Impact of COVID-19 pandemic on accredited programs and graduates who sat for the American Society for Clinical Pathology Board of Certification examination: graduates' perspective

OBJECTIVE

Students in health profession education programs were severely affected by the COVID-19 pandemic at both didactic and clinical training levels. The purpose for this American Society for Clinical Pathology Board of Certification (ASCP BOC) study was to determine the impact of the COVID-19 pandemic on graduates. This study represents the perspectives of laboratory professional graduates who sat for the BOC certification in their respective professional disciplines.

METHODS

A survey was sent to all graduates from the National Accrediting Agency for Clinical Laboratory Science (NAACLS), Accrediting Bureau of Health Education Schools (ABHES), and Commission on Accreditation of Allied Health Education Programs (CAAHEP) accredited programs who sat for the ASCP BOC examination in 2020 and 2021 to determine the impact of COVID-19 on laboratory professional graduates during the pandemic.

RESULTS

A total of 180 graduates responded to the survey. The majority of graduates indicated that at least 1 didactic program component was shifted to an online system during the pandemic and that both clinical and nonclinical student laboratories were affected. Although program completion for most graduates was not delayed, one-third of graduates delayed taking their respective BOC exam. Due to the lack of knowledge application through practical hands-on laboratory experience in their educational programs, graduates reported feeling a lack of readiness with regards to preparing for the national certification examination as well as for employment.

CONCLUSION

The study results showed the pandemic greatly impacted the education experience and readiness for the ASCP BOC examinations for graduates. Factors such as the absence of in-person learning and hands-on experience-both crucial aspects in laboratory training-and the ripple effects as a result of the pandemic, such as job loss, financial constraints, and health concerns, contributed to the decreased quality of education for graduates.

Impact of COVID-19 pandemic on accredited programs and graduates who sat for the American Society for Clinical Pathology-Board of Certification Examination: program directors' perspective

OBJECTIVE

Health professions education programs were severely affected by the COVID-19 pandemic at clinical and didactic training levels. The purpose for this American Society for Clinical Pathology-Board of Certification (BOC) study was to determine the impact of the COVID-19 pandemic on the graduates who sat for BOC certification in their respective professional disciplines from the perspective of program directors (PDs). A separate article will be published on the graduates' perspective.

METHODS

A survey was sent to all PDs from the National Accrediting Agency for Clinical Laboratory Science, Accrediting Bureau of Health Education Schools, and Commission on Accreditation of Allied Health Education Programs, accredited programs whose graduates are certified by the BOC, to determine the impact of COVID-19 on healthcare graduates and education programs during the pandemic.

RESULTS

A total of 201 PDs responded. All programs consistently reported that the pandemic had a negative impact on their students' BOC pass rate and scores. When asked what educational formats were used, all groups used virtual live lectures and recorded lectures. University programs were found to use more online student laboratories and simulation laboratory sessions than the hospital programs, affecting the psychomotor skills of their students.

CONCLUSION

The results indicated that the effects from the COVID-19 pandemic were related to the inherent differences between hospital and university programs. This study revealed that the pandemic affected university programs more than hospital programs.

A novel comprehensive efficacy test for textiles intended for use in the healthcare setting

