Visual outcomes of cataract surgery performed by supervised novice surgeons during training in rural China

To assess the outcomes of cataract surgery performed by novice surgeons during training in a rural programme. Design: Retrospective study. Participants: Three hundred thirty-four patients operated by two trainees under supervision at rural Chinese county hospitals. Methods: Two trainees performed surgeries under supervision. Visual acuity, refraction and examinations were carried out 3 months postoperatively. Main Outcome Measures: Postoperative uncorrected visual acuity, pinhole visual acuity, causes of visual impairment (postoperative uncorrected visual acuity<6/18) Results: Among 518 operated patients, 426 (82.2%) could be contacted and 334 (64.4% of operated patients) completed the examinations. The mean age was 74.1±8.8 years and 62.9% were women. Postoperative uncorrected visual acuity was available in 372 eyes. Among them, uncorrected visual acuity was ≥6/18 in 278 eyes (74.7%) and <6/60 in 60 eyes (16.1%), and 323 eyes (86.8%) had pinhole visual acuity≥6/18 and 38 eyes (10.2%) had pinhole visual acuity<6/60. Main causes of visual impairment were uncorrected refractive error (63.9%) and comorbid eye disease (24.5%). Comorbid eye diseases associated with pinhole visual acuity<6/60 (n=23, 6.2%) included glaucoma, other optic nerve atrophy, vitreous haemorrhage and retinal detachment. Conclusions: The findings suggest that hands-on training remains safe and effective even when not implemented in centralized training centres. Further refinement of the training protocol, providing postoperative refractive services and more accurate preoperative intraocular lens calculations, can help optimize outcomes. © 2012 The Authors Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

Can group exercise programs improve health outcomes in pregnant women? A systematic review

Current scientific evidence supports the recommendation to initiate or continue the practice of physical exercise in healthy pregnant women. Group exercise programs have positive effects in improving health and well-being, as well as social support. In order to understand the scientific evidence in this field, and the outcomes in maternal health, it has generated wide interest in exploring the studies carried out with more relevant group exercise programs. The aim of this systematic review was to evaluate the available evidence on the effectiveness of group exercise programs in improving women’s and newborns health outcomes during pregnancy. Three databases were used to conduct literature searches and strict inclusion and exclusion criteria were employed. Seventeen studies were selected for analysis. All studies were randomized control trials conducted with pregnant women that evaluated the effect of group exercise programs on the health outcomes of mother and newborn. Most studies followed a supervised structured exercise program including a main aerobic part, resistance training, pelvic floor training and stretching and relaxation sections. The significant effects of the programs are related with improved maternal perception of health status, lower maternal weight gain, improved levels of maternal glucose tolerance, improved aerobic fitness and muscular strength, lower frequency of urinary incontinence, improved sick leave due to lumbopelvic pain, fewer cesarean and instrumental deliveries, higher newborn Apgar score and faster postpartum recovery. Exercise and health professionals should advise pregnant women that aerobic group exercise during pregnancy improves a wide range of health outcomes for the women and newborn

The brain-sex theory of occupational choice: a counterexample

The brain-sex theory of occupational choice suggests that males and females in male-typical careers show a male pattern of cognitive ability in terms of better spatial than verbal performance on cognitive tests with the reverse pattern for females and males in female-typical careers, These differences are thought to result from patterns of cerebral functional lateralisation. This study Sought Such occupationally related effects using synonym generation (verbal ability) and mental rotation (spatial ability) tasks used previously. It also used entrants to these careers as participants to examine whether patterns of cognitive abilities might predate explicit training and practice. Using a population of entrants to sex-differentiated University Courses, a moderate occupational effect on the synonym generation task was found, along with a weak (p<.10) sex effect on the mental rotation task. Highest performance on the mental rotation task was by female Students in fashion design, a female-dominated occupation which makes substantial visuospatial demands and attracts many students with literacy problems such as dyslexia. This group then appears to be a counterexample to the brain-sex theory. However, methodological issues Surrounding previous Studies are highlighted: the simple synonym task appears to show limited discrimination of the sexes, leading to questions concerning the legitimacy of inferences about lateralisation based on scores from that test. Moreover, the human figure-based mental rotation task appears to tap the wrong aspect of visuospatial skill, likely to be needed for male-typical courses such as engineering, Since the fashion-clesign career is also one that attracts disproportionately many male students whose sexual orientation is homosexual, data were examined for evidence of female-typical patterns of cognitive performance among that subgroup. This was not found. This study therefore provides Do evidence for the claim that female-pattern cerebral functional lateralisation is likely in gay males.

