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PubMed1990

Training and practice activities of hematology and medical oncology diplomates.

Diplomates of the American Board of Internal Medicine in hematology or medical oncology were surveyed about the content and setting of their practices, adequacy of training for professional activities, and preferences for certification. The response rate was 60% (N = 2516). Approximately 20% of cases seen by diplomates in hematology involve nonhematopoietic neoplasms, and 10% of cases managed by oncologists concern hematologic disorders. Diplomates were satisfied with training in areas corresponding to their own field(s) of certification, except for immune and/or acquired immunodeficiency syndrome-related and nonneoplastic leukocyte disorders. Training deficits most frequently recalled were office management skills and psychosocial/communication skills. Nearly half of the respondents preferred to maintain separate certificates. Data indicate that the two fields are distinct. However, the overlap in practice brings into question the adequacy of training for diplomates who manage problems outside of their field of certification and suggests that some degree of cross-fertilization in all training would be beneficial.

Certification↗
PubMed1999

Effect of training on the phagocytic capacity of peritoneal macrophages from rats exposed to swim stress.

Since strenuous effort may affect the immune system, a study was designed to examine the impact of the progressive training of rats exposed to swim stress. Rats (trained swimmers) were forced to swim daily in a water bath for progressively longer periods. At the end of the study, which continued for a total of 6 weeks, the superoxide anion generation and phagocytic capacity of peritoneal macrophages, the mitogen response of splenic cells (splenocytes) and the serum corticosterone level were examined. The results, compared to those of animals taken in and out of their cages (nonswimmers), showed an increase in superoxide anion generation, as well as a decrease in both the percentage of phagocytosing cells and the number of particles internalized by each individual cell. In trained swimmers, the mitogen response to phytohemagglutinin and concanavalin A (Con A), as well as the corticosterone level, did not change significantly from those of nonswimmers. A third group of animals were forced to swim once only for 30 min, until the appearance of signs of marked fatigue (acute swimmers). Their peritoneal macrophages showed an increased superoxide anion generation and a significantly decreased response to Con A compared to those of the nonswimmers. The serum corticosterone level in acute swimmers was found to be increased compared to that of an additional group of animals kept at complete rest. The findings indicate that the progressive training of rats exposed to swim stress does not prevent alterations in certain immune responses, a fact that should be considered by intensive exercisers.

Animals↗
PubMed1995

Integrated management of the sick child.

Diarrhoea, pneumonia, measles, malaria and malnutrition account for more than 70% of deaths and health facility visits among children under 5 years of age in developing countries. A number of programmes in WHO and UNICEF have developed an approach to the integrated management of the sick child, which is being coordinated by WHO's Division for the Control of Diarrhoeal and Acute Respiratory Disease. Integrated clinical guidelines have been developed and a training course for health workers in outpatient (first level) health facilities has been completed. In addition to case management of these diseases, the course incorporates significant prevention of disease through promotion of breast-feeding, counselling to solve feeding problems, and immunization of sick children. Other materials to train and support health workers are also being developed: an inpatient case management training course, medical school curricular materials, a drug supply management course, and materials to support monitoring and reinforcement of skills after training. A planning guide for interventions to improve household management of childhood illness is also being developed. Since management of the sick child is a cost-effective health intervention, which has been estimated to have a large impact on the global burden of disease in developing countries, the completion of these materials and their wide implementation should have a substantial impact on child mortality.

Case Management↗
PubMed2002

Effects of conjugated linoleic acid supplementation during resistance training on body composition, bone density, strength, and selected hematological markers.

Conjugated linoleic acids (CLA) are essential fatty acids that have been reported in animal studies to decrease catabolism, promote fat loss, increase bone density, enhance immunity, and serve as an antiatherogenic and anticarcinogenic agent. For this reason, CLA has been marketed as a supplement to promote weight loss and general health. CLA has also been heavily marketed to resistance-trained athletes as a supplement that may help lessen catabolism, decrease body fat, and promote greater gains in strength and muscle mass during training. Although basic research is promising, few studies have examined whether CLA supplementation during training enhances training adaptations and/or affects markers of health. This study evaluated whether CLA supplementation during resistance training affects body composition, strength, and/or general markers of catabolism and immunity. In a double-blind and randomized manner, 23 experienced, resistance-trained subjects were matched according to body mass and training volume and randomly assigned to supplement their diet with 9 g;pdd(-1) of an olive oil placebo or 6 g;pdd(-1) of CLA with 3 g;pdd(-1) of fatty acids for 28 days. Prior to and following supplementation, fasting blood samples, total body mass, and dual-energy X-ray absorptiometry (DEXA) determined body composition, and isotonic bench press and leg press 1 repetition maximums (1RMs) were determined. Results revealed that although some statistical trends were observed with moderate to large effect sizes, CLA supplementation did not significantly affect (p > 0.05) changes in total body mass, fat-free mass, fat mass, percent body fat, bone mass, strength, serum substrates, or general markers of catabolism and immunity during training. These findings indicate that CLA does not appear to possess significant ergogenic value for experienced resistance-trained athletes.

Absorptiometry, Photon↗
PubMed1987

Relaxation, imagery, and neuroimmunomodulation.

