What Touched Your Heart? Collaborative Story Analysis Emerging From an Apsáalooke Cultural Context

Community-based participatory research and decolonizing research share some recommendations for best practices for conducting research. One commonality is partnering on all stages of research; co-developing methods of data analysis is one stage with a deficit of partnering examples. We present a novel community-based and developed method for analyzing qualitative data within an Indigenous health study and explain incompatibilities of existing methods for our purposes and community needs. We describe how we explored available literature, received counsel from community Elders and experts in the field, and collaboratively developed a data analysis method consonant with community values. The method of analysis, in which interview/story remained intact, team members received story, made meaning through discussion, and generated a conceptual framework to inform intervention development, is detailed. We offer the development process and method as an example for researchers working with communities who want to keep stories intact during qualitative data analysis.

The Impact of Historical and Current Loss on Chronic Illness: Perceptions of Crow (Apsáalooke) People

The purpose of this research was to gain a better understanding of perceptions about the impact of historical and current loss on Apsáalooke (Crow) people acquiring and coping with chronic illness. This study took a qualitative phenomenological approach by interviewing community members with chronic illness in order to gain insight into their perceptions and experiences. Participants emphasized 10 areas of impact of historical and current loss: the link between mental health and physical health/health behaviors; resiliency and strengths; connection and isolation; importance of language and language loss; changes in cultural knowledge and practices; diet; grieving; racism and discrimination; changes in land use and ownership; and boarding schools. The findings from this research are being used to develop a chronic illness self-care management program for Crow people.

The Acute Effects of Eccentrically-Biased Versus Conventional Weight Training in Older Adults: A Randomised Controlled Cross-Over Study

BACKGROUND

Whilst resistance training has been proven to convey considerable benefits to older people; immediately post-exercise there may be elevated transient risks for cardiac events and falls. Objectives and Measurements: We assessed the acute effects of eccentrically-biased (EB) and conventional (CONV) resistance exercise on: platelet number, activation and granule exocytsosis; and mean velocity of centre of pressure displacement (Vm).

DESIGN, SETTING, PARTICIPANTS AND INTERVENTION

Ten older adults (7 males, 3 females; 69 ± 4 years) participated in this randomised controlled cross-over study in which they performed EB and CONV training sessions that were matched for total work and a control condition.

RESULTS

Immediately post-exercise there was a statistically significant difference in platelet count between the control condition, in which it had declined (pre 224 ± 35 109/L; post 211 ± 30 109/L: P < 0.05) and CONV in which it had increased (pre 236 ± 55 109/L; post 242 ± 51 109/L: P > 0.05). There was no change in platelet activation and granule exocytsosis or Vm following EB and CONV.

CONCLUSIONS

Overall, while minor differences between regimens were observed, no major adverse effect on parameters of platelet function or centre of pressure displacement were observed acutely following either regimen. Eccentrically-biased and conventional resistance exercise training regimens do not appear to present an elevated acute risk in the context of changes to platelet function contributing to a cardiac event or postural stability increasing falls risk for apparently healthy older adults.

Insulin sensitivity not modulated 24 to 78 h after acute resistance exercise in type 2 diabetes patients

Resistance exercise is recommended as part of the exercise guidelines to prevent and manage type 2 diabetes (T2D), however, the frequency of exercise required to improve glycaemic control and insulin sensitivity is not clear. We recruited and tested 10 individuals with T2D by collecting a fasting blood sample immediately prior to, a whole-body moderate-high intensity resistance exercise session, and 24, 48 and 72 h afterwards. No changes to estimates of insulin sensitivity (HOMA2), glucose or insulin were observed using a repeated measures analysis of variance (p > 0.05). Further, there were no changes observed to markers of inflammation at 24 h following the resistance exercise session (p > 0.05). These findings suggest that insulin sensitivity is not acutely modified, positively or negatively, at 24, 48 or 72 h after a bout of resistance exercise. Nor are markers of inflammation altered during this time frame in a way that could cause transient insulin resistance.

Insulin sensitivity in response to a single resistance exercise session in apparently healthy individuals

BACKGROUND

Regular resistance exercise completed for a number of weeks has been shown to increase insulin sensitivity and reduce the risk of diabetes-related complications. However, the acute responses to resistance exercise have not been adequately investigated in relation to training frequency.

AIM

To investigate the changes to insulin sensitivity in apparently healthy individuals following a single session of unaccustomed resistance exercise.

SUBJECTS AND METHODS

Ten sedentary, apparently healthy individuals performed a baseline oral glucose tolerance test and maximal strength testing. Participants then performed a single session of moderate-high intensity resistance exercise which was followed by 4 consecutive days of oral glucose tolerance testing, for which participants replicated their initial diet. Mean estimated insulin sensitivity change scores from baseline values and their 95% confidence intervals were compared to the previously determined values for a clinically meaningful change.

