Zoekresultaten

Pre-Participation Screenings Frequently Miss Occult Cardiovascular Conditions in Apparently Healthy Male Middle-Aged First-Time Marathon Runners

Introduction: The optimal pre-participation screening strategy to identify athletes at risk for exercise-induced cardiovascular events is unknown. We therefore aimed to compare the American College of Sports Medicine (ACSM) and European Society of Cardiology (ESC) pre-participation screening strategies against extensive cardiovascular evaluations in identifying high-risk individuals among 35.50- year-old apparently healthy men. Methods: We applied ACSM and ESC pre-participation screenings to 25 men participating in a study on first-time marathon running. We compared screening outcomes against medical history, physical examination, electrocardiography, blood tests, echocardiography, cardiopulmonary exercise testing, and magnetic resonance imaging. Results: ACSM screening classified all participants as "medical clearance not necessary."ESC screening classified two participants as "high-risk."Extensive cardiovascular evaluations revealed ≥1 minor abnormality and/or cardiovascular condition in 17 participants, including three subjects with mitral regurgitation and one with a small atrial septal defect. Eleven participants had dyslipidaemia, six had hypertension, and two had premature atherosclerosis. Ultimately, three (12%) subjects had a serious cardiovascular condition warranting sports restrictions: aortic aneurysm, hypertrophic cardiomyopathy (HCM), and myocardial fibrosis post-myocarditis. Of these three participants, only one had been identified as "high-risk"by the ESC screening (for dyslipidaemia, not HCM) and none by the ACSM screening. Conclusion: Numerous occult cardiovascular conditions are missed when applying current ACSM/ ESC screening strategies to apparently healthy middle-aged men engaging in their first high-intensity endurance sports event.

Uncoordinated sucking patterns in preterm infants are associated with abnormal general movements

OBJECTIVE: To examine the association between sucking patterns and the quality of fidgety movements in preterm infants.STUDY DESIGN: We studied the sucking patterns and fidgety movements of 44 preterm infants (gestational age <35 weeks) longitudinally from 34 weeks' postmenstrual age up to 14 weeks postterm. We used the Neonatal Oral-Motor Assessment Scale during feeding and scored the sucking patterns as normal or abnormal. Abnormal sucking patterns were categorized into arrhythmic sucking and uncoordinated sucking. At 14 weeks postterm, we scored the quality of fidgety movements from videotapes as normal, abnormal, or absent.RESULTS: The postmenstrual age at which sucking patterns became normal (median, 48 weeks; range, 34 to >50 weeks) was correlated with the quality of fidgety movements (Spearman ρ = -0.33; P = .035). The percentage per infant of normal and uncoordinated sucking patterns was also correlated with the quality of fidgety movements (ρ = 0.31; P = .048 and ρ = -0.33; P = .032, respectively). Infants with uncoordinated sucking patterns had a higher rate of abnormal fidgety movements (OR, 7.5; 95% CI, 1.4-40; P = .019).CONCLUSION: The development of sucking patterns in preterm infants was related to the quality of fidgety movements. Uncoordinated sucking patterns were associated with abnormal fidgety movements, indicating that uncoordinated sucking, swallowing, and breathing may represent neurologic dysfunction.

Cluttering identified: differential diagnostics between cluttering, stuttering and speech impairment related to learning difficulties

Muscle-tendon properties and functional gait outcomes in clubfoot patients with and without a relapse compared to typically developing children

Background Altered muscle-tendon properties in clubfoot patients could play a role in the occurrence of a relapse and negatively affect physical functioning. However, there is a lack of literature about muscle-tendon properties of clubfoot relapse patients. Research question The aim of this study was to determine whether the muscle architecture of the medial gastrocnemius and the morphology of the Achilles tendon differ between typically developing children (TDC) and clubfoot patients with and without a relapse clubfoot and to determine the relationships between morphological and functional gait outcomes. Methods A cross-sectional study was carried out in clubfoot patients treated according to the Ponseti method and TDC aged 4–8 years. A division between clubfoot patients with and without a relapse was made. Fifteen clubfoot patients, 10 clubfoot relapse patients and 19 TDC were included in the study. Morphologic properties of the medial head of the Gastrocnemius muscle and Achilles tendon were assessed by ultrasonography. Functional gait outcomes were assessed using three-dimensional gait analysis. Mean group differences were analysed with ANOVA and non-parametric alternatives. Relationships between functional and morphologic parameters were determined for all clubfoot patients together and for TDC with Spearman’s rank correlation. Results Morphological and functional gait parameters did not differ between clubfoot patients with and without a relapse, with exception of lower maximal dorsiflexor moment in clubfoot relapse patients. Compared to TDC, clubfoot and relapse patients did show lower functional gait outcomes, as well as shorter and more pennate muscles with a longer Achilles tendon. In all clubfoot patients, this longer relative tendon was related to higher ankle power and plantarflexor moment. Significance In clubfoot and relapse patients, abnormalities in morphology did not always relate to worse functional gait outcomes. Understanding these relationships in all clubfoot patients may improve the knowledge about clubfoot and aid future treatment planning.

