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1.
J Sport Rehabil ; 32(5): 597-602, 2023 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-37044378

RESUMO

CONTEXT: Previous studies have found that instructions promoting an external focus (EF) tend to be more effective for movement pattern retraining compared to instructions promoting an internal focus (IF), for a variety of movement tasks. However, few studies have examined how different types of instructions affect running mechanics associated with running-related injury risk. Therefore, the purpose of this study was to compare the effects of instructions promoting different attentional foci on impact forces during running. DESIGN: Cross-sectional study. METHODS: Twenty uninjured female recreational runners ran at a self-selected speed with their typical pattern (no instructions condition) on an instrumented treadmill that measured ground reaction forces. Next, they were given 2 sets of instructions intended to alter their running pattern; one promoted an IF and the other promoted an EF. Repeated-measures analysis of variance was used to compare impact peaks and loading rates across the conditions (no instructions, IF, and EF), with post hoc tests conducted in the case of a significant omnibus test. RESULTS: There were differences among the conditions in the impact peaks (P < .001) and loading rates (P < .001). Impact peaks were lower for the IF (P = .002) and EF (P < .001) conditions compared to the no instructions condition. Loading rates were lower for the EF condition compared to the no instructions (P < .001) and IF (P < .001) conditions; there was no difference between the IF and no instructions conditions (P = .24). CONCLUSIONS: Our findings indicate that instructions promoting an EF may be more effective at reducing loading rates during running compared to instructions promoting an IF. Clinicians should consider these findings when attempting to retrain a runner's running pattern.


Assuntos
Marcha , Corrida , Humanos , Feminino , Estudos Transversais , Fenômenos Biomecânicos , Corrida/lesões , Teste de Esforço
2.
J Therm Biol ; 111: 103399, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36585074

RESUMO

OBJECTIVES: This study aimed to examine the impact of extreme heat exposure frequency on inflammation and well-being in UK Fire Service personnel. METHODS: 136 Fire personnel and 14 controls (CON) were recruited [92 Firefighters (FF), 44 Breathing Apparatus Instructors (BAI)]. BAI were split into low (LBAI; ≤15 exposures per month) and high (HBAI; ≥20 exposures per month) categories. Measures of inflammation, mood and fatigue were collected at 0, 3 and 6 month times points. These variables were analysed for differences between groups and association with frequency of exposure. RESULTS: HBAI exhibited raised IL-1ß, IL-6, IL-10, IgE and lower IgM (p < 0.05). In addition, IL-1ß, IL-6, IL-10 and IgM were associated with monthly exposure number, with exposures accounting for 15.4% of the variance in IL-6, 11.8% of IL-1ß and 25.2% of IL-10. No differences in mood or fatigue were reported (p > 0.05). CONCLUSION: High exposure firefighting consistently causes systemic inflammation without perceptual recognition of potential health risks.


Assuntos
Bombeiros , Exposição Ocupacional , Humanos , Interleucina-10 , Interleucina-6 , Inflamação/etiologia , Fadiga , Imunoglobulina M , Exposição Ocupacional/efeitos adversos
4.
Int J Sports Phys Ther ; 16(5): 1278-1285, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34631248

RESUMO

BACKGROUND: Athletes who have undergone anterior cruciate ligament reconstruction typically exhibit relatively high/rapid loading of their uninvolved limb during bilateral landing and jumping (vs. their limb that underwent reconstruction), which may place their uninvolved limb at risk for injury. However, previous studies have only examined forces and loading rates for tasks involving an isolated land-and-jump. PURPOSE: The purpose of this study was to examine bilateral landing and jumping kinetics during performance of a repetitive tuck jump task in athletes who had undergone anterior cruciate ligament reconstruction and completed rehabilitation. STUDY DESIGN: Cross-sectional study. METHODS: Nine athletes (four males, five females) participated in this study. All participants had undergone successful unilateral anterior cruciate ligament reconstruction, had completed post-operative rehabilitation, and were in the process of completing return-to-sport testing. Athletes performed a repetitive tuck jump task for 10 seconds, while ground reaction forces were recorded for their uninvolved and involved limbs via separate force platforms. Two-way analysis of variance, for within-subjects factors of limb and cycle, was performed for the impact forces, loading rates, and propulsive forces from the first five land-and-jump cycles completed. RESULTS: There was not a limb-by-cycle interaction effect or main effect of cycle for the impact forces, loading rates, or propulsive forces; however, there was a main effect of limb for the impact forces (F(1, 8) = 14.64; p=0.005), loading rates (F(1, 8) = 5.60; p=0.046), and propulsive forces (F(1, 8) = 10.38; p=0.012). Impact forces, loading rates, and propulsive forces were higher for the uninvolved limb, compared to the involved limb, over the five land-and-jump cycles analyzed. CONCLUSION: The athletes in this study consistently applied higher and more rapid loads to their uninvolved limb over multiple land-and-jump cycles. This may help to explain the relatively high injury rates for the uninvolved limb in athletes who have returned to sport following anterior cruciate ligament reconstruction.