RESULTS

Two participants were identified as having hyperinsulinemia and their data were therefore removed from the main analysis. There was a clinically meaningful increase in insulin response (mean >7237 pmol·l⁻¹·120 min⁻¹) on all days following the exercise session and a clinically meaningful increase in glucose response (mean >81 mmol·l⁻¹·120 min⁻¹) on only the 3rd day following exercise. These changes suggest a potentially adverse short-term effect. Additionally, the 2 individuals with hyperinsulinemia displayed more extreme results.

CONCLUSION

These results suggest that insulin sensitivity may be impaired following a single session of unaccustomed resistance exercise for approximately 4 days in healthy untrained, older individuals. Further research is required for individuals with hyperinsulinemia.

Reproducibility of multiple repeated oral glucose tolerance tests

We assessed the oral glucose tolerance test's (OGTT) ability to produce consistent results for estimating insulin sensitivity over four consecutive days. Individual coefficients of variation for OGIS and Stumvoll-ISI were 7.8% and 14.4% with no statistically significant difference between days. Thereby, indicating repeated OGTT's are reliable for estimating insulin sensitivity.

Resistance training improves metabolic health in type 2 diabetes: a systematic review

This paper systematically reviews the effect of resistance training (RT) on glycemic control and insulin sensitivity in adults with type 2 diabetes. Twenty studies were included, with the volume, frequency and intensity of RT varying markedly. Supervised RT improved glycemic control and insulin sensitivity, however, when supervision was removed compliance and glycemic control decreased. Evidence indicates the mechanisms behind the improvements to glucose tolerance require further elucidation. Although research demonstrates apparent benefits of RT for individuals with diabetes, further research is required to elucidate the minimum effective dose by describing frequency, intensity and the duration of acute and chronic improvements.

Responder analysis and correlation of outcome measures: pooled results from two identical studies comparing etoricoxib, celecoxib, and placebo in osteoarthritis

OBJECTIVES

To determine the proportion of responders in two identical osteoarthritis (OA) trials using Outcome Measures in Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) criteria and to assess the comparability and correlation of individual component measurements.

METHODS

Data were pooled from two identical 26-week, double-blind, randomized, parallel, multicenter trials comparing once daily etoricoxib 30 mg (N=475), celecoxib 200 mg (N=488), and placebo (N=244) in patients with OA of the knee or hip. OMERACT-OARSI criteria were (1) improvement in pain or physical function > or =50% and an absolute change > or =20 mm on a 100-mm visual analog scale (VAS); or (2) improvement of > or =20% and with an absolute change > or =10 mm in at least two of the following three categories: pain, physical function, and patient's global assessment. Correlations were assessed between endpoints measured as time-weighted average change from baseline over 12 weeks using Pearson's correlation coefficient (r).

RESULTS

There were significantly greater proportions of responders in the etoricoxib (66.2%) and celecoxib (63.5%) groups compared with the placebo group (43.0%; P<0.001). There was no difference between the two active treatment groups. There was high correlation between pain and physical function (r=0.903), pain and global assessment (r=0.778), and physical function and global assessment (r=0.820). There was high sensitivity (75-87%) and specificity (80-96%) for changes in individual component measurements to predict OMERACT-OARSI responders.

CONCLUSIONS

Significantly more patients receiving etoricoxib or celecoxib than placebo were OMERACT-OARSI responders. The high correlation between individual scales composing this composite response measurement suggests some redundancies between individual components, particularly between pain and physical function.

LDL Particle Size in Habitual Exercisers, Lean Sedentary Men and Abdominally Obese Sedentary Men

Habitual exercisers enjoy considerable protection from coronary heart disease (CHD). Often, however, only modest differences in traditional CHD risk factors are apparent between habitual exercisers and their sedentary counterparts. For this reason, there is increasing interest in novel predictors of CHD, such as a preponderance of small, dense low-density lipoprotein (LDL) particles. Polyacrylamide gel electrophoresis was used to separate lipoprotein subfractions in 32 lean exercisers, 36 lean sedentary men and 21 obese sedentary men aged 30 - 45 years. Well-validated equations were used to determine LDL concentration and peak particle diameter. Waist girth was used to identify lean (< 100 cm) and obese (>or= 100 cm) individuals. LDL concentration was lower in lean exercisers than in lean sedentary men (2.64 +/- 0.44 vs. 3.76 +/- 0.79 mmol . l (-1), p < 0.001), suggesting that habitual exercise influences this risk factor. In contrast, there were no significant differences in LDL peak particle diameter between lean exercisers, lean sedentary men and obese sedentary men (27.92 +/- 0.67, 28.09 +/- 0.62 and 27.77 +/- 0.77 nm, respectively). In multiple linear regression analysis, triglyceride concentration was the only significant predictor of LDL PPD. These data suggest that habitual exercise influences LDL concentration but does not influence LDL particle size in men aged 30 - 45 years.

Cardiovascular disease risk factors in habitual exercisers, lean sedentary men and abdominally obese sedentary men

OBJECTIVE

To investigate whether the favourable cardiovascular disease (CVD) risk factor profile of habitual exercisers is attributable to exercise or leanness.

