 m (LL-HA, n = 35) and native highlanders tested (HAN, n = 20) at the same height. Volunteers performed maximal exercise until exhaustion. Blood samples were collected before and after exercise. Both LL-SL and HAN had shown similar VO2max, which was significantly higher than LL-HA. GSH/GSSG ratio significantly increased in LL-SL and decreased in HAN after exercise. With exercise there were a decrease in superoxide dismutase and increase in glutathione peroxidase and catalase activities in HAN. Therefore, the results have suggested that HAN are more susceptible to oxidative stress when subjected to high-intensity exercise than lowlanders. The cumulative effect of higher VO2max and longer duration of exercise in hypoxia may be the reason of higher level of oxidative insult among HAN. Comparatively better management of antioxidant system observed in lowlanders at HA may be explained by the lower VO2max and shorter duration of exercise in hypoxia.

KILUSAN LIGTAS MALARIA: Advancing Social Mobilization towards Sustainable Malaria Control in the Province of Palawan, the Philippines

As malaria continues to be a public health problem in the Philippines, its control is now the responsibility of the Local Government Unit (LGU). In this set-up, social mobilization is believed to be the key strategy in effective and sustainable implementation of malaria prevention and control activities. Palawan has always been the most malarious province in the country. Despite untiring malaria control efforts and huge funds spent to curb this malady for which Palawan has become known, this province remains the largest contributor of malaria cases and deaths. Thus, Kilusan Ligtas Malaria (KLM: meaning Movement Against Malaria) has focused on social mobilization in the implementation of malaria prevention and control. Microscopic confirmation of malaria is done by trained village microscopists, while health education-promotion activities, advocacy and linkage building are carried out by trained village community organizers. The noticeable outcomes are the increase in malaria case finding as reflected in the total number of malaria smears done, the increase in microscopic confirmation of malaria, and the decline in clinical diagnoses. Other outcomes include policy development and implementation in the form of executive orders and community ordinances to support the village microscopists and community organizers. Now, the biggest challenge of KLM is maintaining the momentum and sustaining gains.

Evaluation of blood preservation methods in the performance of the WHO in vitro micro-test for Plasmodium falciparum in the field

In vitro drug susceptibility testing of <I>Plasmodium falciparum</I> must be conducted immediately after collecting a sample of the patient‘s blood; otherwise the parasites may weaken and the culture fail. Collecting blood samples from individuals in areas far from the field station or clinic where in vitro testing is conducted requires a reliable method of sample preservation during transportation. We examined and compared three different methods used to preserve blood samples in endemic areas in the Philippines. The three methods are as follows: the on-site method (test is conducted soon after blood sampling), flask culture method (sample is taken to the laboratory in a culture flask with medium) and EDTA tube method (sample is taken to the laboratory in a blood collection tube). The WHO <I>in vitro</I> micro-test for susceptibility of <I>P. falciparum</I> to chloroquine was performed using an AnaeroPack® system and a portable thermostat incubator. Evaluation of the three methods was based on schizont maturation, ease of handling, and risk of contamination during the test. The on-site and flask culture methods, but not the EDTA tube method, were effective for keeping the parasites viable. Furthermore, schizont maturation appeared better with the flask method than with the on-site method, especially in the control wells (drug-free wells). In addition, it was easier to perform the flask method than the on-site method. No contamination was observed using any of the methods. The results of the study suggest that the flask culture method is the most effective and useful way to preserve blood samples for the in vitro test and, moreover, that it aids in providing detailed field evidence of drug-resistant malaria.

Energy cost and cardiorespiratory changes during the practice of Surya Namaskar.

