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Ziel der Studie Dieser Artikel untersucht, inwiefern sich die 2016 reformierte Richtlinie im Stadt-Land- sowie im Ost-West-Vergleich auf die ambulante psychotherapeutische Arbeit und Versorgung auswirkt.
Methodik Eine Onlineumfrage unter vertragsärztlich tätigen TherapeutInnen wurde durchgeführt. Die Fragen bezogen sich auf verschiedene Neuerungen in der Richtlinie.
Ergebnisse Unabhängig von der Region schätzten die Befragten ein, dass die Reform zu keiner verbesserten Versorgung führte.
Im Westen und in der Stadt tätige TherapeutInnen verwiesen PatientInnen nach der Sprechstunde öfter an andere Psychotherapiepraxen, im Osten und auf dem Land tätige hingegen öfter auf andere Hilfeangebote.
Schlussfolgerung Stärkere Anreize für die psychotherapeutische Tätigkeit auf dem Land sind zu schaffen. Abbaumaßnahmen der Ost-West-Ungleichheiten in der Versorgungsdichte scheinen nötig.
Background: As the COVID-19 pandemic continues to spread across the globe, the search for an effective medication to treat the symptoms of COVID-19 continues as well. It would be desirable to identify a medication that is already in use for another condition and whose side effect profile and safety data are already known and approved.
Objective: The objective of this study was to evaluate the effect of different medications on typical COVID-19 symptoms by using data from an online surveillance survey.
Methods: Between early April and late-July 2020, a total of 3654 individuals in Lower Saxony, Germany, participated in an online symptom-tracking survey conducted through the app covid-nein-danke.de. The questionnaire comprised items on typical COVID-19 symptoms, age range, gender, employment in patient-facing healthcare, housing status, postal code, previous illnesses, permanent medication, vaccination status, results of reverse transcription polymerase chain reaction (RT-PCR) and antibody tests for COVID-19 diagnosis, and consequent COVID-19 treatment if applicable. Odds ratio estimates with corresponding 95% CIs were computed for each medication and symptom by using logistic regression models.
Results: Data analysis suggested a statistically significant inverse relationship between typical COVID-19 symptoms self-reported by the participants and self-reported statin therapy and, to a lesser extent, antihypertensive therapy. When COVID-19 diagnosis was based on restrictive symptom criteria (ie, presence of 4 out of 7 symptoms) or a positive RT-PCR test, a statistically significant association was found solely for statins (odds ratio 0.28, 95% CI 0.1-0.78).
Conclusions: Individuals taking statin medication are more likely to have asymptomatic COVID-19, in which case they may be at an increased risk of transmitting the disease unknowingly. We suggest that the results of this study be incorporated into symptoms-based surveillance and decision-making protocols in regard to COVID-19 management. Whether statin therapy has a beneficial effect in combating COVID-19 cannot be deduced based on our findings and should be investigated by further study.
The patients’ view
(2020)
Aim:The aim of this meta-synthesis is to find out what it means for patients with age-related macular degeneration to live with visual impairment, how they cope with the illness and how they experience their medical care, including vascular endothelial growth factor inhibitor therapy. Method:Inclusion criteria: qualitative studies exploring patients' experiences with age-related macular degeneration in their daily lives and with medical care, published in journals in English or German. The included studies were analysed following the rules and principles of grounded theory. Results:For the analysis, twenty-four articles matching the inclusion criteria were identified. Three main analytic themes emerged from the included studies: (i) a life shaped by losses; (ii) the burden of medical treatment; and (iii) coping with vision loss. For patients, visual impairment/vision loss means living with multiple losses in various domains of life. With the introduction of vascular endothelial growth factor inhibitor therapy, patients with neovascular age-related macular degeneration have a good chance of slowing down the disease progression; therapy does, however, also represent a major burden. Conclusion:New strategies need to be conceived to reduce the burden of medical treatment and to improve the dissemination of information about age-related macular degeneration.
Teachers' attitudes toward inclusion are frequently cited as being an important predictor of how successfully a given inclusive school system is implemented. At the same time, beliefs about the nature of teaching and learning are discussed as a possible predictor of attitudes toward inclusion. However, more recent research emphasizes the need of considering implicit processes, such as automatic evaluations, when describing attitudes and beliefs. Previous evidence on the association of attitudes toward inclusion and beliefs about teaching and learning is solely based on explicit reports. Therefore, this study aims to examine the relationship between attitudes toward inclusion, beliefs about teaching and learning, and the subsequent automatic evaluations of pre-service teachers (N = 197). The results revealed differences between pre-service teachers' explicit attitudes/beliefs and their subsequent automatic evaluations. Differences in the relationship between attitudes toward inclusion and beliefs about teaching and learning occur when teachers focus either on explicit measures or automatic evaluations. These differences might be due to different facets of the same attitude object being represented. Relying solely on either explicit measures or automatic evaluations at the exclusion of the other might lead to erroneous assumptions about the relation of attitudes toward inclusion and beliefs about teaching and learning.
Objective: This study investigated intraindividual differences of intratendinous blood flow (IBF) in response to running exercise in participants with Achilles tendinopathy.
Design: This is a cross-sectional study.
Setting: The study was conducted at the University Outpatient Clinic.
Participants: Sonographic detectable intratendinous blood flow was examined in symptomatic and contralateral asymptomatic Achilles tendons of 19 participants (42 ± 13 years, 178 ± 10 cm, 76 ± 12 kg, VISA-A 75 ± 16) with clinically diagnosed unilateral Achilles tendinopathy and sonographic evident tendinosis.
Intervention: IBF was assessed using Doppler ultrasound “Advanced Dynamic Flow” before (Upre) and 5, 30, 60, and 120 min (U5–U120) after a standardized submaximal constant load run.
Main Outcome Measure: IBF was quantified by counting the number (n) of vessels in each tendon.
Results: At Upre, IBF was higher in symptomatic compared with asymptomatic tendons [mean 6.3 (95% CI: 2.8–9.9) and 1.7 (0.4–2.9), p < 0.01]. Overall, 63% of symptomatic and 47% of asymptomatic Achilles tendons responded to exercise, whereas 16 and 11% showed persisting IBF and 21 and 42% remained avascular throughout the investigation. At U5, IBF increased in both symptomatic and asymptomatic tendons [difference to baseline: 2.4 (0.3–4.5) and 0.9 (0.5–1.4), p = 0.05]. At U30 to U120, IBF was still increased in symptomatic but not in asymptomatic tendons [mean difference to baseline: 1.9 (0.8–2.9) and 0.1 (-0.9 to 1.2), p < 0.01].
Conclusion: Irrespective of pathology, 47–63% of Achilles tendons responded to exercise with an immediate acute physiological IBF increase by an average of one to two vessels (“responders”). A higher amount of baseline IBF (approximately five vessels) and a prolonged exercise-induced IBF response found in symptomatic ATs indicate a pain-associated altered intratendinous “neovascularization.”
How do people decide which risks they want to get informed about? The present study examines the role of the availability and affect heuristics on these decisions. Participants (N= 100, aged 19-72 years) selected for which of 23 cancers they would like to receive an information brochure, reported the number of occurrences of each type of cancer in their social circle (availability), and rated their dread reaction to each type of cancer (affect); they also made relative judgments about which of 2 cancers was more common in Germany (judged risk). Participants tended to choose information brochures for those cancers for which they indicated a higher availability within their social networks as well as for cancers they dreaded. Mediation analyses suggested that the influence of availability and affect on information choice was only partly mediated by judged risk. The results demonstrate the operation of 2 key judgment heuristics (availability and affect), previously studied in risk perception, also in decisions about information choice. We discuss how our findings can be used to identify which risks are likely to fall from people's radar.
Background
Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only cardiac rehabilitation interventions based on published standards and core components to evaluate cardiac rehabilitation delivery and effectiveness in improving patient prognosis.
Design
A systematic review and meta-analysis.
Methods
Randomised controlled trials and retrospective and prospective controlled cohort studies evaluating patients after acute coronary syndrome, coronary artery bypass grafting or mixed populations with coronary artery disease published until September 2018 were included.
Resulte
Based on CROS inclusion criteria out of 7096 abstracts six additional studies including 8671 patients were identified (two randomised controlled trials, two retrospective controlled cohort studies, two prospective controlled cohort studies). In total, 31 studies including 228,337 patients were available for this meta-analysis (three randomised controlled trials, nine prospective controlled cohort studies, 19 retrospective controlled cohort studies; 50,653 patients after acute coronary syndrome 14,583, after coronary artery bypass grafting 163,101, mixed coronary artery disease populations; follow-up periods ranging from 9 months to 14 years). Heterogeneity in design, cardiac rehabilitation delivery, biometrical assessment and potential confounders was considerable. Controlled cohort studies showed a significantly reduced total mortality (primary endpoint) after cardiac rehabilitation participation in patients after acute coronary syndrome (prospective controlled cohort studies: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; retrospective controlled cohort studies HR 0.64, 95% CI 0.53-0.76; prospective controlled cohort studies odds ratio 0.20, 95% CI 0.08-0.48), but the single randomised controlled trial fulfilling the CROS inclusion criteria showed neutral results. Cardiac rehabilitation participation was also associated with reduced total mortality in patients after coronary artery bypass grafting (retrospective controlled cohort studies HR 0.62, 95% CI 0.54-0.70, one single randomised controlled trial without fatal events), and in mixed coronary artery disease populations (retrospective controlled cohort studies HR 0.52, 95% CI 0.36-0.77; two out of 10 controlled cohort studies with neutral results).
Conclusion
CROS II confirms the effectiveness of cardiac rehabilitation participation after acute coronary syndrome and after coronary artery bypass grafting in actual clinical practice by reducing total mortality under the conditions of current evidence-based coronary artery disease treatment. The data of CROS II, however, underscore the urgent need to define internationally accepted minimal standards for cardiac rehabilitation delivery as well as for scientific evaluation.
Progression or impediment of fundamental motor skills performance (FMSP) in children depends on internal and environmental factors. Shoes as an environmental constraint are believed to affect these movements as children showed to perform qualitatively better with sports shoes than flip-flop sandals. However, locomotor performance assessments based on biomechanical variables are limited. Therefore, the objective of this experiment was to assess the biomechanical effects of wearing shoes while performing fundamental motor skills in children. Barefoot and shod conditions were tested in healthy children between the age of 4 and 7 years. They were asked to perform basic and advanced motor skills including double-leg stance, horizontal jumps, walking as well as counter-movement jumps, single-leg stance and sprinting. Postural control and ground reaction data were measured with two embedded force plates. A 3D motion capture system was used to analyse the spatiotemporal parameters of walking and sprinting. Findings showed that the parameters of single- and double-leg stance, horizontal and counter-movement jump did not differ between barefoot and shod conditions. Most of the spatiotemporal variables including cadence, stride length, stride time, and contact time of walking and sprinting were statistically different between the barefoot and shod conditions. Consequently, tested shoes did not change performance and biomechanics of postural control and jumping tasks; however, the spatiotemporal gait parameters indicate changes in walking and sprinting characteristics with shoes in children.
Cardiac remodeling in child and adolescent athletes in association with sport discipline and sex
(2020)
Continuous high training loads are associated with structural cardiac adaptations and development of an athletic heart in adult athletes, especially in sport disciplines with high dynamic training components. In child and adolescent athletes these effects are increasingly reported. However, study populations are still very small.
Objectives:
The prevalence rates for mental health (MH) problems in cancer patients is high, although reduced uptake of services may be influenced by mental health literacy (MHL). The objective of this study was to investigate the MHL for depression and panic disorder (PD), including treatment preferences in Australian adults who had been diagnosed and treated for cancer, and whether MHL and treatment preferences was influenced by sex, age, and individuals' lived MH experience.
Method:
A total of 421 cancer survivors (n = 378 females) completed a self-report survey. Participants were asked to specify whether they had a lived experience with anxiety and/or depression, and to indicate treatment preferences for managing cancer-related distress. Two vignettes were administered to assess MHL for depression and PD.
Results:
The MHL accuracy for depression was higher than PD. Accuracy rates were higher for females with a lived experience with anxiety and/or depression; although the accuracy rate for PD was significantly lower in males. A high proportion of individuals preferred exercise and in-person counselling to manage depression and PD. Internet-based therapies were not strongly preferred for managing MH problems.
Conclusions:
The MHL for depression and PD is moderate for adult cancer survivors, with higher levels indicated for individuals with a personal lived experience with anxiety and/or depression. Public health campaigns for enhancing MHL should broaden to include individuals experiencing comorbid physical health conditions. Health providers also need to take into account client preferences for evidence-based therapies.
Coordination of the trunk and hips is crucial for successful dynamic balance in many activities of daily living. Persons with recurrent low back pain (rLBP), both while symptomatic and during periods of symptom remission, exhibit dysfunctional muscle activation patterns and coordination of these joints. In a novel dynamic balance task where persons in remission from rLBP exhibit dissociated trunk motion, it is unknown how trunk and hip musculature are coordinated. Activation of hip and trunk muscles were acquired from nineteen persons with and without rLBP during the Balance-Dexterity Task, which involves balancing on one limb while compressing an unstable spring with the other. There were no between-group differences in activation amplitude for any muscle groups tested. In back-healthy control participants, hip and trunk muscle activation amplitudes increased proportionally in response to the added instability of the spring (R = 0.837, p < 0.001). Increases in muscle activation amplitudes in the group in remission from rLBP were not proportional (R = 0.113, p = 0.655). Instead, hip muscle activation in this group was associated with task performance, i.e. dexterous control of the spring (R = 0.676, p = 0.002). These findings highlight atypical coordination of hip and trunk musculature potentially related to task demands in persons with rLBP even during remission from pain.
Core stability exercises are regular part of exercise programs for asymptomatic individuals across ages. The purpose of this study was to examine deep abdominal and multifidus muscle thickness in children and adults and to determine reliability of the rehabilitative ultrasound (RUSI) imaging. Transversus abdominis and lumbar multifidus thickness at rest and during core stability exercise were examined in pre-pubertal children (N = 23), adolescents (N = 20), young adults (N = 21) and middle-aged adults (N = 22). Thirty-nine participants were re-tested one week after to establish reliability. Muscle thickness at rest was lower in children and adolescents compared with young and middle-aged adults (p < 0.008). Young adults displayed the highest relative transversus abdominis thickness upon contraction (p < 0.008). Lumbar multfidus contraction thickness was greater in young-adults than middle-aged adults and prepubertal children (p < 0.008), but it was similar between young-adults and adolescents (p > 0.008). Reliability was high for both muscles (ICC3,3 = 0.76 - 0.99). The age-related differences in muscle thickness indicate that core stability exercises may be beneficial for children and middle-aged adults.
Die Sekundärprävention der koronaren Herzkrankheit umfasst einerseits eine pharmakologische, andererseits eine lebensstilbasierte Säule, die idealerweise interagieren und sich potenzieren. Neben der medikamentösen Blutdruck- und Lipideinstellung auf leitlinienorientierte Zielwerte ermöglichen moderne Antidiabetika eine Optimierung des glukometabolischen Kontinuums und eine Prognosebesserung. Die Lebensstiloptimierung setzt sich aus koronarprotektiver Ernährung, einer individualisierten Trainingstherapie, einer konsequenten Nikotinkarenz und stressreduzierenden Maßnahmen zusammen. Die kardiologische Rehabilitation (Phase II) schließt sich idealerweise unmittelbar einem stationären Aufenthalt wegen eines akuten Koronarereignisses an, kann aber auch im Rahmen einer stabilen Koronarsituation im Rahmen eines allgemeinen Antragsverfahrens durchgeführt werden. Randomisierte und prospektiv angelegte Interventionsstudien belegen die prognostische Wertigkeit der kardiologischen Rehabilitation auch im Zeitalter akuter Revaskularisationstherapie mit 24-h-PCI und moderner Pharmakotherapie.