Soft surfaces, including textiles are found throughout healthcare settings. Pathogens can survive for long periods of time on textiles, and can be transferred to and from the skin. Antimicrobial fabrics are used as an engineering control to prevent infection. Efficacy testing standards have limitations, including single microorganism challenges, multiple fabric plies tested, and lengthy contact times. We developed a novel method that better models in-use conditions through testing standardized mixtures of pathogens and normal skin microorganisms, artificial soils, and a 15-min contact time. Reproducible growth of all microorganisms from frozen stocks was achieved using this method. A novel rechargeable, monitorable N-halamine cotton cellulose fabric, containing 5885 ± 98 ppm of active chlorine, was evaluated with the new method using PBS, artificial sweat, and artificial sweat plus 5% serum as soil. Pathogens tested included Acinetobacter baumannii, Candida albicans, Escherichia coli, vancomycin-resistant Enterococcus faecalis, methicillin-resistant Staphylococcus aureus, methicillin-susceptible Staphylococcus aureus, and Pseudomonas aeruginosa. Each was tested singly and in the presence of a representative normal skin flora mixture, including: Acinetobacter lwoffii, Corynebacterium striatum, Micrococcus luteus, and Staphylococcus epidermidis. When tested singly, all microorganisms were reduced by 3.00 log₁₀ or greater, regardless of artificial soil. In mixture, 4.00 log₁₀ or greater reductions were achieved for all microorganisms. These results suggest that the novel testing method can be used to provide more comprehensive and realistic efficacy information for antimicrobial textiles intended for use in healthcare. Furthermore, the N-halamine fabric demonstrated efficacy against multiple pathogens, singly and in mixtures, regardless of the presence of artificial soils.

Stabilization and controlled release of micro-encapsulated hydrogen peroxide for wound treatment applications

AIMS

Hydrogen peroxide (H₂ O₂ ) disinfection applications are limited by its rapid inactivation. The aims of this study were to (i) micro-encapsulate H₂ O₂ in silica hydrogels to obtain controlled release up to 72 h, (ii) test hydrogel antimicrobial activity against four common pathogens and (iii) assess H₂ O₂ release kinetics and antimicrobial activity in 35-65% relative humidity and 37°C to approximate bandaged wound conditions.

METHODS AND RESULTS

Hydrogels were characterized using scanning electron microscopy, nitrogen sorption porosimetry, Brunauer Emmet Teller analysis and the Barret-Joyner-Halenda method. Hydrogels formed at lower pH demonstrated increased surface area and decreased pore size, resulting in H₂ O₂ release lasting 72 h. Using agar well diffusion for antimicrobial activity, statistically significant zones of inhibition (as compared to controls) were seen for Escherichia coli, Staphylococcus aureus, Pseudomona aeruginiosa and Vancomycin-resistant Enterococcus faecalis. Activity remained for hydrogels aged for 72 h in humid, 37°C conditions.

CONCLUSIONS

Hydrogels can be synthesized to provide a continuous, controlled release of H₂ O₂ for up to 72 h.

SIGNIFICANCE AND IMPACT OF THE STUDY

Stable, controlled-release H₂ O₂ hydrogels have potential applications for wound treatment and disinfection of medical equipment, through bonding to bandages or materials such as catheter lumens.

Cleaning and disinfection in home care: A comparison of 2 commercial products with potentially different consequences for respiratory health

BACKGROUND

Home care aides perform personal care and homemaking services in client homes, including cleaning and disinfection (C&D). Although C&D are performed to remove soil and dust, they are increasingly performed for infection prevention. Many C&D products contain respiratory irritants. The objective of this study was to evaluate 2 commercial products for C&D effectiveness on common household surfaces in seniors' homes.

METHODS

Two C&D visits were conducted in 46 seniors' homes. One visit applied a bleach-containing cleaning product and the other applied an environmentally preferable product. Before and after C&D, the study team performed organic soil bioluminometer measurements on surfaces and collected cotton swab and wipe samples for total bacteria count, Staphylococcus aureus, and Clostridium difficile identification.

RESULTS

Both products removed microorganisms from tested surfaces. S aureus was found in 7 households, 1 strain of which was methicillin-resistant. Both products removed S aureus from all surfaces. Bleach-containing products removed somewhat more soil than environmentally preferable products, although results were statistically significant for only 1 surface.

CONCLUSIONS

The study showed similar, not identical, C&D performance for 2 cleaning products with potentially different consequences for respiratory health. Additional research is needed to develop robust recommendations for safe, effective C&D in home care.

Laundering habits of student nurses and correlation with the presence of Staphylococcus aureus on nursing scrub tops pre- and postlaundering

Little is known about student nurse laundering practices. Student nurses swabbed their scrub tops after clinical and after laundering, and they completed a laundry survey; 13.5% of students wore the same scrub more than once, and few followed recommended guidelines by using hot water (20%) or bleach (5.6%) when laundering scrubs. After clinical shifts, 17% of swabs tested positive for Staphylococcus aureus; however, laundering eradicated it from 64.3% of positive samples. This was not statistically significant.