5.
Exp Physiol ; 106(1): 233-243, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32462715

RESUMO

NEW FINDINGS: What is the central question of this study? Fire service instructors are frequently exposed to live fire scenarios, representing the most extreme chronic occupational heat exposure. These individuals report a series of unique health issues. We sought to identify whether the number of exposures completed was associated with inflammatory and immunological markers and symptoms of ill health. What is the main finding and its importance? Fire service instructors exhibit greater levels of inflammatory markers in comparison to firefighters. The number of exposures to fire is positively related to the prevalence of ill health and inflammation. Implementation of a proposed limit of nine exposures per month might be appropriate to minimize health issues. ABSTRACT: Fire Service Instructors (FSIs) experience ∼10 times more fire exposures than firefighters (FFs), and the increased physiological stress from this potentially puts them at risk of ill health and future cardiac events. The aim of the study was to establish whether FSIs exhibit elevated biomarkers associated with cardiac event risk, identify whether FSIs experience systemic inflammation linked to the frequency of fire exposure and evaluate a proposed exposure limit of nine exposures per month. Blood samples were collected from 110 Fire Service personnel (mean ± SD, age,44 ± 7 years; height, 178.1 ± 7.1 cm; and body mass, 84.3 ± 12.0 kg; FSIs n = 53 and FFs n = 57) for biomarker analysis. Work history details were collected from all participants. Participants with biomarker concentrations above healthy reference ranges were classified as being 'at risk'. The neutrophil-to-lymphocyte ratio, platelet count, cardiac troponin T, interleukin (IL)-6, IL-1ß, C-reactive protein and immunoglobulin G were greater in FSIs than in FFs (P < 0.05). Multiple regression analysis revealed that 18.8% of IL-6, 24.9% of IL-1ß, 29.2% of C-reactive protein and 10.9% of immunoglobulin G variance could be explained by the number of exposures to heat per month. Odds ratios revealed that those FSIs above the nine per month exposure limit were six to 12 times more likely to be classified as 'at risk' and were 16 times more likely to experience symptoms of ill health. Increased cytokine levels suggest that FSIs experience systemic inflammation, which is related to symptoms of ill health. We propose that an exposure limit could reduce the prevalence of these biomarker risk factors and ill health.


Assuntos
Temperatura Alta/efeitos adversos , Inflamação/sangue , Exposição Ocupacional , Estresse Fisiológico/fisiologia , Adulto , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Bombeiros , Humanos , Masculino , Pessoa de Meia-Idade
6.
J Sport Rehabil ; 29(4): 463-468, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31034323

RESUMO

CONTEXT: The bodyweight squat exercise is a common component for treatment and prevention of patellofemoral pain; however, it can also place a high load on the patellofemoral joint. Restricting anterior motion of the knees relative to the toes during squatting appears to reduce patellofemoral loading. However, exercise professionals typically rely on verbal instructions to alter squat technique. OBJECTIVE: To evaluate the influence of verbal instructions regarding squat technique on patellofemoral joint loading. DESIGN: Cross-sectional study. SETTING: Motion analysis laboratory. PARTICIPANTS: Eleven uninjured females. INTERVENTION: Participants performed bodyweight squats before (baseline) and after receiving verbal instructions to limit anterior knee motion. Two different types of verbal instruction were used, one intended to promote an internal focus of attention and the other intended to promote an external focus of attention. Three-dimensional kinematics and kinetics were recorded using a multicamera system and force plate. MAIN OUTCOME MEASURES: Sagittal plane patellofemoral joint forces and stress were estimated using a musculoskeletal model. RESULTS: Participants demonstrated a reduction in patellofemoral joint forces (35.4 vs 31.3 N/kg; P = .01) and stress (10.7 vs 9.2 mPa; P = .002) after receiving instructions promoting an internal focus of attention, compared with their baseline trials. Participants also demonstrated a reduction in patellofemoral joint forces (35.4 vs 32.3 N/kg; P = .03) and stress (10.7 vs 9.6 mPa; P = .04) after receiving instructions promoting an external focus of attention (vs baseline). However, there were no significant differences in patellofemoral forces (P = .84) or stress (P = .41) for trials performed with an internal versus external attentional focus. CONCLUSION: It appears that verbal instruction regarding knee position influences patellofemoral joint loading during squatting.