Field-based sports require athletes to run sub-maximally over significant distances, often while contending with dynamic perturbations to preferred coordination patterns. The ability to adapt movement to maintain performance under such perturbations appears to be trainable through exposure to task variability, which encourages movement variability. The aim of the present study was to investigate the extent to which various wearable resistance loading magnitudes alter coordination and induce movement variability during running. To investigate this, 14 participants (three female and 11 male) performed 10 sub-maximal velocity shuttle runs with either no weight, 1%, 3%, or 5% of body weight attached to the lower limbs. Sagittal plane lower limb joint kinematics from one complete stride cycle in each run were assessed using functional data analysis techniques, both across the participant group and within-individuals. At the group-level, decreases in ankle plantarflexion following toe-off were evident in the 3% and 5% conditions, while increased knee flexion occurred during weight acceptance in the 5% condition compared with unloaded running. At the individual-level, between-run joint angle profiles varied, with six participants exhibiting increased joint angle variability in one or more loading conditions compared with unloaded running. Loading of 5% decreased between-run ankle joint variability among two individuals, likely in accordance with the need to manage increased system load or the novelty of the task. In terms of joint coordination, the most considerable alterations to coordination occurred in the 5% loading condition at the hip-knee joint pair, however, only a minority of participants exhibited this tendency. Coaches should prescribe wearable resistance individually to perturb preferred coordination patterns and encourage movement variability without loading to the extent that movement options become limited.
Beyond randomised studies
(2020)
Background
Generalized weakness and fatigue are underexplored symptoms in emergency medicine. Triage tools often underestimate patients presenting to the emergency department (ED) with these nonspecific symptoms (Nemec et al., 2010). At the same time, physicians' disease severity rating (DSR) on a scale from 0 (not sick at all) to 10 (extremely sick) predicts key outcomes in ED patients (Beglinger et al., 2015; Rohacek et al., 2015). Our goals were (1) to characterize ED patients with weakness and/or fatigue (W|F); to explore (2) to what extent physicians' DSR at triage can predict five key outcomes in ED patients with W|F; (3) how well DSR performs relative to two commonly used benchmark methods, the Emergency Severity Index (ESI) and the Charlson Comorbidity Index (CCI); (4) to what extent DSR provides predictive information beyond ESI, CCI, or their linear combination, i.e., whether ESI and CCI should be used alone or in combination with DSR; and (5) to what extent ESI, CCI, or their linear combination provide predictive information beyond DSR alone, i.e., whether DSR should be used alone or in combination with ESI and / or CCI.
Methods
Prospective observational study between 2013-2015 (analysis in 2018-2020, study team blinded to hypothesis) conducted at a single center. We study an all-comer cohort of 3,960 patients (48% female patients, median age = 51 years, 94% completed 1-year follow-up). We looked at two primary outcomes (acute morbidity (Bingisser et al., 2017; Weigel et al., 2017) and all-cause 1- year mortality) and three secondary outcomes (in-hospital mortality, hospitalization and transfer to ICU). We assessed the predictive power (i.e., resolution, measured as the Area under the ROC Curve, AUC) of the scores and, using logistic regression, their linear combinations.
Findings
Compared to patients without W|F (n = 3,227), patients with W|F (n = 733) showed higher prevalences for all five outcomes, reported more symptoms across both genders, and received higher DSRs (median = 4; interquartile range (IQR) = 3-6 vs. median = 3; IQR = 2-5). DSR predicted all five outcomes well above chance (i.e., AUCs > similar to 0.70), similarly well for both patients with and without W|F, and as good as or better than ESI and CCI in patients with and without W|F (except for 1-year mortality where CCI performs better). For acute morbidity, hospitalization, and transfer to ICU there is clear evidence that adding DSR to ESI and/or CCI improves predictions for both patient groups; for 1-year mortality and in-hospital mortality this holds for most, but not all comparisons. Adding ESI and/or CCI to DSR generally did not improve performance or even decreased it.
Conclusions
The use of physicians' disease severity rating has never been investigated in patients with generalized weakness and fatigue. We show that physicians' prediction of acute morbidity, mortality, hospitalization, and transfer to ICU through their DSR is also accurate in these patients. Across all patients, DSR is less predictive of acute morbidity for female than male patients, however. Future research should investigate how emergency physicians judge their patients' clinical state at triage and how this can be improved and used in simple decision aids.
Background: The relationship between engagement in physical activity and the development of motor competence (MC) is considered to be reciprocal and dynamic throughout childhood and adolescence. The 10-month follow-up study aimed to explore this reciprocal relationship and investigated whether the relationship is mediated by the corresponding self-perception of MC (PMC).
Methods: A total of 51 children aged between 10 and 11 years (M = 10.27 [0.45]) participated in the study (52.9% boys, 47.1% girls). As an indicator for physical activity, the average vigorous physical activity (VPA) per day was measured by ActiGraph accelerometers. Two aspects of MC and PMC were recorded: self-movement and object movement. Saturated pathway models in a cross-lagged panel design with 2 measurement points were analyzed.
Results: Reciprocal and direct relationships between VPA and MC object movement respectively MC self-movement were not found in longitudinal analyses with PMC as a mediator. Indirect effects of MC at t1 on VPA at t2 via PMC were identified (self-movement: beta = 0.13, 95% confidence interval, 0.04 to 0.26; object movement: beta = 0.14, 95% confidence interval, 0.01 to 0.49).
Conclusion: The results highlight the importance of MC and PMC in promoting children's VPA. However, VPA does not drive the development of MC.
Ziel der Studie Dieser Artikel untersucht, inwiefern Aspekte der 2016 reformierten Psychotherapierichtlinie aus Sicht der drei Richtlinienverfahren für die praktische Arbeit unterschiedlich bewertet und genutzt werden. <br /> Methodik Eine Onlineumfrage wurde unter vertragsärztlich tätigen PsychotherapeutInnen (n = 987) durchgeführt. Die Fragen bezogen sich auf die unterschiedlichen Neuerungen in der Psychotherapierichtlinie.
Ergebnisse Signifikante Unterschiede wurden u. a. in der Nutzung der erweiterten Befugnisse sowie in der Abrechnung bestimmter Leistungen deutlich. Die Gruppen unterschieden sich auch in der Beantragung von Behandlungskontingenten. <br /> Schlussfolgerung Es scheint sinnvoll, Elemente der Richtlinienreform aus der Sicht des bevorzugten Behandlungsverfahrens zu evaluieren. Jene Aspekte scheinen bedeutsam, die sich auf die unmittelbare Arbeit mit den PatientInnen beziehen.
One of the major risk factors for global death and disability is alcohol, tobacco, and illicit drug use. While there is increasing knowledge with respect to individual factors promoting the initiation and maintenance of substance use disorders (SUDs), disease trajectories involved in losing and regaining control over drug intake (ReCoDe) are still not well described. Our newly formed German Collaborative Research Centre (CRC) on ReCoDe has an interdisciplinary approach funded by the German Research Foundation (DFG) with a 12-year perspective. The main goals of our research consortium are (i) to identify triggers and modifying factors that longitudinally modulate the trajectories of losing and regaining control over drug consumption in real life, (ii) to study underlying behavioral, cognitive, and neurobiological mechanisms, and (iii) to implicate mechanism-based interventions. These goals will be achieved by: (i) using mobile health (m-health) tools to longitudinally monitor the effects of triggers (drug cues, stressors, and priming doses) and modify factors (eg, age, gender, physical activity, and cognitive control) on drug consumption patterns in real-life conditions and in animal models of addiction; (ii) the identification and computational modeling of key mechanisms mediating the effects of such triggers and modifying factors on goal-directed, habitual, and compulsive aspects of behavior from human studies and animal models; and (iii) developing and testing interventions that specifically target the underlying mechanisms for regaining control over drug intake.
In clinical settings, significant resources are spent on data collection and monitoring patients' health parameters to improve decision-making and provide better care. With increased digitization, the healthcare sector is shifting towards implementing digital technologies for data management and in administration. New technologies offer better treatment opportunities and streamline clinical workflow, but the complexity can cause ineffectiveness, frustration, and errors. To address this, we believe digital solutions alone are not sufficient. Therefore, we take a human-centred design approach for AI development, and apply systems engineering methods to identify system leverage points. We demonstrate how automation enables monitoring clinical parameters, using existing non-intrusive sensor technology, resulting in more resources toward patient care. Furthermore, we provide a framework on digitization of clinical data for integration with data management.
Liposuction for Lipoedema
(2020)
Liposuction is one of the most common procedures undertaken in plastic surgery with a steadily increasing trend over the years. Although usually performed as an aesthetic procedure for body contouring, it can also be utilized in specific patient groups for disease symptom reduction. One such disease entity is lipedema. The goal of this video to present the authors' technique in the surgical treatment of lipedema, and to offer the viewer a better understanding of the differences between an aesthetic liposuction and a functional liposuction as performed on a lipedema patient. Between July 2009 and July 2019, 106 lipedema patients have been treated in the authors' specialized lipedema clinic, with a total of 298 liposuction procedures and a median follow-up of 20 months. The mean amount of lipoaspirate was 6354.73 ml (+/- 2796.72 ml). The patients reported a significant reduction in lipedema-associated complaints and improvement in quality of life. The need for conservative therapy was significantly reduced. No serious complications were reported. The authors also present before and after photographs of three patients.
Purpose:To cross-cultural translate the Cumberland Ankle Instability Tool (CAIT) to Taiwan-Chinese version (CAIT-TW), and to evaluate the validity, reliability and cutoff score of CAIT-TW for Taiwan-Chinese athletic population. Materials and methods:The English version of CAIT was translated to CAIT-TW based on a guideline of cross-cultural adaptation. 77 and 58 Taiwanese collegial athletes with and without chronic ankle instability filled out CAIT-TW, Taiwan-Chinese version of Lower Extremity Functional Score (LEFS-TW) and Numeric Rating Scale (NRS). The construct validity, test-retest reliability, internal consistency and cutoff score of CAIT-TW were evaluated. Results:In construct validity, the Spearman's correlation coefficients were moderate (CAIT-TW vs LEFS-TW: Rho = 0.39,p < 0.001) and strong (CAIT-TW vs NRS: Rho= 0.76,p < 0.001). The test retest reliability was excellent (ICC2.1= 0.91, 95% confidential interval = 0.87-0.94,p < 0.001) with a good internal consistency (Cronbach's alpha: 0.87). Receiver operating characteristic curve showed a cutoff score of 21.5 (Youden index: 0.73, sensitivity: 0.87, specificity 0.85). Conclusions:The CAIT-TW is a valid and reliable tool to differentiate between stable and instable ankles in athletes and may further apply for research or daily practice in Taiwan.
Background Recent shoulder injury prevention programs have utilized resistance exercises combined with different forms of instability, with the goal of eliciting functional adaptations and thereby reducing the risk of injury. However, it is still unknown how an unstable weight mass (UWM) affects the muscular activity of the shoulder stabilizers. Aim of the study was to assess neuromuscular activity of dynamic shoulder stabilizers under four conditions of stable and UWM during three shoulder exercises. It was hypothesized that a combined condition of weight with UWM would elicit greater activation due to the increased stabilization demand. Methods Sixteen participants (7 m/9 f) were included in this cross-sectional study and prepared with an EMG-setup for the: Mm. upper/lower trapezius (U.TA/L.TA), lateral deltoid (DE), latissimus dorsi (LD), serratus anterior (SA) and pectoralis major (PE). A maximal voluntary isometric contraction test (MVIC; 5 s.) was performed on an isokinetic dynamometer. Next, internal/external rotation (In/Ex), abduction/adduction (Ab/Ad) and diagonal flexion/extension (F/E) exercises (5 reps.) were performed with four custom-made-pipes representing different exercise conditions. First, the empty-pipe (P; 0.5 kg) and then, randomly ordered, water-filled-pipe (PW; 1 kg), weight-pipe (PG; 4.5 kg) and weight + water-filled-pipe (PWG; 4.5 kg), while EMG was recorded. Raw root-mean-square values (RMS) were normalized to MVIC (%MVIC). Differences between conditions for RMS%MVIC, scapular stabilizer (SR: U.TA/L.TA; U.TA/SA) and contraction (CR: concentric/eccentric) ratios were analyzed (paired t-test; p <= 0.05; Bonferroni adjusted alpha = 0.008). Results PWG showed significantly greater muscle activity for all exercises and all muscles except for PE compared to P and PW. Condition PG elicited muscular activity comparable to PWG (p > 0.008) with significantly lower activation of L.TA and SA in the In/Ex rotation. The SR ratio was significantly higher in PWG compared to P and PW. No significant differences were found for the CR ratio in all exercises and for all muscles. Conclusion Higher weight generated greater muscle activation whereas an UWM raised the neuromuscular activity, increasing the stabilization demands. Especially in the In/Ex rotation, an UWM increased the RMS%MVIC and SR ratio. This might improve training effects in shoulder prevention and rehabilitation programs.
Dysregulation of physiological stress reactivity plays a key role in the development and relapse risk of alcohol dependence. This article reviews studies investigating physiological responses to experimentally induced acute stress in patients with alcohol dependence. A systematic search from electronic databases resulted in 3641 articles found and after screening 62 articles were included in our review. Studies are analyzed based on stress types (i.e., social stress tasks and nonsocial stress tasks) and physiological markers (i.e., the nervous system, the endocrine system, somatic responses and the immune system). In studies applying nonsocial stress tasks, alcohol-dependent patients were reported to show a blunted stress response compared with healthy controls in the majority of studies applying markers of adrenocorticotropic hormone and cortisol. In studies applying social stress tasks, findings are inconsistent, with less than half of the studies reporting altered physiological stress responses in patients. We discuss the impact of duration of abstinence, comorbidities, baseline physiological arousal and intervention on the discrepancy of study findings. Furthermore, we review evidence for an associationbetween blunted physiological stress responses and the relapse risk among patients with alcohol dependence. (c) 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Hintergrund
Eine Verlängerung der Lebens- und Arbeitszeit erfordert einen aktiven Lebensstil, eine Optimierung von kardiovaskulären Risikofaktoren und psychosoziale Unterstützung chronisch Herzkranker.
Fragestellung
Können die Prognose und Lebensqualität sowie die soziale oder berufliche Teilhabe kardiovaskulär Erkrankter durch kardiologische Rehabilitation (KardReha) verbessert werden?
Material und Methode
Auf der Grundlage neuer Metaanalysen und aktueller Positionspapiere gibt die S3-Leitlinie zur kardiologischen Rehabilitation evidenzbasierte Empfehlungen.
Ergebnisse
Eine KardReha reduziert bei Patienten nach akutem Koronarsyndrom, nach PCI („percutaneous coronary interventions“) oder nach aortokoronarer Koronarbypassoperation (ACB-Op.) sowie nach Klappenkorrektur die Gesamtsterblichkeit. Bei Patienten mit systolischer Herzinsuffizienz (HFrEF [„heart failure with reduced ejection fraction“]) werden Belastbarkeit und Lebensqualität durch eine KardReha verbessert. Psychosozialer Distress kann verringert und die berufliche Wiedereingliederung besser strukturiert werden.
Schlussfolgerung
Im Jahr 2019 liegen aktuelle, evidenzbasierte Leitlinien vor, die aufgrund verbesserter Prognose, Belastbarkeit und Lebensqualität eine multimodale kardiologische Rehabilitation bei Patienten nach akutem kardialem Ereignis auch bei technischem Fortschritt (z. B. katheterbasierter Klappenkorrektur) und unter Aspekten der sozialen und beruflichen Teilhabe empfehlen.
