Heart rate variability after bariatric surgery: The add-on value of exercise

PURPOSE

To assess the impact of bariatric surgery and an added supervised exercise training programme on heart rate variability (HRV) in patients with severe obesity.

METHODS

Fifty-nine patients who underwent bariatric surgery were randomised in the post-operative period to a 12-week supervised exercise training programme (moderate intensity combination aerobic/resistance exercise training programme) or a control group. Indices of HRV including time-domain, spectral-domain, and nonlinear parameters were measured preoperatively, and at 3, 6, and 12 months.

RESULTS

After the surgical procedure, both groups improved anthropometric parameters. Type 2 diabetes, hypertension, and dyslipidemia resolutions were similar between groups. Total body weight loss at 6 and 12 months were also comparable between groups (6 months: 28 ± 6 vs. 30 ± 6%; 12 months: 38 ± 9 vs. 38 ± 10%; control vs. intervention group respectively). Bariatric surgery improved HRV parameters at 12 months compared to the pre-operative values in the intervention group: standard deviation of R-R interval (SDNN) (156.0 ± 46.4 vs. 122.6 ± 33.1 ms), low frequency (LF) (6.3 ± 0.8 vs. 5.8 ± 0.7 ms²), and high frequency (HF) (5.1 ± 0.8 vs. 4.7 ± 0.9 ms²) (all p<0.001). For the control patients, similar improvements in SDNN (150.0 ± 39.4 vs. 118.8 ± 20.1 ms), LF (6.1 ± 0.9 vs. 5.7 ± 0.8 ms²), and HF (5.0 ± 0.9 vs. 4.7 ± 0.9 ms²) were obtained (all p<0.001). However, there was no add-on impact of the supervised exercise training programme on HRV after 12 months (p>0.05 for all HRV parameters).

CONCLUSION

Bariatric surgery is associated with an improvement in HRV. A supervised exercise training programme in the post-operative period did not modulate further the benefits of bariatric surgery regarding HRV parameters.

Effects of canagliflozin on cardiovascular and kidney outcomes and mortality in primary and secondary cardiovascular prevention: pooled analysis from the CANVAS program and CREDENCE trial

Background/Introduction

Individuals with type 2 diabetes mellitus (T2DM) are at a greater risk for experiencing cardiovascular (CV) and kidney events. Canagliflozin is a sodium glucose co-transporter 2 inhibitor that has demonstrated reduction of these events in participants with T2DM with or without a history of CV disease (CVD) in both the CANVAS Program and CREDENCE trial.

Purpose

To determine the pooled effects of canagliflozin on CV outcomes, kidney outcomes, and all-cause mortality in trial participants with and without a history of CVD (secondary and primary prevention, respectively).

Methods

This post hoc analysis pooled individual participant data from the CANVAS Program and CREDENCE trial. The effects of canagliflozin versus placebo on time to first event for CV outcomes (major adverse cardiovascular events [MACE], which was defined as CV death, myocardial infarction [MI] or stroke; CV death; hospitalization for heart failure [HHF], and the composite of CV death or HHF), kidney outcomes (end-stage kidney disease [ESKD], doubling of serum creatinine [dSCr], and the composite of ESKD or dSCr), and all-cause mortality were assessed in participants with T2DM with or without a history of CVD.

Results

Among the 14,543 participants from the pooled CANVAS Program (N=10,142) and CREDENCE trial (N=4401), 5667 (39%; canagliflozin, n=3128; placebo, n=2539) were in the primary prevention group and 8876 (61%; canagliflozin, n=4869; placebo, n=4007) were in the secondary prevention group. Baseline characteristics of participants in each group were generally similar. Across both primary and secondary prevention participants, no heterogeneity in the relative risk reduction of CV outcomes, kidney outcomes, and all-cause mortality with canagliflozin versus placebo was observed (all P interaction &gt;0.624; Figures 1 and 2). The benefits of canagliflozin on MACE and the composite of CV death or HHF were observed as early as 6 months into treatment in both subgroups of participants and were sustained throughout the study.

Conclusions

In this pooled analysis of patient-level data from the CANVAS Program and CREDENCE trial, treatment with canagliflozin demonstrated early benefits and was associated with reduced risk of CV outcomes, kidney outcomes, and all-cause mortality, with similar results across primary and secondary prevention participants with T2DM.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Janssen, Inc.

