Coronary microvascular function in athletes with abnormal exercise test results.

AIMS: In asymptomatic athletes, abnormal exercise test (ET) results have a poor positive predictive value. It is unknown whether abnormal ET results in the absence of obstructive coronary artery disease (CAD) are related to coronary microvascular dysfunction. It is also unknown whether they should be considered false-positive ET results or a consequence of physiological adaptation to sport. In our study, we evaluated whether athletes with abnormal ET results and documented myocardial ischaemia in the absence of obstructive CAD have an attenuated microvascular function and whether coronary microvascular dysfunction is related to endothelial dysfunction. METHODS AND RESULTS: Nine athletes with concordant abnormal ET and myocardial perfusion scintigraphy (MPS) results without obstructive CAD were compared with age- and gender-matched individuals with a low-to-intermediate a priori risk of CAD. Coronary flow reserve was assessed by Rubidium-82 positron emission tomography (PET) imaging. Endothelin­1 concentrations were measured to evaluate endothelial function. Coronary flow reserve was significantly lower in athletes (3.3 ± 0.8 versus 4.2 ± 0.6, p = 0.014 respectively). Endothelin­1 levels were significantly higher in athletes (1.3 ± 0.2 pg/ml versus 1.0 ± 0.2 pg/ml, p = 0.012 respectively). There was no correlation between endothelin­1 concentrations and mean global coronary flow reserve (r = 0.12). CONCLUSION: Athletes with abnormal ET and MPS outcomes indicative for myocardial ischaemia and no obstructive CAD have a lower coronary flow reserve compared with non-athletes with low-to-intermediate a priori risk of CAD, suggesting an attenuated coronary microvascular function. Higher endothelin­1 concentrations in athletes suggest that endothelial-dependent dysfunction is an important determinant of the attenuated microvascular function.

The diagnostic accuracy of exercise electrocardiography in asymptomatic recreational and competitive athletes.

The goals of this study were to determine the prevalence and determinants of false-positive exercise tests in athletes. Data from all athletes who visited the Department of Sport Medicine for assessment of sports eligibility during a 1.5-year period were reviewed retrospectively. Potential determinants of (false) positive test results that were evaluated included demographics, cardiovascular risk factors, sports characteristics, resting electrocardiogram (ECG) abnormalities, and exercise capacity. Data from 1298 athletes were included. In 53 athletes (4.1%), the exercise ECG was classified as positive. Among 38 athletes who were referred to a sports cardiologist for further diagnostic evaluation, 36 (95%) were classified as having a false-positive test result and 2 athletes (5%) required coronary revascularization. Athletes with a false-positive test were older than athletes with a negative test (53 ± 8 vs 45 ± 13 years, P = 0.03). In conclusion, exercise electrocardiography has a low positive predictive value in asymptomatic recreational and competitive athletes, with a false-positive test result being associated with higher age. Given the relatively high prevalence of false-positive test results in this population, efforts should be made to develop strategies aimed at identifying false-positive test results in a simple noninvasive manner.

Treatment completion in latent tuberculosis infection at specialist tuberculosis units in Spain.

SETTING: Treatment of latent tuberculosis infection (LTBI) is essential for tuberculosis (TB) control in low-prevalence countries. However, the long treatment duration and adverse events frequently result in suboptimal treatment completion. OBJECTIVE: To determine completion rates of LTBI treatment and to identify risk factors for non-completion of treatment. DESIGN: Retrospective, observational cohort study. METHODS: All non-human immunodeficiency virus infected adults who started treatment for LTBI at two specialist TB units in Spain between January 2004 and March 2007 were included. Those who discontinued treatment due to toxicity were excluded. RESULTS: Of 599 people who started on treatment, 484 (80.8%, 95%CI 77.5-83.8) completed it. Age <36 years (OR 0.33, 95%CI 0.30-0.76, P = 0.001), male sex (OR 0.58, 95%CI 0.37-0.92, P = 0.02), immigrant status <5 years of residence (OR 0.21, 95%CI 0.12-0.37, P < 0.001) and the presence of social risk factors (OR 0.21, 95%CI 0.11-0.39, P < 0.001) were associated with lower rates of treatment completion. Short treatment regimens were not associated with better treatment completion compared with isoniazid for 6-9 months (OR 0.89, 95%CI 0.45-1.80, P = 0.76). CONCLUSIONS: Overall, completion rates of LTBI treatment in specialist TB units are good. Nevertheless, counselling should be strengthened and new strategies to enhance adherence should be sought for recent immigrants and for people in unfavourable social situations.