Impact of Time Lapse on ASCP Board of Certification Medical Laboratory Scientist (MLS) and Medical Laboratory Technician (MLT) Examination Scores

BACKGROUND

Research in several professional fields has demonstrated that delays (time lapse) in taking certification examinations may result in poorer performance by examinees. Thirteen states and/or territories require licensure for laboratory personnel. A core component of licensure is passing a certification exam. Also, many facilities in states that do not require licensure require certification for employment or preferentially hire certified individuals.

OBJECTIVE

To analyze examinee performance on the American Society for Clinical Pathology (ASCP) Board of Certification (BOC) Medical Laboratory Scientist (MLS) and Medical Laboratory Technician (MLT) certification examinations to determine whether delays in taking the examination from the time of program completion are associated with poorer performance.

METHODS

We obtained examination data from April 2013 through December 2014 to look for changes in mean (SD) exam scaled scores and overall pass/fail rates. First-time examinees (MLS: n = 6037; MLT, n = 3920) were divided into 3-month categories based on the interval of time between date of program completion and taking the certification exam.

RESULTS

We observed significant decreases in mean (SD) scaled scores and pass rates after the first quarter in MLS and MLT examinations for applicants who delayed taking their examination until the second, third, and fourth quarter after completing their training programs.

CONCLUSIONS

Those who take the ASCP BOC MLS and MLT examinations are encouraged to do so shortly after completion of their educational training programs. Delays in taking an exam are generally not beneficial to the examinee and result in poorer performance on the exam.

Variation in detection limits between bacterial growth phases and precision of an ATP bioluminescence system

To determine the detection limits of the SystemSure Plus, Escherichia coli and Staphylococcus aureus growth curve samples were taken in lag (1 h), log (6 h), stationary (12 h) and death phases (E. coli 144 h, Staph. aureus 72 h). At each time point, the log10 CFU ml(-1) was determined for the dilution where the SystemSure read 0 relative light units (RLU). Average detection limits were E. coli: lag 6·27, log 5·88, stationary 7·45 and death 6·88; Staph. aureus: lag 4·37, log 5·15, stationary 7·88 and death 7·57. Between-run precision was determined with positive control; within-run precision with positive control, lag and log growth for each bacteria. Within-run precision mean RLU (CV): positive control 274 (12%), E. coli lag 1 (63%), log 2173 RLU (19%), Staph. aureus lag 2 (58%) and log 5535 (18%). Between-run precision was 232 (16%). The precision is adequate with most values within the 95% confidence interval. The detection limit varied by 3·51 log10 for Staph. aureus and 1·47 log10 for E. coli. The lowest detection limits were during E. coli log and Staph. aureus lag phases; the highest was during stationary phase. These results suggest that organism identification and growth phase both impact ATP RLU readings.

SIGNIFICANCE AND IMPACT OF THE STUDY

Surface hygiene is a critical component of food safety and infection control; increasingly, ATP detection by bioluminescence is used to evaluate surface hygiene and effective cleaning. This is the first study to show that the number of living and potentially infectious bacteria remaining when the device reads zero varies between the different bacterial life cycle phases: lag, log, stationary and death. ATP device users need to be aware of this information to use the devices appropriately.

