Strenuous Event Research Articles

Analysis of ST-elevation myocardial infarction occurring in soldiers during strenous military training

BackgroundAt our tertiary care cardiology center, we are receiving soldiers who sustained acute ST-Elevation Myocardial Infarction (STEMI) during the strenuous Battle Field Efficiency Test (BPET) and other such activities. MethodsThis was a single-center observational study to assimilate and analyze the precipitating causes, risk factors, symptoms, and the efficacy of the management protocols in soldiers sustaining STEMI during the BPET or other forms of strenuous military training. ResultsAll 25 soldiers with documented STEMI following strenuous military training presented with chest pain as the primary symptom. 88% had symptoms either during or within 1st hour of the strenuous activity. 76% underwent thrombolysis with an angiographic success rate of 95%. Primary PCI was possible in only 3/25 (12%) of the cases, of which 2 (66%) did not require stenting after thrombus aspiration; 88% of soldiers reported “training for the event” for less than four times/week. ConclusionSTEMI precipitated by strenuous unaccustomed military training have exclusively single vessel affection with an excellent response to thrombolysis and thrombus aspiration. Thus, the timely institution of pharmacological or mechanical revascularization therapy has dramatic results in the preservation of ventricular function. The lack of training for the strenuous event provides strong evidence for comprehensive, graded, physical training prior to strenuous military activities to prevent acute coronary syndromes.

Contemporaneous evaluation of inguinal hernia causation: a European perspective.

The aim of the study was to evaluate any social, occupational and physical factors, which may influence the occurence or cause of a primary inguinal hernia in two European countries. A questionnaire was completed by all the respondents in the setting of an out-patient clinic prospectively at the time of initial presentation and the data were collected on a secure database. All responses for each question were explored via appropriate descriptive statistics. Statistical comparisons were made using Fisher's exact test where appropriate. 537 adults completed the questionnaire and had their data analysed. Comparisons between those that presented with a primary complaint of either 'bulge/swelling' or 'discomfort/pain' found no differences in occupation, age or any other demographic data. Equal proportions of patients who described a single strenuous event presented with a bulge/swelling or discomfort/pain. The reporting of a causative single strenuous event was not significantly influenced by occupation, lifestyle or amount of activity carried out nor was there any significant influence upon when a hernia presented after the suspected strenuous event, although the majority reported a lump within 1week. This study cannot at present support the belief that a single strenuous eventwill be the sole cause for the development of a primary inguinal hernia.

Applying Qualitative Research to Develop a Guide for Parents of Newborns With Hypoxic-Ischemic Encephalopathy

Moderate-to-severe hypoxic-ischemic encephalopathy (HIE) is a significant cause of neonatal mortality and permanent disability in surviving newborns. Therapeutic hypothermia (TH) is the only effective intervention to reduce these outcomes. Being a parent of these babies is a traumatic and strenuous event. To address these difficulties, parents need information and support. The aim of this article is to describe a qualitative methodological process followed to develop a guide for parents of a newborn with HIE receiving TH as an addendum to clinical practice guidelines. The guide based on the experience of parents of newborns with HIE is presented as 16 meaningful questions and a glossary. It provides information to parents about HIE, treatment and care, future outcomes, and coping strategies. The final version, in Spanish and English, has a didactic format with simple wording, parents’ verbatim queries, and illustrations made expressly for the guide. Furthermore, we think showing the methodological process we followed to develop the guide, detailing the difficulties that arose in doing so, and making the reflexivity of the researchers explicit may provide support for other teams undertaking similar projects. Likewise, this article illustrates in a practical way how the perspective of family can be incorporated into clinical practice guidelines.

A systematic review of the association between a single strenuous event and the development of an inguinal hernia: A medicolegal grey area

Abstract Background Inguinal hernia is a common surgical presentation. Evidence for its causation regarding occupational and recreational physical exposures is limited. The aim of this study is to conduct a systematic review objectively evaluating the evidence for a causal link between a single strenuous event and the development of an inguinal hernia. Method A systematic review was carried out in accordance with PRISMA guidelines. PubMed, Ovid Embase, SCOPUS, and Cochrane Library were searched. In addition, the ISRCTN register, ClinicalTrials.gov, ICTR Platform, and EU Clinical Trials Register were searched. Identified publications were collated and both reviewers independently reviewed their contents. Findings 5508 records were identified, resulting in 5 studies being selected. These 5 studies were all case series. Of 957 patients identified, 1003 hernias were described, of which 983 were inguinal hernias which 255 (26%) were attributed by patients to a single strenuous event. Only two of these studies applied Smith's Criteria (causation of a hernia from a single strenuous event): officially reported, severe pain at the time of the event, no prior history of inguinal hernia, and the diagnosis was made by a doctor within 30 days (preferably 3 days). Only 2 of 54 patients (4%) met all four criteria and so could be considered as having an inguinal hernia relating to a single strenuous event. Conclusion Many patients associate hernias to a single episode, however upon application of more stringent criteria such as Smith's, a much smaller proportion are deemed to be actually attributable to a single strenuous event.