The role of gallbladder emptying in gallstone formation during diet-induced rapid weight loss.

Obese persons are at risk for cholesterol gallstones because their bile is saturated with cholesterol. The risk increases during rapid weight loss by means of certain very-low-calorie diets or gastric bypass surgery. Gallstone risk factors during rapid weight loss include increased bile cholesterol saturation index and gallbladder stasis. Obese subjects were randomized to one of two low-calorie liquid diets for rapid weight loss: a 520-kcal diet with less than 2 g fat/d, and a 900-kcal diet with 30 g fat/d (including one 10-g fat meal to stimulate maximal gallbladder emptying). Bile and blood lipids, saturation index, leukocyte 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase activity, and ultrasonographic gallbladder emptying were measured repeatedly during dietary treatment. Both diets produced comparable weight loss of 22%. Bile cholesterol saturation index increased during both diets (26%), but fell to 15% below prediet level after weight loss. Compared with subjects' maximal gallbladder emptying fraction of 66%, the 520-kcal diet provided poor gallbladder emptying (35%), whereas the 10-g fat meal of the 900-kcal diet provided maximal emptying. Gallstones developed in four of six 520-kcal subjects and none of seven 900-kcal subjects (P = .021), an unanticipated difference that resulted in premature study termination for ethical reasons. Blood lipids and HMG CoA reductase activity in mononuclear leukocytes fell at week 8 during both diets, but recovered while weight was still being lost. The findings suggest that gallstone risk during rapid weight loss may be reduced by maintenance of gallbladder emptying with a small amount of dietary fat. Ultimately, weight loss reduced bile cholesterol saturation and improved highdensity lipoprotein (HDL) levels.

Language development in infants and toddlers.

Speech and language problems constitute the nation's number one handicapping condition. Nurse practitioners are in a unique position to observe the language development of a young child and the social-communicative interaction between parents and child. They need to be aware of the early milestone information regarding language development so that a problem can be identified. It is imperative that these problems be noted early and managed correctly in order to insure the development of adequate communication skills.

Oral health in children: prevention of dental caries.

Dental problems are common among children and adolescents in the United States. More than 90 percent of our youth have dental caries, malocclusions, injury to teeth and mouth and gum disease. However, it is possible to maintain oral health and prevent dental problems and, specifically, dental caries, through education and motivation. Nurses working with children and families are more frequently in a position to initiate a program for dental health than are members of the dental profession. We feel that it is essential in light of disease occurrence and current levels of dental caries, for nurses to incorporate oral health maintenance in their care of children in ambulatory and acute care settings.

Ischaemic heart disease in middle-aged men. Prevalence comparisons in Europe.

The authors report the results of a collaborative study of the prevalence of ischaemic heart disease in 6 samples of middle-aged male clerical workers, drawn from 5 European countries and covering in all 4522 subjects. Detailed standardization of data-collection methods and of coding, analysis and tabulation was undertaken.Estimated prevalence rates for angina and history of possible infarction, based on the use of a standard questionnaire, showed significant variation between samples, but the validity of international comparisons of symptoms remains unproven. Prevalence rates for ischaemic-type ECG findings were high everywhere, and mostly showed no significant variation between the groups studied. Central coding of ECG findings proved essential to the making of unbiased comparisons. Neither the prevalence rates for symptoms nor those for ECG findings in these samples were recognizably correlated with the corresponding national mortality rates for ischaemic heart disease.Several possible risk factors were studied, but the only one found to be consistently associated with ischaemic heart disease was a raised blood pressure. Cigarette smoking was strongly associated with bronchitic symptoms and dyspnoea, but an association with heart disease was not demonstrated.