Assuntos
Exercício Físico/fisiologia , Articulação Patelofemoral/fisiologia , Reforço Verbal , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Síndrome da Dor Patelofemoral/prevenção & controle , Síndrome da Dor Patelofemoral/terapia , Postura/fisiologia , Suporte de Carga , Adulto Jovem
7.
J Immunol ; 203(9): 2472-2484, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31562212

RESUMO

Innate lymphoid cells (ILCs) are strategically positioned at mucosal barrier surfaces where they respond quickly to infection or injury. Therefore, we hypothesized that ILCs are key contributors to the early immune response in the intestine against Listeria monocytogenes Using a modified strain of L. monocytogenes that mimics human gastrointestinal listeriosis in mice, we find ILCs to be essential for control of early replication of L. monocytogenes in the intestine as well as for restricted dissemination of bacteria to peripheral tissues. Specifically, group 1 ILCs (ILC1s) and group 3 ILCs (ILC3s) respond to infection with proliferation and IFN-γ and IL-22 production. Mechanistically, we show that the transcription factor STAT4 is required for the proliferative and IFN-γ effector response by ILC1s and ILC3s, and loss of STAT4 signaling in the innate immune compartment results in an inability to control bacterial growth and dissemination. Interestingly, STAT4 acts acutely as a transcription factor to promote IFN-γ production. Together, these data illustrate a critical role for ILCs in the early responses to gastrointestinal infection with L. monocytogenes and identify STAT4 as a central modulator of ILC-mediated protection.


Assuntos
Gastroenteropatias/imunologia , Listeriose/imunologia , Linfócitos/imunologia , Fator de Transcrição STAT4/fisiologia , Animais , Proteínas de Homeodomínio/fisiologia , Imunidade Inata , Interferon gama/biossíntese , Ativação Linfocitária , Camundongos , Camundongos Endogâmicos C57BL , Transdução de Sinais/fisiologia
8.
Sports Biomech ; 18(2): 163-173, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31042140

RESUMO

Training to reduce landing forces is a common component of anterior cruciate ligament injury prevention programmes. The purpose of this study was to compare the effects of training incorporating instructions promoting an internal versus external attentional focus on landing forces in adolescent rugby athletes. Twenty-two rugby athletes were randomly allocated to groups that received instructions promoting an internal versus an external focus during a two week training programme. Landing forces were recorded before and after completion of the programme. During follow-up testing, landings were performed with and without a secondary cognitive task. Both groups exhibited a similar reduction in landing forces following training for trials performed without the secondary cognitive task. However, the groups responded differently when the secondary cognitive task was imposed. Athletes who were trained with an internal focus demonstrated a prominent increase in landing forces for trials that included the secondary cognitive task (vs. trials performed without the secondary cognitive task), whereas the secondary cognitive task had minimal influence for athletes who were trained with an external focus. It appears that training with an external focus may promote adaptations in landing mechanics that can be implemented more automatically.


Assuntos
Adaptação Fisiológica , Atenção , Futebol Americano/fisiologia , Futebol Americano/psicologia , Extremidade Inferior/fisiologia , Condicionamento Físico Humano/métodos , Adolescente , Lesões do Ligamento Cruzado Anterior/prevenção & controle , Fenômenos Biomecânicos , Cognição , Feminino , Humanos , Masculino , Movimento
9.
J Therm Biol ; 82: 1-9, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31128636

RESUMO

OBJECTIVES: Fire Service Instructors (FSI) experience repeated fire exposures a median of 13 ±â€¯8 times a month; consequently they may develop an acclimatised state. However, the chronic immunological implications of heat acclimation are yet to be understood. This study aimed to establish whether FSI exhibit an increased heat tolerance and altered immunological response to heat exposures, compared to non-exposed individuals. The study also aimed to identify if heat tolerance is related to symptoms of ill health. METHODS: Twenty-two participants were recruited: 11 FSI (age: 41 ±â€¯7 yrs, body mass: 77.4 ±â€¯12.2 kg, height: 174.1 ±â€¯8.2 cm) and 11 non-exposed controls (CON) (age: 41 ±â€¯7 yrs, body mass: 75.9 ±â€¯12.2 kg, height: 177.0 ±â€¯8.1 cm). Participants completed a 40 min heat occupational tolerance test (HOTT) exercising at 6 W kg-1 (50.0 ±â€¯1.0 °C, 12.3 ±â€¯3.3% relative humidity) on two occasions, separated by 2 months. Physiological and perceptual measures were collected throughout and venous blood samples were collected prior to and post exposure. RESULTS: FSI displayed significantly reduced peak rectal temperature (Tre) (-0.42 °C), change in Tre (-0.33 °C), and thermal sensation (-1.0) and increased sweat rate (+0.25 L h-1) at the end of the HOTT compared to CON (p < 0.05). FSI exhibited similar responses to the HOTT as CON for all haematological variables. However, resting interleukin-6, interleukin-1ß, and immunoglobulin G were significantly greater in FSI than CON. There was no difference in responses following the 2 month working period. FSI peak Tre was negatively correlated with symptoms of ill health (rpb = -0.473, p = 0.026) and the number of fire exposures in the previous 2 weeks (rs = -0.589, p = 0.004). CONCLUSION: Despite increased heat tolerance compared to non-exposed individuals, FSI may develop a maladaptation to repeated fire exposures, with elevated resting cytokine levels and an increased prevalence of ill health symptoms.