Impact of a 12-week supervised exercise program on weight loss trajectory, daily physical activity levels and sedentary behaviors after bariatric surgery

Background

The evidence suggests that physical activity (PA) following bariatric surgery can enhance weight loss and other metabolic outcomes. However, most individuals with severe obesity are insufficiently active, and without support, fail to make substantial increases in their daily PA levels postoperatively.

Purpose

The aim of this study was to investigate the effectiveness of a 12-week supervised exercise program on daily PA levels, sedentary time, and on maintenance of the weight loss trajectory following bariatric surgery.

Methods

Fifty-nine individuals with severe obesity (body mass index [BMI] ≥40 or ≥35 kg/m2 with comorbidities) eligible for bariatric surgery were randomly assigned (1:2) to either standard of care (CG, n=19) or a 12-week supervised exercise program (ExG, n=40). Daily PA levels and sedentary time were assessed using an armband accelerometer worn over a 3-day period (2 week-day and 1 weekend day). Body weight, body fat and fat-free mass were assessed using bioelectrical impedance balance. The exercise training program (60 min, 3 times per week for 12 weeks) started 3 months after the bariatric surgery and was supervised by a certified clinical exercise physiologist. Daily PA levels, sedentary time and anthropometric measurements were obtained preoperatively, and at 3, 6 and 12 months after bariatric surgery.

Results

Age of participants was 42±12 years, BMI was 46±6 kg/m2, and 76% were women. Before the exercise training program, PA parameters (daily PA levels, sedentary time and moderate to vigorous intensity PA [MVPA] were comparable between groups. Following the exercise training program, the ExG showed a significant reduction in sedentary time (753±113 to 721±88 min/day), an increase in daily PA levels (4544±1863 to 5853±3101 steps/day) and in MVPA levels (18.8±25.1 to 30.5±38.1 min/day). Further increase in daily MVPA levels were observed at the 12 months follow-up visit (p=0.05). In the standard of care group, changes in PA parameters were also comparable to those in the ExG. All anthropometric measurements indicate statistically significant changes postoperatively, after the intervention and up to 12 months follow-up (p&lt;0.001) without showing any difference between groups. Anthropometric changes up to 12 months follow-up show, respectively for CG and ExG, a total weight loss of 37.8±9.3% and 38.4±10.3%, a body fat reduction of 60.4±13.7% and 61.9±15.2% and fat-free mass loss of 16.6±5.4% and 15.1±7.9%.

Conclusion

This study shows that bariatric surgery candidates have low PA levels and rarely engage in MVPA. We found no additional effect to the standard of care treatment of a postoperative 12-week supervised exercise training program on weight loss trajectory, daily PA levels and sedentary behaviors.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research (CIHR)Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval (IUCPQ - UL)

The Family Income Ratio of Barcelona and its impact on treatment delays and one-year mortality in 3173 cases of STEMI treated at the Codi IAM network

Introduction

STEMI networks have spread reperfusion and have decreased treatment delays.Increased treatment times have a negative impact on mortality after STEMI.The Family Income Ratio of Barcelona (FIRB) is an indicator that combines economic and socio-cultural welfare that is annually documented at the different Barcelona's neighborhoods by the Barcelona Public Health Office.

Purpose

To evaluate if FIRB has a prognostic impact on STEMI treatment times and mortality on patients of Barcelona city treated in the Codi IAM Network with primary PCI.

Methods

Analysis of all data from “Codi IAM Network” from STEMI treatment in Barcelona city from 2010 to 2016 -including treatment delays, clinical risk factors and 1-year all-cause mortality- and corresponding FIRB for each patient and episode.FIRB is divided into tertiles.Multilevel analysis is performed to obtain factors associated to EKG-opening artery time and cox-regression on 1-year all-cause mortality.

Results

3173 cases of STEMI were included with a mean age of 65±13, 25% women,21% diabetes mellitus and 42% hypertension.Characteristics of population, treatment and mortality per FIRB tertile is shown in Table 1.Multilevel analysis showed that age,diabetes mellitus,heart failure at admission,FIRB and who performed first care were associated to EKG-Opening Artery Time (all p&lt;0.003).However,only age,heart failure at admission,who performed first care and EKG-opening artery time&gt;120min were significantly associated to 1-year all-cause mortality (p&lt;0.005) but not FIRB.

