Comparison of intradialytic continuous and interval training on hemodynamics and dialysis adequacy: A crossover randomized controlled trial.

AIM: Circulating blood volume (BV) during exercise changes depending on the intensity and duration, and post-exercise hypotension is observed after continuous exercise. We investigated the safety and efficacy of both interval and continuous IDE at anaerobic threshold (AT) levels with respect to hemodynamic stability and dialysis efficiency. METHODS: In this crossover randomized controlled trial, 16 patients on haemodialysis were subjected to three trial arms, including non-IDE, interval-IDE, and continuous-IDE arms. Systolic blood pressure (SBP), BV, and ultraviolet absorbance - an indicator of dialysis efficiency - were continuously measured, and each change was compared between the three arms by two-way analysis of variance. RESULTS: Continuous IDE decreased SBP from post-exercise to the end of dialysis compared with baseline (pre 142.8 ± 19.0 vs. post 127.5 ± 24.5 mmHg, p = .02), whereas interval IDE maintained better SBP levels post-exercise (pre 139.9 ± 17.1 vs. post 140.1 ± 15.8 mmHg, p = 1.0) than continuous IDE (non-IDE 133.2 ± 19.9 vs. interval 140.1 ± 15.8 vs. continuous 127.5 ± 24.5 mmHg, p = .04). Moreover, interval IDE caused less tiredness and few symptoms (p < .05), despite reaching higher intensity than continuous IDE (p = .001). The BV of each IDE arm decreased during exercise and recovered post-exercise to the same level as non-IDE. Ultraviolet absorbance was not different between each arm (p = .16). CONCLUSION: AT-level interval IDE maintains better hemodynamic stability from post-exercise to the end of dialysis and may represent a novel approach that can be effectively performed with fewer symptoms.

Effect of blood volume change related to intensity of intradialytic aerobic exercise on hemodialysis adequacy: a pilot study.

PURPOSE: Intradialytic exercise may improve dialysis efficiency; however, the association between changes in blood volume (BV) related to exercise intensity and solute removal kinetics remains unknown. We herein investigated the relationship between changes in BV with exercise and removal of solute molecules during hemodialysis. METHODS: Each of the 21 hemodialysis patients underwent cardiopulmonary exercise test to measure anaerobic threshold (AT). According to the exercise intensity, patients were classified into two groups, the low group (n = 12), whose intensity was below the AT, and the high group (n = 9), whose intensity was at the AT level. Each patient completed two trial arms of resting and discontinuous exercise dialysis sessions in a randomized manner. RESULTS: The change in BV with the exercise dialysis session in the high group decreased during exercise (p = 0.028) and remained decreased after exercise (p = 0.016), compared with the low group. In the low group, compared with routine sessions, the removal of potassium (p = 0.030), phosphate (p = 0.024), and urea nitrogen (p = 0.065) increased during exercise, but the total removal of these solutes did not change. In the high group, the removal of phosphate (p < 0.001) and urea nitrogen (p = 0.018) after exercise and even total phosphate (p = 0.027) decreased. CONCLUSION: These findings suggest that the removal of small solute molecules is improved during exercise in intradialytic low-intensity exercise with no change in BV, and decreased after exercise in high-intensity exercise with a decrease in BV. CLINICAL TRIALS REGISTRY: Trial retrospectively registered at the UMIN Clinical Trials Registry: study number UMIN000038629 (Registration date: September 7, 2019).

Japanese bilateral cooperation for the promotion of poliomyelitis eradication in China.

In order to support poliomyelitis eradication in China, Japan launched project-type cooperation, The China Polio Control Project, in Shandong Province in 1990. The outbreaks of poliomyelitis in Shandong Province were successfully controlled by the OPV mass immunization campaigns began in 1991. Subsequently, AFP surveillance was established. The cooperation gradually expanded to include four neighboring provinces and subsequently five provinces in southern China. Hospital-based active surveillance has confirmed substantial improvement of the on-going AFP surveillance in most of the southern provinces. In view of the recent situation of global poliomyelitis eradication, China still needs to maintain high immunization coverage by poliovirus vaccine together with reliable surveillance system since it has been threatened by the importation of wild poliovirus from polio-endemic countries. At the same time, however, the use of inactivated poliovirus vaccine should be considered in the near future in order to prevent further occurrence of VAPP.