Effectiveness of five-day-old 10% bleach in a student microbiology laboratory setting

In the student laboratory, 10% bleach (sodium hypochlorite) is used to disinfect benches before and after work, and when a spill occurs. Centers for Disease Control and Prevention (CDC) Guidelines recommend diluting bleach daily. In a student laboratory setting, the organisms in use are known and may include only selected standard bacteria. Diluting bleach daily is time consuming and wastes bleach. We hypothesized that 10% bleach stored in low density polyethylene (LDPE) wash bottles would maintain sufficient chlorine concentration to be effective against the organisms used in the student laboratory for five days, so that bleach could be diluted weekly instead of daily. Approximately 3 x 10(6) CFU of each bacterium were spotted to a laboratory bench surface in duplicate and allowed to air dry. One spot was individually cleaned with five-day old 10% bleach following the same protocol as student laboratories. The second spot was uncleaned and sampled as a control. Contact plates containing D/E Neutralizing agar were touched to the spots, incubated overnight at 35 degrees C and examined for growth. An uninoculated spot was also sampled as a background control. A total of 22 different organisms were tested, representing the major groups of organisms used in the student laboratories. All organisms tested were eliminated by the five-day old bleach. All uncleaned spots showed dense growth. The background control had no growth. Reducing the dilution of bleach to once a week rather than daily will save time and money, which can then be devoted to more teaching and curriculum responsibilities, while still maintaining laboratory safety.

Systematic assessment of culture review as a tool to assess errors in the clinical microbiology laboratory

CONTEXT

Daily supervisory review is a common practice in microbiology laboratories; however, there are no publications describing errors corrected by this practice.

OBJECTIVE

To determine (1) the correction rates for routinely reviewed positive cultures, (2) the correction rates for negative cultures, and (3) the types of corrections that are found, including the number with potential clinical significance.

DESIGN

We prospectively assessed errors identified during culture report review for all positive (10-month period) and negative (1-month period) cultures at a single, university-based clinical microbiology laboratory in the United States. Errors were classified using predefined categories, and total and per category error rates were determined. A chi(2) test was used to assess significant differences between error rates.

RESULTS

A total of 112,108 culture reports were examined; 914 reports required a total of 1043 corrections. Of 101,703 positive culture reports, 786 (0.8%) required 900 corrections, 302 (0.3%) of which were potentially clinically significant. Of 10,405 negative culture reports, 128 (1.2%) required 143 corrections, 5 (0.05%) of which were potentially clinically significant. The rate of potentially clinically significant errors was significantly higher among positive versus negative culture reports (P < .001). Errors from positive culture reports most commonly involved susceptibility (374 [42%]), reporting (275 [31%]), and identification workup (217 [24%]). Most potentially significant errors from positive culture reports involved susceptibility testing (n = 253) and specimens from wound or lower respiratory tract (P < .001).

CONCLUSIONS

Review of culture reports from positive cultures from nonsterile sites with special attention to antimicrobial susceptibility testing and reporting would be most likely to detect potentially significant errors within the clinical microbiology laboratory.

A 2-year study of Gram stain competency assessment in 40 clinical laboratories

We used a computer-based competency assessment tool for Gram stain interpretation to assess the performance of 278 laboratory staff from 40 laboratories on 40 multiple-choice questions. We report test reliability, mean scores, median, item difficulty, discrimination, and analysis of the highest- and lowest-scoring questions. The questions were reliable (KR-20 coefficient, 0.80). Overall mean score was 88% (range, 63%-98%). When categorized by cell type, the means were host cells, 93%; other cells (eg, yeast), 92%; gram-positive, 90%; and gram-negative, 88%. When categorized by type of interpretation, the means were other (eg, underdecolorization), 92%; identify by structure (eg, bacterial morphologic features), 91%; and identify by name (eg, genus and species), 87%. Of the 6 highest-scoring questions (mean scores, > or = 99%) 5 were identify by structure and 1 was identify by name. Of the 6 lowest-scoring questions (mean scores, < 75%) 5 were gram-negative and 1 was host cells. By type of interpretation, 2 were identify by structure and 4 were identify by name. Computer-based Gram stain competency assessment examinations are reliable. Our analysis helps laboratories identify areas for continuing education in Gram stain interpretation and will direct future revisions of the tests.

Standardized test scores as an admission requirement

OBJECTIVE

The usefulness of standardized test scores as an admission requirement for the University of Washington Medical Technology Program (UWMTP) was evaluated. Scores from the Allied Health Professions Admissions Test (AHPAT) were used.

