When firefighting, the combination of exposition to high temperatures, high physical demands and wearing (heavy and insulated) personal protective equipment lead to increased risk of heat stress and exhaustion in firefighters. Heat stress can easily evolve into a life-threatening heat stroke. Once heat stress occurred, the chance of getting another heat stroke during deployment gets higher. Moreover, intermittent exposure to heat stress over several years, is a risk factor for heart diseases. Similarly, exhausted during a deployment, a firefighter needs more time to rehabilitate before he can safely be deployed again. Heat stress and exhaustion can lead to line-of-duty cardiovascular events. Therefore preventing heat stress and exhaustion during deployment is beneficial for health, functioning and employability of firefighters. Since currently available measurement of the core temperature, such as thermometer pill or neck patch thermometer, are not reliable or practical for firefighters, an alternative approach may be used, namely, estimation of the core temperature based on non-invasive observation of the heart rate. Exhaustion is estimated using the training impulse model based on the heart rate reserve. Our achievement is a MoSeS health monitor system (as a smartphone application) that can real time analyze the health status of a firefighter and predict exhaustion and heat stress during deployment. The system is cheap (only a heart rate sensor and a smartphone application is needed), easy to use (intuitive “traffic light” signal), and objective (the health status is determined based on measurements of the heart rate). The only restriction is that the developed model is strongly dependent on personal maximum and minimum heart rate which need to be established behforehand. Moses Health Monitoring system for Firefighters CC BY-NC-ND Conference Proceedings 17th international e-SOCIETY 2019 IADIS
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Background—Self-management interventions are widely implemented in care for patients with heart failure (HF). Trials however show inconsistent results and whether specific patient groups respond differently is unknown. This individual patient data meta-analysis assessed the effectiveness of self-management interventions in HF patients and whether subgroups of patients respond differently. Methods and Results—Systematic literature search identified randomized trials of selfmanagement interventions. Data of twenty studies, representing 5624 patients, were included and analyzed using mixed effects models and Cox proportional-hazard models including interaction terms. Self-management interventions reduced risk of time to the combined endpoint HF-related all-0.71- in Conclusions—This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death, HF-related hospitalization alone, and elicited a small increase in HF-related quality of life. The findings do not endorse limiting selfmanagement interventions to subgroups of HF patients, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients.
Background To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) the CR guideline from the Dutch Royal Society for Physiotherapists (KNGF) has been updated. This guideline can be considered an addition to the 2011 Dutch Multidisciplinary CR guideline, as it includes several novel topics. Methods A systematic literature search was performed to formulate conclusions on the efficacy of exercise-based interventions during all CR phases in patients with CHD. Evidence was graded (1–4) according the Dutch evidence-based guideline development (EBRO) criteria. In case of insufficient scientific evidence, recommendations were based on expert opinion. This guideline comprised a structured approach including assessment, treatment and evaluation. Results Recommendations for exercise-based CR were formulated covering the following topics: preoperative physiotherapy, mobilisation during the clinical phase, aerobic exercise, strength training, and relaxation therapy during the outpatient rehabilitation phase, and adoption and monitoring of a physically active lifestyle after outpatient rehabilitation. Conclusions There is strong evidence for the effectiveness of exercise-based CR during all phases of CR. The implementation of this guideline in clinical practice needs further evaluation as well as the maintenance of an active lifestyle after supervised rehabilitation. LinkedIn: https://www.linkedin.com/in/tinusjongert/