CAREGIVING TRANSITIONS AND LIFE SATISFACTION OF INFORMAL CAREGIVERS

In the Western world, about two third of care recipients are in home care. This fact holds also for Germany: 70 percent of care recipients are cared for at home. Most of the caregivers are family members without any professional background in caregiving. To date, little is known about how caring for a close relative influences life satisfaction of caregivers in the long run. This study seeks to fill the gap by focusing on the process of transitions into and out of their caregiver role. Further, I examine how the caregivers’ life satisfaction develops after these incisive life events. The analyses are based on the data of the German Socio-Economic Panel, which provides annual information about caregiving situations in German households and life satisfaction since 1997. Using panel data allows to capture intraindividual changes by controlling time constant unobserved heterogeneity. The longitudinal research design also enables to identify effects of adjustment processes in terms of life satisfaction with respect to transitions into and out of caregiving situations. As expected, life satisfaction decreases after transitioning into the caregiving status and—in contrast to the findings of the vast majority of cross-sectional studies—remains stable over the time of caregiving. When analyzing the period that marks the transition out of caregiving, the picture is rather heterogeneous. It seems that women recover more quickly than men from this strenuous event that is often associated with the death of the care recipient. After recovery, life satisfaction increases constantly for both genders.

Sanjay P, Woodward A (2007) Single strenuous event: does it predispose to inguinal herniation? Hernia 11:493–496

Sanjay P, Woodward A (2007) Single strenuous event: does it predispose to inguinal herniation? Hernia 11:493–496

Single strenuous event: Does it predispose to inguinal herniation?

There is a general belief that inguinal hernias are often caused by a single strenuous event, however there are no data to support this association. This study aims to assess the frequency with which inguinal hernia is attributed to a single muscular strain and to identify predisposing factors. All patients who underwent inguinal hernia repair under the care of one surgeon over a nine-year period were studied. Five hundred and twenty patients were sent a structured postal questionnaire. There was a 62% response rate (320). The median age of the study group was 61.5 (range 19-88) years. Out of a total 320 hernias, 51% (163) of the hernias were gradual in onset and in 42.5% (137) of hernias there was a history suggesting an association between a particular strenuous event and the sudden onset of hernia. In the sudden-onset group 101 (74%) patients had indirect hernias while in the gradual-onset group, 93 patients (57%) had indirect hernias (P < 0.05). Thirty-four patients (25%) had direct hernias in the sudden-onset group and 63 (39%) in the gradual-onset group (P < 0.05). The various predisposing factors were lifting (67.8%, 93), coughing (14.5%, 20), exercise (10.2%, 14), and gardening (7.3%, 10). Heavy work was associated with sudden inguinal herniation. This study supports the hypothesis that the appearance of inguinal herniation may be attributed to a single strenuous event. Indirect hernias are more likely to present following such an event.

It is highly unlikely that the development of an abdominal wall hernia can be attributable to a single strenuous event.

There is a commonly held belief that the development of a hernia can be attributed to a single strenuous or traumatic event. Hence, many litigants are successful in compensation claims, causing mounting financial burdens on employers, the courts, insurance companies and the tax-payer. However, there is very little scientific evidence to support this assertion. The aim of this study was to ascertain whether there was any causal link in this process. A total of 133 new patients with 135 abdominal herniae of all varieties (115 inguinal, 3 femoral, 9 umbilical, 4 incisional, and 4 ventral or epigastric), of which 25 were recurrent received structured questionnaires on arrival in the surgical clinic. These questionnaires covered all possible aetiological factors for hernia development (type of work, COAD, smoking, pregnancy, obesity, chronic bladder outflow obstruction, previous surgery including appendicectomy), in addition to any possible attribution to a single strenuous or traumatic event. We then reviewed the GP records in the surgery of all patients who answered positively to the latter possible cause. In the study group, 119 (89%) reported a gradual onset of symptoms. Of the 15 (12 male, 3 female; 11%) who believed that their hernia might be related to a single strenuous or traumatic event, 5 had no other aetiological factors. However, not one of the 15 was found to have contemporaneous forensic medical evidence to support their possible claim. We conclude that we are unable to find any clinical evidence to support the hypothesis that a hernia might develop as the result of one single strenuous or traumatic event. While we accept that this mechanism might still possibly occur, we believe that, at best, it is extremely uncommon. If a medical expert is preparing a report on such a case in a claim for personal injury, then they have a duty to the court to examine carefully all the contemporaneous medical records. If no clinical evidence exists to support the claim, then they have a duty to the court not to support the plaintiff's claim.