This meta-analysis aimed to assess the effects of plyometric jump training (PJT) on volleyball players’ vertical jump height (VJH), comparing changes with those observed in a matched control group. A literature search in the databases of PubMed, MEDLINE, Web of Science, and SCOPUS was conducted. Only randomized-controlled trials and studies that included a pre-to-post intervention assessment of VJH were included. They involved only healthy volleyball players with no restrictions on age or sex. Data were independently extracted from the included studies by two authors. The Physiotherapy Evidence Database scale was used to assess the risk of bias, and methodological quality, of eligible studies included in the review. From 7,081 records, 14 studies were meta-analysed. A moderate Cohen’s d effect size (ES = 0.82, p <0.001) was observed for VJH, with moderate heterogeneity (I2 = 34.4%, p = 0.09) and no publication bias (Egger’s test, p = 0.59). Analyses of moderator variables revealed no significant differences for PJT program duration (≤8 vs. >8 weeks, ES = 0.79 vs. 0.87, respectively), frequency (≤2 vs. >2 sessions/week, ES = 0.83 vs. 0.78, respectively), total number of sessions (≤16 vs. >16 sessions, ES = 0.73 vs. 0.92, respectively), sex (female vs. male, ES = 1.3 vs. 0.5, respectively), age (≥19 vs. <19 years of age, ES = 0.89 vs. 0.70, respectively), and volume (>2,000 vs. <2,000 jumps, ES = 0.76 vs. 0.79, respectively). In conclusion, PJT appears to be effective in inducing improvements in volleyball players’ VJH. Improvements in VJH may be achieved by both male and female volleyball players, in different age groups, with programs of relatively low volume and frequency. Though PJT seems to be safe for volleyball players, it is recommended that an individualized approach, according to player position, is adopted with some players (e.g. libero) less prepared to sustain PJT loads.
Eine wichtige Voraussetzung für das Gelingen der Digitalisierung des Gesundheitswesens ist die digitale Risikokompetenz der Nutzer, also ihre Fähigkeit, Nutzen und Schaden von digitalen Technologien und Informationen zu beurteilen, digitale Angebote kritisch zu nutzen und sich auch mit statistischer Evidenz auseinanderzusetzen. Wie finden Menschen qualitätsgesicherte Gesundheitsinformationen und wie können sie die Qualität von algorithmischen Entscheidungssystemen besser beurteilen? In diesem narrativen Beitrag sollen zwei Ansätze aufgezeigt werden, wie die Fähigkeit zum informierten Entscheiden gefördert werden kann.
Evidenzbasierte und verlässliche Gesundheitsinformationen existieren im Internet, müssen aber von einer Vielzahl unzuverlässiger Informationen unterschieden werden. Verschiedene Institutionen im deutschen Sprachraum haben deshalb Anleitungen bereitgestellt, um Laien eine informierte Entscheidung zu erleichtern. Beispielsweise hat das Harding-Zentrum für Risikokompetenz in Potsdam für diese Zwecke einen Entscheidungsbaum („fast-and-frugal tree“) entwickelt. Im Umgang mit Algorithmen können natürliche Häufigkeitsbäume (NFTs) helfen, die Güte und Fairness eines algorithmischen Entscheidungssystems zu beurteilen.
Neben zuverlässigen und verständlichen digitalen Angeboten sollten weitere Werkzeuge für Laien zur Beurteilung von Informationen und Algorithmen entwickelt und bereitgestellt werden. Diese können auch in Schulungsprogramme zur digitalen Kompetenzförderung aufgenommen werden. Damit wäre ein wichtiger Schritt zum Gelingen der Digitalisierung in der Prävention und Gesundheitsförderung getan.
This study identified key somatic and demographic characteristics that benefit all swimmers and, at the same time, identified further characteristics that benefit only specific swimming strokes. Three hundred sixty-three competitive-level swimmers (male [n = 202]; female [n = 161]) participated in the study. We adopted a multiplicative, allometric regression model to identify the key characteristics associated with 100 m swimming speeds (controlling for age). The model was refined using backward elimination. Characteristics that benefited some but not all strokes were identified by introducing stroke-by-predictor variable interactions. The regression analysis revealed 7 "common" characteristics that benefited all swimmers suggesting that all swimmers benefit from having less body fat, broad shoulders and hips, a greater arm span (but shorter lower arms) and greater forearm girths with smaller relaxed arm girths. The 4 stroke-specific characteristics reveal that backstroke swimmers benefit from longer backs, a finding that can be likened to boats with longer hulls also travel faster through the water. Other stroke-by-predictor variable interactions (taken together) identified that butterfly swimmers are characterized by greater muscularity in the lower legs. These results highlight the importance of considering somatic and demographic characteristics of young swimmers for talent identification purposes (i.e., to ensure that swimmers realize their most appropriate strokes).
Reading requires the assembly of cognitive processes across a wide spectrum from low-level visual perception to high-level discourse comprehension. One approach of unravelling the dynamics associated with these processes is to determine how eye movements are influenced by the characteristics of the text, in particular which features of the words within the perceptual span maximise the information intake due to foveal, spillover, parafoveal, and predictive processing. One way to test the generalisability of current proposals of such distributed processing is to examine them across different languages. For Turkish, an agglutinative language with a shallow orthography-phonology mapping, we replicate the well-known canonical main effects of frequency and predictability of the fixated word as well as effects of incoming saccade amplitude and fixation location within the word on single-fixation durations with data from 35 adults reading 120 nine-word sentences. Evidence for previously reported effects of the characteristics of neighbouring words and interactions was mixed. There was no evidence for the expected Turkish-specific morphological effect of the number of inflectional suffixes on single-fixation durations. To control for word-selection bias associated with single-fixation durations, we also tested effects on word skipping, single-fixation, and multiple-fixation cases with a base-line category logit model, assuming an increase of difficulty for an increase in the number of fixations. With this model, significant effects of word characteristics and number of inflectional suffixes of foveal word on probabilities of the number of fixations were observed, while the effects of the characteristics of neighbouring words and interactions were mixed.
According to coherence-based models of legal judgment, individuals form coherent mental representations to make sense of the available evidence. In this process, evidence supporting the emerging assessment is accentuated, resulting in coherence effects. Dependent on specific implementations of coherence-based models, in legal tasks both overweighting of evidence that is presented early (a primacy effect) or late (a recency effect) can be predicted. In two studies (N-1 = 221, N-2 = 332), we investigate coherence effects, order effects, and their interrelation in a mock legal case. We manipulate the order in which the evidence is presented, and whether or not individuals are induced to assess provisionally whether they deem the defendant guilty after seeing half of the evidence (leaning). This leaning manipulation should increase primacy effects. We consistently observed recency effects and no stronger influence of primacy effects when people indicate a leaning. Order and leaning did not influence the magnitude of coherence effects. In contrast to previous findings in consumer research and risky choice tasks, coherence effects did not mediate the effect of the order in which the evidence in legal judgments is presented. If our results hold more generally, coherence-based models of legal judgment might have to be revised to give more weight to recency effects as compared to the typically predicted primacy effects. This revision would have implications for the design of criminal procedure.
When pandemic hits
(2020)
The governmental lockdowns related to the COVID-19 pandemic have forced people to change their behavior in many ways including changes in exercise. We used the brief window of global lockdown in the months of March/April/May 2020 as an opportunity to investigate the effects of externally imposed restrictions on exercise-related routines and related changes in subjective well-being. Statistical analyses are based on data from 13,696 respondents in 18 countries using a cross-sectional online survey. A mixed effects modeling approach was used to analyze data. We tested whether exercise frequency before and during the pandemic would influence mood during the pandemic. Additionally, we used the COVID-19 pandemic data to build a prediction model, while controlling for national differences, to estimate changes in exercise frequency during similar future lockdown conditions depending on prelockdown exercise frequency. According to the prediction model, those who rarely exercise before a lockdown tend to increase their exercise frequency during it, and those who are frequent exercisers before a lockdown tend to maintain it. With regards to subjective well-being, the data show that those who exercised almost every day during this pandemic had the best mood, regardless of whether or not they exercised prepandemic. Those who were inactive prepandemic and slightly increased their exercise frequency during the pandemic, reported no change in mood compared to those who remained inactive during the pandemic. Those who reduced their exercise frequency during the pandemic reported worse mood compared to those who maintained or increased their prepandemic exercise frequency. This study suggests that under similar lockdown conditions, about two thirds of those who never or rarely exercise before a lockdown might adopt an exercise behavior or increase their exercise frequency. However, such changes do not always immediately result in improvement in subjective well-being. These results may inform national policies, as well as health behavior and exercise psychology research on the importance of exercise promotion, and prediction of changes in exercise behavior during future pandemics.
STEP.De study
(2020)
Introduction Although exercise therapy has widely been shown to be an efficacious treatment modality for depression, evidence for its effectiveness and cost efficiency is lacking. The Sport/Exercise Therapy for Depression study is a multicentre cluster-randomised effectiveness trial that aims to compare the effectiveness and cost efficiency of exercise therapy and psychotherapy as antidepressant treatment. <br /> Methods and analysis 480 patients (aged 18-65) with an International Classification of Diseases diagnosis associated with depressive symptoms are recruited. Up to 30 clusters (psychotherapists) are randomly assigned to allocate patients to either an exercise or a psychotherapy treatment as usual in a 2: 1 ratio. The primary outcome (depressive symptoms) and the secondary outcomes (work and social adjustment, quality of life) will be assessed at six measurement time points (t0: baseline, t1: 8 weeks after treatment initiation, t2: 16 weeks after treatment initiation, t3/ 4/5: 2, 6, 12 months after treatment). Linear regression analyses will be used for the primary endpoint data analysis. For the secondary endpoints, mixed linear and logistic regression models with fixed and random factors will be added. For the cost efficiency analysis, expenditures in the 12 months before and after the intervention and the outcome difference will be compared between groups in a multilevel model. Recruitment start date was 1 July 2018 and the planned recruitment end date is 31 December 2020. <br /> Ethics and dissemination The study protocol was approved by the ethics committee of the University of Potsdam (No. 17/2018) and the Freie Universitat Berlin (No. 206/2018) and registered in the ISRCTN registry. Informed written consent will be obtained from all participants. The study will be reported in accordance with the Consolidated Standards of Reporting Trials and the Recommendations for Interventional Trials statements. The results will be published in peer-reviewed academic journals and disseminated to the public.
We are glad to introduce the Second Journal Club of Volume Five, Second Issue. This edition is focused on relevant studies published in the last few years in the field of resistance training, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the sport, seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.
The manual muscle test (MMT) is a flexible diagnostic tool, which is used in many disciplines, applied in several ways. The main problem is the subjectivity of the test. The MMT in the version of a “break test” depends on the tester’s force rise and the patient’s ability to resist the applied force. As a first step, the investigation of the reproducibility of the testers’ force profile is required for valid application. The study examined the force profiles of n = 29 testers (n = 9 experiences (Exp), n = 8 little experienced (LitExp), n = 12 beginners (Beg)). The testers performed 10 MMTs according to the test of hip flexors, but against a fixed leg to exclude the patient’s reaction. A handheld device recorded the temporal course of the applied force. The results show significant differences between Exp and Beg concerning the starting force (padj = 0.029), the ratio of starting to maximum force (padj = 0.005) and the normalized mean Euclidean distances between the 10 trials (padj = 0.015). The slope is significantly higher in Exp vs. LitExp (p = 0.006) and Beg (p = 0.005). The results also indicate that experienced testers show inter-tester differences and partly even a low intra-tester reproducibility. This highlights the necessity of an objective MMT-assessment. Furthermore, an agreement on a standardized force profile is required. A suggestion for this is given.
(1) Background: People with HIV (PWH) may perform more than one type of exercise cumulatively. The objective of this study is to investigate recreational exercise and its association with health-related quality of life (HRQOL) and comorbidities in relation to potential covariates. (2) Methods: The HIBES study (HIV-Begleiterkrankungen-Sport) is a cross-sectional study for people with HIV. The differences between non-exercisers versus exercisers (cumulated vs. single type of exercises) were investigated using regression models based on 454 participants. (3) Results: Exercisers showed a higher HRQOL score compared to non-exercisers (Wilcox r = 0.2 to 0.239). Psychological disorders were identified as the main covariate. Participants performing exercise cumulatively showed higher scores in duration, frequency, and intensity when compared to participants performing only one type of exercise. The mental health summary score was higher for the cumulated and single type of exercise if a psychological disorder existed. Duration and intensity were associated with an increase of HRQOL, whilst a stronger association between psychological disorders and exercise variables were evident. Exercise duration (minutes) showed a significant effect on QOL (standardized beta = 0.1) and for participants with psychological disorders (standardized beta = 0.3), respectively. (4) Conclusions: Psychological disorders and other covariates have a prominent effect on HRQOL and its association with exercise. For PWH with a psychological disorder, a stronger relationship between HRQOL with exercise duration and intensity emerged. However, differentiation of high-HRQOL individuals warrants further investigation by considering additional factors.
The termprocess modelis widely used, but rarely agreed upon. This paper proposes a framework for characterizing and building cognitive process models. Process models model not only inputs and outputs but also model the ongoing information transformations at a given level of abstraction. We argue that the following dimensions characterize process models: They have a scope that includes different levels of abstraction. They specify a hypothesized mental information transformation. They make predictions not only for the behavior of interest but also for processes. The models' predictions for the processes can be derived from the input, without reverse inference from the output data. Moreover, the presumed information transformation steps are not contradicting current knowledge of human cognitive capacities. Lastly, process models require a conceptual scope specifying levels of abstraction for the information entering the mind, the proposed mental events, and the behavior of interest. This framework can be used for refining models before testing them or after testing them empirically, and it does not rely on specific modeling paradigms. It can be a guideline for developing cognitive process models. Moreover, the framework can advance currently unresolved debates about which models belong to the category of process models.
Objective:
Depression and coronary heart disease (CHD) are highly comorbid conditions. Brain-derived neurotrophic factor (BDNF) plays an important role in cardiovascular processes. Depressed patients typically show decreased BDNF concentrations. We analysed the relationship between BDNF and depression in a sample of patients with CHD and additionally distinguished between cognitive-affective and somatic depression symptoms. We also investigated whether BDNF was associated with somatic comorbidity burden, acute coronary syndrome (ACS) or congestive heart failure (CHF).
Methods:
The following variables were assessed for 225 hospitalised patients with CHD: BDNF concentrations, depression [Patient Health Questionnaire-9 (PHQ-9)], somatic comorbidity (Charlson Comorbidity Index), CHF, ACS, platelet count, smoking status and antidepressant treatment.
Results:
Regression models revealed that BDNF was not associated with severity of depression. Although depressed patients (PHQ-9 score >7) had significantly lower BDNF concentrations compared to non-depressed patients (p = 0.04), this was not statistically significant after controlling for confounders (p = 0.15). Cognitive-affective symptoms and somatic comorbidity burden each closely missed a statistically significant association with BDNF concentrations (p = 0.08, p = 0.06, respectively). BDNF was reduced in patients with CHF (p = 0.02). There was no covariate-adjusted, significant association between BDNF and ACS.
Conclusion:
Serum BDNF concentrations are associated with cardiovascular dysfunction. Somatic comorbidities should be considered when investigating the relationship between depression and BDNF.