DESIGN

Cross-sectional study of 113 nonsmoking men aged 30-45 y. CVD risk factors were compared in exercisers (n=39) and sedentary men (n=74), and in subgroups of lean exercisers (n=37), lean sedentary men (n=46) and obese sedentary men (n=28). Waist girth was used to identify lean (<100 cm) and abdominally obese (> or =100 cm) subgroups.

MEASUREMENTS

Blood pressure, physical activity (7-day recall), physical fitness (maximum oxygen consumption) and fasted lipoproteins, apolipoprotein (apo) B, triglycerides, glucose and fibrinogen.

RESULTS

Exercisers were fitter and leaner than sedentary men and had a better CVD risk factor profile. Total cholesterol, LDL-cholesterol and apo B concentrations were lower in lean exercisers than in lean sedentary men, suggesting that exercise influences these risk factors. Indeed, time spent in vigorous activity was the only significant predictor of total cholesterol and LDL-cholesterol in multiple linear regression models. Exercise status had little influence on triglycerides and HDL-cholesterol (HDL-C), and unfavourable levels were only evident among obese sedentary men. Waist girth was the sole predictor of triglycerides and HDL-C, explaining 44 and 31% of the variance, respectively.

CONCLUSIONS

These findings suggest that the CVD risk factor profile of habitual exercisers is attributable to leanness and exercise. Leanness is associated with favourable levels of HDL-C and triglycerides, while exercise is associated with lower levels of total cholesterol, LDL-cholesterol and apo B.

Velocity at V(.)O(2 max) and peak treadmill velocity are not influenced within or across the phases of the menstrual cycle

Velocity at VO(2 max) (vV(.)O(2 max)) and peak treadmill velocity (PTV) are variables highly predictive of endurance performance. However, how these variables are affected by the menstrual cycle is unknown. The aim of this study was to assess the effect of the menstrual cycle on vV(.)O(2 max) and PTV. Ten, female runners were studied across three menstrual cycles. Training, menstrual history and mood states were assessed for 2 months, with daily salivary samples taken to detect menstrual phases. During the third menstrual cycle, participants completed a maximal test to determine V(.)O(2 max), vV(.)O(2 max) and PTV in the early follicular phase, late follicular phase, early luteal phase, late luteal phase and menses. Progesterone increased at the onset of the luteal phase [mean (SEM); 490 (73.6) pmol l(-1)] compared to the follicular phase [344.6 (59.7) pmol l(-1)). No significant differences in the psychological mood states between the phases of the menstrual cycle were found (P>0.05). No significant differences in vV(.)O(2 max) (P=0.611), or PTV (P=0.472) were found between the phases of the menstrual cycle. Thus, vV(.)O(2 max) and PTV are not affected by the monthly menstrual cycle in female endurance runners.

The menstrual cycle and its effect on the immune status of female endurance runners

Twenty highly trained, eumenorrhoeic female endurance runners were studied over three consecutive menstrual cycles. Average training distance per week, total years training and mood states were recorded throughout the three cycles. Salivary progesterone and menstrual cycle diaries were recorded over the first two cycles to identify luteal phase onset and the presence of any menstrual irregularities. Saliva samples were collected daily over the third cycle for analysis of immunoglobulin A (IgA) concentration and secretion and saliva flow rate. Two-way analysis of variance (ANOVA) revealed no significant differences in mood states across the phases of the menstrual cycle (P > 0.05). Training logs indicated that training did not alter throughout the 3 month study. One-way ANOVA revealed no significant differences in IgA concentration (P = 0.92), secretion rate (P = 0.84) or saliva flow rate (P = 0.95) across the phases of the menstrual cycle. Pearson's product-moment correlation revealed no relationship between IgA concentration and progesterone between the phases of the cycle (r = 0.39). We conclude that, in ovulatory female endurance runners whose physical and emotional stress are stable, IgA concentration is not significantly affected by fluctuations in progesterone during the menstrual cycle.

Rofecoxib versus codeine/acetaminophen in postoperative dental pain: a double-blind, randomized, placebo- and active comparator-controlled clinical trial

BACKGROUND

In recent studies of acute pain and primary dysmenorrhea, rofecoxib, a nonsteroidal anti-inflammatory drug that selectively targets the cyclooxygenase-2 enzyme, was found to be similar in efficacy to ibuprofen and naproxen sodium.

OBJECTIVE

The purpose of this study was to determine the analgesic efficacy of a single oral dose of rofecoxib 50 mg compared with the combination of codeine 60 mg/acetaminophen 600 mg in a model of postsurgical dental pain.

