Improving menstrual health literacy in sport

Menstrual health represents a state of complete physical, mental, and social well-being in relation to a woman's menstrual cycle. From a health literacy perspective, knowledge acquisition and expertise are dependent upon the degree to which an individual can find, access, understand, critically analyse, and apply health information. Therefore, menstrual health literacy can be used to describe the state of knowledge acquisition and application specific to menstrual health-related issues. Menstrual health literacy is low among female athletes, their coaches, and practitioners, and few evidence-informed education or implementation strategies exist to improve menstrual health literacy in sport. Moreover, athletes seldom discuss their menstrual cycles or hormonal contraceptive use with their coaches, despite experiencing menstrual symptoms and/or disturbances and perceiving their menstrual cycles/hormonal contraceptive use to affect performance. Barriers to communication about menstrual cycle- and hormonal contraceptive-related topics include a perceived lack of knowledge among athletes, coaches, and practitioners, concerns about how conversations on these issues will affect interpersonal relationships, and a lack of formal and informal discussion forums. Whilst evidence relating to the effects of the menstrual cycle phase and hormonal contraceptive use on training and performance is currently limited, with existing studies often lacking methodological rigour, impactful steps can still be made to support female athletes. This cornerstone review highlights the current state of menstrual health literacy among athletes, coaches, and practitioners, and provides recommendations for improving menstrual health literacy in sport.

Effectiveness of an intervention in multicomponent exercise in primary care to improve frailty parameters in patients over 70 years of age (MEFAP-project), a randomised clinical trial: rationale and study design

Background

Physical activity may reverse frailty in the elderly, but we encounter barriers to the implementation of exercise programs in this population. Our main aim is to evaluate the effect of a multicomponent physical activity program, versus regular medical practice, on reverting pre-frailty status among the elderly, 12 months post-intervention.

Methods

Randomized parallel group multicenter clinical trial located in primary care setting, among non-dependent and pre-frail patients > 70 years old, including 190 patients (95 intervention, 95 control group). Intervention: Multicomponent physical activity program (MEFAP, for its acronym in Spanish) with twelve 1.5 h-weekly sessions comprised of: 1. Informative session; 2. Exercises for improving aerobic resistance, muscle strength, propioception-balance and flexibility; and 3. Handing out of at-home exercise chart (twice/week). Main variable: pre-frailty according to the Fried phenotype. Secondary variables: sociodemographic, clinical and functional variables; exercise program adherence, patient satisfaction with the program and quality of life. We will perform an intention-to-treat analysis by comparing the retrogression from pre-frailty (1 or 2 Fried criteria) to robust status (0 Fried criteria) by the end of the intervention, 6 months and 12 months post-intervention. The accumulated incidence in each group will be calculated, as well as the relative risk (RR) and the number needed to treat (NNT) with their corresponding 95% confidence intervals. Protocol was approved by the Ethics Committee Hospital la Paz.

Discussion

Within the context of regular clinical practice, our results will provide evidence regarding the effects of exercise interventions on frailty among pre-frail older adults, a key population given their significant potential for functional, physical, and mental health improvement.

Trial registration

NCT03568084. Registered 26 June 2018. Date of enrollment of the first participant to the trial: July 2nd 2018.

The efficacy and cost-effectiveness of a community weight management intervention: a randomized controlled trial of the health weight management demonstration

PURPOSE

The study investigated the efficacy and cost-effectiveness of a cognitive-behavioral weight management program, complemented by an interactive Web site and brief telephone/e-mail coaching.

METHODS

In 2006-2007, 1755 overweight, non-active-duty TRICARE beneficiaries were randomized to one of three conditions with increasing intervention intensity: written materials and basic Web access (RCT1), plus an interactive Web site (RCT2), plus brief telephone/e-mail coaching support (RCT3). The study assessed changes in weight, blood pressure, and physical activity from baseline to 6, 12, and 15-18 months. (Study retention was 31% at 12 months.) Average and incremental cost-effectiveness and cost-offset analyses were conducted.

RESULTS

Participants experienced significant weight loss (-4.0%, -4.0%, and -5.3%, respectively, in each RCT group after 12 months and -3.5%, -3.8%, and -5.1%, respectively, after 15 to 18 months), increased physical activity, and decreased blood pressure. Cost-effectiveness ratios were $900 to $1100/quality-adjusted life year (QALY) for RCT1 and RCT2 and $1900/QALY for RCT3. The cost recovery period to the government was 3 years for RCTs 1 and 2 and 6 years for RCT3.