Conclusions

Patients at the lower FIRB treated for STEMI in Barcelona showed younger age,worse cardiovascular profile and longer treatment delays.Longer EKG-open artery time was associated to diabetes mellitus, heart failure, first assistance care and lower FIRB.One-year all-cause mortality was not associated to FIRB.

Funding Acknowledgement

Type of funding source: None

P924 Benefits of bariatric surgery on subclinical myocardial function using global longitudinal strain in severely obese individuals with and without diabetes

Purpose

To evaluate changes in subclinical LV myocardial function following bariatric surgery in obese individuals with and without diabetes.

Methods

Thirty-eight severely obese individuals [body mass index (BMI) &gt;35kg/m2] with preserved LV ejection fraction (≥ 50%) who underwent bariatric surgery (Surgery group) (BMI 48 ± 7 kg/m2), 19 obese individuals managed conservatively (Cons. group) (BMI 47 ± 9 kg/m2), and 18 age and sex-matched non-obese controls (Non-obese group) were included. Echocardiography with GLS measurements was performed at the beginning of the study and at 6 months. Abnormal myocardial function was defined as a GLS &gt;-17%.

Results

Mean age of obese patients was 42 ± 11, BMI 48 ± 8 kg/m2, and 82% were female. The percentage of total weight loss at 6 months after bariatric surgery (Surgery group) was 26.3 ± 5.2%. Body weight remains unchanged at 6 months in the Cons. group. Proportions of hypertension (61 vs. 30%, P = 0.0005), dyslipidemia (42 vs. 5%, P = 0.0001) and type 2 diabetes (40 vs. 13%, P = 0.002) were reduced in the Surgery group. At the beginning, severely obese patients (Surgery group) displayed subclinical myocardial dysfunction vs. non-obese controls (LV GLS, -17.3 ± 2.5 vs. -19.6 ± 1.7%, P = 0.003). Six months after bariatric surgery, the subclinical myocardial function was comparable between both groups (LV GLS, -19.2 ± 2.1 vs. -19.6 ± 1.7%, P = NS). 22 severely obese individuals (58%) in the Surgery group showed abnormal GLS, which normalized in 82% after bariatric surgery (P = 0.0001). On the contrary, half of severely obese individuals managed conservatively (n = 10, 53%) worsened their GLS during the follow-up (P = 0.002). Remission of type 2 diabetes 6 months after bariatric surgery was associated with improvement in GLS (-17.5 ± 2.6 vs. -18.6± 1.8%), whereas obese individuals with type 2 diabetes managed conservatively showed a worsening in their subclinical myocardial function during the follow-up (-18.0 ± 2.4 vs. -17.4 ± 1.7%).

Conclusions

A great proportion of severely obese individuals with preserved LV ejection fraction have subclinical myocardial dysfunction. Bariatric surgery in obese individuals was associated with significant improvements in the metabolic profile and in subclinical myocardial function.

Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

Species of Metarhizium anisopliae complex implicated in human infections: retrospective sequencing study

OBJECTIVES

Fungi belonging to the Metarhizium anisopliae complex comprise ubiquitous arthropod pathogenic moulds used as mycopesticides. Rare cases of human infections due to M. anisopliae have been reported. We hypothesize misidentifications of fungal strains implicated in these cases or used in mycopesticides.

METHODS

A review of the literature was conducted to identify previously published cases. We collected some of these previous described strains and reported new cases, and a French mycopesticide containing M. anisopliae. All identifications were performed based on elongation factor-1α gene sequencing.

RESULTS

We report eight new cases of Metarhizium infection in humans (three from France and five from Australia). The strains isolated from these cases, and three others from already published cases and reported as M. anisopliae, were molecularly identified based on elongation factor-1α (Ef1-α) gene sequencing as follows: Metarhizium robertsii (six), Metarhizium guizhouense (three), Metarhizium brunneum (one) and Metarhizium pingshaense (one).

