The influence of environmental distraction on cognitive abilities in ADL performance after frontal brain injured.

Background: Previous studies have reported errors in Activities of Daily Living (ADL) under the presence of distracting objects in dementia and brain injury patients. However, little is known about which distractor-target objects relation might be more harmful for performance. Method: We compared the ADL execution in frontal brain injured patients and control participants under two conditions: One in which target objects were mixed with distractor objects that constituted an alternative semantically related but non-required task (contextual condition) and another in which target objects were mixed with related but isolated distractors that did not constituted a coherent task (non-contextual condition). We separately analyzed ADL commission errors (repetitions, substitutions, objects manipulations, failures in sequence, extra actions) and omissions. In addition, the participants were evaluated with a neuropsychological protocol including a very specific executive functions task (Selective attention, Stimulus-Stimulus and Stimulus-Response conflict). Results: We found that frontal patients produced more commission errors compared to control participants, but only under the contextual condition. No between groups significant differences were found in omissions in both conditions or commission errors in non-contextual conditions. Scores in the Stimulus-Response conflict was significantly correlated with commission errors in the contextual condition. Conclusion: The presence of different non-target objects in ADL performance could require different cognitive process. Contextual ADL conditions required a higher level of executive functions, especially at the level of response (Stimulus-Response conflict). Application to Practice: Occupational therapists should control the presence of objects related to the target task according to the intervention objectives with the patients.

Observational research on golf-related injuries

The determination of aetiological factors in sports injuries is challenging. Recently, investigators have devoted significant attention to this topic. A reasonable amount of studies provides information on the occurrence, aetiology, and severity of golf-related injuries. However, gaps of evidence still limit the understanding of the injury problem in golf and the comparability of epidemiological findings. Observational studies using surveys and medical records were reviewed. Surveys are suited to find precise occurrence patterns of golf-related injuries, but fail to adequately ascertain the levels of exposure and aetiological factors. Due to the proximity to the injury event, medical records are able to clearly identify the aetiology and severity of golf-related injuries. While reviewing observational studies using surveys a comment was provided on the methodological quality and risk of bias. Overall, these studies seem to be disturbed on their ability to produce generalizations and comparison of study findings. With the information obtained from reviewing observational studies and the collaboration of a panel of internationally recognised experts on golf science and sports injury research, a web-based bilingual questionnaire was developed and tested for one of the provided languages. The bilingual nature of the questionnaire is also expected to facilitate the acceptance of the scientific community and enable the translation to different languages. A standardised questionnaire applied in different cultural contexts is expected to help and further improve the comparability of epidemiological findings. The questionnaire was proficient in capturing information on golf-related injuries and participation habits of golfers. While using a wider outcome definition focusing on any type of physical complaints, episodes of injury could be recognized despite onset and level of severity. Questions on the need for medical attention, time loss, and impact on performance also enabled additional categorisation of severity.

If a trauma patient is tachycardic, should we call for a counsellor?

BACKGROUND: It has been suggested in the literature that raised heart rate in the early period after trauma is associated with the development of post-traumatic psychopathology, but little account has been taken of the potential confounding effect of injury severity.

MATERIALS AND METHODS: A cohort of 154 patients, studied as part of a wider investigation of trauma outcomes, was included. Initial heart rate in the accident & emergency department, and injury severity score and new injury severity scores were recorded. Patients completed the General Health Questionnaire (GHQ-28) as a measure of psychopathology at presentation and again at two- and six-month follow-up.

RESULTS: There was no relationship between psychopathology at presentation and initial heart rate or injury severity. Raised heart rate was associated with post-traumatic psychopathology at two months but not at six months. When the potential confounding effect of injury severity was controlled for, there was no independent correlation between heart rate and post-traumatic psychopathology. Injury severity score and new injury severity scores were strongly associated with GHQ-28 caseness.