CONCLUSION

A relatively inexpensive cognitive-behavioral weight management intervention improved patient outcomes. Extrapolation of savings for the entire TRICARE population would significantly reduce direct medical costs.

Analysis of rugae in burn victims and cadavers to simulate rugae identification in cases of incineration and decomposition

The most challenging situations in Forensic Odonto-Stomatology are mass disasters, where the forensic dentist is usually confronted with charred human remains or heavily decomposed or fragmented bodies. This article determines the extent of preservation of palatal rugae for use as an alternative identification tool in such situations, using a study group comprising burn victims and cadavers simulating forensic cases of incineration and decomposition. The thermal effects and the decomposition changes on the palatal rugae of burn victims with panfacial third degree burns and human cadavers in storage were respectively assessed and graded on a new scale. Ninety three percent of burn victims and 77% of human cadavers had Grade 0 changes (normal). When changes were noted, they were less pronounced than the generalized body involvement of burns in burn victims and the generalized body decomposition of human cadavers.

Computerized recording of the palatal rugae pattern and an evaluation of its application in forensic identification

In circumstances where identification of an individual by fingerprint or dental record comparison is difficult, palatal rugae may be considered as an alternative source of comparative material. This article evaluates the use of palatal rugae patterns for forensic identification with an indigenously developed computer software program. Comprehensive computerized antemortem records were constructed for 250 subjects and a comparison matching process performed using both recorded and unrecorded samples. The efficiency of this computer-based identification method was then assessed. The program proved to have an average sensitivity of 0.93 and specificity of 1 and had a success rate of 92-97% in matches with digitized rugae pattern samples.

A new method of marking dentures using microchips

Over the years various methods of denture marking have been reported in the literature. They include surface marking and inclusion techniques using metallic or non-metallic materials, microchips and microlabels. The microchips are preferred because of their small size and aesthetic acceptability. They are not however widely used due to the high cost of manufacture and data incorporation. This article details the procedures involved in inscribing a microchip using the photochemical etching process used in the electronics industry. The resulting microchip was cosmetically appealing, cost effective and was able to satisfy all the forensic requirements for a suitable denture marker.

Classification of grossly detectable abnormalities and conditions seen at postmortem in Canadian poultry abattoirs according to a hazard identification decision tree

This study was designed to review all grossly detectable abnormalities and conditions (GDACs) encountered in poultry in Canadian abattoirs to determine which have potential to cause adverse health effects for the consumer. Review of the literature and consultation with scientists in the field of microbiology, epidemiology, poultry pathology, chemistry, and meat inspection served to generate an inventory of GDACs, and a decision tree containing algorithms was developed to identify GDACs potentially representing a health hazard to consumers. Through the use of the decision tree, GDACs were classified into different categories with regard to the risk they represent to humans. A number of GDACs were identified as being of potential concern from a food safety perspective, namely Erysipelas, fowl cholera, Campylobacteriosis, clostridial diseases, hepatitis/enteritis associated with Helicobacter, Listeriosis, Salmonella infections (nontyphoid infections, Salmonella arizonae, pullorum disease, and fowl typhoid), Staphylococcosis, and Toxoplasmosis. Further characterization--i.e., hazard characterization, exposure assessment, and risk characterization--is required to quantify or better characterize the probability that products derived from affected carcasses may affect the consumer as well as the resulting consequences. Risk assessment is a dynamic process. Results presented in this paper are based on available information and expert opinion. As new information is obtained, the inventory of GDACs and their classification may be modified.

The practice of psychotherapy and spiritual direction

The author compares and contrasts insight-oriented psychotherapy, supportive psychotherapy, and spiritual direction in relation to goals and methods; management of resistance, transference, and countertransference; and selection criteria. The enhancement of spiritual formation through insight-oriented psychotherapy and supportive psychotherapy is also discussed.