CONCLUSIONS

In this study, we report new human cases of Metarhizium infections, and, based on Ef-1α gene sequencing, we demonstrate the misidentification of species in case reports. We also correct the species identification of a strain reported as M. anisopliae used in a commercially available mycopesticide. According to our results, none of the strains from the human infection reports reviewed belongs to the species M. anisopliae.

Return-to-Work Interval and Surgery for Carpal Tunnel Syndrome. Results of a Prospective Series of 233 Patients

Aim of the study

To evaluate the connection between the type of patient insurance and the time taken to return to work after carpal tunnel surgery.

Patients and methods

Two hundred and thirty-three patients in full-time work were operated on for carpal tunnel syndrome between 1 January and 30 June 1998. They were divided into three groups: independent workers ( n=87), wage earners in the private sector ( n=90) and civil servants ( n=56). Four categories were defined: manual workers, non-manual workers, patients with social security insurance and patients with workers compensation. The average return-to-work interval after surgery for each of the groups was evaluated and compared group by group.

Results

For independent workers the average time off work is 17 days, for those in the private sector it is 35 days, and for civil servants it is 56 days. Patients with social security insurance were off work for 32 days and those with workers compensation for 49 days.

Discussion

The comparison shows significant differences with regard to social security insurance: the return-to-work interval in civil servants is larger than for private sector workers, and this is higher than in independent workers. The difference between patients with workers compensation and those with social security insurance is 17 days and significant. There is a significant difference between manual and non-manual workers in independent and private sector workers. There is no significant difference between the sub-groups in the civil servants. These cross references enable us to work out the influence that social security status has on the return-to-work time following surgery.

Underexposure of Seniors to Heart Failure Drug Therapy

BACKGROUND

Little is known about exposure to heart failure (HF) treatment among seniors with ischemic heart disease.

OBJECTIVES

In a population of seniors, we: 1) estimated the association between age and exposure to HF drug therapy at 6, 12, 36 and 60 month intervals after HF diagnosis, and 2) determined the influence of the passage of time on exposure to drug therapy.

METHODS

Using the Quebec provincial administrative databases, we conducted a population-based inception cohort study that included all individuals aged ≥ 65 with a first HF diagnosis between 2000 and 2009 and an ischemic heart disease diagnosis in the year before HF diagnosis. We assessed exposure to HF drug therapy and to drug therapy at target doses at 6, 12, 36 and 60 month intervals after HF diagnosis. Adjusted prevalence ratios (aPR) between age at diagnosis and exposure to drug therapy and the influence of time (6-month periods) were assessed using multivariate modified Poisson regressions.

RESULTS

Among the 86,428 seniors, those who were older were less likely to be exposed to both HF drug therapy and drug therapy at target doses at each time point, than were the younger ones (aged 65-69). The aPRs for exposure to drug therapy for the 90+ age group were 0.64, 0.64, 0.56 and 0.53 at the 6, 12, 36 and 60 month intervals, respectively. After HF diagnosis, exposure increased by a maximum of 8% per 6-month period.

CONCLUSION

Increasing age is associated with a decrease in exposure to drug therapy, with only slight improvement in exposure after HF diagnosis.

Early diagnosis and monitoring of mucormycosis by detection of circulating DNA in serum: retrospective analysis of 44 cases collected through the French Surveillance Network of Invasive Fungal Infections (RESSIF)

The main objective of this study was to assess the diagnostic performance of a set of three Mucorales quantitative PCR assays in a retrospective multicentre study. Mucormycosis cases were recorded thanks to the French prospective surveillance programme (RESSIF network). The day of sampling of the first histological or mycological positive specimen was defined as day 0 (D0). Detection of circulating DNA was performed on frozen serum samples collected from D-30 to D30, using quantitative PCR assays targeting Rhizomucor, Lichtheimia, Mucor/Rhizopus. Forty-four patients diagnosed with probable (n = 19) or proven (n = 25) mucormycosis were included. Thirty-six of the 44 patients (81%) had at least one PCR-positive serum. The first PCR-positive sample was observed 9 days (range 0-28 days) before diagnosis was made using mycological criteria and at least 2 days (range 0-24 days) before imaging. The identifications provided with the quantitative PCR assays were all concordant with culture and/or PCR-based identification of the causal species. Survival rate at D84 was significantly higher for patients with an initially positive PCR that became negative after treatment initiation than for patients whose PCR remained positive (48% and 4%, respectively; p <10^-6). The median time for complete negativity of PCR was 7 days (range 3-19 days) after initiation of l-AmB treatment. Despite some limitations due to the retrospective design of the study, we showed that Mucorales quantitative PCR could not only confirm the mucormycosis diagnosis when other mycological arguments were present but could also anticipate this diagnosis. Quantification of DNA loads may also be a useful adjunct to treatment monitoring.

