Inadequate Exercise Research Articles

Safe MRI-Compatible electrical muscle stimulation (EMS) system.

To develop an inexpensive magnetic resonance imaging (MRI)-compatible electrical muscle stimulation (EMS) unit and test it for safety and efficacy. A simple MRI-compatible EMS device was developed using radiofrequency (RF) translucent electrodes at 3T. RF heating concerns were assessed using optical temperature measurements at electrode sites, during scanning of a phantom. EMS efficacy and consistency was investigated through in vivo (n = 5) measures of 31 P-MRS phosphocreatine (PCr) reduction, and altered blood oxygen level-dependent (BOLD) signal and the results were compared to effects from equivalent voluntary effort on the same subjects. The presence of an EMS pulse did not interfere with the T2 * signal in a phantom. However, signal-to-noise ratio (SNR) was reduced by 70% at electrode sites, but only by 10% 4 cm distally. Under RF intense conditions, the temperature at the electrode site increased by only 4.7°C over a 16-minute time span. In vivo muscle stimulation resulted in 13.5 ± 1.8% reduction in PCr, which was not significantly (P < 0.195) different from voluntary contraction. Reproducible muscle BOLD signal changes following EMS were noted, with a maximal increase of 10.0 ± 2.6% seen in the central soleus. For soleus and gastrocnemius compartments, EMS produced significantly higher BOLD signal change compared to voluntary contraction (P < 0.05). A safe and inexpensive MRI-compatible EMS unit can be easily built for evaluating muscle function and metabolism within a 3T MRI scanner. Clinical applications might include evaluating skeletal muscle function in patients with limited or absent voluntary skeletal motor function or inadequate exercise capacity. J. Magn. Reson. Imaging 2016;44:1530-1538.

Inadequate Sleep and Exercise Associated with Burnout and Depression Among Medical Students

The authors studied whether low levels of exercise or inadequate sleep correlated with higher levels of burnout and depression in medical students. Medical students of all years at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, were invited to participate in an anonymous online survey in Fall 2012 and Winter 2013. Validated measures were used to assess exercise, sleep, burnout, and depression. Response rates were 28.7% at the beginning of the school year and 22.6% at the middle of the school year. Burnout rates overall were 22.4% at the beginning of the year and 19.2% in the middle of the year. Eight percent of students screened positive for depression at the beginning of the year and 9.3% in the middle of the year. Decreased exercise frequency was significantly correlated with lower professional efficacy. Pathological sleepiness was significantly associated with a higher prevalence of burnout. Inadequate sleep correlated with significantly lower professional efficacy and higher exhaustion scores. Burnout was associated with a positive depression screen. Positive depression screening, pathological sleepiness, and sleeping less than 7h a night were independent predictors of burnout. Sleep habits, exercise, and a positive depression screen were associated with burnout risk within the medical student population.

Exercise in Young Adulthood with Simultaneous and Future Changes in Fruit and Vegetable Intake

Objectives: Regarding weight management, changes in exercise behavior can also influence nutrition behavior by application of self-regulatory psychological resources across behaviors (transfer effect). This study aimed to determine: (1) if changes in exercise frequency in young adulthood predict simultaneous changes in fruit/vegetable intake (transfer as co-occurrence); and (2) if exercise frequency affects future fruit/vegetable intake (transfer as carry-over).Methods: 6244 respondents of the National Longitudinal Survey of Youth 1997 were followed at ages 18–22 (Time-1), 23–27 (Time-2), and 27–31 (Time-3). Repeated measures analysis of variance and hierarchical multiple regression determined if the change in exercise frequency between Time-1 and Time-2 was associated with simultaneous and sequential changes in fruit/vegetable intake frequency, controlling for sex, race/ethnicity, education, income, body mass index, and baseline fruit/vegetable intake.Results: Only 9% continued exercising for 30 minutes more than 5 days/week, while 15% transitioned to adequate exercise and another 15% transitioned to inadequate exercise; for both fruits and vegetables, intake of once per day or more increased with age. Males were more likely to exercise adequately and females to consume fruits/vegetables adequately. Exercise frequency transition was linearly associated with concurrent fruit/vegetable intake during Time-1 and Time-2. The highest increase in mean fruit/vegetable intake occurred for participants who transitioned from inadequate to adequate exercise. A significant Time-2 exercise frequency effect on Time-3 fruit/vegetable intake emerged, after accounting for baseline intake. Increase in Time-2 exercise by one day/week resulted in increased Time-3 fruit and vegetable intakes by 0.17 and 0.13 times/week, respectively.Conclusion: Transfer effects, although usually discussed in interventions, may also be applicable to voluntary behavior change processes. Newly engaging in and continuing exercise behavior over time may establish exercise habits that facilitate improved fruit/vegetable consumption. Interventions that facilitate transferring resources across behaviors likely will enhance this effect.