DESIGN

Student data (n = 183) were analyzed and evaluated statistically using Pearson correlation and Cox proportional hazards regression analyses. Sensitivity and specificity for several admissions criteria were calculated.

SETTING

The UWMTP is a 2 + 2 medical technology program (MTP) located in a large public university.

PARTICIPANTS

Student records for classes of 1993 through 2000 were reviewed. Eligibility for inclusion was based on completeness of student record.

MAIN OUTCOME MEASURES

Several admission criteria were analyzed for their ability to predict success in the UWMTP and on the ASCP Board of Registry (BOR) certification examination, and for their sensitivity and specificity.

RESULTS

Pearson correlations for the AHPAT total score were r = 0.402 with the MTP GPA and r = 0.414 with the BOR exam. Cox proportional hazards regression analysis defined the decreased likelihood of failure for each unit increase in the test score. For the MTP GPA, the risk decrease was 0.8% for the AHPAT total and 2.8% for the Biology subtest. For the BOR exam, the risk decrease was 0.8% for the AHPAT total and 2.8% for the Verbal subtest. The admissions criteria selected based on specificity (26.7%) and maximum sensitivity (100%) was one in which the student must achieve at least two of the following three scores: AHPAT total > or = 150, Biology subtest score > or = 10, Verbal subtest score > or = 5.

CONCLUSIONS

Scores on a standardized test can be used to predict success in a MTP and on the ASCP BOR exam.

Inflammatory mediators induce sequestration of VE-cadherin in cultured human endothelial cells

The mechanisms through which inflammatory mediators modify endothelial junctional structure are not well understood. Endothelial cells exposed to 1 mM H2O2, 0.1 mM histamine or 4 mM EDTA displayed decreased amounts of VE-cadherin on the cell surface in a time-dependent manner. H2O2 and EDTA-treated cells showed a sustained reduction in surface VE-cadherin, but histamine (0.1 mM) decreased cell surface VE-cadherin only at 5 and 15 min, not at 30 and 60 min. Sequestering of VE-cadherin could also be visualized as a decrease in immunofluorescent labeling of endothelial junctions in fixed, non-extracted monolayers. However, junctional staining was observed in these cells after membrane extraction. This decreased surface expression of VE-cadherin was actin-filament, but not PKC/MAP kinase dependent. VE-cadherin binding to the cytoskeleton was decreased by EDTA, but was not diminished by histamine or H2O2. Therefore, by promoting sequestration of junctional cadherins, inflammatory mediators may decrease adhesive bonds between apposed endothelial cells and increase solute permeability.

Radioreceptor assay for sirolimus in patients with decreased platelet counts

OBJECTIVE

Sirolimus (RAPA) is a new immunosuppressive drug currently in Phase III clinical trials in combination with cyclosporine A (CsA). The toxicity profiles for CsA and RAPA are only partially overlapping, with RAPA toxicity consisting primarily of hyperlipidemia and myelodepression but without the nephrotoxicity, neurotoxicity, and hepatotoxicity, which are seen with CsA. Patients in the clinical trial are being monitored using HPLC or LC/MS/MS assays; there is no immunoassay for RAPA reported to date. We have previously reported a radioreceptor assay (RRA) for RAPA, which has an excellent correlation with the HPLC assay (r = 0.997). The RRA has several advantages including excellent precision, sensitivity, rapid turnaround time, and a one-step extraction procedure. We report the evaluation of blood samples from patients who were exhibiting RAPA toxicity and comparison of the RRA results with the HPLC results.

METHODS

EDTA whole blood specimens (n = 42) were obtained from six renal transplant recipients taking RAPA and CsA and exhibiting decreased platelet counts. Thirty-two samples from patients without decreased platelet counts were also received. The samples were analyzed with the RRA and the results were compared to those obtained with the HPLC assay.

RESULTS

By HPLC, the results ranged from 3.2-72.6 micrograms/L RAPA with 43% of the results > or = 30 micrograms/L. With the RRA, the range was 7.7-83.0 micrograms/L RAPA equivalents, with 60% of the results > or = 30 micrograms/L. The RRA results are distinctly higher than the HPLC results all along the range. The correlation between the two assays was 0.861, with a slope of 0.966 and a Y-intercept of 11.1.