Psychometrics of Wearable Devices Measuring Physical Activity in Ambulant Children With Gait Abnormalities

Objective: To evaluate psychometrics of wearable devices measuring physical activity (PA) in ambulant children with gait abnormalities due to neuromuscular conditions. Data Sources: We searched PubMed, Embase, PsycINFO, CINAHL, and SPORTDiscus in March 2023. Study Selection: We included studies if (1) participants were ambulatory children (2-19y) with gait abnormalities, (2) reliability and validity were analyzed, and (3) peer-reviewed studies in the English language and full-text were available. We excluded studies of children with primarily visual conditions, behavioral diagnoses, or primarily cognitive disability. We performed independent screening and inclusion, data extraction, assessment of the data, and grading of results with 2 researchers. Data Extraction: Our report follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed methodological quality with Consensus-based Standards for the selection of health measurement instruments. We extracted data on reported reliability, measurement error, and validity. We performed meta-analyses for reliability and validity coefficient values. Data Synthesis: Of 6911 studies, we included 26 with 1064 participants for meta-analysis. Results showed that wearables measuring PA in children with abnormal gait have high to very high reliability (intraclass correlation coefficient [ICC]+, test-retest reliability=0.81; 95% confidence interval [CI], 0.74-0.89; I2=88.57%; ICC+, interdevice reliability=0.99; 95% CI, 0.98-0.99; I2=71.01%) and moderate to high validity in a standardized setting (r+, construct validity=0.63; 95% CI, 0.36-0.89; I2=99.97%; r+, criterion validity=0.68; 95% CI, 0.57-0.79; I2=98.70%; r+, criterion validity cutoff point based=0.69; 95% CI, 0.58-0.80; I2=87.02%). The methodological quality of all studies included in the meta-analysis was moderate. Conclusions: There was high to very high reliability and moderate to high validity for wearables measuring PA in children with abnormal gait, primarily due to neurological conditions. Clinicians should be aware that several moderating factors can influence an assessment.

Do subclinical vascular abnormalities precede impaired physical ability and ADL disability?

Cardiovascular disease is an important cause of disability in activities of daily living (ADL) through its effect on physical functioning. However, it is unclear whether subclinical vascular abnormalities and rate of change in subclinical vascular abnormalities is also associated with an impaired physical ability and with ADL disability. In a longitudinal study, 490 middle-aged and older persons were included. Physical ability was measured using the Short Physical Performance Battery and ADL disability using a questionnaire on self-reported basic and instrumental ADL. Subclinical vascular abnormalities were measured by pulse wave velocity (PWV) and carotid intima media thickness (CIMT, in men only). Longitudinal associations between baseline markers of subclinical vascular abnormalities, their rate of change, and change in physical ability or ADL disability were assessed using generalized estimation equation models. After adjustment for confounders, higher baseline PWV, change in PWV, baseline CIMT (in men) and change in CIMT (in men) were associated with a higher rate of change in physical ability (regression coefficients 0.035, 95% CI [0.018; 0.052]; 0.047, 95% CI [0.024; 0.069]; 0.214, 95% CI [0.070; 0.358] and 0.148, 95% CI [0.019; 0.277], respectively). No relations were found for change in ADL disability. In subjects with incident cardiovascular disease, higher change in PWV was associated with a higher rate of change in ADL disability (regression coefficient 0.054, 95% CI [0.001; 0.106]). The present study showed that subclinical vascular abnormalities and rate of change were associated with higher rate of change in physical ability. The association between (change in) subclinical vascular abnormalities and ADL disability tended to be stronger in persons with incident and prevalent cardiovascular disease. These data may suggest that ADL decline is more a direct effect of experienced clinically manifest vascular events rather than the effect of progression of subclinical vascular abnormalities.