Comparative effectiveness of cardioprotective drugs in elderly individuals with type 2 diabetes

AIMS

Although many elderly individuals suffer from type 2 diabetes, the effectiveness of cardioprotective drugs in primary prevention of cardiovascular events in clinical practice in this population has rarely been evaluated. We aimed to assess the effectiveness of, (i) angiotensin converting enzyme inhibitors or angiotensin receptor blockers, (ii) statins, (iii) antiplatelet drugs and (iv) the combination of these three drugs, in the prevention of myocardial infarction (MI) and stroke in elderly individuals with type 2 diabetes.

METHODS

Using Quebec administrative databases, we conducted nested case-control analyses among a cohort of 17,384 individuals without a history of cardiovascular disease. Individuals were aged ≥ 66 years, newly treated with oral antidiabetes drugs and had not used any of the three above classes of cardioprotective drugs in the year before cohort entry. For each case (MI/stroke during follow-up), five controls were matched for age, year of cohort entry and sex. Use of each drug and of their combination was defined as current, past or no use. We calculated adjusted odds ratios (AOR) of MI/stroke.

RESULTS

We observed no reduction in the MI/stroke risk for users of ACEI/ARB nor for users of the three drugs combination. Longer exposure to statins was associated with a lower risk (AOR for every 30 days of therapy: 0.97; 95% CI: 0.96-0.99). By contrast, current use of antiplatelet drugs was associated with an increased risk of MI/stroke (1.40; 1.12-1.75).

CONCLUSION

The benefit of cardioprotective drugs in primary prevention was not clear in this cohort of elderly individuals with type 2 diabetes. A short duration of exposure to these drugs might explain the lack of benefit.

A comparison of the assessment and management of cardiometabolic risk in patients with and without type 2 diabetes mellitus in Canadian primary care

AIM

To investigate the cardiometabolic risk (CMR) assessment and management patterns for individuals with and without type 2 diabetes mellitus (T2DM) in Canadian primary care practices.

METHODS

Between April 2011 and March 2012, physicians from 9 primary care teams and 88 traditional non-team practices completed a practice assessment on the management of 2461 patients >40 years old with no clinical evidence of cardiovascular disease and diagnosed with at least one of the following risk factor-T2DM, dyslipidaemia or hypertension.

RESULTS

There were 1304 individuals with T2DM and 1157 without. Pharmacotherapy to manage hyperglycaemia, dyslipidaemia and hypertension was widely prescribed. Fifty-eight percent of individuals with T2DM had a glycated haemoglobin (HbA1c) ≤7.0%. Amongst individuals with dyslipidaemia, median low-density lipoprotein cholesterol (LDL-C) was 1.8 mmol/l for those with T2DM and 2.8 mmol/l for those without. Amongst individuals with hypertension, 30% of those with T2DM achieved the <130/80 mmHg target, whereas 60% of those without met the <140/90 mmHg target. The composite glycaemic, LDL-C and blood pressure (BP) target outcome was achieved by 12% of individuals with T2DM. Only 17% of individuals with T2DM and 11% without were advised to increase their physical activity. Dietary modifications were recommended to 32 and 10% of those with and without T2DM, respectively.

CONCLUSIONS

Patients at elevated CMR were suboptimally managed in the primary care practices surveyed. There was low attainment of recommended therapeutic glycaemic, lipid and BP targets. Advice on healthy lifestyle changes was infrequently dispensed, representing a missed opportunity to educate patients on the long-term benefits of lifestyle modification.