METHODS

In this double-blind, placebo- and active comparator-controlled, parallel-group study, patients experiencing moderate or severe pain after the surgical extraction of > or = 2 third molars, at least 1 of which was a mandibular impaction, were randomized to receive placebo, rofecoxib 50 mg, or codeine 60 mg/acetaminophen 600 mg. Patient evaluations of pain intensity, pain relief, and global assessments were recorded throughout the 24-hour period after dosing. The 2-stopwatch method was used to determine time to confirmed perceptible pain relief. The primary end point assessing overall analgesic effect was total pain relief over 6 hours (TOPAR6). Secondary end points were patient global assessment of response to therapy (PGART) at 6 hours, onset of analgesia, peak analgesic effect, and duration of analgesia.

RESULTS

A total of 393 patients were enrolled; 182 received rofecoxib, 180 received codeine/acetaminophen, and 31 received placebo. The overall analgesic effect of rofecoxib 50 mg was greater than that of codeine 60 mg/acetaminophen 600 mg for TOPAR6 (12.4 vs 7.0; P < 0.001) and PGART at 6 hours (P < 0.001). The onset of analgesic effect was similar for rofecoxib and codeine/acetaminophen. Peak analgesic effect as measured by peak pain relief scores during the first 6 hours was significantly greater in the rofecoxib group compared with the codeine/acetaminophen group (P < 0.001), as was the duration of analgesic effect measured by the time to rescue analgesia (9.6 hours vs 2.3 hours, P < 0.001). Adverse events were reported in 33.0%, 46.1%, and 32.3% of patients treated with rofecoxib, codeine/acetaminophen, and placebo, respectively. The most common adverse events were nausea (6.0%, 25.0%, and 9.7%, respectively) and vomiting (3.8%, 18.3%, and 6.5%, respectively). Significantly more patients in the codeine/acetaminophen group than in the rofecoxib group experienced adverse events overall (P < 0.050) and nausea in particular (P < 0.001).

CONCLUSION

In this study of moderate to severe postoperative dental pain, the analgesic efficacy of rofecoxib 50 mg was greater than that of codeine/acetaminophen, with a lower incidence of adverse events and nausea.

Reliability of mean power recorded during indoor and outdoor self-paced 40 km cycling time-trials

The purpose of this study was to assess reliability of both indoor and outdoor 40 km time-trial cycling performance. Eight trained cyclists completed three indoor 40 km time-trials on an air-braked ergometer (Kingcycle) and three outdoor 40 km time-trials on a local course. Power output was measured for all trials using the SRM powermeter. Mean performance time across three indoor trials was 54.21 +/- 2.59 (min:sec) and was significantly different (P<0.05) to mean time across three outdoor trials (57.29 +/- 3.22 min:sec). However, there was no significant difference (P = 0.34) for mean power across three indoor trials (303+/-35W) when compared to outdoor performances (312 +/- 23 W). Within-subject variation for mean power output expressed as a coefficient of variation (CV) improved in both indoors and outdoors for trials 2 and 3 (CV = 1.9%, 95% CI 1.0 - 3.4 and CV = 2.1 %, 95 % CI 1.1 - 3.8) when compared to trials 1 and 2 (CV=2.1%, 95% CI 1.2-3.8 and CV=2.4%, 95% CI 1.3-4.3). These findings indicate that power output measured using the SRM powermeter is highly reproducible for both laboratory-based and actual 40 km time-trial cycling performance.

Reliability of an air-braked ergometer to record peak power during a maximal cycling test

PURPOSE

To assess the reliability of the Kingcycle ergometer, this study compared peak power recorded using a Kingcycle and SRMTM power meters during Kingcycle maximal aerobic power tests.

METHODS

The study was completed in two parts: for part 1, nine subjects completed three maximal tests with a stabilizing kit attached to the Kingcycle rig and calibration of the Kingcycle checked against SRM (MAP(C)); and for part 2, nine subjects completed two maximal tests without the stabilizing kit and the Kingcycle calibrated using the standard procedure (MAP(S)). Each MAP(C) test was separated by 1 wk; however, MAPs tests were separated by 54 +/- 32 d, (mean +/- SD). Testing procedure was repeated for each MAP and peak power output was calculated as the highest average power output recorded during any 60-s period of the MAP test using the Kingcycle (King(PPO)) and SRM (SRM(PPO)).

RESULTS

Coefficient of variations (CVs) for King(PPO) were larger than those of SRM(PPO); 2.0% (95%CI = 1.5-3.0) versus 1.3% (95%CI = 1.0-2.0) and 4.6% (95%CI = 2.7-7.6) versus 3.6% (95%CI = 2.1-6.0) for MAPC( and MAP(S), respectively. During all tests, King(PPO) was higher than SRM(PPO) by an average of approximately 10% (P < 0.001).

CONCLUSIONS

Investigators should be aware of the discrepancy between the two systems when assessing peak power and that SRM cranks provide a more reproducible measure of peak power than the Kingcycle ergometer.

Peak power predicts performance power during an outdoor 16.1-km cycling time trial

PURPOSE

To assess i) the reproducibility of peak power output recorded during a maximal aerobic power test (MAP), and ii) its validity to predict endurance performance during a field based 16.1-km time trial (16.1-km TT).