Association of Chronic Kidney Disease With Chronotropic Incompetence in Heart Failure With Preserved Ejection Fraction

Chronotropic incompetence (CI) is common in heart failure with preserved ejection fraction (HFpEF) and may be a key reason underlying exercise intolerance in these patients. However, the determinants of CI in HFpEF are unknown. We prospectively studied 157 patients with consecutive HFpEF who underwent cardiopulmonary exercise testing and defined CI according to specific thresholds of the percent heart rate reserve (%HRR). CI was diagnosed as present if %HRR <80 if not taking a β blocker and <62 if taking β blockers. Participants who achieved inadequate exercise effort (respiratory exchange ratio ≤1.05) on cardiopulmonary exercise testing were excluded. Multivariable-adjusted logistic regression was used to determine the factors associated with CI. Of the 157 participants, 108 (69%) achieved a respiratory exchange ratio >1.05 and were included in the final analysis. Of these 108 participants, 70% were women, 62% were taking β blockers, and 38% had chronic kidney disease. Most patients with HFpEF met criteria for CI (81 of 108; 75%). Lower estimated glomerular filtration rate (GFR), higher B-type natriuretic peptide, and higher pulmonary artery systolic pressure were each associated with CI. A 1-SD decrease in GFR was independently associated with CI after multivariable adjustment (adjusted odds ratio 2.2, 95% confidence interval 1.1 to 4.4, p= 0.02). The association between reduced GFR and CI persisted when considering a variety of measures of chronotropic response. In conclusion, reduced GFR is the major clinical correlate of CI in patients with HFpEF, and further study of the relation between chronic kidney disease and CI may provide insight into the pathophysiology of CI in HFpEF.

Lifestyle habits and obesity progression in overweight and obese American young adults: Lessons for promoting cardiometabolic health.

Obesity among young adults is a growing problem in the United States and is related to unhealthy lifestyle habits, such as high caloric intake and inadequate exercise. Accurate assessment of lifestyle habits across obesity stages is important for informing age-specific intervention strategies to prevent and reduce obesity progression. Using a modified version of the Edmonton Obesity Staging System (mEOSS), a new scale for defining obesity risk and predicting obesity morbidity and mortality, this cross-sectional study assessed the prevalence of overweight/obese conditions in 105 young adults and compared their lifestyle habits across the mEOSS stages. Descriptive statistics, chi-square tests, and one-way analyses of variance were performed. Eighty percent of participants (n = 83) fell into the mEOSS-2 group and had obesity-related chronic disorders, such as diabetes, hypertension, and/or dyslipidemia. There were significant differences in dietary quality and patterns across the mEOSS stages. Findings highlighted the significance of prevention and early treatment for overweight and obese young adults to prevent and cease obesity progression.

Abstract 17050: Association of Kidney Dysfunction with Chronotropic Incompetence in Heart Failure with Preserved Ejection Fraction