The beta-1 adrenergic antagonist, atenolol, decreases acylation stimulating protein, exercise capacity and plasma free fatty acids in men with type 2 diabetes

BACKGROUND AND AIMS

Atenolol is a beta-1 adrenergic antagonist commonly prescribed for the treatment of systemic hypertension or coronary artery disease yet its use in individuals with type 2 diabetes mellitus (T2DM) is controversial due to potentially negative side effects on insulin resistance. Non-esterified fatty acid (NEFA) metabolism is altered in T2DM especially under conditions of metabolic stress such as exercise or the postprandial state. We evaluated atenolol effects on circulating NEFA and related hormones in men with T2DM during acute cardiorespiratory exercise in both the fasting and postprandial state, including the adipokine acylation stimulating protein (ASP) which stimulates adipose tissue NEFA uptake.

METHODS AND RESULTS

Ten men with T2DM underwent four 1-h exercise sessions at 60% of their maximal oxygen uptake (VO(2max)) under the following conditions: 1) fasting (F), and 2) 2 h postprandial (PP) without medication; and 3) fasting (F-Atenolol), and 4) 2 h postprandial (PP-Atenolol) after a one-week treatment with atenolol. Results were tested for the effects of atenolol via two-way ANOVA for the F vs F-Atenolol and PP vs PP-Atenolol states separately. Atenolol treatment decreased fasting and postprandial glycerol (p < 0.0001) and NEFA (p < 0.0001), postprandial epinephrine (p = 0.048), postprandial cortisol (p = 0.02), postprandial ASP (p = 0.04) and postprandial dopamine (p < 0.004).

CONCLUSION

Atenolol alters fatty acid metabolism and associated metabolic hormones including ASP during exercise in men with T2DM and its effects are more apparent during conditions of stress such as the postprandial state, acute exercise and obesity.

Impact of mercury exposure on blood pressure and cardiac autonomic activity among Cree adults (James Bay, Quebec, Canada)

Aboriginal populations from Quebec (Canada) are exposed to higher mercury levels than southern regions since these populations consume high quantities of fish. Epidemiological evidence suggests a detrimental impact of mercury on cardiovascular risk factors such as heart rate variability (HRV) and blood pressure (BP). The objective of this study was to assess the impact of mercury exposure on BP, resting heart rate (HR) and HRV among Cree adults. Data were collected among 791 adults≥18 years old living in seven communities of the James Bay. Blood mercury and hair levels were used as biomarkers of recent and long-term exposure. BP was measured through a standardised protocol while HRV was derived from a 2-h Holter monitoring assessment. The relationship between mercury and the outcomes was studied using ANOVA and ANCOVA analysis. Geometric mean of blood mercury and hair mercury concentration was 17.0 nmol/L (95%CI: 6.1-44.0) and 2.36 nmol/g (95%CI: 2.09-2.65); respectively. After adjusting for confounders, blood mercury was associated with HRV parameters such as LF (β=0.21, P=0.0002), HF (β=0.15, P=0.004) and LF/HF (β=0.06, P=0.003). Similar associations were observed with hair mercury. In contrast, no significant association was observed between blood mercury or hair mercury and BP after adjusting for confounders. In conclusion, mercury exposure seems to affect HRV among Cree adults even after considering fish nutrients (n-3 fatty acids and selenium) and other contaminants (lead and polychlorinated biphenyls) that are also present in the traditional diet of this population.

The effect of theory-based interventions on physical activity participation among overweight/obese individuals: a systematic review

Little attention has been paid to the evaluation of the long-term impact of theory-based interventions on physical activity participation among overweight/obese individuals after the interventions have ended. The primary aim of this systematic review was to investigate the long-term effectiveness of theory-based interventions increasing physical activity and identify the most effective techniques for behaviour change among overweight/obese individuals. The secondary aim was to investigate the effect of these interventions on theoretical variables. Eighteen studies were reviewed. Among these studies, three reported significant short-term and two long-term effects of interventions on physical activity participation. Most of the studies observed a significant short- or long-term effect of time on this behaviour. Theoretical frameworks most often applied included the Behavioural Model and the Social Learning/Cognitive Theory. However, few of the studies reported any impact on theoretical variables. The most prevalent techniques consisted of providing opportunities for social comparison and instruction as well as self-monitoring. Leading techniques differentiating the experimental group from the control group included prompting practice and intentions formation and barriers identification. Although the combination of these three techniques appears successful, the long-term impact of theory-based interventions remains ambiguous.