CONCLUSION

Since the RRA is consistently higher than HPLC concentration in patients with decreased platelet counts, but correlates well in patients with no signs of toxicity, the RRA may be useful for monitoring patients for toxicity, by giving a better indication of increasing degree of immunosuppression than the HPLC assay.

Identification of a 37 kDa tacrolimus, sirolimus and cyclosporine binding immunophilin possessing glyceraldehyde 3-phosphate dehydrogenase activity isolated from the Jurkat T cell line

OBJECTIVE

The isolation and partial characterization of a 37 kDa minor immunophilin from the Jurkat cell line which binds to cyclosporine (CsA), Tacrolimus (FK506) and Sirolimus (RAPA).

DESIGN AND METHODS

Using standard protein purification steps including isoelectric focusing and cation exchange chromatography, we have isolated and purified to homogeneity a minor immunophilin from the Jurkat cell line which has a molecular weight of 37 kDa. Binding properties for immunosuppressive drugs CsA, FK506 and RAPA were assessed by Scatchard and displacement analysis. The amino acid analysis and the protein sequences were also studied.

RESULTS

The immunophilin was purified to homogeneity and the molecular weight corresponds to 37 kDa. Saturation experiments using 3Hdihydro FK506 gave a Kd of 4.5 nM and the Bmax of 117 nmol/mg protein. Displacement studies using 3Hdihydro FK506 and RAPA gave a Kd of 0.8 nM. For CsA binding, the protein showed somewhat less avid binding. The amino acid composition was in close agreement with the amino acid composition of uracil DNA glycosylase which corresponds to part of the monomer of glyceraldehyde 3 phosphate dehydrogenase (G3PD). Protein digestion gave at least 3 peptides. The primary sequence of the first of these matched 7 of 8 residues of human liver nuclear uracil DNA glycosylase. The 37 kDa immunophilin was found to have G3PD activity not inhibited by FK506.

CONCLUSIONS

The amino acid analysis, protein sequences, binding properties and G3PD activity indicate that this 37 kDa immunophilin is different from any other known immunophilins.

Radioreceptor assay for sirolimus

OBJECTIVES

To develop a radioreceptor assay (RRA) for sirolimus (rapamycin, RAPA).

METHODS

A direct methanol extraction was used to prepare 45 patient samples for the RRA. Results were compared to the results obtained previously using high-performance liquid chromatography (HPLC). Between-run precision, recovery, and drug interference studies were also performed.

RESULTS

The RRA is sensitive to 1.0 microgram/L RAPA equivalents in whole blood. Comparison with HPLC yielded a correlation coefficient for 45 patient samples of 0.977. Between-run precision at 2.5, 7.5, 12.5, and 20 micrograms/L showed coefficients of variation (CVs) of 12.9, 9.2, 8.5, and 5.9%, respectively. Recoveries from the extraction procedure were 93% at 7.5 micrograms/L and 103% at 12.5 micrograms/L. Drug interference studies showed no interference in the RRA by cyclosporine (CsA), dexamethasone, prednisone, or methotrexate.

CONCLUSION

We have demonstrated that the RRA for RAPA correlates well with HPLC, and has excellent precision and recovery. The procedure is far less time-consuming and complex than HPLC and has potential for automation.

Comparison of binding characteristics of four rapamycin metabolites to the 14 and 52 kDa immunophilins with their pharmacologic activity measured by the mixed-lymphocyte culture assay

OBJECTIVES

To compare the binding characteristics of four rapamycin (RAPA) metabolites to the 14 and 52 kDa minor immunophilins with their pharmacologic activity, as measured by the mixed-lymphocyte culture (MLC) assay.