METHODS

Two studies were completed: for part I, nine subjects performed three MAP tests; for part II, 16 subjects completed a MAP test and 16.1-km TT. Power output was recorded using an SRM power meter and was calculated as peak power output (PPO) recorded during 60 s of MAP and mean power output for the 16.1-km TT (16.1-km TT(PO)).

RESULTS

There was no difference between PPO recorded during the three MAP trials, mean coefficient of variation for individual cyclists was 1.32% (95%CI = 0.97-2.03), and test-retest reliability expressed as an intraclass correlation coefficient was 0.99 (95%CI = 0.96-1.00). A highly significant relationship was found between PPO and 16.1-km TT(PO) (r = 0.99, P < 0.001) but not for PPO and 16.1-km TT time (r = 0.46. P > 0.05).

CONCLUSION

The results show that PPO affords a valid and reliable measure of endurance performance which can be used to predict average power during a 16.1-km TT but not performance time.

The validity of power output recorded during exercise performance tests using a Kingcycle air-braked cycle ergometer when compared with an SRM powermeter

This study assessed the validity of power output recorded using an air-braked cycle ergometer (Kingcycle) when compared with a power measuring crankset (SRM). For part one of the study thirteen physically active subjects completed a continuous incremental exercise test (OBLA), for part two of the study twelve trained cyclists completed two tests; a maximal aerobic power test (MAP) and a 16.1 km time-trial (16.1 km TT). The following were compared; the peak power output (PPO) recorded for 1 min during MAP, the average power output for the duration of the time-trial and power output recorded during each stage of OBLA. For all tests, power output recorded using Kingcycle was significantly higher than SRM (P < 0.001). Ratio limits of agreement between SRM and Kingcycle for OBLA showed a bias (P < 0.00) of 0.90 (95%CI = 0.90-0.91) with a random error of X or / 1.07, and for PPO and 16.1 km TT ratio limits of agreement were 0.90 (95%CI = 0.88-0.92) X or / 1.07 and 0.92 (95% CI = 0.90-0.94) X or / 1.07, respectively. These data revealed that the Kingcycle ergometry system did not provide a valid measure of power output when compared with SRM.

The efficacy of accumulated short bouts versus single daily bouts of brisk walking in improving aerobic fitness and blood lipid profiles

Fifty-six subjects (19 men and 37 woman) aged between 40 and 66 completed the study. They were allocated into three walking groups and a control group (C). The three walking groups performed the same total amount of walking for 18 weeks, but completed it in bouts of differing durations and frequencies. These were Long Walkers (LW; 20-40 min/bout), Intermediate Walkers (IW; 10-15 min/bout) and Short Walkers (SW; 5-10 min/bout); with the IW and SW performing more than one bout of walking a day. Following the 18 week walking programme, compared to the C group all walking groups showed similar improvements in fitness as determined by a reduction in blood lactate during a graded treadmill walking test (LW 1.0 mmol/l; IW 0. 8 mmol/l; SW 1.2 mmol/l; C 0.2 mmol/l; P = 0.003) and reduction in final heart rate (LW 8 beats/min; IW 6 beats/min; SW 10 beats/min; C 0 beats/min; P = 0.056). Also compared to the C group, the LW and IW groups recorded statistically significant decreases in low-density lipoprotein cholesterol (LW 0.29 mmol/l; IW 0.41 mmol/l; P = 0.024), whereas the control group showed a mean increase of 0.22 mmol/l. The LW and IW groups also showed significant reductions in apolipoprotein (apo) A-II (LW 0.05 g/l; IW 0.02 g/l; SW 0.01 g/l; C 0.00 g/l; P = 0.012) with the LW recording a statistically significant increase in the ratio of apo A-I/A-II (LW, 0.19, P = 0. 044). In conclusion, some health benefits were achieved from all walking programmes. However, whilst the changes in aerobic fitness were similar, the effects upon blood lipid profiles were not. The findings from this study suggest that the LW regimen was most effective in benefiting blood lipid profile, followed by the IW regimen, with the SW being least potent. Nevertheless, for the sedentary/low-active members of society, any improvement in health may be considered as important. Therefore accumulated bouts of moderate intensity exercise, which according to theories of exercise behaviour may be more easily incorporated into an individual's lifestyle than single prolonged bouts, may be advocated for health promotion but may not be as effective as the traditionally prescribed 20-40 min bouts.

Safety, tolerability and immunogenicity of concomitant injections in separate locations of M-M-R II, VARIVAX and TETRAMUNE in healthy children vs. concomitant injections of M-M-R II and TETRAMUNE followed six weeks later by VARIVAX

OBJECTIVES AND STUDY DESIGN

The primary objectives of this study were to compare immunologic responses, antibody persistence, safety and varicella breakthrough rates when VARIVAX (varicella vaccine) is given at the same time as M-M-R II (measles, mumps, rubella vaccine) and TETRAMUNE (conjugate Haemophilus influenzae type b, diphtheria, tetanus and whole cell pertussis vaccine) at separate injection sites (Group A) vs. VARIVAX given 6 weeks after M-M-R II and TETRAMUNE (Group B). Six hundred nine healthy children, 12 to 23 months of age, were randomized to one of two treatment (immunization) groups (Group A and Group B). Blood for antibody titers was drawn on the day of immunization, 6 weeks after each injection and 1 year later. Local and systemic adverse reactions were recorded. Exposure and cases of varicella were documented through a 1-year follow-up period.