Cell-free protein synthesis
(2020)
Proteins are the main source of drug targets and some of them possess therapeutic potential themselves. Among them, membrane proteins constitute approximately 50% of the major drug targets. In the drug discovery pipeline, rapid methods for producing different classes of proteins in a simple manner with high quality are important for structural and functional analysis. Cell-free systems are emerging as an attractive alternative for the production of proteins due to their flexible nature without any cell membrane constraints. In a bioproduction context, open systems based on cell lysates derived from different sources, and with batch-to-batch consistency, have acted as a catalyst for cell-free synthesis of target proteins. Most importantly, proteins can be processed for downstream applications like purification and functional analysis without the necessity of transfection, selection, and expansion of clones. In the last 5 years, there has been an increased availability of new cell-free lysates derived from multiple organisms, and their use for the synthesis of a diverse range of proteins. Despite this progress, major challenges still exist in terms of scalability, cost effectiveness, protein folding, and functionality. In this review, we present an overview of different cell-free systems derived from diverse sources and their application in the production of a wide spectrum of proteins. Further, this article discusses some recent progress in cell-free systems derived from Chinese hamster ovary and Sf21 lysates containing endogenous translocationally active microsomes for the synthesis of membrane proteins. We particularly highlight the usage of internal ribosomal entry site sequences for more efficient protein production, and also the significance of site-specific incorporation of non-canonical amino acids for labeling applications and creation of antibody drug conjugates using cell-free systems. We also discuss strategies to overcome the major challenges involved in commercializing cell-free platforms from a laboratory level for future drug development.
The purpose of this systematic review with meta-analysis was to examine the effects of strength training (ST) on selected components of physical fitness (e.g., lower/upper limb maximal strength, muscular endurance, jump performance, cardiorespiratory endurance) and sport-specific performance in rowers. Only studies with an active control group were included if they examined the effects of ST on at least one proxy of physical fitness and/or sport-specific performance in rowers. Weighted and averaged standardized mean differences (SMD) were calculated using random-effects models. Subgroup analyses were computed to identify effects of ST type or expertise level on sport-specific performance. Our analyses revealed significant small effects of ST on lower limb maximal strength (SMD = 0.42, p = 0.05) and on sport-specific performance (SMD = 0.32, p = 0.05). Non-significant effects were found for upper limb maximal strength, upper/lower limb muscular endurance, jump performance, and cardiorespiratory endurance. Subgroup analyses for ST type and expertise level showed non-significant differences between the respective subgroups of rowers (p >= 0.32). Our systematic review with meta-analysis indicated that ST is an effective means for improving lower limb maximal strength and sport-specific performance in rowers. However, ST-induced effects are neither modulated by ST type nor rowers' expertise level.
This study examined the effects of a short-term (i.e., 8 weeks) combined horizontal and vertical plyometric jump training (PJT) program in combination with regular soccer-specific training as compared with soccer-specific training only on jump and change of direction (CoD) performances, speed, and repeated-sprint ability (RSA) in prepuberal male soccer players. Twenty-four players were recruited and randomly assigned to either a PJT group (PJT(G); n = 13; 12.7 +/- 0.2 years) or an active control group (CONG; n = 11; 12.7 +/- 0.2 years). The outcome measures included tests for the assessment of jump performance (drop jump from 20- to 40-cm height [DJ20 and DJ40] and 3-hop test [THT]), speed (20-m sprint), CoD (T-test), and RSA (20-m repeated shuttle sprint). Data were analyzed using magnitude-based inferences. Within-group analyses revealed large performance improvements in the T-test (d = -1.2), DJ20 (d = 3.7), DJ40 (d = 3.6), THT (d = 0.6), and the RSA(total) (d = -1.6) in the PJT(G). Between-group analyses showed greater performance improvements in the T-test (d = -2.9), 20-m sprint time (d = -2.0), DJ20 (d = 2.4), DJ40 (d = 2.0), THT (d = 1.9), RSA(best) (d = -1.9), and the RSA(total) (d = -1.9) in the PJT(G) compared with CONG. Eight weeks of an in-season PJT in addition to regular soccer-specific training induced larger increases in measures of physical fitness in prepuberal male soccer players compared with regular soccer-specific training only. More specifically, PJT was effective in improving RSA performance.
Performance- and healthrelated benefits of yoThere is ample evidence that youth resistance training (RT) is safe, joyful, and effective for different markers of performance (e.g., muscle strength, power, linear sprint speed) and health (e.g., injury prevention). Accordingly, the first aim of this narrative review is to present and discuss the relevance of muscle strength for youth physical development. The second purpose is to report evidence on the effectiveness of RT on muscular fitness (muscle strength, power, muscle endurance), on movement skill performance and injury prevention in youth. There is evidence that RT is effective in enhancing measures of muscle fitness in children and adolescents, irrespective of sex. Additionally, numerous studies indicate that RT has positive effects on fundamental movement skills (e.g., jumping, running, throwing) in youth regardless of age, maturity, training status, and sex. Further, irrespective of age, sex, and training status, regular exposure to RT (e.g., plyometric training) decreases the risk of sustaining injuries in youth. This implies that RT should be a meaningful element of youths’ exercise programming. This has been acknowledged by global (e.g., World Health Organization) and national (e.g., National Strength and Conditioning Association) health- and performance-related organizations which is why they recommended to perform RT as an integral part of weekly exercise programs to promote muscular strength, fundamental movement skills, and to resist injuries in youth.uth resistance training
An update on secular trends in physical fitness of children and adolescents from 1972 to 2015
(2020)
Background There is evidence that physical fitness of children and adolescents (particularly cardiorespiratory endurance) has declined globally over the past decades. Ever since the first reports on negative trends in physical fitness, efforts have been undertaken by for instance the World Health Organization (WHO) to promote physical activity and fitness in children and adolescents. Therefore, it is timely to re-analyze the literature to examine whether previous reports on secular declines in physical fitness are still detectable or whether they need to be updated. Objectives The objective of this systematic review is to provide an 'update' on secular trends in selected components of physical fitness (i.e., cardiorespiratory endurance, relative muscle strength, proxies of muscle power, speed) in children and adolescents aged 6-18 years. Data Sources A systematic computerized literature search was conducted in the electronic databases PubMed and Web of Science to locate studies that explicitly reported secular trends in physical fitness of children and adolescents. Study Eligibility Criteria Studies were included in this systematic review if they examined secular trends between at least two time points across a minimum of 5 years. In addition, they had to document secular trends in any measure of cardiorespiratory endurance, relative muscle strength, proxies of muscle power or speed in apparently healthy children and adolescents aged 6-18 years. Study Appraisal and Synthesis Methods The included studies were coded for the following criteria: nation, physical fitness component (cardiorespiratory endurance, relative muscle strength, proxies of muscle power, speed), chronological age, sex (boys vs. girls), and year of assessment. Scores were standardized (i.e., converted to z scores) with sample-weighted means and standard deviations, pooled across sex and year of assessment within cells defined by study, test, and children's age. Results The original search identified 524 hits. In the end, 22 studies met the inclusion criteria for review. The observation period was between 1972 and 2015. Fifteen of the 22 studies used tests for cardiorespiratory endurance, eight for relative muscle strength, eleven for proxies of muscle power, and eight for speed. Measures of cardiorespiratory endurance exhibited a large initial increase and an equally large subsequent decrease, but the decrease appears to have reached a floor for all children between 2010 and 2015. Measures of relative muscle strength showed a general trend towards a small increase. Measures of proxies of muscle power indicated an overall small negative quadratic trend. For measures of speed, a small-to-medium increase was observed in recent years. Limitations Biological maturity was not considered in the analysis because biological maturity was not reported in most included studies. Conclusions Negative secular trends were particularly found for cardiorespiratory endurance between 1986 and 2010-12, irrespective of sex. Relative muscle strength and speed showed small increases while proxies of muscle power declined. Although the negative trend in cardiorespiratory endurance appears to have reached a floor in recent years, because of its association with markers of health, we recommend further initiatives in PA and fitness promotion for children and adolescents. More specifically, public health efforts should focus on exercise that increases cardiorespiratory endurance to prevent adverse health effects (i.e. <br /> , overweight and obesity) and muscle strength to lay a foundation for motor skill learning.
This exploratory study aimed to monitor long-term seasonal developments in measures of anthropometry, body composition, and physical fitness in young judo athletes, and to compute associations between these measures and sporting success. Forty-four young judoka (20 females, 24 males) volunteered to participate. Tests for the assessment of anthropometry (e.g., body height/mass), body-composition (e.g., lean body mass), muscle strength (isometric handgrip strength), vertical jumping (e.g., countermovement-jump (CMJ) height), and dynamic balance (Y-balance test) were conducted at the beginning and end of a 10-month training season. Additionally, sporting success at the end of the season was recorded for each athlete. Analyses revealed significant time x sex interaction effects for lean-body-mass, isometric handgrip strength, and CMJ height (0.7 <= d <= 1.6). Post-hoc analyses showed larger gains for all measures in young males (1.9 <= d <= 6.0) compared with females (d = 2.4) across the season. Additionally, significant increases in body height and mass as well as Y-balance test scores were found from pre-to-post-test (1.2 <= d <= 4.3), irrespective of sex. Further, non-significant small-to-moderate-sized correlations were identified between changes in anthropometry/body composition/physical fitness and sporting success (p > 0.05; -0.34 <= rho <= 0.32). Regression analysis confirmed that no model significantly predicted sporting success. Ten months of judo training and/or growth/maturation contributed to significant changes in anthropometry, body composition, and physical fitness, particularly in young male judo athletes.
Hintergrund:
Eine gut ausgeprägte Rumpfstabilität ist eine wichtige Voraussetzung für die Mobilität der oberen und unteren Extremitäten während des sportlichen Bewegungsvollzugs. Vor diesem Hintergrund könnte die Rumpfkraft ein leistungsdeterminierender Faktor bei der Ausführung judospezifischer Bewegungen darstellen. Das Ziel der vorliegenden Studie war es, statistische Zusammenhänge zwischen der Rumpfkraft und kinetischen Parametern bei Anriss-Bewegungen von Judoka zu untersuchen.
Methode:
An der Untersuchung nahmen 21 leistungsorientierte Judoka mit einem mittleren Alter von 22 ± 4 Jahre und einem Trainingsumfang von 15 ± 4 Stunden pro Woche teil. Das maximale isokinetische Drehmoment (PIT) der Rumpfflexoren (PITFlex), -extensoren (PITEx) und -rotatoren (PITRot) wurde unter Verwendung eines isokinetischen Dynamometers (IsoMed 2000) erfasst. Zusätzlich wurden kinetische Parameter (mechanische Arbeit [W], dynamisch-realisierte Maximalkraft [Fmax]) bei Anriss-Bewegung im Stand und bei Anriss- mit Eindrehbewegung (d. h. Morote-seoi-nage) mithilfe eines judospezifischen Mess- und Informationssystems (JERGo©) erhoben.
Ergebnisse:
Die statistische Analyse zeigte signifikante Korrelationen (0,62 ≤ r P ≤ 0,72) zwischen den maximalen isokinetischen Drehmomenten (PITFlex, PITEx, PITRot) und der Anriss-Bewegung im Stand (W). Zudem konnten signifikante Zusammenhänge (0,59 ≤ r P ≤ 0,65) zwischen den isokinetischen Tests (PITEx, PITRot) und Fmax auf der Hubarmseite bei der Anriss-Bewegung im Stand gefunden werden. Für die Anriss- mit Eindrehbewegung ergaben sich signifikante Korrelationen (0,47 ≤ r P ≤ 0,88) zwischen den isokinetischen Tests (PITFlex, PITEx, PITRot) und Leistungskennwerten der judospezifischen Bewegung (W und Fmax), unabhängig von der untersuchten Armseite. Es wurden vergleichbare Korrelationskoeffizienten zwischen PIT der Rumpfflexoren, -extensoren und -rotatoren und judospezifischen Leistungskennwerten festgestellt. Weiterhin identifizierte die Regressionsanalyse den Kennwert PIT bei Rumpfextension als besten Prädiktor für die mechanische Arbeit bei Anriss-Bewegung im Stand (46,9 %). Bei der Anriss- mit Eindrehbewegung konnte PIT der Rumpfrotatoren auf die Hubarmseite als bester Prädiktor für die mechanische Arbeit (69,4 %) ermittelt werden.
Schlussfolgerung:
Die Ergebnisse zeigen, dass die Rumpfkraft, insbesondere bei der Rumpfrotationsbewegung, mit Variablen der judospezifischen Leistungskennwerte bei der Anriss- mit Eindrehbewegung assoziiert ist. Dies impliziert, dass vor allem durch rumpfrotationskräftigende Übungen Einfluss auf die Anriss- mit Eindrehbewegung (d. h. Morote-seoi-nage) genommen werden könnte.
Background
Change-of-direction (CoD) speed is a physical fitness attribute in many field-based team and individual sports. To date, no systematic review with meta-analysis available has examined the effects of resistance training (RT) on CoD speed in youth and adults.
Objective
To aggregate the effects of RT on CoD speed in youth and young physically active and athletic adults, and to identify the key RT programme variables for training prescription.
Data sources
A systematic literature search was conducted with PubMed, Web of Science, and Google Scholar, with no date restrictions, up to October 2019, to identify studies related to the effects of RT on CoD speed.
Study Eligibility Criteria
Only controlled studies with baseline and follow-up measures were included if they examined the effects of RT (i.e., muscle actions against external resistances) on CoD speed in healthy youth (8-18 years) and young physically active/athletic male or female adults (19-28 years).
Study Appraisal and Synthesis Methods
A random-effects model was used to calculate weighted standardised mean differences (SMD) between intervention and control groups. In addition, an independent single training factor analysis (i.e., RT frequency, intensity, volume) was undertaken. Further, to verify if any RT variable moderated effects on CoD speed, a multivariate random-effects meta-regression was conducted. The methodological quality of the included studies was assessed using the physiotherapy evidence database (PEDro) scale.
Results
Fifteen studies, comprising 19 experimental groups, were included. The methodological quality of the studies was acceptable with a median PEDro score of 6. There was a significant large effect size of RT on CoD speed across all studies (SMD = - 0.82 [- 1.14 to - 0.49]). Subgroup analyses showed large effect sizes on CoD speed in males (SMD = - 0.95) contrasting with moderate improvements in females (SMD = - 0.60). There were large effect sizes on CoD speed in children (SMD = - 1.28) and adolescents (SMD = - 1.21) contrasting with moderate effects in adults (SMD = - 0.63). There was a moderate effect in elite athletes (SMD = - 0.69) contrasting with a large effect in subelite athletes (SMD = - 0.86). Differences between subgroups were not statistically significant. Similar improvements were observed regarding the effects of independently computed training variables. In terms of RT frequency, our results indicated that two sessions per week induced large effects on CoD speed (SMD = - 1.07) while programmes with three sessions resulted in moderate effects (SMD = - 0.53). For total training intervention duration, we observed large effects for <= 8 weeks (SMD = - 0.81) and > 8 weeks (SMD = - 0.85). For single session duration, we found large effects for <= 30 min and >= 45 min (both SMD = - 1.00). In terms of number of training sessions, we identified large effects for <= 16 sessions (SMD = - 0.83) and > 16 sessions (SMD = - 0.81). For training intensity, we found moderate effects for light-to-moderate (SMD = - 0.76) and vigorous-to-near maximal intensities (SMD = - 0.77). With regards to RT type, we observed large effects for free weights (SMD = - 0.99) and machine-based training (SMD = - 0.80). For combined free weights and machine-based training, moderate effects were identified (SMD = - 0.77). The meta-regression outcomes showed that none of the included training variables significantly predicted the effects of RT on CoD speed (R-2 = 0.00).
Conclusions
RT seems to be an effective means to improve CoD speed in youth and young physically active and athletic adults. Our findings indicate that the impact of RT on CoD speed may be more prominent in males than in females and in youth than in adults. Additionally, independently computed single factor analyses for different training variables showed that higher compared with lower RT intensities, frequencies, and volumes appear not to have an advantage on the magnitude of CoD speed improvements. In terms of RT type, similar improvements were observed following machine-based and free weights training.