Wii-Workouts on Chronic Pain, Physical Capabilities and Mood of Older Women: A Randomized Controlled Double Blind Trial

Chronic Low Back Pain (CLBP) is a public health problem and older women have higher incidence of this symptom, which affect body balance, functional capacity and behavior. The purpose of this study was to verifying the effect of exercises with Nintendo Wii on CLBP, functional capacity and mood of elderly. Thirty older women (68 ± 4 years; 68 ± 12 kg; 154 ± 5 cm) with CLBP participated in this study. Elderly individuals were divided into a Control Exercise Group (n = 14) and an Experimental Wii Group (n = 16). Control Exercise Group did strength exercises and core training, while Experimental Wii Group did ones additionally to exercises with Wii. CLBP, balance, functional capacity and mood were assessed pre and post training by the numeric pain scale, Wii Balance Board, sit to stand test and Profile of Mood States, respectively. Training lasted eight weeks and sessions were performed three times weekly. MANOVA 2 x 2 showed no interaction on pain, siting, stand-up and mood (P = 0.53). However, there was significant difference within groups (P = 0.0001). ANOVA 2 x 2 showed no interaction for each variable (P > 0.05). However, there were significant differences within groups in these variables (P < 0.05). Tukey's post-hoc test showed significant difference in pain on both groups (P = 0.0001). Wilcoxon and Mann-Whitney tests identified no significant differences on balance (P > 0.01). Capacity to Sit improved only in Experimental Wii Group (P = 0.04). In conclusion, physical exercises with Nintendo Wii Fit Plus additional to strength and core training were effective only for sitting capacity, but effect size was small.

Men and women differ in their cardiovascular responses to affective pictures

Empirical evidence supports the hypothesis that emotional states might contribute to cardiovascular disease and health through multiple pathways. To the extent that the acute cardiovascular response to emotional events plays a role in cardiovascular health and disease, an essential step in order to understand this possible link is to define the hemodynamic response to affective challenges. This was the aim of the present study. We assessed blood pressure (BP), heart rate (HR), stroke volume (SV), cardiac output, and total peripheral resistance (TPR) in response to 13 picture series in 18 men and 19 women (mean age 26) in order to investigate their hemodynamic responses associated with activation of the appetitive and defensive motivational systems underlying emotional experience. The hemodynamic parameters were recorded by finger-cuff photoplethysmography with Finometer™ (FMS Finapres Medical Systems, Amsterdam) and electrocardiography with the Lifeshirt system (VivoMetrics Inc., Ventura, California). Participants rated self-perceived pleasantness and arousal for each series. In men, BP and SV, but not TPR, increased with increasing self-rated arousal both for appetitive and defensive activation, whereas in women these relationships were almost absent, especially, for defensive activation. HR decelerated more in response to negative than positive and neutral pictures, and more so in men than women. These findings indicate striking sex differences. In particular, it is suggested that the sympathetic inotropic effect to the heart increases with increasing self-rated arousal strongly in men but only weakly in women. Regardless of sex differences, the modulation of the cardiovascular response to affective pictures along the dimensions of pleasantness and arousal is primarily myocardial, and the pattern of cardiovascular response is consistent with a configuration of cardiac sympathetic-parasympathetic coactivation. One possible implication of the observed sex differences concerns the link between affective states and cardiovascular health and disease. Men have a higher incidence of cardiovascular diseases than premenopausal women, and exaggerated sympathetic reactivity to emotional events is a potential pathophysiological mechanism. These findings extend current knowledge showing that under several acute behavioral challenges men demonstrate stronger cardiovascular reactivity than women.