CONCLUSION: Post-traumatic tachycardia is not associated with development of psychopathology, but injury severity is. Previous studies that have suggested a link between tachycardia and development of psychopathology are flawed because they have not considered the confounding effect of severity of injury.

Can early dietetic intervention improve outcomes in patients with hip fracture?

Aim: To assess whether the introduction of a new approach to nutritional care for hip fracture patients, in both acute and subacute admissions, can improve nutritional status, length of stay and pressure injuries. Methods: Medical records of patients admitted to Austin Health, Melbourne, Australia with a fractured hip between January and June 2014 after implementation of a new nutritional care guideline were compared to a historical control group admitted between January and June 2013 prior to introduction of the guideline. Data were collected for both acute and subacute admissions and included length of stay, date of first contact with a dietitian, subjective global assessment category and occurrence of pressure injuries. Results: There was a significantly shorter length of stay overall for patients who received care under the new guideline (21.6 ± 15.1 vs 26.4 ± 20.4 days; P = 0.043) and during the subacute admission (20.1 ± 10.6 vs 28.8 ± 15.8 days; P < 0.001); however, there was no significant difference in the acute hospital length of stay period. The post-guideline group had a significantly shorter time between admission and first contact with a dietitian (4.8 ± 3.3 vs 7.5 ± 6.2 days; P < 0.001). Post-guideline patients also had a significantly lower incidence of pressure injuries with 29, compared to 41 in pre-guideline patients (P = 0.045). There were significantly less malnourished patients in the post-guideline group compared to the pre-guideline group across both acute and subacute admissions (29% vs 35%; P = 0.015). Conclusions: A nutritional care guideline for patients with hip fractures is associated with improved patient outcomes with a significant reduction in overall and subacute length of stay and pressure injury incidence and earlier dietetic assessment and intervention.

Efficacy of progressive aquatic resistance training for tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis: a randomised controlled trial

OBJECTIVE: To study the efficacy of aquatic resistance training on biochemical composition of tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis (OA).

DESIGN: Eighty seven volunteer postmenopausal women, aged 60-68 years, with mild knee OA (Kellgren-Lawrence grades I/II and knee pain) were recruited and randomly assigned to an intervention (n = 43) and control (n = 44) group. The intervention group participated in 48 supervised aquatic resistance training sessions over 16 weeks while the control group maintained usual level of physical activity. The biochemical composition of the medial and lateral tibiofemoral cartilage was estimated using single-slice transverse relaxation time (T2) mapping and delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC index). Secondary outcomes were cardiorespiratory fitness, isometric knee extension and flexion force and knee injury and OA outcome (KOOS) questionnaire.

RESULTS: After 4-months aquatic training, there was a significant decrease in both T2 -1.2 ms (95% confidence interval (CI): -2.3 to -0.1, P = 0.021) and dGEMRIC index -23 ms (-43 to -3, P = 0.016) in the training group compared to controls in the full thickness posterior region of interest (ROI) of the medial femoral cartilage. Cardiorespiratory fitness significantly improved in the intervention group by 9.8% (P = 0.010).

CONCLUSIONS: Our results suggest that, in postmenopausal women with mild knee OA, the integrity of the collagen-interstitial water environment (T2) of the tibiofemoral cartilage may be responsive to low shear and compressive forces during aquatic resistance training. More research is required to understand the exact nature of acute responses in dGEMRIC index to this type of loading. Further, aquatic resistance training improves cardiorespiratory fitness.

The training load of aerial skiing

This study quantified the training load experienced by elite aerial skiers. Nine elite female aerial skiers were monitored during 16 training sessions over a 13 day period. Time-motion, landing impact and heart rate (HR) data were measured from 688 jumps using integrated GPS, accelerometer and HR transmitters while rating of perceived exertion (RPE) was taken using Borg's scale. Each jump was delineated into five components from the GPS time-motion data to determine the work to rest ratios. Participants completed 16 ± 3 jumps per session with a work to rest ratio of 1.9:1 Heart rates averaged 65 ± 3.1% HRmax and peaked at 85 ± 4.4% HRmax while and an RPE score of 12 ± 1 was evoked. Landing impacts were significantly higher (p ≤ 0.001) when participants jumped off ramps with a larger take-off angle or when they completed jumps with a mid-air rotation. The training load experienced by elite aerial skiers may be causative of the high incidence of injuries reported. Significantly differing levels of impact load during the study suggest training load for these athletes can be easily modified and periodised allowing optimised performance and minimised injury.