Surya Namaskar (SN), a group of Yogic exercise consists of a set of twelve postures which is practiced by some of the yoga practitioners. The present study was undertaken to observe critically the energy cost and different cardiorespiratory changes during the practice of SN. Twenty-one male volunteers from the Indian Army practiced selected Yogic exercises for six days in a week for three months duration. The Yogic practice schedule consisted of Hatha Yogic Asanas (28 min), Pranayama (10.5 min) and Meditation (5 min). In the Yogic practice schedule 1st they practiced Kapal Bhathi (breathing maneuvers) for 2 min then Yogamudra (yogic postural exercise) for 2 min, after that they took rest until oxygen consumption and heart rate (HR) came to resting value. Subsequently subjects performed SN for 3 min 40 seconds on an average. After three months of training at the beginning of the fourth month subjects performed entire Yogic practice schedule in the laboratory as they practiced during their training session and experiments were carried out. Their pulmonary ventilation, carbondioxide output, Oxygen consumption, HR and other cardiorespiratory parameters were measured during the actual practice of SN. Oxygen consumption was highest in the eighth posture (1.22+/-0.073 1 min(-1)) and lowest in the first posture (0.35+/-0.02 1 min(-1)). Total energy cost throughout the practice of SN was 13.91 kcal and at an average of 3.79 kcal/min. During its practice highest HR was 101+/-13.5 b.p.m. As an aerobic exercise SN seemed to be ideal as it involves both static stretching and slow dynamic component of exercise with optimal stress on the cardiorespiratory system.

Effect of yogic exercises on physical and mental health of young fellowship course trainees.

A study was undertaken to observe any beneficial effect of yogic practices during training period on the young trainees. 54 trainees of 20-25 years age group were divided randomly in two groups i.e. yoga and control group. Yoga group (23 males and 5 females) was administered yogic practices for the first five months of the course while control group (21 males and 5 females) did not perform yogic exercises during this period. From the 6th to 10th month of training both the groups performed the yogic practices. Physiological parameters like heart rate, blood pressure, oral temperature, skin temperature in resting condition, responses to maximal and submaximal exercise, body flexibility were recorded. Psychological parameters like personality, learning, arithmetic and psychomotor ability, mental well being were also recorded. Various parameters were taken before and during the 5th and 10th month of training period. Initially there was relatively higher sympathetic activity in both the groups due to the new work/training environment but gradually it subsided. Later on at the 5th and 10th month, yoga group had relatively lower sympathetic activity than the control group. There was improvement in performance at submaximal level of exercise and in anaerobic threshold in the yoga group. Shoulder, hip, trunk and neck flexibility improved in the yoga group. There was improvement in various psychological parameters like reduction in anxiety and depression and a better mental function after yogic practices.

Aerobic capacity & perceived exertion after practice of Hatha yogic exercises.

BACKGROUND & OBJECTIVES: Reports on the effect of yogic exercises on aerobic capacity are few. There is also no literature available on the effect of yogic exercise on perceived exertion (PE) after maximal exercise. In this study the effect of training in Hatha yogic exercises on aerobic capacity and PE after maximal exercise was observed. METHODS: Forty men from the Indian army (aged 19-23 yr) were administered maximal exercise on a bicycle ergometer in a graded work load protocol. The oxygen consumption, carbon dioxide output, pulmonary ventilation, respiratory rate, heart rate (HR) etc., at maximal exercise and PE score immediately thereafter were recorded. The subjects were divided into two equal groups. Twelve subjects dropped out during the course of study. One group (yoga, n = 17) practiced Hatha yogic exercises for 1 h every morning (6 days in a week) for six months. The other group (PT, n = 11) underwent conventional physical exercise training during the same period. Both groups participated daily in different games for 1 h in the afternoon. In the 7th month, tests for maximal oxygen consumption (VO2Max) and PE were repeated on both groups of subjects. RESULTS: Absolute value of VO2Max increased significantly (P < 0.05) in the yoga group after 6 months of training. The PE score after maximal exercise decreased significantly (P < 0.001) in the yoga group after 6 months but the PT group showed no change. INTERPRETATION & CONCLUSION: The practice of Hatha yogic exercises along with games helps to improve aerobic capacity like the practice of conventional exercises (PT) along with games. The yoga group performed better than the PT group in terms of lower PE after exhaustive exercise.