Assuntos
Termotolerância , Adulto , Regulação da Temperatura Corporal , Teste de Esforço , Bombeiros , Resposta ao Choque Térmico , Temperatura Alta , Humanos , Imunoglobulina G/sangue , Inflamação/sangue , Inflamação/etiologia , Interleucina-1beta/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos
10.
Womens Health Issues ; 29(5): 424-431, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30930075

RESUMO

OBJECTIVES: This study aimed to identify specific health and well-being issues that women firefighters may experience as part of their daily working practices. Issues identified from this under-represented population can drive future research, education, and strategy to guide safety and health practices. METHODS: A total of 840 women firefighters from 14 separate countries (255 United Kingdom and Ireland, 320 North America, 177 Australasia, and 88 mainland Europe) completed the survey over a 4-month period. Questions related to general health and well-being and role-specific health concerns, gender-related issues, and available exercise facilities. RESULTS: Women firefighters in North America reported a higher prevalence of lower back (49%) and lower limb (51%) injuries than all other groups. North American respondents reported more heat illnesses (45%) than respondents from other places (36%). Although many participants did not respond, of those who did, 39% thought the menstrual cycle (199/512) or menopause (55/151) affected their work, and 36% were concerned for their ability to meet future job demands. Sixteen percent felt confident they could complete the role after 60 years of age. Women firefighters identified a lack of strength and conditioning support (50%) or lack of gym access (21%). There appears to be poor availability of female-specific personal protective equipment, with availability greatest in the United Kingdom (66%) compared with the sample as a whole (42%). CONCLUSIONS: There is a need for female-specific strength and conditioning support and facilities to decrease injury and illness risk and improve longevity. Research and education into gynecological issues, heat exposure, and their effects on women firefighters' fertility and cancer risk is required.


Assuntos
Acidentes de Trabalho/estatística & dados numéricos , Bombeiros/psicologia , Bombeiros/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Saúde Ocupacional/estatística & dados numéricos , Qualidade de Vida/psicologia , Saúde da Mulher , Adulto , Australásia , Europa (Continente) , Exercício Físico/fisiologia , Feminino , Humanos , Dor Lombar/epidemiologia , Masculino , Pessoa de Meia-Idade , América do Norte , Aptidão Física , Prevalência , Inquéritos e Questionários , Local de Trabalho , Ferimentos e Lesões/epidemiologia
11.
Scand J Med Sci Sports ; 29(5): 663-668, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30664255

RESUMO

Endurance exercise is an established cause of cardiac troponin (cTn) elevation, of further interest is whether this rise represents clinical significance. This study compared cTnT rise in three cohorts of marathon runners using a high-sensitivity assay; control runners, those with known heart disease and runners who collapsed at the finish line. Control runners (n = 126) and runners with heart disease (n = 12) were prospectively recruited with cTnT levels measured pre-race and at race completion. Collapsed runners (n = 15) were retrospectively recruited. A mixed model ANCOVA was used to compare the three groups. Pre-race median cTnT for the control group and heart disease groups was 3.9 ng/L (IQR 3.1 ng/L) and 4.1 ng/L (IQR 3.4 ng/L). Post-race values for the three groups were control 45.6 ng/L (IQR 42.5 ng/L), heart disease 41.2 ng/L (IQR 36.1 ng/L), and collapsed 41.9 ng/L (IQR 57.8 ng/L). Post-race cTnT and cTnT change were significantly correlated with pre-race cTnT within the control group (r = 0.38 and 0.30, P < 0.01). There was no difference in post-race cTnT (adjusted for pre-race cTnT) between the three groups. None of the runners reported symptoms suggestive of acute myocardial infarction on follow-up. These results demonstrate that marathon running is associated with an asymptomatic cTnT rise for all runners, and this rise is significantly correlated to baseline cTnT levels, in addition, marathon runners with pre-existing cardiac pathology or who collapse at the finish line do not exhibit an increased cTnT rise compared to healthy runners.