Workplace pedometer interventions for increasing physical activity

Background
The World Health Organization and the World Economic Forum have recommended further research to strengthen current knowledge of workplace health programmes, particularly on effectiveness and using simple instruments. A pedometer is one such simple instrument that can be incorporated in workplace interventions.

Objectives
To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes.

Search methods
Electronic searches of the Cochrane Central Register of Controlled Trials (671 potential papers), MEDLINE (1001), Embase (965), CINAHL (1262), OSH UPDATE databases (75) and Web of Science (1154) from the earliest record to between 30th January and 6th February 2012 yielded 3248 unique records. Reference lists of articles yielded an additional 34 papers. Contact with individuals and organisations did not produce any further records.

Selection criteria
We included individual and cluster-randomised controlled trials of workplace health promotion interventions with a pedometer component in employed adults. The primary outcome was physical activity and was part of the eligibility criteria. We considered subsequent health outcomes, including adverse effects, as secondary outcomes.

Data collection and analysis
Two review authors undertook the screening of titles and abstracts and the full-text papers independently. Two review authors (RFP and MC) independently completed data extraction and risk of bias assessment. We contacted authors to obtain additional data and clarification.

Main results
We found four relevant studies providing data for 1809 employees, 60% of whom were allocated to the intervention group. All studies assessed outcomes immediately after the intervention had finished and the intervention duration varied between three to six months. All studies had usual treatment control conditions; however one study’s usual treatment was an alternative physical activity programme while the other three had minimally active controls. In general, there was high risk of bias mainly due to lack of blinding, self reported outcome measurement, incomplete outcome data due to attrition, and most of the studies had not published protocols, which increases the likelihood of selective reporting.

Three studies compared the pedometer programme to a minimally active control group, but the results for physical activity could not be combined because each study used a different measure of activity. One study observed an increase in physical activity under a pedometer programme, but the other two did not find a significant difference. For secondary outcomes we found improvements in body mass index, waist circumference, fasting plasma glucose, the quality of life mental component and worksite injury associated with the pedometer programmes, but these results were based on limited data from one or two small studies. There were no differences between the pedometer programme and the control group for blood pressure, a number of biochemical outcomes and the quality of life physical component. Sedentary behaviour and disease risk scores were not measured by any of the included studies.

One study compared a pedometer programme and an alternative physical activity programme, but baseline imbalances made it difficult to distinguish the true improvements associated with either programme.

Overall, there was insufficient evidence to assess the effectiveness of pedometer interventions in the workplace.

There is a need for more high quality randomised controlled trials to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes. To improve the quality of the evidence available, future studies should be registered in an online trials register, publish a protocol, allocate time and financial support to reducing attrition, and try to blind personnel (especially those who undertake measurement). To better identify the effects of pedometer interventions, future studies should report a core set of outcomes (total physical activity in METs, total time sitting in hours and minutes, objectively measured cardiovascular disease and type II diabetes risk factors, quality of life and injury), assess outcomes in the long term and undertake subgroup analyses based upon demographic subgroups (e.g. age, gender, educational status). Future studies should also compare different types of active intervention to test specific intervention components (eligibility, duration, step goal, step diary, settings), and settings (occupation, intervention provider).

Authors’ conclusions
There was limited and low quality data providing insufficient evidence to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes.