METHODS

Four RAPA metabolites were isolated by HPLC from the urine of renal transplant patients. Each metabolite was evaluated at 40 micrograms/L for its pharmacologic activity using the MLC assay. The results of the MLC assay were compared to those obtained using the radioreceptor assay (RRA), which measured the binding characteristics of equal concentrations of the metabolites to the 14 and 52 kDa minor immunophilins.

RESULTS

Each of the four RAPA metabolites showed low immunosuppressive activity by MLC. RM2 showed the highest activity, with 9% of parent RAPA activity. RM1, 3, and 4 showed 2%, 8%, and 4% activity, respectively. Only RM1 was found to bind significantly to either minor immunophilin, with 21% of parent binding to the 14 kDa protein and 25% of parent binding to the 52 kDa protein. RM2, 3, and 4 bound to both proteins with < or = 2% of parent binding.

CONCLUSION

We have demonstrated that the RRA for these four RAPA metabolites shows little cross-reactivity. There is no commercially available immunoassay for RAPA at present. The RRA, therefore, provides an excellent way to rapidly assess efficacy/toxicity of RAPA in patients receiving the drug.

Immunophilin receptors for immunosuppressive drugs

The major immunophilins that bind cyclosporine (cyclophilin) and FK-506/rapamycin (FK-BP 12) have been well characterized. They possess rotamase activity, which is inhibited by the immunosuppressant that binds to them. The immunosuppressive action does not appear to be coupled to rotamase activity. The literature is reviewed on some possible mechanisms of immunosuppression. Minor immunophilins of 14, 36, and 52 kDa have also been isolated and partially characterized. Receptor assays employing immunophilins have been developed.

Surrogate measures of physical activity and physical fitness. Evidence for sedentary traits of resting tachycardia, obesity, and low vital capacity

Studies on physical activity, physical fitness, and health have been hampered because of invalid, unreliable, or impractical measures of physical activity. This report examines the validity of sedentary traits (resting tachycardia, obesity, and low vital capacity) as predictors of physical fitness as assessed by a maximal treadmill exercise test. Study participants were women (n = 3,943) and men (n = 15,627) with at least one visit to the Cooper Clinic in Dallas, Texas. Association of the sedentary traits with physical fitness was examined by multiple regression analyses. Sedentary traits were associated with physical fitness in all age and sex groups, accounting for 12-40% of the variance in treadmill time. When smoking, a simple physical activity index, and sedentary traits were included in a model to predict physical fitness, R2 values ranged from 0.20 to 0.53 in women and 0.45 to 0.61 in men and were significant at p less than 0.0001. These models account for approximately twice as much variance in physical fitness as has been reported previously. The addition of sedentary traits measurements to a simple physical activity index provides a valid estimate of physical fitness in epidemiologic studies.

Benefits of a statewide high-risk perinatal program

A study was undertaken to determine whether newborn infants of women in a statewide high-risk program had less perinatal mortality and higher birth weight than newborn infants of high-risk women not in the program. The number of fetal and neonatal deaths was twice as high in the nonprogram group, but there was no statistical difference in birth weight distribution in the two groups. Possible reasons for the program's effectiveness are the facts that a greater number of program women had more prenatal visits and were delivered in a Level II or Level III hospital by appropriate personnel.

Changes in coronary heart disease risk factors associated with increased treadmill time in 753 men

Associations between changes in treadmill time and changes in coronary heart disease risk factors were studied in 753 middle-aged men seen between 1978-1981 at the Cooper Clinic in Dallas, Texas. Men were free of known disease at baseline. Significant increases (p less than 0.01) in exercise habits and treadmill time were seen over the course of the study; average follow-up was 1.6 years. In bivariate analyses, increases in treadmill time and weight loss were associated with improvements (p less than 0.01) in risk factors. Multiple regression models were calculated for several risk factors with age, length of follow-up, change in weight, and change in treadmill time as independent variables. After controlling for confounding, increase in treadmill time was independently associated with decreases in the total cholesterol/high density lipoprotein-cholesterol ratio (p less than 0.01) and serum uric acid (p less than 0.05). High density lipoprotein-cholesterol rose with increase in treadmill time (p less than 0.05).