Introduction: Chronotropic incompetence (CI) is an important pathophysiologic factor underlying reduced exercise capacity in heart failure with preserved ejection fraction (HFpEF), but clinical factors associated with CI in HFpEF are unknown. Based on anecdotal clinical experience, we hypothesized that coronary artery disease (CAD) and chronic kidney disease (CKD) are associated with CI in HFpEF. Methods: We studied 157 consecutive HFpEF patients undergoing cardiopulmonary exercise testing, and defined CI as maximal heart rate (HR) &lt; 80% of estimated HR reserve (&lt; 65% if using beta-blockers). Participants who achieved inadequate exercise effort (respiratory exchange ratio [RER] ≤ 1.05) were excluded. Unadjusted and multivariable-adjusted regression models were used to determine correlates of CI. Results were re-assessed using alternative formulations of chronotropic response. Results: Of 157 participants, 73% were women, 64% used beta-blockers, 32% had CKD, and 40% had CAD. RER &gt; 1.05 was achieved by 108 (69%) participants, including 79/108 (76%) with CI. Lower estimated GFR, higher B-type natriuretic peptide, and higher pulmonary artery systolic pressure (but not CAD) were each associated with CI. A 1-SD decrease in GFR was independently associated with CI (adjusted odds ratio = 2.4, 95% confidence interval = [1.3, 4.6]) after adjustment for smoking status, log BNP, and beta blocker usage. Linear regression models demonstrated that GFR was independently and linearly associated with %HR reserve (β=0.31, SE=0.10; P=0.002; Figure). Findings were unchanged after re-calculation of %HR reserve and CI based on alternative formulations used in the literature. Conclusions: CI is common and strongly associated with GFR in HFpEF. Our results indicate that kidney function may mark or contribute to the development of CI in HFpEF. HFpEF patients with CKD may need to be screened for CI prior to starting medications (e.g., beta blockers) that could exacerbate CI.

Which modifiable health risks are associated with changes in productivity costs?

The purpose of this retrospective, longitudinal study was to assess longitudinal associations between modifiable health risks and workplace absenteeism and presenteeism and to estimate lost productivity costs. Across the 4-year study period (2007-2010), 17,089 unique employees from a large US computer manufacturer with a highly technical workforce completed at least 1 health risk assessment. Generalized estimating equation models were used to estimate the mean population-level absenteeism and presenteeism for 11 modifiable health risks and adjust for 9 sociodemographic and employment-related factors. Because patient age was highly correlated with several other variables, the analysis was stratified by age (<45 vs. ≥45 years). For all ages, poor emotional health, inadequate exercise, tobacco use, and having a body mass index (BMI) greater than 35 (all P<.05) were consistently associated with both absenteeism and presenteeism. Having a BMI over 35 and poor emotional health were associated with the largest impact in absenteeism (0.46 days) and presenteeism (4.03 days), respectively. Younger and older workers had similar associations between health risks and presenteeism; however, hypertension, blood sugar, inadequate exercise, and alcohol were associated (P⋜.01) with greater absenteeism among older but not younger workers. The results suggest that productivity loss is strongly related to emotional health and obesity-related health risks (eg, BMI, exercise) but differs by age. These findings could help prioritize preventive health programs offered by employers at their worksite health centers. Given the aging of the US workforce, keeping older workers healthy and productive will be crucial to remaining competitive in the global economy. (Population Health Management 2015;18:30-38).

Differences in food intake and nutritional habits between Spanish adolescents who engage in ski activity and those who do not.

Increasing obesity among adolescents in the industrialized world may result from poor nutritional habits and inadequate exercise. To determine differences in food intake, nutritional habits, and body mass index between Spanish adolescents who engage in ski activity and those who do not. A socio-demographic survey, food frequency questionnaire, 24-hr dietary recall, and physical activity questionnaire were completed by 300 Spanish schoolchildren aged 10 to 18 yrs. RESULTS were compared (Student's t, chi-square and Fisher's exact test) between adolescents engaged (SP) and not engaged (N-SP) in skiing according to their sex. SP adolescents devoted > 4 h/day to physical activity versus < 1 h for N-SP adolescents. No significant differences were found in nutrient intake or nutritional habits between SP and N-SP adolescents. Protein and fat intakes of both groups were above recommended levels. A higher proportion of N-SP than SP males were overweight. Logistic regression analysis showed that the maintenance of a normal weight was favored by the practice of skiing, the consumption of sugar-free drinks, and supplementation with vitamins/mineral salts and was negatively associated with body weight dissatisfaction, intake of nutritional supplements other than vitamins or minerals, and the consumption of snacks. The diet of this adolescent population was poorly balanced. Engagement in physical activity appears to be a key factor in maintaining a healthy body mass index.

Joint influence of individual choices, parenting practices, and physician advice on adolescent obesity, Nebraska, 2008.