Coaches and athletes in elite sports are constantly seeking to use innovative and advanced training strategies to efficiently improve strength/power performance in already highly-trained individuals. In this regard, high-intensity conditioning contractions have become a popular means to induce acute improvements primarily in muscle contractile properties, which are supposed to translate to subsequent power performances. This performance-enhancing physiological mechanism has previously been called postactivation potentiation (PAP). However, in contrast to the traditional mechanistic understanding of PAP that is based on electrically-evoked twitch properties, an increasing number of studies used the term PAP while referring to acute performance enhancements, even if physiological measures of PAP were not directly assessed. In this current opinion article, we compare the two main approaches (i.e., mechanistic vs. performance) used in the literature to describe PAP effects. We additionally discuss potential misconceptions in the general use of the term PAP. Studies showed that mechanistic and performance-related PAP approaches have different characteristics in terms of the applied research field (basic vs. applied), effective conditioning contractions (e.g., stimulated vs. voluntary), verification (lab-based vs. field tests), effects (twitch peak force vs. maximal voluntary strength), occurrence (consistent vs. inconsistent), and time course (largest effect immediately after vs. similar to 7 min after the conditioning contraction). Moreover, cross-sectional studies revealed inconsistent and trivial-to-large-sized associations between selected measures of mechanistic (e.g., twitch peak force) vs. performance-related PAP approaches (e.g., jump height). In an attempt to avoid misconceptions related to the two different PAP approaches, we propose to use two different terms. Postactivation potentiation should only be used to indicate the increase in muscular force/torque production during an electrically-evoked twitch. In contrast, postactivation performance enhancement (PAPE) should be used to refer to the enhancement of measures of maximal strength, power, and speed following conditioning contractions. The implementation of this terminology would help to better differentiate between mechanistic and performance-related PAP approaches. This is important from a physiological point of view, but also when it comes to aggregating findings from PAP studies, e.g., in the form of meta-analyses, and translating these findings to the field of strength and conditioning.
Introduction:
In children, the impact of hearing loss on biomechanical gait parameters is not well understood. Thus, the objectives of this study were to examine three-dimensional lower limb joint torques in deaf compared to age-matched healthy (hearing) children while walking at preferred gait speed.
Methods:
Thirty prepubertal boys aged 8-14 were enrolled in this study and divided into a group with hearing loss (deaf group) and an age-matched healthy control. Three-dimensional joint torques were analyzed during barefoot walking at preferred speed using Kistler force plates and a Vicon motion capture system.
Results:
Findings revealed that boys with hearing loss showed lower joint torques in ankle evertors, knee flexors, abductors and internal rotators as well as in hip internal rotators in both, the dominant and non-dominant lower limbs (all p < 0.05; d = 1.23-7.00; 14-79%). Further, in the dominant limb, larger peak ankle dorsiflexor (p < 0.001; d = 1.83; 129%), knee adductor (p < 0.001; d = 3.20; 800%), and hip adductor torques (p < 0.001; d = 2.62; 350%) were found in deaf participants compared with controls.
Conclusion:
The observed altered lower limb torques during walking are indicative of unstable gait in children with hearing loss. More research is needed to elucidate whether physical training (e.g., balance and/or gait training) has the potential to improve walking performance in this patient group. (C) 2019 Elsevier Ltd. All rights reserved.
Growth and maturation affect long term physical performance, making the appraisal of athletic ability difficult. We sought to longitudinally track youth soccer players to assess the developmental trajectory of athletic performance over a 6-year period in an English Premier League academy. Age-specific z-scores were calculated for sprint and jump performance from a sample of male youth soccer players (n = 140). A case study approach was used to analyse the longitudinal curves of the six players with the longest tenure. The trajectories of the sprint times of players 1 and 3 were characterised by a marked difference in respective performance levels up until peak height velocity (PHV) when player 1 achieved a substantial increase in sprint speed and player 3 experienced a large decrease. Player 5 was consistently a better performer than player 2 until PHV when the sprint and jump performance of the former markedly decreased and he was overtaken by the latter. Fluctuations in players' physical performance can occur quickly and in drastic fashion. Coaches must be aware that suppressed, or inflated, performance could be temporary and selection and deselection decisions should not be made based on information gathered over a short time period.
Background:
Shoe mileage is an important factor that may influence the risk of sustaining injuries during walking. The aims of this study were to examine the effects of shoe mileage on ground reaction forces and activity of lower limb muscles during walking in genu varus individuals compared with controls.
Methods:
Fifteen healthy and 15 genu varus females received a new pair of running shoes. They were asked to wear these shoes over 6 months. Pre and post intervention, mechanical shoe testing was conducted and ground reaction forces and muscle activities of the right leg were recorded during walking at preferred gait speed.
Findings:
Significant group-by-time interactions were found for shoe stiffness, antero-posterior and vertical impact peak. We observed higher shoe stiffness and lower impact peaks after intervention in both groups with larger effect sizes in genu varus. Significant group-by-time interactions were identified for vastus medialis (loading phase) and rectus femoris (loading and push-off). For vastus medialis, significant decreases were found from pre-to-post during the loading phase in the control group. Rectus femoris activity was higher post intervention during the loading and push-off phases in both groups with larger effect sizes in genu varus.
Interpretation:
Our findings indicate that the observed changes in ground reaction forces are more prominent in genu varus individuals. Together with our findings on shoe stiffness, it seems appropriate to change running shoes after an intense wearing time of 6 months, particularly in genu varus individuals.
Background Over the past decades, an exponential growth has occurred with regards to the number of scientific publications including meta-analyses on youth resistance training (RT). Accordingly, it is timely to summarize findings from meta-analyses in the form of an umbrella review. Objectives To systematically review and summarise the findings of published meta-analyses that investigated the effects of RT on physical fitness in children and adolescents. Design Systematic umbrella review of meta-analyses. Data Sources Meta-analyses were identified using systematic literature searches in the databases PubMed, Web of Science, and Cochrane Library. Eligibility Criteria for Selecting Meta-analyses Meta-analyses that examined the effects of RT on physical fitness (e.g., muscle strength, muscle power) in healthy youth (<= 18 years). Results Fourteen meta-analyses were included in this umbrella review. Eleven of these meta-analyses reported between-subject effect sizes which are important to eliminate bias due to growth and maturation. RT produced medium-to-large effects on muscle strength, small-to-large effects on muscle power, small-to-medium effects on linear sprint, a medium effect on agility/change-of-direction speed, small-to-large effects on throwing performance, and a medium effect on sport-specific enhancement. There were few consistent moderating effects of maturation, age, sex, expertise level, or RT type on muscle strength and muscle power across the included meta-analyses. The analysed meta-analyses showed low-to-moderate methodological quality (AMSTAR2) as well as presented evidence of low-to-very low quality (GRADE). Conclusion This umbrella review proved the effectiveness of RT in youth on a high evidence level. The magnitude of effects varies according to the respective outcome measure and it appears to follow the principle of training specificity. Larger effect sizes were found for strength-related outcome measures. Future studies should consistently report data on participants' maturational status. More research is needed with prepubertal children and girls, irrespective of their maturational status.
Repetitive, monotonic, and effortful voluntary muscle contractions performed for just a few weeks, i.e., resistance training, can substantially increase maximal voluntary force in the practiced task and can also increase gross motor performance. The increase in motor performance is often accompanied by neuroplastic adaptations in the central nervous system. While historical data assigned functional relevance to such adaptations induced by resistance training, this claim has not yet been systematically and critically examined in the context of motor performance across the lifespan in health and disease. A review of muscle activation, brain and peripheral nerve stimulation, and imaging data revealed that increases in motor performance and neuroplasticity tend to be uncoupled, making a mechanistic link between neuroplasticity and motor performance inconclusive. We recommend new approaches, including causal mediation analytical and hypothesis-driven models to substantiate the functional relevance of resistance training-induced neuroplasticity in the improvements of gross motor function across the lifespan in health and disease.
Purpose: To examine the effects of loaded (LPJT) versus unloaded plyometric jump training (UPJT) programs on measures of muscle power, speed, change of direction (CoD), and kicking-distance performance in prepubertal male soccer players. Methods: Participants (N = 29) were randomly assigned to a LPJT group (n = 13; age = 13.0 [0.7] y) using weighted vests or UPJT group (n = 16; age = 13.0 [0.5] y) using body mass only. Before and after the intervention, tests for the assessment of proxies of muscle power (ie, countermovement jump, standing long jump); speed (ie, 5-, 10-, and 20-m sprint); CoD (ie, Illinois CoD test, modified 505 agility test); and kicking-distance were conducted. Data were analyzed using magnitude-based inferences. Results: Within-group analyses for the LPJT group showed large and very large improvements for 10-m sprint time (effect size [ES] = 2.00) and modified 505 CoD (ES = 2.83) tests, respectively. For the same group, moderate improvements were observed for the Illinois CoD test (ES = 0.61), 5- and 20-m sprint time test (ES = 1.00 for both the tests), countermovement jump test (ES = 1.00), and the maximal kicking-distance test (ES = 0.90). Small enhancements in the standing long jump test (ES = 0.50) were apparent. Regarding the UPJT group, small improvements were observed for all tests (ES = 0.33-0.57), except 5- and 10-m sprint time (ES = 1.00 and 0.63, respectively). Between-group analyses favored the LPJT group for the modified 505 CoD (ES = 0.61), standing long jump (ES = 0.50), and maximal kicking-distance tests (ES = 0.57), but not for the 5-m sprint time test (ES = 1.00). Only trivial between-group differences were shown for the remaining tests (ES = 0.00-0.09). Conclusion: Overall, LPJT appears to be more effective than UPJT in improving measures of muscle power, speed, CoD, and kicking-distance performance in prepubertal male soccer players.
The load-depended loss of vertical barbell velocity at the end of the acceleration phase limits the maximum weight that can be lifted. Thus, the purpose of this study was to analyze how increased barbell loads affect the vertical barbell velocity in the sub-phases of the acceleration phase during the snatch. It was hypothesized that the load-dependent velocity loss at the end of the acceleration phase is primarily associated with a velocity loss during the 1st pull. For this purpose, 14 male elite weightlifters lifted seven load-stages from 70-100% of their personal best in the snatch. The load-velocity relationship was calculated using linear regression analysis to determine the velocity loss at 1st pull, transition, and 2nd pull. A group mean data contrast analysis revealed the highest load-dependent velocity loss for the 1st pull (t = 1.85, p = 0.044, g = 0.49 [-0.05, 1.04]) which confirmed our study hypothesis. In contrast to the group mean data, the individual athlete showed a unique response to increased loads during the acceleration sub-phases of the snatch. With the proposed method, individualized training recommendations on exercise selection and loading schemes can be derived to specifically improve the sub-phases of the snatch acceleration phase. Furthermore, the results highlight the importance of single-subject assessment when working with elite athletes in Olympic weightlifting.
Wendepunkt für Gesundheit
(2019)
Purpose: The concepts of creativity and intuition have been well studied in isolation, but less is known about their distinctive contributions to option generation in decision making. Method: We examined the relation between creative and intuitive decision making in two studies-one involving coaches and one involving soccer players-using video footage of real soccer matches. Additionally, we analyzed whether this relation is culture generic or culture specific by conducting matched cross-cultural studies in a European and a South American country. Results: In Study 1, results indicate a conceptual overlap of creativity and intuition for Brazilian and German soccer coaches. Furthermore, coaches did not differ in their evaluation of creative and intuitive actions of players of both cultures. In Study 2, we found that for both subsamples the total number of generated options was positively correlated with the quality of the first and the final option and that the quality of players' first (intuitive) option was higher than that of options generated later. Moreover, results indicate a positive correlation between a player's creativity score and the quality of the first generated option for the whole sample. Conclusion: Overall, our findings provide meaningful information regarding athletes' and coaches' option-generation processes in decision making in complex team sports.
Locally delivered anti-inflammatory compounds can restore the homeostasis of the degenerated intervertebral disc (IVD). With beneficial effects on IVD cells, epigallocatechin 3-gallate (EGCG) is a promising therapeutic candidate. However, EGCG is prone to rapid degradation and/or depletion. Therefore, the purpose of this study was to develop a method for controlled EGCG delivery in the degenerated IVD. Primary IVD cells were isolated from human donors undergoing IVD surgeries. EGCG was encapsulated into microparticles by electrospraying of glutaraldehyde-crosslinked gelatin. The resulting particles were characterized in terms of cytocompatibility and anti-inflammatory activity, and combined with a thermoresponsive carrier to produce an injectable EGCG delivery system. Subsequently, electrospraying was scaled up using the industrial NANOSPIDER (TM) technology. The produced EGCG microparticles reduced the expression of inflammatory (IL-6, IL-8, COX-2) and catabolic (MMP1, MMP3, MMP13) mediators in pro-inflammatory 3D cell cultures. Combining the EGCG microparticles with the carrier showed a trend towards modulating EGCG activity/release. Electrospray upscaling was achieved, leading to particles with homogenous spherical morphologies. In conclusion, electrospray-based encapsulation of EGCG resulted in cytocompatible microparticles that preserved the activity of EGCG and showed the potential to control EGCG release, thus favoring IVD health by downregulating local inflammation. Future studies will focus on further exploring the biological activity of the developed delivery system for potential clinical use.
Objectives: To explore predictors of return to work in patients after acute coronary syndrome and coronary artery bypass grafting, taking into account cognitive performance, depression, physical capacity, and self-assessment of the occupational prognosis. Design: Observational, prospective, bicentric. Setting: Postacute 3-week inpatient cardiac rehabilitation (CR). Participants: Patients (N=401) <65 years of age (mean 54.5 +/- 6.3y), 80% men. Interventions: Not applicable. Main Outcome Measures: Status of return to work (RTW) 6 months after discharge from CR. Results: The regression model for RTW showed negative associations for depression (odds ratio 0.52 per SD, 95% confidence interval 0.36-0.76, P=.001), age (odds ratio 0.72, 95% confidence interval 0.52-1.00, P=.047), and in particular for a negative subjective occupational prognosis (expected incapacity for work odds ratio 0.19, 95% confidence interval 0.06-0.59, P=.004; unemployment odds ratio 0.08, 95% confidence interval 0.01-0.72, P=.024; retirement odds ratio 0.07, 95% confidence interval 0.01-0.067, P=.021). Positive predictors were employment before the cardiac event (odds ratio 9.66, 95% confidence interval 3.10-30.12, P<.001), capacity to work (fit vs unfit) at discharge from CR (odds ratio 3.15, 95% confidence interval 1.35-7.35, P=.008), and maximum exercise capacity (odds ratio 1.49, 95% confidence interval 1.06-2.11, P=.022). Cognitive performance had no effect.