Myocardial Ca-sequestration failure and compensatory increase in Ca-ATPase with congestive cardiomyopathy: kinetic characterization by a homogenate microassay using real-time ratiometric indo-1 spectrofluorometry

A novel, simple, rapid and reproducible microassay is used for kinetic analysis of Ca-sequestration by homogenates of myocardium of turkeys with furazolidone-induced congestive cardiomyopathy. The assay monitors Ca in real-time using dual-emission ratiometric spectrofluorometry and the Ca-indicator dye indo-1. Using this assay and isolated SR studies we make several novel findings regarding the mechanism of SR failure in furazolidone cardiomyopathy. Qualitative differences in Ca-sequestration were not detected between groups. However, compared to controls the furazolidone treatment resulted in: 1) 50% depression in maximal activities (1.54 +/- 0.36 vs 0.73 +/- 0.12 microM/sec); 2) 2-fold increases in post-sequestration concentrations of ionized Ca (79 +/- 23 vs 141 +/- 13 nmol Ca/L homogenate); 3) 2-fold increases in Ca half-life (415 vs 790 msec); and 4) 25% increased passive Ca-binding capacity of homogenates. The Ca-ATPase specific activity of isolated sarcoplasmic reticulum was 60% increased in congestive cardiomyopathy (543 +/- 140 vs 873 +/- 108 nmol ATP hydrolyzed/min/mg membrane protein) although membrane yield was 20% decreased (0.79 +/- 0.09 vs 0.63 +/- 0.03 mg/g heart). The increased ATPase and decreased Ca-uptake activities in combination with the occurrence of 36% cardiac hypertrophy and 19% decreased body weights resulted in estimates of the relative energy cost to the animal for myocardial Ca transport being 5.5-fold increased with cardiomyopathy (20.5 vs 111 nmol ATP hydrolyzed per microM decrease of sarcoplasmic free Ca/kg body weight). These data indicate that congestive cardiomyopathy is associated with markedly increased permeability of sarcoplasmic reticulum to Ca and compensatorily increased Ca-ATPase activity. Accelerated energy consumption due to the increased energy cost of Ca transport and increased time of myocyte activation are predicted to predispose the myocardium to fatigue and irreversible failure.

Spiritual discernment in psychiatric patients

The author uses resources from the Christian tradition of discernment of spirits to provide clinicians with guidelines for distinguishing the authentic and pathological aspects of religion in psychiatric patients.

Functional scoliosis as a long-term complication of surgical ligation for patent ductus arteriosus in premature infants

Follow-up evaluation was performed on two groups of children, all premature infants who had undergone surgical ligation of a patent ductus arteriosus in the first days of life (Group I, 12 months postligation; Group II, 4 years postligation). Overall, two of 11 patients had significant functional scoliosis associated with weakness of shoulder girdle musculature and three additional patients had functional weakness on the affected side but with normal vertebral alignment. Patients post-patent ductus ligation should be observed for this long-term complication.

Foci of cartilage in the lung of broiler chickens

Many small masses of cartilage, degenerating cartilage, and mineralized material were found on histologic examination of the lung of a broiler chicken that had severe tibiotarsal and tarsometatarsal dyschondroplasia. A small survey revealed that occasional masses of similar material could be found in the lungs of many normal broiler chickens.

The action of progesterone and diethylstilboestrol on the dehydrogenase and esterase activities of a purified aldehyde dehydrogenase from rabbit liver

A steroid-sensitive aldehyde dehydrogenase (EC 1.2.1.3) was purified from rabbit liver and is homogeneous by the criterion of electrophoresis in polyacrylamide gels with or without sodium dodecyl sulphate. The enzyme is tetrameric, of subunit mo.wt. 48 300, and contains no tightly bound zinc. The fluorescence of the protein is decreased in the presence of progesterone, which is inhibitory to the reactions catalysed by the enzyme. When NADH is bound to the enzyme, the fluorescence of the coenzyme is augmented to an extent independent of the presence of steroids or acetaldehyde. The purified enzyme catalyses the oxidation of acetaldehyde and glucuronolactone, and the hydrolysis of 4-nitrophenyl acetate. Each of these reactions is inhibited by progesterone in such a manner as to suggest the formation of a catalytically active enzyme-hormone complex. Diethylstilboestrol inhibits the hydrolysis of esters by this enzyme, but stimulates the oxidation of aldehydes, except at low aldehyde concentrations; the ligand is then inhibitory. NADH inhibits the hydrolysis of 4-nitrophenyl acetate by the enzyme in a partially competitive fashion.