IntroductionReducing childhood obesity remains a public health priority given its high prevalence and its association with increased risk of adult obesity and chronic diseases. The objective of this study was to examine the joint influence of multiple risk factors on adolescent overweight status.MethodsWe conducted a random-digit-dialed telephone survey of adolescents aged 12 to 19 years in fall 2008 in a Midwestern city in Nebraska. On the basis of survey data for 791 youths aged 12 to 18 years, we conducted latent class analysis to group youths by the joint occurrence of dietary behavior, physical activity, parenting practices, and physician advice. We then examined the association between the groups and overweight status by using logistic regression, controlling for age, sex, race/ethnicity, and parent and family information.ResultsYouths were clustered into 3 groups. Group I (52%) were youths with healthy dietary behavior and physical activity, less permissive parenting practices, and physician advice; Group II (30%) were youths with moderately healthy dietary behavior and physical activity, less permissive parenting practices, and no physician advice; and Group III (18%) were youths with unhealthy dietary behavior and physical activity, permissive parenting practices, and physician advice. Youths in Groups I and II were less likely to be overweight than youths in Group III.ConclusionsYouths with healthier behavior and less permissive parenting practices were less likely to be overweight. Study findings highlight the need to address obesity risk factors among youths with unhealthy dietary behavior, inadequate exercise, permissive parenting practices, and some physician advice. Tailored interventions should be used to target youths with different obesity risk factors.

Amino acid supplementation and impact on immune function in the context of exercise.

Moderate and chronic bouts of exercise may lead to positive metabolic, molecular, and morphological adaptations, improving health. Although exercise training stimulates the production of reactive oxygen species (ROS), their overall intracellular concentration may not reach damaging levels due to enhancement of antioxidant responses. However, inadequate exercise training (i.e., single bout of high-intensity or excessive exercise) may result in oxidative stress, muscle fatigue and muscle injury. Moreover, during the recovery period, impaired immunity has been reported, for example; excessive-inflammation and compensatory immunosuppression. Nutritional supplements, sometimes referred to as immuno-nutrients, may be required to reduce immunosuppression and excessive inflammation. Herein, we discuss the action and the possible targets of key immuno-nutrients such as L-glutamine, L-arginine, branched chain amino acids (BCAA) and whey protein.Electronic supplementary materialThe online version of this article (doi:10.1186/s12970-014-0061-8) contains supplementary material, which is available to authorized users.

Asia Women's Fund Revisited

The Asian Women's Fund's atonement project for former comfort women set a new vision of Japan in which the people along with the Japanese government proactively participate in performing the moral responsibility for the suffering of former comfort women in cross-boundary and cross-generational ways. This article argues that the Fund's imperfect reconciliation with former comfort women particularly in Taiwan and South Korea was due to the misunderstanding about moral responsibility as an evasion of the Japanese government's legal responsibility and due to the inadequate exercise of political and administrative leadership. Underneath these factors lie the intertwined root causes of the limited availability of facts on the issue of comfort women and the ideologically driven discourse. The article suggests the following measures as a further atonement project: strong political leadership to present the clear meaning of moral responsibility, cooperation with the governments and support groups in the victims' countries, and an international truth investigation.

Institutional Health Care for the Elderly in North-eastern Thailand

This qualitative research aims to assess the state of institutional health care in North-eastern Thailand. The investigation was conducted from October 2012 to October 2013. Results found that a number of elderly people are neglected by their families. The majority have difficulty moving, poor health and emotional problems. Everyday lifestyle problems are caused by inadequate exercise. Caregivers must be dedicated. Social activities are provided for elderly people, such as Old People’s Day, Mother’s Day and New Year’s Day. Most elderly people receive a pension and some supplement their income through other sources. Elderly people have a low income and a high cost of living so are required to work to support themselves. The government and private sector both support a variety of activities to promote the healthcare of elderly people in North-eastern Thailand.

Health behaviors among testicular cancer survivors.