RESULTS

Measles, mumps and rubella seroconversion rates and geometric mean titers (GMTs) were similar for both treatment groups. Varicella seroconversion rates were also similar between groups. However, varicella GMTs and percent with a varicella-protective level [> or =5.0 glycoprotein (gp) enzyme-linked immunosorbent assay (ELISA) units] did not meet the prespecified criteria for similarity were lower for Group A (GMT 10.5; 82.8% > or =5.0 gp ELISA units) than for Group B (GMT 14.5; 91.2% > or =5.0 gp ELISA units). The GMTs between groups for other antibodies were similar. At the 1-year follow-up antibody titers were comparable in both groups and breakthrough varicella cases appeared generally similar. There were fewer local adverse events (AEs) at the VARIVAX injection sites (9.8% and 2.9%, Group A and B, respectively) than at the TETRAMUNE sites (27.9% and 24.0%). Systemic AEs were not statistically different when M-M-R II was administered alone (8.6%) or concomitantly with VARIVAX (8.9%). When VARIVAX was given alone AEs were 1.8%. The rate of fever > or =102 degrees F after M-M-R II and TETRAMUNE administered together was 10.7% on Days 0 to 3 and 23.7% on Days 7 to 21. When VARIVAX was administered alone, the rate of fever was 5.4% on Days 0 to 3 (P = 0.018) and 10.8% on Days 7 to 21 (P<0.001).

CONCLUSION

Because the varicella titers were comparable and varicella breakthrough rates generally similar at 1 year in both groups, we expect that the concomitant administration of VARIVAX with M-M-R II and TETRAMUNE has clinical effectiveness similar to that with VARIVAX 6 weeks after the administration of these other two vaccines. VARIVAX appears to be less reactogenic than M-M-R II and TETRAMUNE.

The effect of two different 18-week walking programmes on aerobic fitness, selected blood lipids and factor XIIa

Forty-nine previously sedentary or low active individuals aged 40-71 years were allocated to three groups. The long walking group participated in an 18-week walking programme which consisted of walks lasting 20-40 min; the repetitive short walking group completed walks of between 10 and 15 min, up to three times a day, with no less than 120 min between each walk; and the control group maintained their low level of activity. Both walking programmes began at a prescribed 60 min x week(-1), which increased steadily up to 200 min x week(-1) by week 12. During the study, the long walking group walked for an estimated 2514 min (139 min x week(-1)), expending an estimated 67.5 MJ (3.72 MJ x week(-1)) at an estimated 73% of their age-predicted maximum heart rate and 68% of their estimated VO2max. The repetitive short walking group walked for an estimated 2476 min (135 min x week(-1)), expending an estimated 58.5 MJ (3.17 MJ x week(-1)) at an estimated 71% of their age-predicted maximum heart rate and 65% of their estimated VO2max. The results showed a statistically significant reduction in heart rate during a standardized step test (pre- vs post-intervention) in both walking groups, indicating an improvement in aerobic fitness, although the control group showed a higher average heart rate during the post-intervention test, indicating reduced fitness. When compared with the male subjects pre-intervention, the females possessed more favourable levels of high-density lipoprotein (HDL) cholesterol (P< 0.001), apolipoprotein (apo) AI (P < 0.001) and ratios of total cholesterol:HDL cholesterol (P< 0.02) and low-density lipoprotein (LDL) cholesterol: HDL cholesterol (P< 0.02). Compared with the controls post-intervention, the walking groups showed no statistically significant changes in total cholesterol, LDL cholesterol, HDL cholesterol, apo AI, apo AII, apo B, or the ratios of total cholesterol: HDL cholesterol, LDL cholesterol: HDL cholesterol, apo AI: apo B or apo AI: apo AII (P > 0.05). Relative to the walking groups, factor XIIa increased in the control group (P < 0.05). We conclude that, although both walking programmes appeared to improve aerobic fitness, there was no evidence of improvements in the blood lipids or associated apolipoproteins of the walking groups. Further analysis indicated that this apparent lack of change may have been related to the subjects' relatively good pre-intervention blood lipid profiles, which restricted the potential for change. The implications of the observed changes in the coagulation/fibrinolytic factors remain unclear.

Safety and immunogenicity of a bivalent Haemophilus influenzae type b/hepatitis B vaccine in healthy infants. Hib-HB Vaccine Study Group

OBJECTIVE

To assess the safety, tolerability and immunogenicity of COMVAX, a liquid, bivalent Haemophilus influenzae type b-hepatitis B vaccine, containing the polyribosylribitol phosphate (PRP)-Neisseria meningitidis outer membrane protein complex conjugate used in the Hib vaccine, PedvaxHIB, and the yeast-derived hepatitis B surface antigen (HBsAg) used in the HB vaccine, RECOMBIVAX HB.