Physical activity protects from incident anxiety: A meta-analysis of prospective cohort studies
(2019)
Background Prospective cohorts have suggested that physical activity (PA) can decrease the risk of incident anxiety. However, no meta-analysis has been conducted. Aims To examine the prospective relationship between PA and incident anxiety and explore potential moderators. Methods Searches were conducted on major databases from inception to October 10, 2018 for prospective studies (at least 1 year of follow-up) that calculated the odds ratio (OR) of incident anxiety in people with high PA against people with low PA. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was conducted and heterogeneity was explored using subgroup and meta-regression analysis. Results Across 14 cohorts of 13 unique prospective studies (N = 75,831, median males = 50.1%) followed for 357,424 person-years, people with high self-reported PA (versus low PA) were at reduced odds of developing anxiety (adjusted odds ratio [AOR] = 0.74; 95% confidence level [95% CI] = 0.62, 0.88; crude OR = 0.80; 95% CI = 0.69, 0.92). High self-reported PA was protective against the emergence of agoraphobia (AOR = 0.42; 95% CI = 0.18, 0.98) and posttraumatic stress disorder (AOR = 0.57; 95% CI = 0.39, 0.85). The protective effects for anxiety were evident in Asia (AOR = 0.31; 95% CI = 0.10, 0.96) and Europe (AOR = 0.82; 95% CI = 0.69, 0.97); for children/adolescents (AOR = 0.52; 95% CI = 0.29, 0.90) and adults (AOR = 0.81; 95% CI = 0.69, 0.95). Results remained robust when adjusting for confounding factors. Overall study quality was moderate to high (mean NOS = 6.7 out of 9). Conclusion Evidence supports the notion that self-reported PA can confer protection against the emergence of anxiety regardless of demographic factors. In particular, higher PA levels protects from agoraphobia and posttraumatic disorder.
Unexpected perturbations during locomotion can occur during daily life or sports performance. Adequate compensation for such perturbations is crucial in maintaining effective postural control. Studies utilising instrumented treadmills have previously validated perturbed walking protocols, however responses to perturbed running protocols remain less investigated. Therefore, the purpose of this study was to investigate the feasibility of a new instrumented treadmill-perturbed running protocol. <br /> Fifteen participants (age = 2 8 +/- 3 years; height = 172 +/- 9 cm; weight = 69 +/- 10 kg; 60% female) completed an 8-minute running protocol at baseline velocity of 2.5 m/s (9 km/h), whilst 15 one-sided belt perturbations were applied (pre-set perturbation characteristics: 150 ms delay (post-heel contact); 2.0 m/s amplitude; 100 ms duration). Perturbation characteristics and EMG responses were recorded. Bland-Altman analysis (BLA) was employed (bias +/- limits of agreement (LOA; bias +/- 1.96*SD)) and intra-individual variability of repeated perturbations was assessed via Coefficients of Variation (CV) (mean +/- SD). <br /> On average, 9.4 +/- 2.2 of 15 intended perturbations were successful. Perturbation delay was 143 +/- 10 ms, amplitude was 1.7 +/- 0.2 m/s and duration was 69 +/- 10 ms. BLA showed -7 +/- 13 ms for delay, -0.3 +/- 0.1 m/s for amplitude and -30 +/- 10 ms for duration. CV showed variability of 19 +/- 4.5% for delay, 58 +/- 12% for amplitude and 30 +/- 7% for duration. EMG RMS amplitudes of the legs and trunk ranged from 113 +/- 25% to 332 +/- 305% when compared to unperturbed gait. This study showed that the application of sudden perturbations during running can be achieved, though with increased variability across individuals. The perturbations with the above characteristics appear to have elicited a neuromuscular response during running.
Research question: The purpose of this study was to evaluate the test-retest reliability of lower extremity kinematics during squat, hip abduction and lunge exercises captured by the Kinect and to evaluate the agreement to a reference 3D camera-based motion system. Methods: Twenty-one healthy individuals performed five repetitions of each lower limb exercise on two different days. Movements were simultaneously assessed by the Kinect and the reference 3D motion system. Joint angles and positions of the lower limb were calculated for sagittal and frontal plane. For the inter-session reliability and the agreement between the two systems standard error of measurement (SEM), bias with limits of agreement (LoA) and Pearson Correlation Coefficient (r) were calculated. Results: Parameters indicated varying reliability for the assessed joint angles and positions and decreasing reliability with increasing task complexity. Across all exercises, measurement deviations were shown especially for small movement amplitudes. Variability was acceptable for joint angles and positions during the squat, partially acceptable during the hip abduction and predominately inacceptable during the lunge. The agreement between systems was characterized by systematic errors. Overestimations by the Kinect were apparent for hip flexion during the squat and hip abduction/adduction during the hip abduction exercise as well as for the knee positions during the lunge. Knee and hip flexion during hip abduction and lunge were underestimated by the Kinect. Significance: The Kinect system can reliably assess lower limb joint angles and positions during simple exercises. The validity of the system is however restricted. An application in the field of early orthopedic rehabilitation without further development of post-processing techniques seems so far limited.
In der vorliegenden Studie wurde die Prävalenz der Besiedlung mit multiresistenten Keimen an 155 Patienten aus der onkologischen und 157 Patienten aus der kardiologischen Rehabilitation mittels mikrobiologischen Screenings untersucht. Dabei zeigten 4,5% der onkologischen und 4,5% der kardiologischen Rehabilitationspatienten eine Besiedlung mit multiresistenten Erregern. Am häufigsten wurden 2-MRGN und ESBL (2,9%) nachgewiesen. Onkologische Rehapatienten zeigten doppelt so hohe Prävalenzraten für 3-MRGN im Vergleich zu kardiologischen (2,6 und 1,3%). Insgesamt zeigen onkologische und kardiologische Rehabilitationspatienten vergleichsweise niedrige Prävalenzraten für multiresistente Krankenhauskeime.
Transient receptor potential (TRP) channels have emerged as potential sensors and transducers of inflammatory pain. The aims of this study were to investigate (1) the expression of TRP channels in intervertebral disc (IVD) cells in normal and inflammatory conditions and (2) the function of Transient receptor potential ankyrin 1 (TRPA1) and Transient receptor potential vanilloid 1 (TRPV1) in IVD inflammation and matrix homeostasis. RT-qPCR was used to analyze human fetal, healthy, and degenerated IVD tissues for the gene expression of TRPA1 and TRPV1. The primary IVD cell cultures were stimulated with either interleukin-1 beta (IL-1) or tumor necrosis factor alpha (TNF-) alone or in combination with TRPA1/V1 agonist allyl isothiocyanate (AITC, 3 and 10 mu M), followed by analysis of calcium flux and the expression of inflammation mediators (RT-qPCR/ELISA) and matrix constituents (RT-qPCR). The matrix structure and composition in caudal motion segments from TRPA1 and TRPV1 wild-type (WT) and knock-out (KO) mice was visualized by FAST staining. Gene expression of other TRP channels (A1, C1, C3, C6, V1, V2, V4, V6, M2, M7, M8) was also tested in cytokine-treated cells. TRPA1 was expressed in fetal IVD cells, 20% of degenerated IVDs, but not in healthy mature IVDs. TRPA1 expression was not detectable in untreated cells and it increased upon cytokine treatment, while TRPV1 was expressed and concomitantly reduced. In inflamed IVD cells, 10 mu M AITC activated calcium flux, induced gene expression of IL-8, and reduced disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS5) and collagen 1A1, possibly via upregulated TRPA1. TRPA1 KO in mice was associated with signs of degeneration in the nucleus pulposus and the vertebral growth plate, whereas TRPV1 KO did not show profound changes. Cytokine treatment also affected the gene expression of TRPV2 (increase), TRPV4 (increase), and TRPC6 (decrease). TRPA1 might be expressed in developing IVD, downregulated during its maturation, and upregulated again in degenerative disc disease, participating in matrix homeostasis. However, follow-up studies with larger sample sizes are needed to fully elucidate the role of TRPA1 and other TRP channels in degenerative disc disease.
The development of cynical attitudes towards elite sport is a core symptom of athlete burnout and has been associated with dropout from elite sport. To date, this phenomenon has mainly been studied by investigating explicit attitudes towards sport, whereas athletes’ automatic evaluations (i.e. implicit attitudes) that have been shown to influence behavior as well were not considered. This study aimed to compare explicit and implicit attitudes towards sport of young elite athletes with high (N = 24) versus low (N = 26) burnout symptoms. Using self-reported measures, general and athlete burnout symptoms were assessed. Additionally, a single-target implicit association test was administered to examine participants’ automatic evaluation of sport. Statistical analysis revealed greater emotional/physical exhaustion and sport devaluation in athletes reporting high compared to low burnout symptoms. Implicit attitudes towards sport did not significantly differ between the groups. Furthermore, no significant correlations were observed between different athlete burnout symptoms and implicit attitudes. Athletes with high burnout symptoms show a tendency to explicitly detach themselves from sport, thus fostering sport devaluation as a core symptom of athlete burnout. However, this process does not seem to be reflected in their implicit attitudes towards sport.
Inflammatory cytokines play an important role in intervertebral disc degeneration. Although largely produced by immune cells, nucleus pulposus (NP) cells can also secrete them under various conditions, for example, under free swelling. Thus, tissue hypotonicity may be an inflammatory trigger for NP cells. The aim of this study was to investigate whether decreased tonicity under restricted swelling conditions (as occurring in early disc degeneration) could initiate an inflammatory cascade that mediates further degeneration. Healthy bovine NP tissue was balanced against different PEG concentrations (0-30%) to obtain various tissue tonicities. Samples were then placed in an artificial annulus (fixed volume) and were cultured for 3, 7, or 21 days, with free swelling NP as control. Tissue content (water, glycosaminoglycan, collagen) was analyzed, and both the tissue and medium were screened for tumor necrosis factor alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), interleukin-8 (IL-8), prostaglandin-E-2 (PGE(2)), and nitric oxide (NO). A range of tonicities (isotonic to hypotonic) was present at day 3 in the PEG-treated samples. However, during culture, the tonicity range narrowed as GAGs leached from the tissue. TNF-alpha and IL-1 beta were below detection limits in all conditions, while mid- and downstream inflammatory cytokines were detected. This may suggest that the extracellular environment directly affects NP cells instead of inducing a classical inflammatory cascade. Furthermore, IL-8 increased in swelling restricted samples, while IL-6 and PGE(2) were elevated in free swelling controls. These findings may suggest the involvement of different mechanisms in disc degeneration with intact AF compared to herniation, and encourage further investigation. (c) 2019 The Authors. Journal of Orthopaedic Research (R) Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res
An association between static and dynamic postural control exists in adults with back pain. We aimed to determine whether this association also exists in adolescent athletes with the same condition. In all, 128 athletes with and without back pain performed three measurements of 15s of static (one-legged stance) and dynamic (star excursion balance test) postural control tests. All subjects and amatched subgroup of athletes with and without back pain were analyzed. The smallest center of pressure mediolateral and anterior-posterior displacements (mm) and normalized highest reach distance were the outcome measures. No association was found between variables of the static and dynamic tests for all subjects and the matched group with and without back pain. The control of static and dynamic posture in adolescent athletes with and without back pain might not be related.
Study Design. A nonrandomized, prospective, and single- center clinical trial of the ProDisc Vivo prosthesis. Objective. The aim of this study was to investigate the clinical and radiological results of a refined total cervical disc replacement (cTDR), the ProDisc Vivo, with two years of follow-up (FU). The incidence of implant-related complications was recorded as a secondary outcome variable. Summary of Background Data. Previous generations of the ProDisc artificial cervical disc replacement generate high primary stability due to keel-based designs with opening of the anterior cortex during the implantation and subsequent high rates of heterotopic ossifications. Methods. Clinical outcome scores included the Neck Disability Index (NDI), Visual Analogue Scale (VAS), arm and neck pain self-assessment questionnaires. The radiological outcome included the range of motion (ROM) and the occurrence of heterotopic ossifications. The incidence of implant-related complications with new implant design was recorded as a secondary outcome variable. Results. A total of 55 patients received a single-level treatment with the ProDisc Vivo cTDR between C3/4 and C6/7, with a follow-up rate of 78%. The clinical outcome scores improved in all parameters significantly (P 1/4 0.0001) (NDI: 68.3 -> 17.4; VAS arm: 6.3 -> 1.4; VAS neck: 4.9 -> 1.6). The ROM of the indexsegment did not show a significant change (P 1/4 0.26) (7.9 degrees -> 9.2 degrees). Heterotopic ossifications at the index segment was found as grade 0 in 5%, grade 1 in 22%, grade 2 in 10%, grade 3 (with functional impairment of the prosthesis) in 7%, and grade 4 in 3% of the cases. We observed three implant-related complications (5.5%), with two implant dislocations anteriorly and one low-grade infect. Conclusion. cTDR with ProDisc Vivo demonstrated a significant and sustained improvement of all clinical outcome parameters. A less invasive implantation mechanism with lower primary stability of the cTDR might be a reason for a higher dislocation rate than the keel-based previous generation ProDisc C.
Background: The anterior cruciate ligament (ACL) rupture is a severe knee injury. Altered kinematics and kinetics in ACL reconstructed (ACL-R) patients compared to healthy participants (ACL-I) are known and attributed to an altered sensorimotor control. However, studies on neuromuscular control often lack homogeneous patient cohorts. The objective was to examine neuromuscular activity during stair descent in patients one year after ACL reconstruction. Method: Neuromuscular activity of vastus medialis (VM) and lateralis (VL), biceps femoris (BF) and semitendinosus (ST) was recorded by electromyography in 10 ACL-R (age: 26 +/- 10 years; height: 175 +/- 6 cm; mass: 75 +/- 14 kg) and 10 healthy matched controls (age: 31 +/- 7 years; height: 175 +/- 7 cm; mass: 68 +/- 10 kg). A 10-minute walking treadmill warm-up was used for submaximal normalization. Afterwards participants descended 10 times a six-step stairway at a self-selected speed. The movement was separated into pre-activation (PRE), weight acceptance (WA) and push-off phase (PO). Normalized root mean squares for each muscle, limb and movement phase were calculated. Kruskal-Wallis ANOVA compared ACL-R injured and contralateral leg and the ACL-I leg (alpha = 0.05). Results: Significant increased normalised activity in ST during WA in ACL-R injured leg compared to ACL-I and during PO in VL in the ACL-R contralateral leg compared to ACL-I. Decreased activity was shown in VM in ACL-R injured compared to contralateral leg (p < 0.05). Conclusion: Altered neuromuscular activations are present one year after ACL reconstruction compared to the contralateral and healthy matched control limb. Current standard rehabilitation programs may not be able to fully restore sensorimotor control and demand further investigations. (C) 2018 Elsevier B.V. All rights reserved.
We propose to use artificial neural networks (ANNs) for raw measurement data interpolation and signal shift computation and to demonstrate advantages for wavelength-scanning coherent optical time domain reflectometry (WS-COTDR) and dynamic strain distribution measurement along optical fibers. The ANNs are trained with synthetic data to predict signal shifts from wavelength scans. Domain adaptation to measurement data is achieved, and standard correlation algorithms are outperformed. First and foremost, the ANN reduces the data analysis time by more than two orders of magnitude, making it possible for the first time to predict strain in real-time applications using the WS-COTDR approach. Further, strain noise and linearity of the sensor response are improved, resulting in more accurate measurements. ANNs also perform better for low signal-to-noise measurement data, for a reduced length of correlation input (i.e., extended distance range), and for coarser sampling settings (i.e., extended strain scanning range). The general applicability is demonstrated for distributed measurement of ground movement along a dark fiber in a telecom cable. The presented ANN-based techniques can be employed to improve the performance of a wide range of correlation or interpolation problems in fiber sensing data analysis and beyond. (C) 2019 Optical Society of America under the terms of the OSA Open Access Publishing Agreement
Unabhängig von der Art der kritischen Erkrankung haben tracheotomierte Patienten ein hohes Risiko, eine Schluckstörung zu entwickeln. Diese ist potenziell lebensbedrohlich, da sie zu Aspiration und Pneumonie führen kann. Vor einer oralen Nahrungsgabe sollte daher unbedingt eine Schluckdiagnostik mittels Bolusfärbetest und/oder FEES durchgeführt werden. Da ein physiologischer Luftstrom durch den Larynx und ein adäquater subglottischer Druck Schlüsselkomponenten eines effektiven Schluckaktes sind, sollte eine Oralisierung bei geblockter Trachealkanüle möglichst vermieden werden.