Displaced women professionals: an exploration of perceived learning processes during workplace transition /

This study focused on obtaining a deeper understanding of the perceived learning of female professionals during workplace transition. The women's lived experiences were explored through a feminist interpretive lens (Bloom, 1998). The study also drew upon concepts from adult learning such as barriers and facilitating factors to learning, resistance, transformative learning, and multiple ways of knowing. Five women participated in a 1 -hour interview and a focus group activity. The findings are presented under the 2 broad themes of perceived learning and factors affecting learning. The most common theme of perceived learning was participants' experience of increased self-knowledge. Additionally, while learning was thought of as a struggle, it provided either an opportunity for a reexamination of goals or a reexamination of self. Reflection by participants seemed to follow two orientations and other types of perceived learning included experiential, formal, and informal learning. In the broad theme of factors affecting learning, contradictions and conflict emerged through the examination of participants' multiple subjectivities, and within their naming of many factors as both facilitating factors and barriers to learning. The factors affecting learning themes included personal relationships, professional communities, selfesteem, attitude and emotion, the gendered experience of transition, time, and finances. The final theme explored participants' view of work and their orientations to the future. A proposed model of learning during workplace transition is presented (Figure 1 ) and the findings discussed within this proposed model's framework. Additional developmental theories of women (Josselson, 1987; Levinson & Levinson, 1996), communities of practice theories (Wenger, 1998), and career resilience theories (Pulley, 1995) are discussed within the context of the proposed model. Implications to practice for career counsellors, people going through workplace transition, human resource managers and career coaches were explored. Additionally implications to theory and future areas of research are also discussed.

Athletic injury care training in high school coaches

The purpose of this qualitative study was to understand the client and occupational therapist experiences of a mental health group. A secondary aim was to explore the extent to which this group seemed to have reflected a client-centred approach. The topic emerged from personal and professional issues related to the therapist as teacher and to inconsistencies in practice with the profession's client-centred philosophy. This philosophy, the study's frame of reference, was established in terms of themes related to the client-therapist relationship and to client values. Typical practice was illustrated through an extensive literature review. Structured didacticexperiential methods aiming toward skill development were predominant. The interpretive sciences and, to a lesser extent, the critical sciences directed the methodology. An ongoing support group at a community mental health clinic was selected as the focus of the study; the occupational therapist leader and three members became the key participants. A series of conversational interviews, the . core method of data collection, was supplemented by observation, document review, further interviews, and fieldnotes. Transcriptions of conversations were returned to participants for verification and for further reflection Analysis primarily consisted of coding and organizing data according to emerging themes. The participants' experiences of group, presented as narrative stories within a group session vignette, were also returned to participants. There was a common understanding of the group's structure and the importance of having "air time" within the group; however, differences in perceptions of such things as the importance of the group in members' lives were noted. All members valued the therapeutic aspects of group, the role of group as weekly activity and, to a lesser extent, the learning that came from group. The researcher's perspective provided a critique of the group experience from a client-centred perspective. Some areas of consistency with client-centred practice were noted (e.g., therapist attitudes); however the group seemed to function far from a client-centred ideal. Members held little authority in a -relationship dominated by the leaders, and leader agendas rather than member values controlled the session. Possible reasons for this discrepancy ranging from past health care encounters through to co-leader discord emerged. The actual and potential significance of this study was discussed according to many areas of implications: to OT practice, especially client-centred group practice, to theory development, to further areas of research and methodology considerations, to people involved in the group and to my personal growth and development.

The Effect of a Stickhandling and Puck Control (SPC) Training Intervention on SPC Skills and Wrist Shot Performance Variables in Female Collegiate Ice Hockey Players

The purpose of the study was to investigate the effect of a 16 session stickhandling and puck control (SPC) off-ice training intervention on SPC skills and wrist shot performance variables. Eighteen female collegiate ice hockey players participated in a crossover design training intervention, whereby players were randomly assigned to two groups. Each group completed 16 SPC training sessions in two conditions [normal vision (NV) and restricted vision (RV)]. Measures obtained after the training intervention revealed significant improvements in SPC skills and wrist shot accuracy. Order of training condition did not reach significance, meaning that SPC improvement occurred as a result of total training volume as opposed to order of training condition. However, overall changes in the RV-NV condition revealed consistently higher effect sizes, meaning a greater improvement in performance. Therefore, support can be provided for this technical approach to SPC training and an alternative method of challenging SPC skills.