Cardiac hazard associated with eating habits. A case of infected intrapericardial foreign body due to an ingested toothpick

An unusual case of a toothpick perforating the distal one-third of the duodenum, penetrating the inferior vena cava and thereafter migrating to the right atrium with extensive pericardial fibrosis is reported. A 60-year-old man was admitted to the emergency department because of epigastric pain, which had progressively worsened. After partial recovery, he was discharged. However, after four episodes of different gastrointestinal bacteria septicemias of unknown origin over a period of five months, the patient was transferred to Laval Hospital (Laval, Quebec) for clinical investigation. Cardiac echocardiography demonstrated a right atrial mass, suggestive of the presence of a thrombus. Thus, after exploratory thoracotomy was performed to remove the so-called thrombus, a toothpick was found in the right atrium.

Impact of high-fat /low-carbohydrate, high-, low-glycaemic index or low-caloric meals on glucose regulation during aerobic exercise in Type 2 diabetes

AIMS

A decrement in blood glucose (BG) may be observed in patients with Type 2 diabetes (T2DM) when exercise is performed after a meal, in contrast to fasting. We determined the impact of different pre-exercise meal macronutrient compositions with modulation of the glycaemic index (GI) on glucose regulation during exercise in patients with T2DM.

METHODS

Using a randomized, single-blind crossover design, 10 sedentary men performed five exercise sessions, once after an overnight fast, and also after each of four test meals, consisting of a high-fat/low-carbohydrate meal, a high-GI meal, a low-GI meal, and a low-calorie meal.

RESULTS

Pre-exercise BG and insulin levels were comparable for all four meals. Exercise decreased BG and insulin levels during all meal conditions (all P < 0.001) compared with the fasting state in which BG levels did not change. The magnitude of BG and insulin decrements was similar after consuming the low-calorie, the high-GI and the high-fat/low-carbohydrate meals, whereas the low-GI meal induced the lowest BG fall. Adrenaline response was higher after consumption of the high-, the low-GI and the low-caloric meals compared with the high-fat/low-carbohydrate meal and with the fasting state (P < 0.05).

CONCLUSIONS

This study underlines the beneficial effect of low-GI foods and the differential impact of pre-exercise meal macronutrient composition on BG decrease. This may protect against exercise-induced hypoglycaemia, and reiterates the safety of exercising while fasting in T2DM patients.

Impact of diabetes and gender on survival after acute myocardial infarction in the Province of Quebec, Canada--a population-based study

AIMS

To examine the impact of diabetes, gender and their interaction on 30-day, 1-year and 5-year post-acute myocardial infarction (AMI) mortality in three age groups (20-64, 65-74 and > or = 75 years).

METHODS

Retrospective analysis including 23 700 patients aged > or = 20 years (22% with diabetes) admitted to hospital for a first AMI in any hospital in the Province of Quebec, Canada, between April 1995 and March 1997. Administrative databases were used to identify patients and assess outcomes.

RESULTS

Regarding 30-day mortality, there was non-significant interaction between diabetes and gender. Women aged < 75 years had, independently of diabetes status, at least a 38% (P < 0.05) higher mortality than their male counterparts after adjustment for socio-economic status and co-morbid conditions. Gender difference disappeared, however, after controlling for in-hospital complications. Regarding 1-year mortality (31-365 days), there was no significant gender disparity for all age groups. During the 5-year follow-up, no gender differences were seen in any age group, except for younger (< 65 years) women with diabetes, who had a 52% (P = 0.004) higher mortality than men after controlling for co-variables. This female disadvantage was demonstrated by a significant interaction between diabetes and gender in patients aged < 65 years (P = 0.009).

CONCLUSIONS

The higher 30-day mortality post-AMI in younger (20-64 years) and middle-aged (65-74 years) women compared with men was not influenced by diabetes status. However, during the 5-year follow-up, the similar gender mortality observed in patients without diabetes seemed to disappear in younger patients with diabetes, which may be explained by the deleterious, long-term, post-AMI impact of diabetes in younger women.