Assuntos
Cardiopatias/sangue , Corrida/fisiologia , Troponina T/sangue , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Arch Environ Occup Health ; 74(6): 322-330, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29621422

RESUMO

Analysis of Fire Service Instructors (FSI) working practices and health is needed to minimise health risks related to heat illness, cardiovascular events and immunological stress. Online surveys were distributed to UK FSI and Firefighters (FF). One hundred and thirty FSI (age: 43 ± 7yrs) and 232 FF (age: 41 ± 8yrs) responded. FSI experienced 2-10 live fires per week, with 45% of FSI reporting management does not set a limit on the number of exposures. Few FSI followed hydration guidelines, or cooling methods. New symptoms of ill health were reported by 41% of FSI and 21% of FF. FSI with ≥11 Breathing Apparatus exposures per month were 4.5 times (95% CI 1.33-15.09) more likely to experience new symptoms. A large proportion of FSI are experiencing new symptoms of illness after starting their career, and guidelines on exposure and hydration are not universally in place to reduce the risk of future health problems.


Assuntos
Bombeiros , Nível de Saúde , Saúde Ocupacional , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Inquéritos e Questionários , Reino Unido
13.
J Occup Environ Hyg ; 16(1): 27-40, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30277854

RESUMO

Fire service instructors (FSI) regularly experience different types of fire exercises, however the strain experienced from these scenarios is not well understood. This study aims to identify the physiological and perceptual strain of Fire Service Instructors (FSI) to three training exercises: DEMO, ATTACK, COMPARTMENT, and the different roles performed: SETTER, INSTRUCTOR. The study also aims to assess the effect that different exercise patterns over a day (BOX, MULTI, COMBINATION) have on immunological responses. Sixteen FSI (age: 41 ± 8 years, body mass: 83.7 ± 6.7 kg, height: 177.0 ± 6.7 cm) were recruited, with 10 FSI completing the three exercises. Physiological and perceptual measures were collected prior to and immediately post each exercise. Venous blood samples were collected at the beginning and end of each day. One-way analysis of variance (ANOVA) were conducted to assess differences in physiological variables between exercise types, independent samples t-tests were conducted between roles. Day changes in hematological variables were assessed by paired sample t-tests and analyzed by one-way ANOVAs to identify differences between exercise patterns. The COMPARTMENT exercise resulted in a greater change in rectal temperature (ΔTre) (0.49 ± 0.28 °C) than both the DEMO (0.23 ± 0.19 °C, p = 0.045) and ATTACK (0.27 ± 0.22 °C, p = 0.016). Within the COMPARTMENT exercise, the SETTER resulted in a greater ΔTre and rating of perceived exertion than the INSTRUCTOR (0.67 ± 0.29 °C vs. 0.43 ± 0.18 °C, p = 0.027 and 14 ± 2 vs. 11 ± 2, p = 0.001, respectively). Following a day of fire exercises white blood cells (WBC), neutrophils, lymphocytes (LYMPH), monocytes (MONO), platelets (PLT), mean platelet volume (MPV), Interleukin (IL)-6, and cardiac troponin T (cTnT) all increased (p < 0.05). Exercise patterns containing a COMPARTMENT exercise resulted in greater PLT, MPV, and IL-6. Total daily variation in ΔTre was correlated with post-exercise WBC, MONO, and LYMPH. COMPARTMENT exercises produce the greatest physiological strain, with the SETTER role within this exercise causing the greatest ΔTre. Although predominately physiological responses remain within safe limits. Exercise patterns that include a COMPARTMENT exercise also generate a greater inflammatory response.


Assuntos
Bombeiros/educação , Incêndios , Exposição Ocupacional/efeitos adversos , Adulto , Contagem de Células Sanguíneas , Temperatura Corporal/fisiologia , Feminino , Temperatura Alta , Humanos , Inflamação/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/fisiopatologia , Troponina T/sangue , Reino Unido
14.
PLoS One ; 13(12): e0208798, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30576330

