Asthma and high-intensity interval training have no effect on clustered cardiometabolic risk or arterial stiffness in adolescents.

PURPOSE: Cardiometabolic risk, including arterial stiffness, is increasing in youth. Those with asthma are suggested to be particularly at risk of cardiovascular disease. Efficient and effective strategies are required to prevent the atherosclerotic process in youth. The purpose of this study was to investigate the effect of 6 months high-intensity interval training (HIIT) on cardiometabolic risk in youth with and without asthma. METHODS: 65 adolescents (31 mild asthma; 34 non-asthma) were recruited, 32 (16 asthma) of whom were randomly allocated to receive HIIT three times per week for 6 months. At baseline, mid-intervention, post-intervention and at a 3-month follow-up, anthropometric, metabolic and vascular determinants of cardiometabolic risk were assessed. Following principal component analysis (PCA), linear mixed models were used to assess the influence of asthma, HIIT and their interaction. RESULTS: Seven factors were identified which explained 88% of the common variance shared among the parameters. Those with asthma demonstrated lower arterial stiffness factor scores mid-intervention (P = 0.047) and lower cholesterol factor scores post-intervention (P = 0.022) but there was no effect of the intervention, or interaction effects, on any PCA-identified factor, at any time-point. HIIT was associated with a lower low-density lipoprotein and diastolic blood pressure at mid-intervention. DISCUSSION: Neither arterial stiffness nor clustered cardiometabolic risk are influenced by HIIT in adolescents with or without asthma, despite important changes in blood lipid and pressure profiles. Blood pressure, augmentation and pulse wave velocity should be considered physiologically distinct constructs and as potential markers of cardiovascular health.

Perceptions of asthma and exercise in adolescents with and without asthma.

OBJECTIVE: To elicit the views of adolescents, with and without asthma, about exercise and asthma, and the perceived benefits of and barriers to participation. The adolescent views elicited would subsequently inform the design of a high-intensity exercise intervention to improve asthma control. METHODS: Fifty-four adolescents (age 13.1 ± 0.9 years; 26 with asthma) participated in twelve semi-structured group interviews. Questions were structured around knowledge, attitudes and beliefs towards asthma and its impact on exercise participation and lifestyle. The interviews were transcribed verbatim, thematically analysed and presented via diagrams of emergent themes. Ethical approval was granted by the institutional research ethics committee. RESULTS: Fear of an asthma attack emerged as the main barrier to exercise, with many adolescents with asthma withdrawing from exercise as a coping strategy; many healthy adolescents perceived this withdrawal as laziness or an excuse. Despite this, the majority (81%) of adolescents with asthma reported exercise to be their most enjoyable activity. Adolescents suggested incorporating mixed activities, such as team games (e.g., rounders, football, netball), for future interventions to ensure adherence. CONCLUSIONS: Whilst exercise is important in the management of asthma, the tendency of those with asthma to withdraw from exercise to avoid adverse events could be addressed through a games-based high-intensity exercise intervention. Furthermore, educating all adolescents on asthma could simultaneously reduce stigmatisation and enhance exercise engagement.

Whole-Genome Sequences and Classification of Streptococcus agalactiae Strains Isolated from Laboratory-Reared Long-Evans Rats (Rattus norvegicus).

In collaboration with the CDC's Streptococcus Laboratory, we report here the whole-genome sequences of seven Streptococcus agalactiae bacteria isolated from laboratory-reared Long-Evans rats. Four of the S. agalactiae isolates were associated with morbidity accompanied by endocarditis, metritis, and fatal septicemia, providing an opportunity for comparative genomic analysis of this opportunistic pathogen.

Factors affecting recruitment and retention of rehabilitation professionals in Northern Ontario, Canada: a cross-sectional study.

