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Economy and rate of carbohydrate oxidation during running with rearfoot and forefoot strike patterns.

It continues to be argued that a forefoot (FF) strike pattern during running is more economical than a rearfoot (RF) pattern; however, previous studies using one habitual footstrike group have found no difference in running economy between footstrike patterns. We aimed to conduct a more extensive study by including both habitual RF and FF runners. The purposes of this study were to determine whether there were differences in running economy between these groups and whether running economy would change when they ran with the alternative footstrike pattern. Nineteen habitual RF and 18 habitual FF runners performed the RF and FF patterns on a treadmill at 3.0, 3.5, and 4.0 m/s. Steady-state rates of oxygen consumption (Vo2, ml·kg(-1)·min(-1)) and carbohydrate contribution to total energy expenditure (%CHO) were determined by indirect calorimetry for each footstrike pattern and speed condition. A mixed-model ANOVA was used to assess the differences in each variable between groups and footstrike patterns (α = 0.05). No differences in Vo2 or %CHO were detected between groups when running with their habitual footstrike pattern. The RF pattern resulted in lower Vo2 and %CHO compared with the FF pattern at the slow and medium speeds in the RF group (P < 0.05) but not in the FF group (P > 0.05). At the fast speed, a significant footstrike pattern main effect indicated that Vo2 was greater with the FF pattern than with the RF pattern (P < 0.05), but %CHO was not different (P > 0.05). The results suggest that the FF pattern is not more economical than the RF pattern.

[Evolution and follow-up of hunger strikers: experience from an interregional hospital secured unit]. / Évolution et surveillance des patients grévistes de la faim : expérience d'une unité hospitalière sécurisée interrégionale.

PURPOSE: A hunger strike is a voluntary fast, performed to protest publicly against an issue deemed unfair. In the case of French prisoners, hospitalization in an interregional hospital secured units (UHSI) may be necessary. METHODS: A retrospective epidemiological study based on one UHSI medical records was performed on the period of May, 2006 to December, 2008, and focused on symptoms, outcomes and ethical problems encountered. RESULTS: Seven men and one woman with a mean age of 32.6 years were hospitalized in an UHSI, with nine episodes of hunger strike of a median duration of 57 days. Clinical symptoms began after two weeks of voluntary deprivation in the form of dizziness, weakness, muscle pain and headache. Laboratory tests showed hypoglycemia (<0.4g/L) on admission, 16.3% decrease of albumin after 40.5 days, and dehydration in case of thirst strike. The clinical tolerance was good and no patient presented Wernicke's encephalopathy. A diabetic patient developed acidocetosis during two hunger strikes. All hunger strikes were respected by medical staff, and treatment was based upon surveillance of symptoms, vitamin B and sweetened drinks administration and explanations of the clinical hazards on a daily basis. CONCLUSION: The special problem encountered in the medical management of these strikers was to convince them to accept treatments in order to avoid a coercive life-saving treatment as requested by French law.

Neurological complications of prolonged hunger strike.

We investigated neurological findings in 41 prisoners (mean age: 28.6) who participated in a hunger strike between 2000 and 2002. All cases were evaluated using neuropsychological, neuroradiological, and electrophysiological methods. The total duration of fasting ranged from 130 to 324 days (mean 199 days). All cases had 200-600 mg/day thiamine orally for 60-294 days (mean 156) during the hunger strike, and had neurological findings consistent with Wernicke-Korsakoff syndrome. All 41 patients exhibited altered consciousness which lasted from 3 to 31 days. All patients also presented gaze-evoked horizontal nystagmus and truncal ataxia. Paralysis of lateral rectus muscles was found in 14. Amnesia was apparent in all cases. Abnormal nerve conduction study parameters were not found in the patient group, but the amplitude of compound muscle action potential of the median and fibular nerves and sensory nerve action potential amplitude of the sural nerve were lower than the control group, and distal motor latency of the posterior tibial nerve was significantly prolonged as compared with the control group. The latency of visual evoked potential was prolonged in 22 cases. Somatosensory evoked potential (P37) was prolonged but not statistically significant. Our most significant finding was that the effect of hunger was more prominent on the central nervous system than on the neuromuscular system, despite the fact that all patients were taking thiamine. In our opinion, partial recovery of neurological, and neurocognitive signs in prolonged hunger could be a result of permanent neurological injury.

[Assistance in hunger strikes: legal guidelines]. / Hulpverlening bij hongerstaking; het juridisch kader.

Hunger strikes raise ethical and legal issues, in addition to societal and medical ones. The World Medical Association adopted resolutions in 1975 (Declaration of Tokyo) and 1991 (Declaration of Malta) in which respect for the decision to refuse food was confirmed. A survey of the relevant international and national standards shows that in the Netherlands law and policy are more supportive of respect for food refusal (and against forced feeding) than would seem to be the case at the international level. However, respect for the decision of the hunger striker requires that it is well-considered, informed, and free from group coercion. The existence of an unambiguous legal framework will not save the advising physician from difficult dilemmas which will in particular occur in case of a protracted hunger strike. In anticipation of expected loss of judgement capacities in protracted hunger strikers it is advisable that the wishes of the striker and the professional policy that the physician will adopt are written down. In case of hunger strike legal standards cannot fully replace psychological insight, professional ethics and conscience, however.