P L A I N  L A N G U A G E  S U M M A R Y

Do workplace pedometer interventions increase physical activity?
The World Health Organization recommends that most people should undertake at least 30 minutes of moderate-intensity physical activity on most days, as it reduces the risk of cardiovascular disease, diabetes and some cancers. However, less than 40% of the world’s population are undertaking adequate amounts of physical activity and rates have been declining. Here we assess whether pedometer workplace interventions increase physical activity and thereby lead to subsequent health benefits.

To assess this, we searched for randomised controlled trials of workplace health promotion interventions that involved the use of a pedometer undertaken in employed adults. Between 30th January and 6th February 2012 we searched a range of electronic libraries and references of relevant papers, retrieving 3282 potential papers.

We eventually included four studies in the review. One study compared pedometer programmes with an alternative physical activity programme, but there were important baseline differences between the intervention and control groups that made it difficult to distinguish the true effect. The three remaining studies compared pedometer programmes with minimally active control groups. One study observed an improvement in physical activity in the pedometer programme, but two other studies found no significant difference between the pedometer group and the control group. We could not combine these results together, as each study used a different measure for physical activity, so it is not clear what the overall effect is. Single studies found beneficial changes in body mass index, fasting plasma glucose, the mental component of quality of life and worksite injury associated with the pedometer programmes as opposed to the control group. However, none of the studies identified consistent differences between the pedometer programme and the control group for waist circumference, blood pressure and quality of life outcomes. In addition, we judged the majority of included studies to have a high risk of bias, mainly due to participants and staff knowing who was in the intervention and who was in the control group, attrition of participants and not having published a protocol prior to running the study.

We conclude that there was insufficient evidence to assess whether workplace pedometer interventions are of benefit. There is a need for further high quality randomised controlled trials to be undertaken with a range of health outcomes and assessment in the long term.

Tratamento de sementes para manejo do percevejo-barriga-verde na cultura de soja e milho em sucessão.

RESUMO: O objetivo deste trabalho foi avaliar o efeito do tratamento de sementes com inseticidas sobre o manejo de Dichelops melacanthus e a produtividade da soja e do milho, cultivados em sucessão. O estudo foi realizado em campo, nas safras 2012/2013 (I) e 2013/2014 (II). Avaliaram-se os inseticidas imidacloprido, tiametoxam, tiodicarbe, fipronil e abamectina. Determinaram-se: a densidade populacional do percevejo, a produtividade de soja e milho, e a intensidade da injúria em milho. A densidade do percevejo permaneceu abaixo de um inseto por metro quadrado, na maior parte do ciclo da soja. Os picos populacionais foram observados nas primeiras semanas, após a emergência do milho, e atingiram 2,2 (safra I) e 6,7 (safra II) percevejos por metro quadrado. Na cultura da soja, os inseticidas não reduziram a densidade populacional do percevejo. Na cultura do milho, o imidacloprido reduziu a densidade do percevejo em 23,2% (safra I) e 38,8% (safra II), e a injúria em 61,8% (safra I) e 26,4% (safra II). O tiametoxam reduziu a densidade dos insetos em 27,8% (safra II) e a injúria em 42,7% (safra I). O tratamento de sementes com inseticidas não proporciona aumento de produtividade à soja e ao milho, portanto, não se justifica sua utilização nas condições deste estudo. ABSTRACT: The objective of this work was to evaluate the effect of seed treatment with insecticides on the management of Dichelops melacanthus on the yield of soybean and corn, grown in succession. The study was carried out in a field, in the 2012/2013 (I) and 2013/2014 (II) crop seasons. The evaluated insecticides were: imidacloprid, thiamethoxam, thiodicarb, fipronil, and abamectin. The following were determined: stink bug population density, soybean and corn yield, and corn injury. Population density remained below one stink bug per square meter, in most of the soybean cycle. Population peaks were observed in the first weeks, after corn emergence, and they reached 2.2 (crop season I) and 6.7 (crop season II) stink bugs per square meter. In the soybean crop, the insecticides did not reduce the stink bug population density. In the corn crop, imidacloprid reduced the stink bug density in 23.2% (crop season I) and 38.8% (crop season II), and injury in 61.8% (crop season I) and 26.4% (crop season II). Thiamethoxam reduced the insect population density in 27.8% (crop season II) and injury in 42.7% (crop season I). Seed treatment with insecticides does not provide increase for soybean and corn yields, therefore, their use is not justified in this study's conditions.