The Impact of Personal Trainer’s Leadership Style on Self-Presentational Concerns, Enjoyment, Task Self-Efficacy and Intention to Exercise in an Introductory Weight Training Orientation

The purpose of the present study was to examine two leadership styles of personal trainers (bland versus enriched) to evaluate their effects on exercise-related outcomes. Participants were 103 university women with no previous experience weight training. Participants were randomly assigned to one of the two leadership style conditions. They completed primary measures prior to being introduced to the personal trainer. Next, participants completed an introductory weight training session, followed by post-manipulation measures. The leadership styles were successfully manipulated. Participants in the enriched leadership style condition reported significantly higher levels of enjoyment and intention to exercise. Participants in the bland leadership style condition reported significantly higher levels of social anxiety; no differences were found for task self-efficacy, self-presentational efficacy, social physique anxiety, or handgrip performance between groups. Thus, an enriched leadership style of personal trainers can increase positive psychological outcomes.

The Impact of Directed Mirror Focus and Technique Cues on Psychological, Cognitive and Emotional Exercise Correlates in an Introductory Weight Training Orientation

The purpose of the study was to investigate whether teaching inactive and low active women to use mirrors for form and technique purposes could lessen the negative impact of mirrors on self-presentational concerns, affect, and self-efficacy. Eligible women (N = 82) underwent a one-on-one weight training orientation with a personal trainer. Participants were randomized into one of four experimental groups, each unique in the type of feedback (general or technique-specific) and the degree of focus on the mirror for technique reinforcement. Questionnaires assessed study outcomes pre- and post-orientation. Results indicated groups did not significantly differ on any post-condition variables, when controlling for pre-condition values (all p’s >.05). All groups showed outcome improvements following the orientation. This suggests that during a complex task, a personal trainer who emphasizes form and technique can facilitate improvements to psychological outcomes in novice exercisers, independent of the presence of mirrors or directional cues provided.

Sector-Specific Training and Mobility in Germany

This article studies mobility patterns of German workers in light of a model of sector-specific human capital. Furthermore, I employ and describe little-used data on continuous on-the-job training occurring after apprenticeships. Results are presented describing the incidence and duration of continuous training. Continuous training is quite common, despite the high incidence of apprenticeships which precedes this part of a worker's career. Most previous studies have only distinguished between firm-specific and general human capital, usually concluding that training was general. Inconsistent with those conclusions, I show that German men are more likely to find a job within the same sector if they have received continuous training in that sector. These results are similar to those obtained for young U.S. workers, and suggest that sector-specific capital is an important feature of very different labor markets. In addition, they suggest that the observed effect of training on mobility is sensible to the state of the business cycle, indicating a more complex interaction between supply and demand that most theoretical models allow for.

Sector-Specific on-the-Job Training: Evidence from U.S. Data.

Using data from the National Longitudinal Survey of Youth (NLSY), we re-examine the effect of formal on-the-job training on mobility patterns of young American workers. By employing parametric duration models, we evaluate the economic impact of training on productive time with an employer. Confirming previous studies, we find a positive and statistically significant impact of formal on-the-job training on tenure with the employer providing the training. However, the expected net duration of the time spent in the training program is generally not significantly increased. We proceed to document and analyze intra-sectoral and cross-sectoral mobility patterns in order to infer whether training provides firm-specific, industry-specific, or general human capital. The econometric analysis rejects a sequential model of job separation in favor of a competing risks specification. We find significant evidence for the industry-specificity of training. The probability of sectoral mobility upon job separation decreases with training received in the current industry, whether with the last employer or previous employers, and employment attachment increases with on-the-job training. These results are robust to a number of variations on the base model.

Lung cancer risk associated with occupational exposure to nickel, chromium VI, and cadmium in two population-based case-control studies in Montreal.