RESUMO

BACKGROUND: Chronic liver disease is an escalating problem both in the United Kingdom and worldwide. In the UK mortality rates have risen sharply over the previous 50 years predominantly due to alcohol, however the increasing prevalence of non-alcohol related fatty liver disease both in the UK and elsewhere is also of concern. Liver disease develops silently hence early detection of fibrosis is essential to prevent progression. Primary care presents an opportunity to identify at risk populations, however assessment largely comprises of indirect markers of fibrosis which have little prognostic value. We hypothesised that setting up nurse-led primary care based liver clinics using additional non-invasive testing would increase the number of new diagnoses of liver disease compared to usual care. METHODS: This was a prospective, cluster randomised feasibility trial based in urban primary care in Southampton, United Kingdom. 10 GP practices were randomised to either intervention (liver health nurse) or control (care as usual). Pre recruitment audits were carried out in each practice to ascertain baseline prevalence of liver disease. Participants were subsequently recruited in intervention practices from July 2014-March 2016 via one of 3 pathways: GP referral, nurse led case finding based on risk factors or random AUDIT questionnaire mailouts. Liver assessment included the Southampton Traffic Light test (serum fibrosis markers HA and P3NP) and transient elastography (FibroScan). Cases were ascribed as 'no fibrosis', 'liver warning', 'progressive fibrosis' or 'probable cirrhosis'. Post recruitment audits were repeated and incident liver diagnoses captured from July 2014-September 2016. Each new diagnosis was reviewed in a virtual clinic by a consultant hepatologist. FINDINGS: 910 participants were seen in the nurse led clinic-44 (4.8%) probable cirrhosis, 141 (15.5%) progressive fibrosis, 220 (24.2%) liver warning and 505 (55.5%) no evidence of liver fibrosis. 450 (49.5%) cases were due to NAFLD with 356 (39.1%) from alcohol. In the 405 with a liver disease diagnosis, 136 (33.6%) were referred by GP, 218 (53.8%) from nurse led case finding and 51 (12.6%) from the AUDIT mailout. 544 incident cases were identified in the intervention arm compared to 221 in the control arm in the period July 2014-September 2016 (adjusted odds ratio 2.4, 95% CI 2.1 to 2.8). CONCLUSIONS: The incorporation of a liver health nurse into GP practices was simple to arrange and yielded a much higher number of new diagnoses of liver disease compared to usual care. Nearly half of all participants recruited had a degree of liver disease. Nurse led case finding and GP referrals were most effective compared to AUDIT questionnaire mailouts in an urban population in identifying unknown disease. Utilising study and previous data allowed quick and effective virtual review by a hepatologist. Identifying those who are at risk of liver disease from harmful alcohol use remains a challenge and needs to be addressed in future work.


Assuntos
Acessibilidade aos Serviços de Saúde , Hepatopatia Gordurosa não Alcoólica , Padrões de Prática em Enfermagem , Atenção Primária à Saúde , Inquéritos e Questionários , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/terapia , Estudos Prospectivos , Fatores de Risco , Reino Unido/epidemiologia
15.
J Therm Biol ; 78: 42-50, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30509666

RESUMO

Heat tolerance tests identify those susceptible to heat illnesses and monitor heat adaptations. Currently, tolerance tests do not replicate the uncompensable heat strain environments experienced in some occupations. In addition, tests can take up to 2 h to complete, and cannot offer intra and inter individual comparisons, due to the use of a fixed exercise intensity. This study aimed to assess the validity and reliability of a new heat occupational tolerance test (HOTT: 40 min at 6 W kg-1 metabolic heat production, 50 °C 10% RH, in protective clothing) to the standard heat tolerance test (HTT: 2 h walk at 5 km h-1 1% gradient, 40 °C 40% RH, in shorts and t-shirt). Eighteen participants (age: 21 ±â€¯3 yrs, body mass: 81.3 ±â€¯5.9 kg) completed trials to assess the validity and/or reliability of the HOTT. Peak rectal temperature (Tre) displayed strong agreement and low measurement error (0.19 °C) between HTT (38.7 ±â€¯0.4 °C) and HOTT (38.6 ±â€¯0.4 °C). Strong agreement was also displayed for physiological and perceptual measures between the two HOTT trials, including peak Tre (38.5 ±â€¯0.4 °C vs. 38.5 ±â€¯0.4 °C) and peak heart rate (182 ±â€¯20 b min-1 vs. 182 ±â€¯21 b min-1). The HOTT is the first tolerance test that assesses individuals' responses whilst wearing protective clothing in high temperatures. It can consistently identify individuals' levels of heat tolerance within a reduced time frame. In addition, it allows for participant monitoring over time and comparisons between individuals to be made. A continuum based approach is recommended when assessing individuals' responses to the HOTT.