DESIGN

Eight hundred eighty-two healthy infants, approximately 2 months of age, were enrolled in an open, multicenter (n = 11) clinical trial and randomized to receive either COMVAX (7.5 micrograms of PRP/5 micrograms of HBsAg in 0.5 ml) or concurrent injections of the liquid formulation of PedvaxHIB (P) (7.5 micrograms of PRP in 0.5 ml) and RECOMBIVAX HB (R) (5 micrograms of HBsAg in 0.5 ml) at 2, 4 and 12 or 15 months of age. Safety and tolerability were monitored after each injection. The serum concentrations of anti-PRP and anti-HBs were determined at the time of each vaccination, 2 months after the second vaccination and 1 month after the third vaccination.

RESULTS

COMVAX was well-tolerated and proved to be immunologically comparable with a series of concomitant P+R injections. There were no serious adverse experiences attributable to the study vaccines. The most commonly reported nonserious adverse experiences were all events prelisted on diary cards given to parents. These included generally mild and transient signs of inflammation at the injection site (pain/ soreness, erythema, swelling/induration), somnolence and irritability. Because children are at peak risk of invasive Hib disease during the first year of life, 6 months of age (2 months after the second dose of vaccine) was designated the time of primary interest with regard to the development of anti-PRP. At that time 94.8% of the infants given COMVAX had > 0.15 microgram/ml of anti-PRP and 72.4% had > 1.0 microgram/ ml, with a geometric mean concentration (GMC) of 2.5 micrograms/ml, compared with 95.2%, 76.3% and 2.8 micrograms/ml, respectively, in recipients of P+R. The third injection given at 12 or 15 months of age induced a secondary rise in antibody. The proportions with > 0.15 microgram/ml and > 1.0 microgram/ml of anti-PRP increased to 99.3 and 92.6%, respectively, and the GMC rose to 9.5 micrograms/ml among COMVAX recipients, compared with 98.9%, 92.3% and 10.2 micrograms/ml in children given concurrent injections of P+R. In contrast to Hib few infants in countries with low endemicity of HBV infection are at near term risk of exposure to virus. Consequently the anti-HBs response after the last dose of vaccine was designated the outcome of primary interest. At 13 to 16 months of age (1 month after the third dose of vaccine) 98.4% of children given COMVAX had a protective anti-HBs concentration of > or = 10 mIU/ml with a GMC of 4468 mIU/ml, compared with 100% and a GMC of 6944 mIU/ml among children given P+R.

CONCLUSIONS

COMVAX is well-tolerated by healthy infants and can induce immunity against invasive Hib disease and HBV infection using only three injections compared with six injections if separate courses of monovalent PedvaxHIB and RECOMBIVAX HB are given.

The effect of sodium bicarbonate ingestion on 1500-m racing time

Twelve athletes, all of whom regularly participated in middle- or long-distance running races at club to national standard, competed in simulated 1500-m races under three conditions: following ingestion of 300 mg sodium bicarbonate per kg of body mass (B); following ingestion of a placebo (100 mg sodium chloride per kg of body mass and 200 mg calcium carbonate per kg of body mass) (P); and following ingestion of neither (C). A double-blind protocol was used between the B and P trials. Each condition was replicated so that the athletes competed in six races. Ten of the athletes completed all the races. The athletes' average times for trials B, P and C were 253.9, 256.8 and 258.0 s, respectively. The data were analysed using a two-way ANOVA with replicates and Tukey tests. This revealed a difference between trial B and trials P and C (P < 0.05), but no difference between trials P and C. These findings, therefore, indicate that sodium bicarbonate can have an ergogenic effect upon 1500-m running.

Heart rates during competitive orienteering

This study investigated the heart rate profiles of 16 experienced, competitive orienteers (aged 15-62 years) during three competitive events. Each competitor was assessed over three different types of course which were classified as: fast run (FR), slow run (SR) and highly physical (HP). The results showed that all subjects recorded heart rates that were between 140 and 180 beats min-1 for the majority of each event (irrespective of age or course type). The heart rate data indicated that the activity was largely aerobic but varied in intensity, with phases of strenuous anaerobic work. The type of course was shown significantly (analysis of variance; P < 0.001) to affect the mean heart rate attained by each orienteer (FR = 160, HP = 158, SR = 150 beats min-1), with courses that required more technical skill and hence slower running producing lower mean heart rates; although the general physical demands were similar for all courses. The older orienteers (> 45 years) recorded heart rate profiles that were similar to those of the young orienteers with no correlation being found between age and mean heart rate while exercising.