Risk of transmission of hepatitis B virus through childhood immunization in northwestern China.

Transmission of bloodborne pathogens by means of unsafe injection practices is a significant public health problem in developing countries. Although the overall proportion for immunization is low among injections, unsafe immunization practices affect mostly infants, a population with an increased likelihood of becoming hepatitis B virus carriers. This study estimated the prevalence of unsafe injection among vaccinators working at the peripheral level in northwestern China and the risk of HBV infections among infant vaccinees, and analyzed factors contributing to the most prevalent unsafe practice: the reuse of a non-sterilized reusable syringe among infants. A knowledge-attitude-practice survey was conducted in which 180 peripheral vaccinators selected by multi-stage cluster sampling in each of four provinces and one autonomous region completed a self-administered questionnaire. The lack of observational data for assessing the validity of the self-reported practices made the study prone to systematic respondent bias that may have skewed the results towards underestimation of unsafe practices. The minimum estimate of the percentage of peripheral vaccinators reusing a syringe and/or needle without sterilization between infants was 7.2-55.0%, whereas the percentage of those disposing of used disposable syringes and needles inappropriately was 8.9-23.3% by province. According to a model-based estimate, the annual number of HBV infections among 100,000 fully immunized children due to unsafe immunization injection was at least 135-3120. An insufficient supply of syringes and the attitude to justify reuse were significantly associated with the unsafe reuse of a reusable syringe in most part of the area studied. Introduction of auto-disable syringes may contribute to curb the unsafe practices, but the development of safe collection and disposal procedures for used syringes and needles is prerequisite. Sufficient supply of equipment as well as training, supervision, and monitoring targeting specifically on the risk behaviors and concerned attitudes are essential for behavior changes among the vaccinators.

[Survey of knowledge, attitude and behavior regarding safe injection among health practitioners in Shandong, China].

PURPOSE: To assess the knowledge, attitude and behavior of health practitioners (HPs) about safe injection in Shandong, China and to clarify risk factors related to unsafe injection and improper handling of used disposable syringes. METHODS: A cross-sectional study of 497 HPs in three-levels of health units (village clinic, township health center, and county hospital) in two areas of Shandong, China was carried out using a questionnaire. RESULTS: 468 HPs returned completed questionnaires. The proportion that did not receive formal medical education in the village (21.5%) was higher than in the township (9.9%) and in the county (2.5%). Proportions of HPs who only used disposable syringes were 97.0% in the county, 81.1% in the township and 69.0% in the village. Scores for safe injection knowledge among village HPs were significantly lower than those with township and county HPs (P < 0.001). Rate of unsafe injection practice was 6.2%, rate of improper handling of used disposable syringes was 7.6%, and both of which were significantly greater at the village level. Four factors were found to be significantly related to unsafe injection practice (P < 0.05): lower than middle level professional grade; knowledge scores of < 15 (full score 18); thinking that AIDS is not a terrible disease; and thinking that patients would accept the practice of sharing the same syringe for different persons. Four factors were found to be significantly related to improper handling of used disposable syringes (P < 0.05): working in the village; knowledge scores of < 15; thinking that patients would accept the practice of sharing the same syringe for different persons; and unwillingness to properly handle used disposable syringes. CONCLUSIONS: HPs working in village clinics had comparatively high rates of unsafe injection practice and improper handling of used disposable syringes, and a lower level of knowledge about safe injection. Lack of knowledge about safe injection was a risk factor for both unsafe injection and improper handling of used disposable syringe. Therefore, interventions should focus on this insufficient level of safe injection knowledge.