Assuntos
Transtornos de Estresse por Calor/fisiopatologia , Monitorização Fisiológica/métodos , Doenças Profissionais/fisiopatologia , Termotolerância , Temperatura Corporal , Estudos de Viabilidade , Transtornos de Estresse por Calor/urina , Humanos , Masculino , Monitorização Fisiológica/normas , Doenças Profissionais/urina , Distribuição Aleatória , Respiração , Adulto Jovem
16.
Appl Ergon ; 70: 26-33, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29866317

RESUMO

This study aimed to identify a pre-cooling method to reduce the physiological and perceptual strain, and the inflammatory response, experienced by individuals who wear personal protective equipment. Eleven males (age 20 ±â€¯2 years, weight 75.8 ±â€¯9.3 kg, height 177.1 ±â€¯5.0 cm) completed 15min pre-cooling (phase change vest [PCV], forearm cooling [ARM], ice slurry consumption [ICE], or a no cooling control [CON]) and 45min intermittent walk (4  km h-1, 1% gradient) in 49.5 ±â€¯0.6 °C and 15.4 ±â€¯1.0% RH, whilst wearing firefighter ensemble. ICE reduced rectal temperature (Tre) before heat exposure compared to CON (ΔTre: 0.24 ±â€¯0.09 °C, p < 0.001, d = 0.38) and during exercise compared to CON, ARM, and PCV (p = 0.026, ηp2 = 0.145). Thermal sensation was reduced in ICE and ARM vs. CON (p = 0.018, ηp2 = 0.150). Interleukin-6 was not affected by pre-cooling (p = 0.648, ηp2 = 0.032). It is recommended that those wearing protective equipment consume 500 ml of ice slurry 15min prior to work to reduce physiological and perceptual strain.


Assuntos
Crioterapia/métodos , Transtornos de Estresse por Calor/fisiopatologia , Temperatura Alta/efeitos adversos , Exposição Ocupacional/efeitos adversos , Saúde Ocupacional , Adolescente , Exercício Físico/fisiologia , Antebraço , Frequência Cardíaca , Transtornos de Estresse por Calor/prevenção & controle , Humanos , Gelo , Interleucina-6/sangue , Masculino , Consumo de Oxigênio , Equipamento de Proteção Individual/efeitos adversos , Temperatura Cutânea , Sensação Térmica , Adulto Jovem
17.
Cogn Emot ; 32(8): 1625-1636, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29411684

RESUMO

This research investigated whether precues engage proactive control to reduce emotional interference during speech production. A picture-word interference task required participants to name target pictures accompanied by taboo, negative, or neutral distractors. Proactive control was manipulated by presenting precues that signalled the type of distractor that would appear on the next trial. Experiment 1 included one block of trials with precues and one without, whereas Experiment 2 mixed precued and uncued trials. Consistent with previous research, picture naming was slowed in both experiments when distractors were taboo or negative compared to neutral, with the greatest slowing effect when distractors were taboo. Evidence that precues engaged proactive control to reduce interference from taboo (but not negative) distractors was found in Experiment 1. In contrast, mixing precued trials in Experiment 2 resulted in no taboo cueing benefit. These results suggest that item-level proactive control can be engaged under certain conditions to reduce taboo interference during speech production, findings that help to refine a role for cognitive control of distraction during speech production.


Assuntos
Sinais (Psicologia) , Fala/fisiologia , Tabu/psicologia , Adolescente , Adulto , Atenção , Emoções , Feminino , Humanos , Masculino , Tempo de Reação , Semântica , Adulto Jovem
18.
Front Nutr ; 5: 141, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30723717

RESUMO

Objective: To investigate (a) the acute effect of a bout of high intensity interval exercise (HIIE) on mood, cognitive function, and blood pressure in overweight perimenopausal women and (b) to compare the effects of high carbohydrate vs. high protein pre-HIIE feedings on exercise capacity, mood and cognitive function in this population. Methods: Twelve, overweight, perimenopausal women (age; 45.5 ± 2.3 years, body fat; 32.2 ± 2.1%) completed a bout of HIIE under 3 pre-exercise feedings (HCHO: high-carbohydrate-low-protein; LCHP: low-carbohydrate-high-protein; control: fasted) in a randomized crossover design. HIIE consisted of 4 intervals of 4 min walking at 85-90% of maximum heart rate and 3 min recovery. Before and after HIIE, the shortened version of the profile of mood state questionnaire, the exercise-induced feeling inventory questionnaire and three cognitive function tests (Stroop test, Shift Stroop test, n-back test) were administered. Blood pressure was measured pre- and post-exercise. Following HIIE a performance test to volitional fatigue was conducted. Results: A single bout of HIIE resulted in significant reductions in blood pressure and improvements in cognitive capacity (p < 0.05). Both the HCHO and LCHP feedings led to significantly longer exercise performance compared to CON (422 ± 71 s and 340 ± 46 vs. 240 ± 32 s, respectively, p < 0.01), with a 1.22-fold greater increase in performance time in HCHO compared to LCHP, although not statistically significant (p > 0.05). Only the HCHO trial improved total mood disturbance and positive engagement 1 h-post-exercise compared to CON (p < 0.05). HCHO and LCHP improved physical exhaustion and revitalization feelings post-exercise vs. CON (p < 0.01). Conclusions: A single HIIE session improves cognitive function and blood pressure in overweight perimenopausal women. High-carbohydrate pre-HIIE feedings can result in greater enhancements in mood and positive engagement to exercise and may improve exercise performance compared to a high-protein meal.