INTRODUCTION: Historically, Northern Ontario, Canada, has been an underserviced area for health care, including the rehabilitation professions of occupational therapy, physiotherapy, speech-language pathology and audiology. The Rehabilitation Studies and Northern Studies Stream programs were created in the 1990s to improve the recruitment and retention of rehabilitation professionals to Northern Ontario. However, no recent research has been conducted examining the factors that lead to rehabilitation professionals relocating to and remaining in the region. METHODS: A cross-sectional survey of rehabilitation professionals living and working in Northern Ontario was administered in 2009. Information collected included demographics and a rating of the personal and professional factors that had an impact on an individual's decision to continue living and working in Northern Ontario. RESULTS: A total of 345 individuals completed the survey (response rate 57%). Multiple personal and professional factors were closely linked to recruitment and retention with differences noted between those individuals originally from Northern Ontario and those who were not. Rural or remote education experiences and rural/remote origin were identified as important recruitment factors while job satisfaction and lifestyle options were important factors for retention of rehabilitation professionals to rural and remote areas of practice. CONCLUSIONS: This study has provided updated information specific to the recruitment and retention of rehabilitation professionals in Northern Ontario, Canada. These findings support previous work examining health professions worldwide and have clear implications for educational programs, funding agencies, and health human resource planning in underserviced areas.

Outcome of women with index smear showing mild dyskaryosis: effects of age and evidence of HPV infection.

OBJECTIVE: Recent national guidelines (NHSCSP Document 20) recommend colposcopy referral after one mildly dyskaryotic smear, compared with the current practice of cytological surveillance and referral if the abnormality persists. The aim of this study was to identify the percentage of women whose first abnormal smear, showing mild dyskaryosis, returned to normal with cytological surveillance. Colposcopy could therefore be avoided in this group. This study also assessed whether age or human papillomavirus (HPV) status affected this outcome and the impact of non-attenders on the reliability of surveillance. METHODS: This was a retrospective study examining the follow-up of 1484 women whose first abnormal smear showed mild dyskaryosis between 1996 and 1998. The possible outcomes were: persisting abnormality referred to colposcopy, follow-up by cytology alone (negative follow-up), lost to follow-up or moved out of the area. Results were further assessed in terms of age (over or under 35 years) and cytological evidence of HPV effect. RESULTS: In this study 50.9% of women, presenting with a mildly dyskaryotic smear, returned to normal without colposcopy within the follow-up period of 6-8 years. Age (over/under 35) or cytological evidence of HPV did not significantly affect this figure. CONCLUSIONS: Immediate colposcopy would overtreat 50% of the study group resulting in 159 extra colposcopies in this unit per year. High-grade abnormalities were twice as prevalent (22% versus 11%) in the younger age group, suggesting that younger rather than older women would benefit from immediate referral.

Oral meperidine, atropine, and pentobarbital for pediatric conscious sedation.

PURPOSE: To document the effectiveness and safety of using a combination of oral meperidine, atropine, and pentobarbital for pediatric conscious sedation. METHOD: Sixty-three patients ages 6 months to 23 years (M = 5 years) undergoing outpatient cardiac catheterization were given an oral premedication consisting of meperidine, atropine, and pentobarbital for sedation. The effectiveness of the medication in providing sedation and the complication of over sedation when using a standard dose based upon weight were analyzed. RESULTS: Seventy six percent of the patients were deemed sedated on arrival to the catheterization laboratory. Forty eight percent did not require any further sedation during the procedure. Need for further sedation was related to the length of the procedure. Three patients (4.8%) incurred complications of sedation; all three had received additional sedation during the procedure. CONCLUSIONS: The combination of meperidine, atropine, and pentobarbital is a safe and effective premedication for cardiac catheterization when administered in standard dosage based upon body weight.

Urinary catheters for intermittent use.

The long-term use of intermittent catheterisation is often suitable for patients with voiding problems who are able to perform self-care. Use of the technique may result in fewer urinary tract problems, the achievement of continence and improvements in quality of life.

Urinary catheters for intermittent use.

Intermittent catheterisation is suitable for a range of patients and has a high level of patient satisfaction. Careful education is required to minimise the risk of complications and nurses should be aware of the various types of catheter available.

An organization-wide approach for an effective communication system, Part 2.

This is the second article in a two-part series that describes an organization's approach to designing, implementing, and evaluating a communication system. Part 1 of this series, published in the March 1998 issue, focused on the design and implementation of this system. This article addresses the evaluation of outcomes related to identified goals to improve communication flow and decision making on multiple levels and to promote accountability for clinical and operational performance. Implementation strategies involving change management, emergence of issues with related implications, and planned evolution of this system also are discussed for ongoing organizational performance improvement.

An organization-wide approach for an effective communication system, Part 1.