With modern treatment, more than 95% of American men who are diagnosed with testicular cancer will be cured. Although there is growing evidence that these individuals may face heightened risk of cardiovascular disease after chemotherapy, there is a paucity of research to objectively classify health-promoting behaviors in this population and to identify the barriers to improving their health behaviors. To identify health behavior patterns in a group of testicular cancer survivors (TCSs) and the barriers to more positive health behaviors and to examine the relationship between barriers, health behaviors, and quality of life (QOL). TCSs from the Pennsylvania State Cancer Registry who had been diagnosed during 1990-2005 completed a comprehensive survey about QOL, health behaviors, and barriers to optimal healthy behaviors. QOL, health behaviors, and the barriers were assessed for 189 respondents. Smoking (25%), risky drinking (35%), elevated body-mass index (83%), poor diet (95% did not meet the guidelines for fruit and vegetable intake), and inadequate exercise (50%) were common. Barriers to achieving optimal health behaviors were categorized as either cancer-related or competing demands. Cancer-related barriers contributed to worse physical QOL, whereas competing demands related to worse mental-health-related QOL. Our sample size was moderate and self-selected. In addition, we used self-reports rather than the more standardized observation or interview-based data collection. TCSs demonstrate behaviors that put them at increased risk for future cardiovascular disease and complications. Interventions aimed at reducing tobacco and risky alcohol use and improving dietary and physical activity levels are needed. NCI grant number 1R03CA124217; the Livestrong Foundation. The authors have no disclosures.

Inadequate Exercise as a Risk Factor for Sepsis Mortality

ObjectiveTest whether inadequate exercise is related to sepsis mortality.Research Design and MethodsMortality surveillance of an epidemiological cohort of 155,484 National Walkers' and Runners' Health Study participants residing in the United States. Deaths were monitored for an average of 11.6-years using the National Death index through December 31, 2008. Cox proportional hazard analyses were used to compare sepsis mortality (ICD-10 A40-41) to inadequate exercise (<1.07 METh/d run or walked) as measured on their baseline questionnaires. Deaths occurring within one year of the baseline survey were excluded.ResultsSepsis was the underlying cause in 54 deaths (sepsisunderlying) and a contributing cause in 184 deaths (sepsiscontributing), or 238 total sepsis-related deaths (sepsistotal). Inadequate exercise was associated with 2.24-fold increased risk for sepsisunderlying (95%CI: 1.21 to 4.07-fold, P = 0.01), 2.11-fold increased risk for sepsiscontributing (95%CI: 1.51- to 2.92-fold, P<10−4), and 2.13-fold increased risk for sepsistotal (95%CI: 1.59- to 2.84-fold, P<10−6) when adjusted for age, sex, race, and cohort. The risk increase did not differ significantly between runners and walkers, by sex, or by age. Sepsistotal risk was greater in diabetics (P = 10−5), cancer survivors (P = 0.0001), and heart attack survivors (P = 0.003) and increased with waist circumference (P = 0.0004). The sepsistotal risk associated with inadequate exercise persisted when further adjusted for diabetes, prior cancer, prior heart attack and waist circumference, and when excluding deaths with cancer, or cardiovascular, respiratory, or genitourinary disease as the underlying cause. Inadequate exercise also increased sepsistotal risk in 2163 baseline diabetics (4.78-fold, 95%CI: 2.1- to 13.8-fold, P = 0.0001) when adjusted, which was significantly greater (P = 0.03) than the adjusted risk increase in non-diabetics (1.80-fold, 95%CI: 1.30- to 2.46-fold, P = 0.0006).ConclusionInadequate exercise is a risk factor for sepsis mortality, particular in diabetics.

The Association Between Modifiable Well-Being Risks and Productivity

To examine the longitudinal relationship between modifiable well-being risks and productivity. A total of 19,121 employees from five employers participated in baseline and follow-up well-being assessment surveys. Multivariate regressions assessed whether changes in absenteeism, presenteeism, and job performance were associated with changes in 19 modifiable well-being risks. Over time, a 5% reduction in total count of well-being risks was significantly associated with 0.74% decrease in absenteeism, 2.38% decrease in presenteeism, and 0.24% increase in performance. High blood pressure, recurring pain, unhealthy diet, inadequate exercise, poor emotional health, poor supervisor relationship, not utilizing strengths doing job, and organization unsupportive of well-being had greater independent contributions in explaining productivity impairment. The often-ignored well-being risks such as work-related and financial health risks provided incremental explanation of longitudinal productivity variations beyond traditional measures of health-related risks.