19.
Am J Physiol Endocrinol Metab ; 313(2): E243-E256, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28588097

RESUMO

Calorie restriction (CR) decreases adiposity, but the magnitude and defense of weight loss is less than predicted due to reductions in total daily energy expenditure (TEE). The purpose of the current investigation was to determine whether high-intensity interval training (HIIT) would increase markers of sympathetic activation in white adipose tissue (WAT) and rescue CR-mediated reductions in EE to a greater extent than moderate-intensity aerobic exercise training (MIT). Thirty-two 5-wk-old male C57BL/6J mice were placed on ad libitum HFD for 11 wk, followed by randomization to one of four groups (n = 8/group) for an additional 15 wk: 1) CON (remain on HFD), 2) CR (25% lower energy intake), 3) CR + HIIT (25% energy deficit created by 12.5% CR and 12.5% EE through HIIT), and 4) CR + MIT (25% energy deficit created by 12.5% CR and 12.5% EE through MIT). Markers of adipose thermogenesis (Ucp1, Prdm16, Dio2, and Fgf21) were unchanged in either exercise group in inguinal or epididymal WAT, whereas CR + HIIT decreased Ucp1 expression in retroperitoneal WAT and brown adipose tissue. HIIT rescued CR-mediated reductions in lean body mass (LBM) and resting energy expenditure (REE), and both were associated with improvements in glucose/insulin tolerance. Improvements in glucose metabolism in the CR + HIIT group appear to be linked to a molecular signature that enhances glucose and lipid storage in skeletal muscle. Exercise performed at either moderate or high intensity does not increase markers of adipose thermogenesis when performed in the presence of CR but remodels skeletal muscle metabolic and thermogenic capacity.


Assuntos
Restrição Calórica , Glucose/metabolismo , Treinamento Intervalado de Alta Intensidade , Metabolismo dos Lipídeos , Obesidade/metabolismo , Condicionamento Físico Animal/métodos , Animais , Composição Corporal , Dieta Hiperlipídica , Metabolismo Energético/fisiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Obesidade/etiologia , Obesidade/terapia , Termogênese/fisiologia
20.
J Therm Biol ; 63: 41-48, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28010814

RESUMO

Fire Service Instructors frequently experience high levels of physiological and perceptual strain during live fire exposures. Instructors are also at risk of cardiovascular illnesses, with cardiac death being the greatest cause of fire fighter death. Current practice for UK instructors is to select undergarment type based on personal preference, between a boiler suit (BOILER) and a wicking base layer (WBL). Research suggests that shorts and t-shirt (SHORTS) may also be a beneficial alternative undergarment choice. The UK South East Fire Service requested an investigation to identify if undergarment selection can lessen the strain experienced by instructors, and reduce the acute inflammatory response to fire exposures. Eight males completed three 45min sessions in a heat chamber (49.5±1.4°C and 16.9±4.3% RH) whilst performing intermittent walking. At the end of heat exposure change in heart rate was not effected by garment type (p=0.061, ηp2=0.373). Change in rectal temperature was different between garments (p=0.009, ηp2=0.271), with trends suggesting that BOILER resulted in a greater change (1.03±0.60°C) than SHORTS (0.76±0.37°C, p=0.589, d=0.21) and WBL (0.72±0.33°C, p=0.545, d=0.25). Interleukin-6 post exposure was greater for BOILER (6.96±0.28pgmL-1) than both SHORTS (6.59±0.30pgmL-1, p=0.043, d=0.42) and WBL (6.45±0.43pgmL-1, p=0.031, d=0.51). Overall, undergarment type had little impact on physiological or perceptual strain. However, wearing WBL or SHORTS may reduce the inflammatory response, and consequently decrease the risk of cardiovascular events.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Bombeiros , Temperatura Alta/efeitos adversos , Interleucina-6/sangue , Doenças Profissionais/prevenção & controle , Roupa de Proteção/normas , Estresse Psicológico/prevenção & controle , Temperatura Corporal , Doenças Cardiovasculares/etiologia , Humanos , Masculino , Doenças Profissionais/etiologia , Percepção , Roupa de Proteção/efeitos adversos , Estresse Psicológico/etiologia , Adulto Jovem
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