Antioxidant Action of Mangrove Polyphenols against Gastric Damage Induced by Absolute Ethanol and Ischemia-Reperfusion in the Rat

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Parecoxib reduces renal injury in an ischemia/reperfusion model in rats

To evaluate the effect of parecoxib (an NSAID) on renal function by measuring plasma NGAL (serum neutrophil gelatinase-associated lipocalin) levels in an induced-ischemia rat model. METHODS: Forty male Wistar rats were randomly assigned to one of four groups: Ischemia (I), Ischemia/parecoxib (IP), No-ischemia (NI), and No-ischemia/parecoxib (NIP). Body weight, mean arterial pressure, heart rate, body temperature, NGAL levels, and renal histology were compared across groups. RESULTS: The Ischemia (I) group, which did not receive parecoxib, showed the highest NGAL levels (p=0.001), while the IP group, which received the medication, had NGAL levels similar to those of the non-ischemic (NI and NIP) groups. CONCLUSION: Parecoxib resulted in renal protection in this experimental model.

Retinol binding protein 4 and retinol in steatotic and nonsteatotic rat livers in the setting of partial hepatectomy under ischemia/reperfusion

Steatotic livers show increased hepatic damage and impaired regeneration after partial hepatectomy (PH) under ischemia/reperfusion (I/R), which is commonly applied in clinical practice to reduce bleeding. The known function of retinol-binding protein 4 (RBP4) is to transport retinol in the circulation. We examined whether modulating RBP4 and/or retinol could protect steatotic and nonsteatotic livers in the setting of PH under I/R. Steatotic and nonsteatotic livers from Zucker rats were subjected to PH (70%) with 60 minutes of ischemia. RBP4 and retinol levels were measured and altered pharmacologically, and their effects on hepatic damage and regeneration were studied after reperfusion. Decreased RBP4 levels were observed in both liver types, whereas retinol levels were reduced only in steatotic livers. RBP4 administration exacerbated the negative consequences of liver surgery with respect to damage and liver regeneration in both liver types. RBP4 affected the mobilization of retinol from steatotic livers, and this revealed actions of RBP4 independent of simple retinol transport. The injurious effects of RBP4 were not due to changes in retinol levels. Treatment with retinol was effective only for steatotic livers. Indeed, retinol increased hepatic injury and impaired liver regeneration in nonsteatotic livers. In steatotic livers, retinol reduced damage and improved regeneration after surgery. These benefits of retinol were associated with a reduced accumulation of hepatocellular fat. Thus, strategies based on modulating RBP4 could be ineffective and possibly even harmful in both liver types in the setting of PH under I/R. In terms of clinical applications, a retinol pretreatment might open new avenues for liver surgery that specifically benefit the steatotic liver. Liver Transpl 18:1198-1208, 2012. (c) 2012 AASLD.

Annexin-A1 peptide down-regulates the leukocyte recruitment and up-regulates interleukin-10 release into lung after intestinal ischemia-reperfusion in mice