Emergency hospitalizations for severe hypoglycaemia in patients with type 2 diabetes

Hypoglycaemia remains an important issue in the management of diabetes despite recent advances in diabetes treatment. It is often mild, but, in its more severe forms, can cause seizure, coma and death. Therefore, severe hypoglycaemia could be an important cause of hospitalization [1]. In patients with type 2 diabetes mellitus (T2DM), often older adults, several factors contribute to the risk of severe hypoglycaemia, including the use of hypoglycaemic medication, inadequate caloric intake, physical exercise and frequent illnesses [2–4]. The purpose of this study is to describe cases of severe hypoglycaemia requiring the hospitalization in T2DM patients. A retrospective cohort study was conducted using the access card/dismissal database from 1 January 2011 to 31 December 2011 in the emergency department of Livorno Hospital (Italy). This department serves approximately 250 thousand inhabitants. We considered as severe hypoglycaemic all events requiring medical assistance (visit to emergency room, treatment by medical personnel, hospitalization) and identified by a diagnosis of hypoglycaemia (ICD-CM codes 250.3, 250.8, 251.2, 962.3). We identified 126 cases of severe hypoglycaemia among a total of 70,000 accesses recorded in the study period. Excluding non-diabetic subjects and type 1 diabetes, we obtained 93 patients with T2DM that had one or more bouts of severe hypoglycaemia for a total of 115 accesses to the emergency room. For all patients, we recorded clinical characteristics, including anti-hyperglycaemic medications and renal function. Our study cohort includes 55 males and 38 females with a mean age of 77.1 ± 12.8 years and a diabetes duration of 16.2 ± 7.8 years; 40 of them (43 %) were treated with insulin, 45 with oral hypoglycaemic agents (OHA: 48 %) and 8 (9 %) with combined therapy insulin plus OHA. Insulin therapy was performed by insulin analogues in 18 patients (45 %) and human insulin in 22 (55 %). Forty five T2DM patients treated with OHA (85 %) received therapy with sulphonylureas and other 8 (15 %) with glinides (23.6 %) alone or in combination with insulin-sensitizing agents (metformin or pioglitazone); two patients were treated with incretins added to sulphonylureas plus metformin therapy (Table 1). Impaired renal function (serum creatinine level C1.5 mg/dl) was present in 34 patients (22 OHA and 12 insulin-treated, respectively). The consequences of severe hypoglycaemia were frequently clinically significant. In fact, 30 of the hypoglycaemic events (28.6 %) described in this paper resulted in prolonged hospitalizations (two or more days). This group included 7 patients treated with insulin (23.3 %) and 23 (67.7 %) with OHA, (5 sulphonylureas ? metformin, 18 sulphonylureas alone); in this last group (OHA), 18 cases had impaired renal function. In conclusion, patients with T2DM with severe hypoglycaemia requiring a prolonged hospitalization were in most cases old people, with impaired renal function and treated with long-acting sulphonylureas. Communicated by Renato Lauro.

Associations between healthy behaviors and coronary heart disease risk factors in women

Objectives: To describe the heart-healthy behaviors in a convenience sample of 210 women from a Midwestern state in the US and examine the associations between the behaviors and having risk factors to coronary heart disease. Methods: Logistic regression was used to examine the association between the behaviors of diet, exercise, and medication adherence with the risks of hypertension, hyperlipidemia, diabetes, family history of heart disease, and cigarette smoking. Results: There were a low consumption of heart-healthy meals, inadequate exercise participation, and inadequate medications adherence. Having personal hyperlipidemia, a family history of heart disease, age and education were significantly associated with the behaviors. Conclusion: The findings point to the need for evidence-based education aimed at increasing women’s awareness of heart disease risks, improving their behaviors, and emphasizing the link between risk reduction and the behaviors.

Awareness of disease and risk factors among patients with ischemic heart disease (IHD) in Government general hospital Kurnool, Andhra Pradesh

Background: Ischemic heart disease among is the most common causes of death and disability in the world. The Indian subcontinent (including India, Pakistan, Bangladesh, Sri Lanka, and Nepal) has among the highest rates of cardiovascular disease (CVD) globally. Previous reports have highlighted the high CVD rates among South Asian immigrants living in Western countries, but the enormous CVD burden within the Indian subcontinent itself has been underemphasized. Methods: A cross sectional study was conducted at Government General Hospital, Kurnool. Twenty consecutive patients with documented Ischemic Heart disease admitted in Cardiac Care Unit, and Cardiac Ward were enrolled. Patients were interviewed with structured questionnaire enquiring into their awareness of risk factors for Ischemic Heart disease and their knowledge level regarding disease. To assess knowledge and identify risk factors, an in-depth structured interview was conducted with structured interview questionnaire which included 66 questions. Results: Awareness of risk factors was high for smoking, hypertension, inadequate exercise, stress in family, use of ground nut oil in cooking, A-Type personality and no exercises among patients with ischemic heart disease. A majority 9 (45%) of patients had average level of knowledge regarding risk factors of Ischemic heart disease, whereas 7 (35%) of participants had below average and 4 (20%) had above average level of knowledge. Conclusion: An Indian population in a hospital setting shows a lack of knowledge relating to modifiable risk factors of ischemic heart disease. By segregating demographic predictors of poor knowledge, such as current smokers and persons who do not exercise regularly, educational interventions can be effectively targeted and executed as primary and secondary prevention strategies to reduce the problem of ischemic heart disease in India.