Dysphagien sind eine häufige und potenziell lebensbedrohliche Komplikation bei langzeitbeatmeten tracheotomierten Patienten. Denn sie können zu Aspiration (Eindringen von Speichel und Nahrung in die Luftwege) und einer sich daraus entwickelnden Pneumonie führen [1]. Bevor diese Patienten auf orale Ernährung umgestellt und mit einem Sprechventil versehen werden, muss daher unbedingt die Schluckfähigkeit geprüft werden.
REFS-D
(2019)
Ziel des vorliegenden Artikels ist die teststatistische Überprüfung und Validierung einer deutschsprachigen Version der Referee Self-Efficacy Scale (REFS). Die REFS erfasst im englischsprachigen Original die Selbstwirksamkeit von Schiedsrichterinnen und Schiedsrichtern mit den Subskalen Wissen über das Spiel, Entscheidungsfindung, Druck und Kommunikation. Die Items wurden mit Hilfe der Übersetzung-Rückübersetzung ins Deutsche übertragen. Die Struktur und die psychometrischen Eigenschaften der deutschen Items wurden anhand einer Stichprobe aus 265 deutschsprachigen Fußballschiedsrichterinnen und -schiedsrichtern überprüft. Da die im englischsprachigen Original vorgeschlagene Skalenzuordnung der REFS nach der Übersetzung ins Deutsche nicht replizierbar war, wurden Items mit mangelhaften Skaleneigenschaften aus der deutschsprachigen REFS-Version (REFS-D) ausgeschlossen. Das Resultat der Analysen ist eine Skala mit acht Items, die sich drei Subskalen, Spielumsetzung, Druck und Kommunikation, zuordnen lassen. Die REFS-D weist zufriedenstellende interne Konsistenzen und signifikante mittelhohe Korrelationen mit allgemeiner Selbstwirksamkeit auf. Trotz einiger Einschränkungen stellt die REFS-D als ökonomische Skala einen Ansatzpunkt für zukünftige Forschung dar.
Compulsive behaviors (e.g., addiction) can be viewed as an aberrant decision process where inflexible reactions automatically evoked by stimuli (habit) take control over decision making to the detriment of a more flexible (goal-oriented) behavioral learning system. These behaviors are thought to arise from learning algorithms known as "model-based" and "model-free" reinforcement learning. Gambling disorder, a form of addiction without the confound of neurotoxic effects of drugs, showed impaired goal-directed control but the way in which problem gamblers (PG) orchestrate model-based and model-free strategies has not been evaluated. Forty-nine PG and 33 healthy participants (CP) completed a two-step sequential choice task for which model-based and model-free learning have distinct and identifiable trial-by-trial learning signatures. The influence of common psychopathological comorbidities on those two forms of learning were investigated. PG showed impaired model-based learning, particularly after unrewarded outcomes. In addition, PG exhibited faster reaction times than CP following unrewarded decisions. Troubled mood, higher impulsivity (i.e., positive and negative urgency) and current and chronic stress reported via questionnaires did not account for those results. These findings demonstrate specific reinforcement learning and decision-making deficits in behavioral addiction that advances our understanding and may be important dimensions for designing effective interventions.
Introduction
Injury prevention programs (IPPs) are an inherent part of training in recreational and professional sports. Providing performance-enhancing benefits in addition to injury prevention may help adjust coaches and athletes’ attitudes towards implementation of injury prevention into daily routine. Conventional thinking by players and coaches alike seems to suggest that IPPs need to be specific to one’s sport to allow for performance enhancement. The systematic literature review aims to firstly determine the IPPs nature of exercises and whether they are specific to the sport or based on general conditioning. Secondly, can they demonstrate whether general, sports-specific or even mixed IPPs improve key performance indicators with the aim to better facilitate long-term implementation of these programs?
Methods
PubMed and Web of Science were electronically searched throughout March 2018. The inclusion criteria were randomized control trials, publication dates between Jan 2006 and Feb 2018, athletes (11–45 years), injury prevention programs and included predefined performance measures that could be categorized into balance, power, strength, speed/agility and endurance. The methodological quality of included articles was assessed with the Cochrane Collaboration assessment tools.
Results
Of 6619 initial findings, 22 studies met the inclusion criteria. In addition, reference lists unearthed a further 6 studies, making a total of 28. Nine studies used sports specific IPPs, eleven general and eight mixed prevention strategies. Overall, general programs ranged from 29–57% in their effectiveness across performance outcomes. Mixed IPPs improved in 80% balance outcomes but only 20–44% in others. Sports-specific programs led to larger scale improvements in balance (66%), power (83%), strength (75%), and speed/agility (62%).
Conclusion
Sports-specific IPPs have the strongest influence on most performance indices based on the significant improvement versus control groups. Other factors such as intensity, technical execution and compliance should be accounted for in future investigations in addition to exercise modality.
Chronisch unspezifische Rückenschmerzen (CURS) gehören international zu den häufigsten Schmerzphänomenen und können für Athletinnen und Athleten karrierelimitierend sein. Knapp ein Drittel der jährlichen Trainingsausfallzeiten werden auf CURS zurückgeführt. In der Entstehung von chronischen Schmerzen ist ein multifaktorielles Ätiologiemodell mit einem signifikanten Einfluss psychosozialer Risikofaktoren evident. Obwohl dies in der Allgemeinbevölkerung bereits gut erforscht ist, gibt es in der Sportwissenschaft vergleichsweise wenige Arbeiten darüber. Dieses Thema wird daher in drei Multicenterstudien und zahlreichen Teilstudien des MiSpEx-Netzwerks (Medicine in Spine-Exercise-Network, Förderzeitraum 2011 – 2018) aufgegriffen. Entsprechend der Empfehlung einer frühzeitigen Diagnostik von Chronifizierungsfaktoren in der „Nationalen Versorgungsleitlinie Kreuzschmerz“, beschäftigt sich das Netzwerk u. a. mit der Überprüfung, Entwicklung und Evaluation diagnostischer Möglichkeiten. Der vorliegende Beitrag beschreibt die Entwicklung einer Diagnostik von psychosozialen Risikofaktoren, die einerseits eine Einschätzung des Risikos der Entwicklung von CURS und andererseits eine individuelle Zuweisung zu (Trainings)Interventionen erlaubt. Es wird die Entwicklungsrationale beschrieben und dabei verschiedene methodische Herangehensweisen und Entscheidungssequenzen reflektiert.
Evaluation of technology-based interventions for informal caregivers of patients with dementia
(2019)
Objective: The aim of this study was to estimate the efficacy of technology-based interventions for informal caregivers of people with dementia (PWD). Methods: PubMed, PsycINFO, and Cochrane Library databases were searched in August 2018, with no restrictions in language or publication date. Two independent reviewers identified 33 eligible randomized controlled trials (RCTs) conducting a technology-based intervention for informal carers of PWD. Meta-analyses for the outcome measures caregiver depression and caregiver burden were conducted with subgroup analyses according to mode of delivery (telephone, computer/web-based, combined interventions). To assess methodologic quality, the Cochrane risk-of-bias assessment was rated. Results: Meta-analyses revealed a small but significant postintervention effect of technology-based interventions for caregiver depression and caregiver burden. Combined interventions showed the strongest effects. Conclusion: Technology-based interventions have the potential to support informal caregivers of PWD. Because of advantages such as high flexibility and availability, technology-based interventions provide a promising alternative compared with "traditional services," e.g., those for people living in rural areas. More high-quality RCTs for specific caregiver groups are needed.
Purpose: Postoperative cognitive dysfunction (POCD) appears in up to 30% of patients suffering from postoperative delirium (POD). Both are associated with higher mortality and postoperative complications, prolonged hospital stays, and increased costs. Multi-modal models with pre-admission risk reduction counselling, perioperative monitoring, and training of multidisciplinary patient care providers have been shown to decrease the prevalence of both. The aim of our study is to understand how far those measures are known and implemented in routine care and to detect potential gaps in the current practice regarding risk communication and information flow between involved caregivers for patients at risk for POD/POCD. Patients and Methods: As part of a multicenter study, seven semi-structured focus group (FG) discussions with nurses and physicians from tertiary care hospitals (surgery, anesthesiology, and orthopedics, n=31) and general practitioners (GPs) in private practice (n=7) were performed. Transcribed discussions were analyzed using qualitative content analysis. Results: POD is present above all in the daily work of nurses, whereas physicians do not perceive it as a relevant problem. Physicians report that no regular risk assessment or risk communication was performed prior to elective surgery. Information about POD often gets lost during hand-offs and is not regularly reported in discharge letters. Thus, persisting cognitive dysfunction is often missed. The importance of standardized documentation and continuous education concerning risks, screening, and treatment was emphasized. The often-suggested pre-OP medication adjustment was seen as less important; in contrast, avoiding withdrawal was regarded as far more important. Conclusion: Altogether, it seems that standards and available best practice concepts are rarely implemented. In contrast to physicians, nurses are highly aware of delirium and ask for standardized procedures and more responsibility. Therefore, raising awareness regarding risks, screening tools, and effective preventive measures for POD/POCD seems an urgent goal. Nurses should have a central role in coordination and care of POD to prevent the risk for POCD.
Poverty and social exclusion are closely related to an increased risk for the deterioration of mental health. In 2018 approximately 19% of the German population were threatened by poverty and the associated social ostracization. Migrant groups in particular often show an increased risk for poverty and are often exposed to multiple socioeconomic stress factors depending on the context of migration, pre-migration and post-migration social factors. Numerous studies have shown that societal exclusion, precarious living conditions and the residential environment negatively affect mental health beyond the effects of pre-migration risk factors. This article provides a review and discussion on the relationship between mental health, poverty and related constructs, such as social cohesion, social capital and social exclusion in general as well as in specific risk groups, such as migrant and refugee populations.
BACKGROUND: Pavlovian-to-instrumental transfer (PIT) describes the influence of conditioned stimuli on instrumental behaviors and is discussed as a key process underlying substance abuse. Here, we tested whether neural responses during alcohol-related PIT predict future relapse in alcohol-dependent patients and future drinking behavior in adolescents. METHODS: Recently detoxified alcohol-dependent patients (n = 52) and young adults without dependence (n = 136) underwent functional magnetic resonance imaging during an alcohol-related PIT paradigm, and their drinking behavior was assessed in a 12-month follow-up. To predict future drinking behavior from PIT activation patterns, we used a multivoxel classification scheme based on linear support vector machines. RESULTS: When training and testing the classification scheme in patients, PIT activation patterns predicted future relapse with 71.2% accuracy. Feature selection revealed that classification was exclusively based on activation patterns in medial prefrontal cortex. To probe the generalizability of this functional magnetic resonance imaging-based prediction of future drinking behavior, we applied the support vector machine classifier that had been trained on patients to PIT functional magnetic resonance imaging data from adolescents. An analysis of cross-classification predictions revealed that those young social drinkers who were classified as abstainers showed a greater reduction in alcohol consumption at 12-month follow-up than those classified as relapsers (Delta = -24.4 +/- 6.0 g vs. -5.7 +/- 3.6 g; p = .019). CONCLUSIONS: These results suggest that neural responses during PIT could constitute a generalized prognostic marker for future drinking behavior in established alcohol use disorder and in at-risk states.
Objectives: Although expected, tendon adaptations in adolescent elite athletes have been underreported. Morphologically, adaptations may occur by an increase in collagen fiber density and/or organization. These characteristics can be captured using spatial frequency parameters extracted from ultrasound images. This study aims to compare Achilles tendon (AT) morphology among sports-specific cohorts of elite adolescent athletes and to compare these findings to recreationally active controls by use of spatial frequency analysis. Design: Cross-sectional observational study. Method: In total, 334 healthy adolescent athletes from four sport categories (ball, combat, endurance, explosive strength) and 35 healthy controls were included. Longitudinal ultrasound scans were performed at the AT insertion and midportion. Intra-tendinous-morphology was quantified by performing spatial frequency analysis assessing eight parameters at standardized ROls. Increased values in five parameters suggest a higher structural organization, and in two parameters higher fiber density. One parameter represents a quotient combining both organization and fiber density. Results: Among athletes, only ball sport athletes exhibited an increase in one summative parameter at pre-insertion site compared to athletes from other sport categories. When compared to athletes, controls had significantly higher values of four parameters at pre-insertion and three parameters at midportion site reflecting differences in both, fiber organization and density. Conclusions: Intra-tendinous-morphology was similar in all groups of adolescent athletes. Higher values found in non-athletes might suggest higher AT fiber density and organization. It is yet unclear whether the lesser structural organization in young athletes represents initial AT pathology, or a physiological adaptive response at the fiber cross-linking level. (C) 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
The role of perceived need support from exercise professionals in improving mental health was examined in a sample of older adults, thereby validating the short Health Care Climate Questionnaire. A total of 491 older people (M = 72.68 years; SD = 5.47) attending a health exercise program participated in this study. Cronbach's alpha was found to be high (alpha = .90). Satisfaction with the exercise professional correlated moderately with the short Health Care Climate Questionnaire mean value (r = .38; p < .01). The mediator analyses yielded support for the self-determination theory process model in older adults by showing both basic need satisfaction and frustration as mediating variables between perceived autonomy support and depressive symptoms. The short Health Care Climate Questionnaire is an economical instrument for assessing basic need satisfaction provided by the exercise therapist from the participant's perspective. Furthermore, this cross-sectional study supported the link from coaching style to the satisfaction/frustration of basic psychological needs, which in turn, predicted mental health. Analyses of criterion validity suggest a revision of the construct by integrating need frustration.
Purpose
After therapy of cancer of the esophagus or the esophagogastric junction, patients often suffer from anxiety and depression. Some risk factors for elevated anxiety and depression are reported, but the influence of steatorrhea, the frequency of which has only recently been reported, has not yet been investigated.
Method
Using the Hospital Anxiety and Depression Scale (HADS), we analyzed the correlation of anxiety and depression with steatorrhea, appetite, and weight loss in 72 patients with cancer of the esophagus or of the esophagogastric junction, who were treated at our rehabilitation clinic between January 2011 and December 2014. In addition, effectiveness of psychological interviews was analyzed.
Results
We have evaluable anxiety questionnaires from 51 patients showing a median anxiety value of 5 (range 0-13). As for the depression, results from evaluable questionnaires of 54 patients also showed a median value of 5 (range 0-15). Increased anxiety and depression values (> 7) were observed in 25.4% and 37.0% of the patients respectively. Patients who were admitted with steatorrhea for rehabilitation showed a statistically higher anxiety value (median 6.3 vs. 4.7, p < 0.05), reduced appetite, and a weight loss above 15 kg depicting a correlation to anxiety and depression. Psychological conversations helped lowering the depression but had no influence on anxiety.
Conclusions
Impairments after cancer treatment, such as steatorrhea, appetite loss, and weight loss, should be interpreted as an alarm signal and should necessitate screening for increased anxiety and depression. Psychological therapy can help improving the extent of the depression.