Cancer du poumon associé à l’exposition au nickel, au chrome VI et au cadmium dans le milieu de travail utilisant deux études populationnelles cas-témoins à Montréal. Au début des années 1990, le nickel, le chrome VI et le cadmium ont été classés en tant qu’agents cancérigènes de classe 1 par le CIRC (Centre International de Recherche sur le Cancer). Cependant, les résultats des études ayant permis la classification de ces métaux n’ont pas toujours été reproduits, et d’importantes questions demeurent quant aux effets de ces métaux à de faibles niveaux d’exposition. Un plus grand nombre de recherches empiriques est donc nécessaire afin de réaffirmer la cancérogénicité de ces agents, et d’identifier les circonstances dans lesquelles ils peuvent être néfastes. L'objectif de cette étude était d'explorer la relation entre l’exposition à un des métaux (soit le nickel, le chrome VI, ou le cadmium) et les risques subséquents de développer un cancer du poumon chez des travailleurs provenant de différents milieux de travail qui sont exposés à ces métaux à de différents degrés. Deux études cas-témoins de base populationnelle menées à Montréal ont fourni les données nécessaires pour examiner la cancérogénicité de ces métaux. La première étude était menée entre 1979 et 1986 chez des hommes âgés de 35 à 70 ans ayant un cancer dans l’un de 19 sites anatomiques de cancer sélectionnés. La seconde étude était menée entre 1996 et 2001 chez des hommes et des femmes âgés de 35 à 75 ans, avec un diagnostic de tumeur maligne au poumon. Dans ces deux études, les cas ont été recensés dans tous les hôpitaux de l'île de Montréal, tandis que les contrôles populationnels appariés par âge et stratifiés par sexe, ont été sélectionnés des listes électorales. Une entrevue avec chaque sujet a permis d'obtenir un historique d'emploi détaillé ainsi que des informations précises sur les facteurs de risques socio-économiques et personnels. Les descriptions de poste ont été évaluées par une équipe d'experts chimistes et hygiénistes afin de déterminer si le sujet a été exposé à chaque agent, et pour mesurer à la fois la concentration et la durée de chaque exposition, ainsi que l’exposition cumulative tout au long de la vie de chaque participant. Pour déterminer si une exposition à l’un des trois métaux en cause était associée à une augmentation de l'incidence du cancer du poumon, des données ont été analysées par régression logistique : des ajustements ont été effectués pour des facteurs de confusion pertinents incluant un historique détaillé du tabagisme. Des mesures catégoriques d'exposition cumulée ont été également analysées, ainsi que la modification des effets par le tabagisme. Les deux études ont été analysées séparément, puis par la suite combinées afin d'augmenter la puissance statistique. Les niveaux d'exposition mesurés dans cette population ne semblaient pas poser un excès de risque de cancer du poumon pour les travailleurs exposés au chrome VI. Cependant, ceux qui ont été exposés au nickel ont subi une augmentation significative du risque, et ce, quel que soit leur niveau d'exposition. Le risque de développer un cancer du poumon suite à une exposition au cadmium était élevé, mais pas de manière significative. Pour chacun des trois métaux, le risque de cancer du poumon était très élevé parmi les non-fumeurs, mais pas parmi les fumeurs. L’effet combiné du tabagisme et de l’exposition aux métaux était compatible avec un excès de risque additif. Cependant, les intervalles de confiance dans cette étude tendaient à être larges, et une faiblesse de puissance statistique peut limiter l’interprétation de certains résultats. Cette étude est unique dans la mesure où elle a fourni des preuves empiriques sur les risques de développer le cancer du poumon liés aux faibles niveaux d’exposition au nickel, au chrome VI, ou au cadmium provenant de divers contextes de travail. Dans la plupart des autres études, la majorité des expositions pertinentes n’ont pas été bien contrôlées. À l'inverse, cette étude a bénéficié de la collecte et de la disponibilité d'information détaillée concernant le tabagisme et d’autres facteurs de risque. Les résultats de cette étude ont d'importantes conséquences pour la santé publique, tant au niveau de la détermination des risques pour les travailleurs actuellement exposés à ces métaux, qu'au niveau de l’évaluation des risques pour la population en général, elle-même exposée à ces métaux par le biais de la pollution et de la fumée de cigarette. Cette analyse contribuera fort probablement à une réévaluation par le CIRC de la cancérogénicité de ces métaux. L'exploration de la relation entre les risques de cancer du poumon et l'exposition au nickel, au chrome VI et au cadmium est donc opportune et pertinente.