Effect of caffeinated coffee on running speed, respiratory factors, blood lactate and perceived exertion during 1500-m treadmill running

Using a motorized treadmill the study investigated the effects of the ingestion of 3 g of caffeinated coffee on: the time taken to run 1500 m; the selected speed with which athletes completed a 1-min 'finishing burst' at the end of a high-intensity run; and respiratory factors, perceived exertion and blood lactate levels during a high intensity 1500-m run. In all testing protocols decaffeinated coffee (3 g) was used as a placebo and a double-blind experimental design was used throughout. The participants in the study were middle distance athletes of club, county and national standard. The results showed that ingestion of caffeinated coffee: decreases the time taken to run 1500 m (P less than 0.005); increases the speed of the 'finishing burst' (P less than 0.005); and increases VO2 during the high-intensity 1500-m run (P less than 0.025). The study concluded that under these laboratory conditions, the ingestion of caffeinated coffee could enhance the performance of sustained high-intensity exercise.

Effect of pre-exercise protein ingestion upon VO2, R and perceived exertion during treadmill running

The study investigated the effect of pre-exercise protein ingestion upon the oxygen consumption (VO2), respiratory exchange ratio (R) and perceived exertion (PE) of athletes during treadmill running at intensities of approximately 60, 80, 90 and 100% of their VO2max. Seventeen female athletes aged between 17 and 22 years participated in the study. Subjects completed six assessment sessions, each being preceded by one of the following dietary regimens: a protein solution ingested 3h before assessment (P3), a protein solution ingested 1 h before assessment (P1) and the ingestion of water 1-3 h before assessment (B). The subjects' VO2, R and PE were measured at all exercise intensities using standardized procedures. The results showed that P1 produced significantly higher values for VO2 (P less than 0.05) at all exercise intensities and was associated with an increased PE (P less than 0.01). The findings could have implications for athletes when considering the composition of their pre-exercise meal, especially if performing in activities which require the participants to exercise close to or at their VO2max.

Effect of sodium bicarbonate ingestion upon repeated sprints

The purpose of the study was to assess the effect of sodium bicarbonate ingestion upon repeated bouts of intensive short duration exercise. Twenty-three subjects participated in the investigation (8 females and 15 males, age 21.4 +/- 2.3, mean +/- sd). Subjects completed six trials; three following the ingestion of sodium bicarbonate (300 mg/kg body weight) and three following the ingestion of a placebo (8 g sodium chloride). Each trial consisted of ten ten-second sprints on a cycle ergometer with 50 seconds recovery between each sprint. 'Peak power' and 'average power output' during each ten second sprint was measured from the flywheel of the ergometer using a light-sensitive monitor (Cranlea) linked to a BBC microcomputer. The power outputs recorded during each ten-second sprint of the bicarbonate trials were then compared with those recorded during the corresponding sprint of the placebo trials. The bicarbonate trials produced higher mean 'average power' outputs in all ten of the ten-second sprints, with the difference in 'average power' output being statistically significant in eight of these (p less than 0.05). The results also revealed that the difference in the 'average power' outputs attained during the bicarbonate and placebo trials increased as the number of sprint repetitions increased (p less than 0.01). 'Peak power' output was also greater in the bicarbonate trials with it being significantly higher (p less than 0.001) during the final ten-second sprint. It was concluded that during exercise consisting of repeated, short-duration sprints, power output was enhanced following the ingestion of sodium bicarbonate, (300 mg/kg body weight).

Anthropometric comparison of cyclists from different events

An anthropometric analysis was conducted upon 36 competitive male cyclists (mean age 23.4 years) who had been competing on average for 8.2 years. Cyclists were allocated to one of four groups; sprint, pursuit, road and time trial according to their competitive strengths. The sample included cyclists who were classified as category 1, 2, 3 or professional (British Cycling Federation and Professional Cycling Association). The sprint cyclists were significantly shorter and more mesomorphic than the other three groups (p less than 0.05). The time trialists were the tallest, most ectomorphic group, having the longest legs (p less than 0.01), the highest leg length/height ratio (p less than 0.05) and the greatest bitrochanteric width (p less than 0.05). The pursuit and road cyclists were found to have similar physiques, which were located between those of the sprinters and time trialists. The biomechanical implications of these differences in physique may be related to the high rate of pedal revolutions required by sprinters and the higher gear ratios used by time trialists.

Pre-exercise food and heart rate during submaximal exercise

The heart rates of 20 movement studies students were measured during multi-stage cycle ergometer tests. The tests were repeated on five occasions following the ingestion of different pre-exercise meals and the results compared. A glucose solution taken three hours prior to the exercise (G3) resulted in the lowest heart rates at each work rate. The highest heart rates at each work rate were recorded following the ingestion of glucose or protein one hour before the exercise (G1 and P1 respectively). The heart rate values during G3 were on average 10.3 beat.min-1 lower than those used during G1 and P1. Intermediate heart rates were obtained with protein taken three hours prior to the exercise or a complete fast for 12 to 14 hours. The results have implications for those attempting to predict maximum oxygen uptake from submaximal heart rates.