This two-part series provides a cogent discussion of designing and implementing an effective communication system, with a committee structure based on the Joint Commission on Accreditation of Health Care Organizations (JCAHO) functions. Part one includes the development and design using a systems approach. Part two, which will be published in the April 1998 issue of JONA, will address the evaluation of outcomes and implications of this communication system. The experiential learning gained from this process is illustrated by the analysis of themes that surfaced during the implementation.

Catheterisation: extending the scope of practice.

Continuing our series on issues surrounding the Scope of Professional Practice, this article describes the nurse's role in male and suprapubic catheterisation. It relates to UKCC Professional Development Categories: Care enhancement and Reducing risk.

Basing catheter care on research principles.

This review outlines the research-based principles which should be considered when caring for any patient with an indwelling urinary catheter. As principles they are not prescriptive, but should encourage reflection and allow nurses to make informed decisions regarding their care delivery based on current research.

New strains of seizure-prone mice.

The origins of two new strains of seizure-prone mice are provided, and some of their behavioral characteristics are described. Comparison of the hippocampal granule cell layer of one of the new strains with the two inbred strains from which it was derived revealed strain differences in the diameter of granule cell nuclei and in the number of granule cells in the suprapyramidal blade. Basket cell counts did not differ between the strains, but both basket cell and granule cell number were consistently higher for the suprapyramidal blade than for the infrapyramidal blade. The existence of these and other blade differences suggests that the two blades will prove to be functionally distinctive neuronal systems.

The Centers for Disease Control-National Heart, Lung and Blood Institute Lipid Standardization Program. An approach to accurate and precise lipid measurements.

In collaboration with the National Heart, Lung, and Blood Institute, the CDC has supported programs for standardizing lipid measurements for more than 30 years. These programs were begun because comparable and accurate quantitative measurements were needed for epidemiologic studies of coronary heart disease. Since the first program was initiated, over 500 national and international laboratories have participated in the various CDC lipid standardization programs. The cornerstone of these standardization programs has been an accuracy base of lipid reference materials and methods developed by CDC. Specifically, CDC has developed human, serum-based reference materials for cholesterol, HDL, triglyceride, and apolipoproteins A-I and B and reference methods for total cholesterol, HDL, and triglyceride. The CDC reference method for cholesterol has been adopted as the national reference method for cholesterol by the National Reference System for the Clinical Laboratory Council of the National Committee for Clinical Laboratory Standards. The approved CDC reference method along with an approved NBS definitive method, an approved NBS certified Reference Material, and the CDC certified serum-based secondary reference materials make up the accuracy base for serum cholesterol measurements in the United States, and together they are recognized as the National Reference System for Cholesterol. The NCEP Laboratory Standardization Panel recommends that cholesterol measurements made by all clinical laboratories should be standardized so that cholesterol values are traceable to the National Reference System for Cholesterol. In support of the NCEP's efforts, CDC will establish a standardization program permitting the laboratory and manufacturing community to trace cholesterol measurements and the development of cholesterol diagnostic products back to the national reference system. The major emphasis of this standardization effort is to establish a network of reference method laboratories (1) to assign cholesterol values to all commercially prepared lots of calibrators and control materials and (2) to provide reference measurements on individual "fresh" human serum specimens to manufacturers and clinical laboratories. CDC is also working to (1) provide reference materials to manufacturers, (2) collaborate with NBS to maintain documentation of the national reference system accuracy base, (3) cooperate with proficiency testing organizations to assist in the accurate labeling of reference materials, and (4) provide training and education pertinent to cholesterol standardization.(ABSTRACT TRUNCATED AT 400 WORDS)

Pulmonary valvuloplasty as an alternative to surgery in the pediatric patient: implications for nursing.

Recent innovations in the use of balloon catheters to dilate stenosis have made it possible to successfully perform balloon valvuloplasty (BV) on stenotic intracardiac valves. BV is fast becoming the treatment of choice for isolated valvular pulmonary stenosis (IVPS) in pediatric patients. IVPS and other obstructive lesions involving the right ventricle and pulmonary arteries occur in 25% to 30% of all persons with congenital heart disease. Current data suggest that use of BV for IVPS provides both short- and long-term hemodynamic relief and eliminates the need for open heart surgery. BV is also being used for other forms of congenital heart disease. Therefore, it is important for nurses in the pediatric setting to be aware of this technique and its implications. We review the anatomy, physiology, and clinical features of IVPS, the valvuloplasty procedure, and the nursing plan of care relevant to it.