Review of cases of hyponatraemia in the Port Moresby General Hospital between August 1993 and June 1995.

Hyponatraemia (serum sodium level below 130 mmol/l) is a common electrolyte abnormality in a hospital population. It can be associated with dehydration, overhydration or normal hydration. Clinically, it is important to recognize the common diseases associated with hyponatraemia since correct treatment in terms of fluid replacement is essential in preventing complications of low serum sodium. We have reviewed results of serum sodium tested from patients admitted to the Port Moresby General Hospital between 1993 and 1995. This was aimed at identifying the most common features associated with low sodium. Clinical information and diagnosis were obtained by looking through a series of request forms. Of the approximately 30,000 blood samples taken over 23 months, the percentage of samples with hyponatraemia was about 1%. Hyponatraemia was more common in medical (38%) and paediatric (35%) cases and at the extremes of ages, ie, under the age of 6 years and above 40 years. Over a quarter of the hyponatraemic patients had severe hyponatraemia (serum sodium below 120 mmol/l). Clinical conditions commonly associated with hyponatraemia, in descending order of importance, were diarrhoea and vomiting, renal failure, central nervous system infections and trauma, pulmonary infections, oedematous states (eg, nephrotic syndrome) and diabetes mellitus.

Body composition in air and road inductees at high altitude during the initial days of acclimatization.

This study assesses body composition changes and their time course during the initial days of acclimatization to high altitude (HA). Comparisons were made between gradual and acute induction to HA using 60 male lowlander volunteers (24-28 years of age) divided into two equal groups for inducting them to HA. Thirty subjects were air-lifted from sea level (SL) to 3500 m HA in 1 h. These subjects were air inductees (AI). The other 30 subjects were transported in 4 days by road to the same location at 3500 m. These were road inductees (RI). After remaining for 15 days at 3500 m both groups were inducted to 4200 m by road. All the subjects could not reach the various altitudes at the same time due to logistical problems. Ultimately, data for each altitude (SL, 3500 m and 4200 m) were available for only 26 RI subjects and 10 AI subjects. Skinfold thickness (SKF) measurements for the subscapular, thigh, triceps, biceps, juxtanipple, umbilicus, suprailiac and calf regions were taken in order to calculate fat percentages. Measurements were taken at SL and on days 1 and 9 at both 3500 m and 4200 m. On day 1 at 3500 m, RI showed a significant fall in body weight (BW) with respect to SL but AI maintained it. On subsequent days at HA both groups showed a significant fall in BW and lean body mass but not in percentage fat. SKF in the biceps and triceps regions decreased significantly but in the umbilicus and suprailiac regions it significantly increased at HA in both groups. Body composition, along with other parameters, is discussed determining the acclimatization schedule for sojourners at HA. Possibly, translocation of body fat takes place from the periphery to deep body fat depots in the core/main trunk due to the cold at HA.

Physiological, biochemical and histological changes due to physostigmine in monkeys.

Physostigmine (Phy), a short-acting reversible anticholinesterase agent is considered to be a potent prophylactic antidote for the highly toxic organophosphorous (OP) compounds. The toxic effects, if any, of the probable prophylactic doses of Phy have been evaluated by studying its physiological, biochemical and histological effects in monkeys. Phy only at 100 micrograms/kg resulted in certain cholinergic signs such as salivation, lacrymation and muscular faciculations; physiological changes such as mild tachycardia, tachypnea, higher amplitude in electrical activity of the brain, clinico-chemical effects like fall in PO2, PCO2 and alkalosis and histologically an inflammatory reaction in the lungs. On the other hand, the lower dose, i.e. 50 micrograms/kg appeared to be devoid of cholinergic signs and symptoms. However, we observed a significant inhibition of both plasma and erythrocyte ChE and increase in the rectal temperature in both the Phy treated groups. From this study, Phy at a dose of 50 micrograms/kg could be inferred as a safe, sign free intramuscular dose and may probably be used in pretreatment regimen against nerve agents.