Background Aversive stimuli in the environment influence human actions. This includes valence-dependent influences on action selection, e.g., increased avoidance but decreased approach behavior. However, it is yet unclear how aversive stimuli interact with complex learning and decision-making in the reward and avoidance domain. Moreover, the underlying computational mechanisms of these decision-making biases are unknown. Methods To elucidate these mechanisms, 54 healthy young male subjects performed a two-step sequential decision-making task, which allows to computationally model different aspects of learning, e.g., model-free, habitual, and model-based, goal-directed learning. We used a within-subject design, crossing task valence (reward vs. punishment learning) with emotional context (aversive vs. neutral background stimuli). We analyzed choice data, applied a computational model, and performed simulations. Results Whereas model-based learning was not affected, aversive stimuli interacted with model-free learning in a way that depended on task valence. Thus, aversive stimuli increased model-free avoidance learning but decreased model-free reward learning. The computational model confirmed this effect: the parameter lambda that indicates the influence of reward prediction errors on decision values was increased in the punishment condition but decreased in the reward condition when aversive stimuli were present. Further, by using the inferred computational parameters to simulate choice data, our effects were captured. Exploratory analyses revealed that the observed biases were associated with subclinical depressive symptoms. Conclusion Our data show that aversive environmental stimuli affect complex learning and decision-making, which depends on task valence. Further, we provide a model of the underlying computations of this affective modulation. Finally, our finding of increased decision-making biases in subjects reporting subclinical depressive symptoms matches recent reports of amplified Pavlovian influences on action selection in depression and suggests a potential vulnerability factor for mood disorders. We discuss our findings in the light of the involvement of the neuromodulators serotonin and dopamine.
Background: The pathophysiology behind the subacute but persistent hypercoagulable state after traumatic brain injury (TBI) is poorly understood but contributes to morbidity induced by venous thromboembolism. Because platelets and their microvesicles have been hypothesized to play a role in post-traumatic hypercoagulability, administration of commonly used agents may ameliorate this coagulability. We hypothesized that utilization of aspirin, ketorolac, amitriptyline, unfractionated heparin, or enoxaparin would modulate the platelet aggregation response after TBI. Methods: Concussive TBI was induced by weight drop. Mice were then randomized to receive aspirin, ketorolac, amitriptyline, heparin, enoxaparin, or saline control at 2 and 8 h after TBI. Mice were sacrificed at 6 or 24 h after injury to determine coagulability by rotational thromboelastometry (ROTEM), platelet function testing with impedance aggregometry, and microvesicle enumeration. Platelet sphingolipid metabolites were analyzed by mass spectrometry. Results: ROTEM demonstrated increased platelet contribution to maximum clot firmness at 6 h after TBI in mice that received aspirin or amitriptyline, but this did not persist at 24 h. By contrast, adenosine diphosphate- and arachidonic acid-induced platelet aggregation at 6 h was significantly lower in mice receiving ketorolac, aspirin, and amitriptyline compared with mice receiving saline at 6 h after injury and only arachidonic acid-initiated platelet aggregation was decreased by aspirin at 24 h. There were no differences in microvesicle production at either time point. Platelet sphingosine-1-phosphate levels were decreased at 6 h in the group receiving amitriptyline and increased at 24 h along with platelet ceramide levels at 24 h in the amitriptyline group. Conclusion: After TBI, amitriptyline decreased platelet aggregability and increased contribution to clot in a manner similar to aspirin. The amitriptyline effects on platelet function and sphingolipid metabolites may represent a possible role of the acid sphingomyelinase in the hypercoagulability observed after injury. In addition, inhibition of platelet reactivity may be an underappreciated benefit of low molecular weight heparins, such as enoxaparin. (C) 2019 Elsevier Inc. All rights reserved.
Ziel Vergleich der Erkennungsgüte von drei Depressions-Screeninginstrumenten bei Patienten mit koronarer Herzerkrankung (KHK).
Methodik 1019 KHK-Patienten erhielten den Patient Health Questionnaire (PHQ-9 und PHQ-2) und die Hospital Anxiety and Depression Scale (HADS-D) sowie ein klinisches Interview (Composite International Diagnostic Interview) als Referenzstandard.
Ergebnisse Bezüglich der Erkennungsgüte waren PHQ-9 und HADS-D dem PHQ-2 überlegen. Optimale Cut-off-Werte waren 7 (PHQ-9 und HADS-D) und 2 (PHQ-2).
Schlussfolgerung PHQ-9 und HADS-D haben eine vergleichbare Diskriminationsfähigkeit für depressive Störungen bei KHK-Patienten.
A Fuzzy Rule-Based Model for Remote Monitoring of Preterm in the Intensive Care Unit of Hospitals
(2019)
The use of Remote patient monitoring (RPM) systems to monitor critically ill patients in the Intensive Care Unit (ICU) has enabled quality and real-time healthcare management. Fuzzy logic as an approach to designing RPM systems provides a means for encapsulating the subjective decision-making process of medical experts in an algorithm suitable for computer implementation. In this paper, a remote monitoring system for preterm in neonatal ICU incubators is modeled and simulated. The model was designed with 4 input variables (body temperature, heart rate, respiratory rate, and oxygen level saturation), and 1 output variable (action performed represented as ACT). ACT decides whether-an alert is generated or not and also determines the message displayed when a notification is required. ACT classifies the clinical priority of the monitored preterm into 5 different fields: code blue, code red, code yellow, code green, and-code black. The model was simulated using a fuzzy logic toolbox of MATLAB R2015A. About 216 IF_THEN rules were formulated to monitor the inputs data fed into the model. The performance of the model was evaluated using-the confusion matrix to determine the model’s accuracy, precision, sensitivity, specificity, and false alarm rate. The-experimental results obtained shows that the fuzzy-based system is capable of producing satisfactory results when used for monitoring and classifying the clinical statuses of neonates in ICU incubators.
Stress plays a key role in modulating addictive behavior and can cause relapse following periods of abstinence. Common effects of stress and alcohol on the dopaminergic system have been suggested, although the precise mechanisms are unclear. Here, we investigated 20 detoxified alcohol-dependent patients and 19 matched healthy controls and assessed striatal D2/D3 availability using [F-18]-fallypride positron emission tomography and stressful life events. We found a strong association between striatal D2/D3 availability and stress in patients, but not in healthy controls. Interestingly, we found increased D2/D3 receptor availability in patients with higher stress levels. This mirrors complex interactions between stress and alcohol intake in animal studies and emphasizes the importance to investigate stress exposure in neurobiological studies of addiction.
Effects of Aerobic and Resistance Exercise on Cardiovascular Parameters for People Living With HIV
(2019)
People living with HIV (PLWH) have limited exercise capacity because of anemia, neuromuscular disorders, and pulmonary limitations. We used a meta-analysis to examine the effect of aerobic and resistance exercise alone and in combination on cardiovascular parameters. Subgroup meta-analyses were conducted and long-term effects of exercise were investigated. A systematic literature search was conducted up to July/August 2017. The Physiotherapy Evidence Database-scale was used to rate quality and assess the risk of bias on the papers. Standardized mean differences (SMDs) were calculated to assess the effect of exercise. Posttreatment comparison between the exercise and control groups revealed moderate and large effect sizes in favor of the intervention group for VO2max (SMD50.66, p < .0001) and the 6-minute walk test (SMD = 1.11, p = .0001). Exercise had a positive effect on cardiovascular parameters in PLWH. Exercise can be a prevention factor for PLWH dealing with multiple comorbidities.
In animals and humans, behavior can be influenced by irrelevant stimuli, a phenomenon called Pavlovian-to-instrumental transfer (PIT). In subjects with substance use disorder, PIT is even enhanced with functional activation in the nucleus accumbens (NAcc) and amygdala. While we observed enhanced behavioral and neural PIT effects in alcohol-dependent subjects, we here aimed to determine whether behavioral PIT is enhanced in young men with high-risk compared to low-risk drinking and subsequently related functional activation in an a-priori region of interest encompassing the NAcc and amygdala and related to polygenic risk for alcohol consumption. A representative sample of 18-year old men (n = 1937) was contacted: 445 were screened, 209 assessed: resulting in 191 valid behavioral, 139 imaging and 157 genetic datasets. None of the subjects fulfilled criteria for alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders-IV-TextRevision (DSM-IV-TR). We measured how instrumental responding for rewards was influenced by background Pavlovian conditioned stimuli predicting action-independent rewards and losses. Behavioral PIT was enhanced in high-compared to low-risk drinkers (b = 0.09, SE = 0.03, z = 2.7, p < 0.009). Across all subjects, we observed PIT-related neural blood oxygen level-dependent (BOLD) signal in the right amygdala (t = 3.25, p(SVC) = 0.04, x = 26, y = -6, z = -12), but not in NAcc. The strength of the behavioral PIT effect was positively correlated with polygenic risk for alcohol consumption (r(s) = 0.17, p = 0.032). We conclude that behavioral PIT and polygenic risk for alcohol consumption might be a biomarker for a subclinical phenotype of risky alcohol consumption, even if no drug-related stimulus is present. The association between behavioral PIT effects and the amygdala might point to habitual processes related to out PIT task. In non-dependent young social drinkers, the amygdala rather than the NAcc is activated during PIT; possible different involvement in association with disease trajectory should be investigated in future studies.
The vocational reintegration of patients after an acute coronary syndrome is a crucial step towards complete convalescence from the social as well as the individual point of view. Return to work rates are determined by medical parameters such as left ventricular function, residual ischaemia and heart rhythm stability, as well as by occupational requirement profile such as blue or white collar work, night shifts and the ability to commute (which is, in part, determined by physical fitness). Psychosocial factors including depression, self-perceived health situation and pre-existing cognitive impairment determine the reintegration rate to a significant extent. Patients at risk of poor vocational outcomes should be identified in the early period of rehabilitation to avoid a reintegration failure and to prevent socio-professional exclusion with adverse psychological and financial consequences. A comprehensive healthcare pathway of acute coronary syndrome patients is initiated by cardiac rehabilitation, which includes specific algorithms and assessment tools for risk stratification and occupational restitution. As the first in its kind, this review addresses determinants and legal aspects of reintegration of patients experiencing an acute coronary syndrome, and offers practical advice on reintegration strategies particularly for vulnerable patients. It presents different approaches and scientific findings in the European countries and serves as a recommendation for action.
The purpose of this study was to examine the acute effects of short-term Achilles tendon vibration on plantar flexor torque, twitch contractile properties as well as muscle and cortical activity in young athletes. Eleven female elite soccer players aged 15.6 +/- 0.5 years participated in this study. Three different conditions were applied in randomized order: Achilles tendon vibration (80 Hz) for 30 and 300 s, and a passive control condition (300 s). Tests at baseline and following conditions included the assessment of peak plantar flexor torque during maximum voluntary contraction, electrically evoked muscle twitches (e.g., potentiated twitch peak torque [PT]), and electromyographic (EMG) activity of the plantar flexors. Additionally, electroencephalographic (EEG) activity of the primary motor and somatosensory cortex were assessed during a submaximal dynamic concentric-eccentric plantar flexion exercise using an elastic rubber band. Large-sized main effects of condition were found for EEG absolute alpha-1 and beta-1 band power (p <= 0.011; 1.5 <= d <= 2.6). Post-hoc tests indicated that alpha-1 power was significantly lower at 30 and 300 s (p = 0.009; d = 0.8) and beta-1 power significantly lower at 300 s (p < 0.001; d = 0.2) compared to control condition. No significant effect of condition was found for peak plantar flexor torque, electrical evoked muscle twitches, and EMG activity. In conclusion, short-term local Achilles tendon vibration induced lower brain activity (i.e., alpha-1 and beta-1 band power) but did not affect lower limb peak torque, twitch contractile properties, and muscle activity. Lower brain activity following short-term local Achilles tendon vibration may indicate improved cortical function during a submaximal dynamic exercise in female young soccer players.
Background: There is evidence that frontal plane lower limb malalignment (e.g., genu varus) is a risk factor for knee osteoarthritis development. However, only scarce information is available on gait biomechanics and muscle activity in boys with genu varus. Research question: To examine the effects of knee varus alignment on lower limb kinematics, kinetics and muscular activity during walking at self-selected speed in boys with genu varus versus healthy age-matched controls. Methods: Thirty-six boys were enrolled in this study and divided into a group of boys with genu varus (n = 18; age: 11.66 +/- 1.64 years) and healthy controls (n = 18; age: 11.44 +/- 1.78 years). Three-dimensional kinematics, ground reaction forces, loading rates, impulses and free moments of both limbs were recorded during five walking trials at self-selected speed. Surface electromyography was recorded for rectus femoris and vastus lateralis/medialis muscles. Results: No significant between-group differences were found for gait speed. Participants in the genu varus group versus controls showed larger peak knee flexion (p = 0.030; d = 0.77), peak knee adduction (p < 0.001; d = 1.63), and peak ankle eversion angles (p < 0.001; d = 2.06). Significantly higher peak ground reaction forces were found at heel contact (vertical [p = 0.002; d = 1.16] and posterior [p < 0.001; d = 1.63] components) and at push off (vertical [p = 0.010; d = 0.93] and anterior [p < 0.001; d = 1.34] components) for genu varus versus controls. Peak medial ground reaction force (p = 0.032; d = 0.76), vertical loading rate (p < 0.001; d = 1.52), anterior-posterior impulse (p = 0.011; d = 0.92), and peak negative free moment (p = 0.030; d = 0.77) were significantly higher in genu varus. Finally, time to reach peak forces was significantly shorter in genu varus boys compared with healthy controls (p < 0.01; d = 0.73-1.60). The genu varus group showed higher activities in vastus lateralis (p < 0.001; d = 1.82) and vastus medialis (p = 0.013; d = 0.90) during the loading phase of walking. Significance: Our study revealed genu varus specific gait characteristics and muscle activities. Greater knee adduction angle in genu varus boys may increase the load on the medial compartment of the knee joint. The observed characteristics in lower limb biomechanics and muscle activity could play a role in the early development of knee osteoarthritis in genu varus boys.
Swimming performance can be improved not only by in-water sport-specific training but also by means of dry land-training (e.g., plyometric jump training [PJT]). This study examined the effects of an 8-week PJT on proxies of muscle power and swimming performance in prepubertal male swimmers. Participants were randomly allocated to a PJT group (PJT; n = 14; age: 10.3 +/- 0.4 years, maturity-offset = -3 +/- 0.3) or a control group (CG; n = 12; age: 10.5 +/- 0.4 years, maturity-offset = -2.8 +/- 0.3). Swimmers in PJT and CG performed 6 training sessions per week. Each training session lasted between 80 and 90 minutes. Over the 8 weeks in-season training period, PJT performed two PJT sessions per week, each lasting between 25 to 30 minutes (similar to 1 hour per week) in replacement of sport-specific swimming drills. During that time, CG followed their regular sport-specific swimming training (e.g., coordination, breathing, improving swimming strokes). Overall training volume was similar between groups. Pre- and post-training, tests were conducted to assess proxies of muscle power (countermovement-jump [CMJ]), standing-long-jump [SLJ]) and sport-specific swimming performances (15-, 25-, and 50-m front-crawl, 25-m kick without push [25-m kick WP], and 25-m front-crawl WP). No training or test-related injuries were detected over the course of the study. Between-group analyses derived from magnitude-based inferences showed trivial-to-large effects in favour of PJT for all tests (ES = 0.28 to 1.43). Within-group analyses for the PJT showed small performance improvements for CMJ (effect-size [ES] = 0.53), 25-m kick WP (ES = 0.25), and 50-m front crawl (ES = 0.56) tests. Moderate performance improvements were observed for the SLJ, 25-m front-crawl WP, 15-m and 25-m front-crawl tests (ES = 0.95, 0.60, 0.99, and 0.85, respectively). For CG, the within-group results showed trivial performance declines for the CMJ (ES=-0.13) and the 50-m front-crawl test (ES = -0.04). In addition, trivial-to-small performance improvements were observed for the SLJ (ES = 0.09), 25-m kick WP (ES = 0.02), 25-m front-crawl WP (ES = 0.19), 25-m front-crawl (ES = 0.2), (SLJ [ES = 0.09, and 15-m front crawl (ES = 0.36). Short-term in-season PJT, integrated into the regular swimming training, was more effective than regular swimming training alone in improving jump and sport-specific swimming performances in prepubertal male swimmers.