Effects of a long-distance run on cardiac markers in healthy athletes

Running a marathon is a stressful event for athletes. Limited research exists on the role of cardiac markers during such a strenuous event. The aim of this study was to investigate detailed changes in cardiac markers before and after a long-distance run. We studied 25 male and 2 female runners (age 34-64 years) who were running the Visé-Maastricht-Visé marathon. Blood samples were drawn just before and immediately after finishing the marathon. An additional blood sample was collected 24 h later. Running the marathon led to a significant increase in cortisol. This returned to baseline values 24 h after the marathon. There was a slight increase in brain natriuretic peptide (BNP); however, this was not statistically significant. On the contrary, the N-terminal fragment of BNP (NT-pro-BNP) was significantly increased immediately after the run and was normalized 24 h later in 26 out of 27 runners (96%). The magnitude of the transient elevations in BNP and NT-pro-BNP increased with the age of the athletes. Furthermore, in 9 out of 27 runners there was a significant increase in troponin T. However, in all these runners this increase was transient and troponin-T levels returned to baseline values 24 h after the marathon. Running a marathon significantly increases NT-pro-BNP levels in healthy adults. This increase could be partially attributed to cardiac stress. The transient increases in BNP, NT-pro-BNP and troponin T are more likely to reflect myocardial stunning than cardiomyocyte damage. It seems that the magnitude of the increase in BNP could serve as a marker of the biological age of the myocardium.

Maintenance of bodyweight during a multiple-day chuckwagon race meet.

The gruelling race schedules maintained by horses competing in chuckwagon racing raises concern for the horses' ability to recover quickly and continue to perform at a high level. The amount of bodyweight lost and the time required for recovery of this weight loss have been used to assess the level of stress imposed on horses competing in various multiple-day events. In this study, bodyweights were obtained from 40 Thoroughbred geldings (mean +/- s.e.; bodyweight 521.5 +/- 4.4 kg) before and after racing during a 5 day chuckwagon race meet. Body condition score (BCS) was determined on the first and last day of competition. Comparisons were based on the number of consecutive days the horse raced. Average bodyweight loss (P = 0.039) from each race was 3.5 +/- 0.3 kg (0.7% of initial bodyweight) and was not affected by the number of days the horse raced. The largest bodyweight deficit (P = 0.005) occurred within the 24 h period after their first race (5.3 +/- 0.5 kg; 1.0% of initial bodyweight). Horses racing on 2-5 consecutive days retained a 4.8 +/- 0.3 kg deficit (P = 0.01), which was maintained throughout the remainder of the race meet. Horses began and ended the race meet with a BCS of 4.9 +/- 0.2 and 4.7 +/- 0.2, respectively (using the 1 to 9 BCS system). Although chuckwagon horses compete in a strenuous event on several consecutive days, they appear to be managed well and have the ability to maintain their bodyweight despite the physical and psychological demands of frequent racing.

PRE-EXISTING MEDICAL PROBLEMS AMONG IRONMAN TRIATHLON WORLD CHAMPIONSHIPS ENTRANTS

An Ironman triathlon is a grueling test of an athlete's skill and endurance, involving a 2.4-mile swim, a 112-mile bike and a 26.2-mile run. The 2001 Ironman Triathlon World Championships in Kona, Hawaii involved 1,518 entrants who ranged in age from 19 to 78. Knowledge of common pre-existing medical conditions would be helpful to race medical staff in planning for potential complications, and in advising patients with medical problems who are contemplating participation in such a strenuous event. PURPOSE: To determine common pre-existing medical problems among Ironman entrants. METHODS: We reviewed the medical data from each participant's pre-race questionnaire to ascertain the types and frequency of medical problems among this year's entrants. RESULTS: Of the 1,518 entrants, only 102 (6.7%) reported pre-existing medical problems. The most common reported problems were asthma or EIA (37), allergic rhinitis (12), hypothyroidism (10), hypercholesterolemia (6), gastroesophageal reflux disease (GERD) (5), and hypertension (6). Several entrants disclosed more serious chronic diseases including atrial fibrillation (2), Crohn's disease (2), lymphoma (2), diabetes (1), epilepsy (1), and cystic fibrosis (1). Additionally, 25 entrants (1.7%) reported a pre-existing physical condition. The most common were recent fractures (within a year) (3), below the knee amputation (2), paraplegia (2) and a single kidney (2). Additionally, 43 athletes reported a history of hypersensitivity to bee's, wasps, or jellyfish. Only 86 entrants (5.7%) reported significant problems associated with past triathlon races, the most common of which were dehydration (57), hyponatremia (10), and heat exhaustion (3). CONCLUSIONS: Based on our review, it is clear that entrants into the Ironman Triathlon World Championships represent a healthy cohort of athletes, however a small percentage compete despite a history of serious medical and physical conditions.

Motoring

Our Motoring Correspondent recounts his experiences in the Liège-Sofia-Liège, the most strenuous event in motor sport.