Pediatric Headache: A Review

1. Heidi K. Blume, MD, MPH 1. Division of Pediatric Neurology, Seattle Children’s Hospital and Research Institute, Seattle, WA. * Abbreviations: CSF: : cerebrospinal fluid ICH: : intracranial hemorrhage ICP: : intracranial pressure IIH: : idiopathic intracranial hypertension NDPH: : new daily persistent headache NSAID: : nonsteroidal anti-inflammatory drug SVT: : sinus venous thrombosis TAC: : trigeminal autonomic cephalalgia Headaches are common in children; while most are caused by a benign problem or primary headache disorder, headaches can be a sign of a serious underlying condition. Pediatricians must be aware of the most recent recommendations for evaluating and managing headaches. After reading this article, readers should be able to: 1. Understand the evaluation of a child who has headache. 2. Recognize the diagnostic criteria for pediatric migraine. 3. Recognize “red flags” for elevated intracranial pressure or other underlying conditions in the child who has headache. 4. Discuss treatment strategies for migraine, tension, and chronic headache disorders. Headaches are common in children and adolescents and are a frequent chief complaint in office and emergency department visits. The vast majority of childhood headaches are due to a primary headache disorder, such as migraine, or an acute, relatively benign process, such as viral infection. However, clinicians also need to consider other causes of headaches in children. Even when headaches are benign, they may cause significant dysfunction for the child and family and must be managed appropriately to minimize disability and optimize function. In this review, we discuss the epidemiology of childhood headache, evaluation of the child who has headaches, when to consider secondary headache syndromes, and the diagnosis and management of primary headache disorders such as migraine and tension-type headaches. Acute and chronic headaches are relatively common in children and adolescents, although estimates of the precise prevalence of headache and migraine vary widely. Depending on the study definition of headache, population involved, and time periods studied, 17% to 90% of children report headaches, with an overall prevalence of 58% reporting some form of headache in the past year. (1 …

Prevalence and Control of Stroke Risk Factors in a South Florida Population

ABSTRACTObjective: To assess the prevalence and control of stroke risk factors in our South Florida service population. Methods: We obtained data from the 2006–2010 Cleveland Clinic Florida annual “stroke prevention screening” questionnaires. Participants responded to questions regarding demographic information and stroke risk factors including pertinent comorbidity, alcohol consumption, and smoking. Onsite weight, height, blood pressure, and cholesterol levels were obtained. Our hospital's Director of Research did not identify any issues requiring formal institutional review board evaluation. Those with three or more modifiable risk factors breaching recommended targets met criteria for “poorly controlled.” Results: There were 298 participants, average age: 62.5 years, 65% were females. 36.9% had hypercholesterolemia, 32.9% hypertension, 14.4% diabetes mellitus, 8% transient ischemic attack/stroke, 7% coronary artery disease, 5.7% atrial fibrillation, and 2.7% carotid artery disease. 81.8% had a BMI of 25 or more and 37.8% had inadequate exercise. 38.3% had elevated cholesterol levels, 26.4% had blood pressures of 140/90mmHg or more, 6% were smokers, and 2.1% had excessive alcohol intake. 29.1% of the composite sample met the criteria outlined for “poorly controlled” stroke risk factors. Conclusion: Control of stroke risk factors especially obesity was worse compared to United States national data. Additionally, there is a higher prevalence of hypercholesterolemia and physical inactivity compared to statewide data. There is a definite need for local healthcare professionals to disseminate more stroke risk factor information. However, health promotion at the public policy or patient level should advocate personal responsibility especially pertaining to lifestyle and behavioral changes necessary for stroke prevention.