Modalities of exercise training on liver fat accretion and inflammatory markers in ovariectomized rats

Les facteurs de risque des maladies cardiovasculaires, telle, que la détérioration du profil lipidique, deviennent plus prononcés après la ménopause, ce qui fait de la maladie coronarienne, l’une des principales causes de décès chez les femmes ménopausées. Une proportion importante de femmes prennent du poids après la ménopause en particulier dans la région abdominale entraînant par conséquent des perturbations métaboliques. Des données récentes suggèrent également que l’absence des œstrogènes observée à la ménopause favorise le développement de la stéatose hépatique. Cette dernière a été incriminée pour incriminée dans le développement de la résistance à l'insuline, et est de ce fait considérée comme une composante hépatique du syndrome métabolique. Il est impératif d'établir des stratégies visant à contrecarrer l'accumulation de graisse dans le foie et l’accroissement du tissu adipeux chez les femmes ménopausées, en tenant compte que l'utilisation de l'hormonothérapie substitutive est de nos jours moins soutenue. Les quatre études de la présente thèse ont été conduites pour tenter de fournir des informations sur le traitement et la prévention de l’augmentation de la masse graisseuse et de la stéatose hépatique qu’entraîne la suppression des œstrogènes, à travers les modifications du mode de vie (diète et exercice physique) chez la rate ovariectomizée (Ovx); un modèle animal de la ménopause. Dans les deux premières études nous nous sommes concentrés sur l’augmentation de la masse graisseuse et sa reprise suite à une perte de poids. Dans la première étude, nous avons montré que les rates Ovx qui ont suivi un programme de restriction alimentaire (FR) ont diminué significativement (P < 0.01) leur poids corporel, leur contenu en graisses intra-abdominales ainsi que leurs triacylglycérols (TAG) hépatiques, comparativement aux rates Ovx nourries à la diète normale. De plus, l’entraînement en résistance (RT) a prévenu la reprise de poids corporel ainsi que l’accroissement du tissu adipeux et l’accumulation de lipides dans le foie des rates Ovx, après l’arrêt du régime amaigrissant. Les résultats de la deuxième étude ont confirmé l'efficacité de la restriction alimentaire associée à l’entraînement en résistance (FR + RT) dans la réduction du poids corporel, des lipides dans le foie et le tissu adipeux chez les rates Ovx. Tenant compte des résultats de notre première étude, l’entraînement en résistance seulement a constitué un atout pour atténuer le poids corporel et la masse grasse reprise par les rates Ovx suite à un programme de perte de poids (FR + RT); bien que l'impact ait été moindre comparé au maintien seul de la restriction alimentaire. De la même manière que la supplémentation en œstrogènes, les résultats de la troisième étude indiquent que l'entraînement en endurance mené concurremment avec l’ovariectomie a significativement atténué l'accumulation de lipides dans le foie ainsi que dans le tissu adipeux. Toutefois, l’entraînement en endurance effectué avant l'ovariectomie n'a pas protégé contre l'accumulation des graisses qu’entraîne l'ovariectomie, si celui-ci est interrompu après l'ovariectomie. Enfin, pour compléter les résultats antérieurs, nous avons montré dans la quatrième étude que l’expression des gènes impliqués dans la synthèse de lipide; SREBP-1c, SCD-1, ChREBP, et ACC dans le foie a augmenté après le retrait des œstrogènes, tandis qu’une diminution (P < 0.01) des niveaux d'ARNm de PPAR-α a été observée. De plus, l'expression hépatique des gènes des cytokines pro-inflammatoires incluant IKKβ, IL-6 ainsi que le contenu protéinique de NF-кB étaient augmentés (P < 0.01) chez les rates Ovx par rapport aux rates ayant subi une Ovx simulée (Sham). Toutes ces perturbations ont été améliorées avec la supplémentation en œstrogènes seulement, ainsi qu'avec l'entraînement en endurance seulement. Dans l'ensemble, nos résultats indiquent que l'exercice physique (en résistance ou en endurance) a un impact significatif sur la réduction de l'accumulation des lipides dans le foie et dans le tissu adipeux des rates Ovx. De plus, chez les rates Ovx, l’entraînement en endurance mimerait les effets des œstrogènes sur l'expression des gènes impliqués dans l'accumulation de lipides et l’inflammation préclinique dans le foie.