Abstract Background Intestinal ischemia/reperfusion (IR) injury is a serious and triggering event in the development of remote organ dysfunction, from which the lung is the main target. This condition is characterized by intense neutrophil recruitment, increased microvascular permeability. Intestinal IR is also responsible for induction of adult respiratory distress syndrome, the most serious and life-threatening form of acute lung injury. The purpose of this study was to investigate the effect of annexin-A1 protein as an endogenous regulator of the organ remote injury induced by intestinal ischemia/reperfusion. Male C57bl/6 mice were subjected to intestinal ischemia, induced by 45 min occlusion of the superior mesenteric artery, followed by reperfusion. Results The intestinal ischemia/reperfusion evoked a high intensity lung inflammation as indicated by the number of neutrophils as compared to control group. Treatment with annexin-A1 peptidomimetic Ac2-26, reduced the number of neutrophils in the lung tissue and increased its number in the blood vessels, which suggests a regulatory effect of the peptide Ac2-26 in the neutrophil migration. Moreover, the peptide Ac2-26 treatment was associated with higher levels of plasma IL-10. Conclusion Our data suggest that the annexin-A1 peptidomimetic Ac2-26 treatment has a regulatory and protective effect in the intestinal ischemia/reperfusion by attenuation of the leukocyte migration to the lung and induction of the anti-inflammatory cytokine IL-10 release into the plasma. The anti-inflammatory action of annexin-A1 and its peptidomimetic described here may serve as a basis for future therapeutic approach in mitigating inflammatory processes due to intestinal ischemia/reperfusion.

Annexin-A1 peptide down-regulates the leukocyte recruitment and up-regulates interleukin-10 release into lung after intestinal ischemia-reperfusion in mice

BACKGROUND: Intestinal ischemia/reperfusion (IR) injury is a serious and triggering event in the development of remote organ dysfunction, from which the lung is the main target. This condition is characterized by intense neutrophil recruitment, increased microvascular permeability. Intestinal IR is also responsible for induction of adult respiratory distress syndrome, the most serious and life-threatening form of acute lung injury. The purpose of this study was to investigate the effect of annexin-A1 protein as an endogenous regulator of the organ remote injury induced by intestinal ischemia/reperfusion. Male C57bl/6 mice were subjected to intestinal ischemia, induced by 45 min occlusion of the superior mesenteric artery, followed by reperfusion. RESULTS: The intestinal ischemia/reperfusion evoked a high intensity lung inflammation as indicated by the number of neutrophils as compared to control group. Treatment with annexin-A1 peptidomimetic Ac2-26, reduced the number of neutrophils in the lung tissue and increased its number in the blood vessels, which suggests a regulatory effect of the peptide Ac2-26 in the neutrophil migration. Moreover, the peptide Ac2-26 treatment was associated with higher levels of plasma IL-10. CONCLUSION: Our data suggest that the annexin-A1 peptidomimetic Ac2-26 treatment has a regulatory and protective effect in the intestinal ischemia/reperfusion by attenuation of the leukocyte migration to the lung and induction of the anti-inflammatory cytokine IL-10 release into the plasma. The anti-inflammatory action of annexin-A1 and its peptidomimetic described here may serve as a basis for future therapeutic approach in mitigating inflammatory processes due to intestinal

Role of complement and perspectives for intervention in ischemia-reperfusion damage

Reperfusion of an organ following prolonged ischemia instigates the pro-inflammatory and pro-coagulant response of ischemia / reperfusion (IR) injury. IR injury is a wide-spread pathology, observed in many clinically relevant situations, including myocardial infarction, stroke, organ transplantation, sepsis and shock, and cardiovascular surgery on cardiopulmonary bypass. Activation of the classical, alternative, and lectin complement pathways and the generation of the anaphylatoxins C3a and C5a lead to recruitment of polymorphonuclear leukocytes, generation of radical oxygen species, up-regulation of adhesion molecules on the endothelium and platelets, and induction of cytokine release. Generalized or pathway-specific complement inhibition using protein-based drugs or low-molecular-weight inhibitors has been shown to significantly reduce tissue injury and improve outcome in numerous in-vitro, ex-vivo, and in-vivo models. Despite the obvious benefits in experimental research, only few complement inhibitors, including C1-esterase inhibitor, anti-C5 antibody, and soluble complement receptor 1, have made it into clinical trials of IR injury. The results are mixed, and the next objectives should be to combine knowledge and experience obtained in the past from animal models and channel future work to translate this into clinical trials in surgical and interventional reperfusion therapy as well as organ transplantation.