Thirty undergraduates screened for high absorption ability were randomly assigned to three conditions. The first condition consisted of relaxation alone (progressive muscle relaxation and focused breathing). The second one combined this same relaxation training with mental imagery of the immune system. The third condition served as an alertness or mild arousal control; in a vigilance task subjects discriminated between tones presented in variable inter-trial intervals. Subjects reported trial levels of tension and daily stress. Before and after the protocols, which lasted about 1 hour, salivary immunoglobulin A (SIgA), cortisol and catecholamines (saliva and plasma), mood states, and power motivation were assessed. Afterwards, subjects doing relaxation alone and with imagery had a higher level of SIgA than did the vigilance task control group, with a large effect size. When the influence of plasma cortisol was controlled, this immune effect size increased by half, mainly by doubling the SIgA level after relaxation alone. SIgA was significantly and negatively correlated with saliva norepinephrine. The saliva and plasma levels for the neuroendocrine variables appear to be independent. Yet some saliva measures (e.g., epinephrine) did correspond highly with other plasma measures (e.g., norepinephrine).

Epinephrine↗
PubMed1998

Resistance training and elite athletes: adaptations and program considerations.

The skepticism surrounding the potential benefits of resistance exercise training prevalent just decades ago has evolved over the years to an understanding of the integral nature muscular overload plays in the training programs for athletes. The science of training elite athletes is progressing rapidly, as insights into the physiological adaptations resulting from varying program configurations become available. Resistance training impacts several body systems, including muscular, endocrine, skeletal, metabolic, immune, neural, and respiratory. An understanding and appreciation of basic scientific principles related to resistance training is necessary in order to optimize training responses. Careful selection of the acute program variables in a workout to simulate sports-specific movements is required for optimal transfer of gains made in training to competition. Thus, whether athletes require predominantly eccentric, isometric, slow-velocity, or high-velocity strength or power in their athletic event will dictate the time commitment to each component and form the basis for designing individual workouts. Program variation over a training period is essential to maximize gains and prevent overtraining.

Adaptation, Physiological↗
PubMedDate not supplied

The immune system.

This inservice describes the basic components and actions of the immune system, whose activity is necessary for the body to protect itself against invasions of infectious diseases, parasites, cancers, viruses and more. When one reads about such diseases and how they break down the body's defenses, specific references are made to the immune system. For a better understanding of the diseases confronting us in today's healthcare environment, one needs to become familiar with the immune system.

Humans↗
PubMed1991

AIDS: knowledge, skills and attitudes among vocational trainees and their trainers.

In order to assess the adequacy of learning about the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS) in vocational training for general practice, a postal questionnaire survey was carried out among trainers and their trainees in seven health regions of England and Scotland. A total of 616 trainers (62%) and 538 trainees (58%) responded to the questionnaire asking about their knowledge, skills and attitudes regarding HIV and AIDS. Trainees' principal difficulties with HIV and AIDS resembled those of general practitioners currently in practice. More than 60% of trainees lacked knowledge about HIV and AIDS in babies, 50% would not accept intravenous drug misusers onto their list, only 12% found it easy to discuss sex with homosexual male patients, and only 37% felt able to offer counselling about HIV and AIDS. Trainees who had had a tutorial on HIV and AIDS as part of vocational training were significantly more knowledgeable than the remainder (P less than 0.01). In addition, trainees who found workshops on HIV and AIDS useful were more willing than others to take on drug misusers (P less than 0.05) and more confident in their ability to counsel patients with HIV infection (P less than 0.01). No significant associations were found between the trainers' own knowledge, attitudes and skills regarding HIV and AIDS and those of their trainees. It is concluded that there is a need to improve teaching about HIV and AIDS in vocational training for general practice. All general practitioner trainees should receive a tutorial to update their knowledge about HIV and AIDS, and attend a suitable workshop to challenge unfavourable attitudes and improve confidence in counselling.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Interns as health educators.

Interns are being used in two experimental health education projects in a rural area of India. In one the interns talk to mothers waiting with their children at an immunization clinic; in the other they train volunteer schoolchildren to act as school health guides in a child-to-child programme.

Child↗
PubMed1994

Immunological status of competitive cyclists before and after the training season.

The total number of leucocytes, T lymphocyte subsets, mitogen induced proliferation of lymphocytes, Il-2 generation, adherence capacity and chemiluminescence of granulocytes were measured and a leukergy test performed in fifteen young cyclists. The investigations were carried out at rest at the beginning of a training season and after six months of intensive training and a racing season, cycling approximately 500 km a week. Baseline values of the tested immune parameters were within the range observed in 16 non-trained healthy controls except significantly increased non stimulated neutrophil chemiluminescence. The second cyclo-ergometer test in August showed a marked improvement in the performance capacity of the cyclists. Significant decrease in absolute numbers of CD3+ and CD4+ cells, diminished IL-2 generation and fMLP and PMA stimulated chemiluminescence of neutrophils were noted. Surprisingly, a marked increase in lymphocyte proliferation induced by PHA and anti-CD3 MoAb and normalisation in non stimulated neutrophil chemiluminescence were also observed at rest after the training season. We conclude that long-lasting intensive training may result in significant alterations in lymphocyte number and composition and in neutrophil oxidative burst capacity, but their actual significance for immunity is seen controversially.

Adult↗
PubMed2001

The cytokine response to physical activity and training.

Cytokines are soluble glycoproteins that are produced by and mediate communication between and within immune and nonimmune cells, organs and organ systems throughout the body. Pro- and anti-inflammatory mediators constitute the inflammatory cytokines, which are modulated by various stimuli, including physical activity, trauma and infection. Physical activity affects local and systemic cytokine production at different levels, often exhibiting striking similarity to the cytokine response to trauma and infection. The present review examines the cytokine response to short term exercise stress, with an emphasis on the balance between pro- and anti-inflammatory mechanisms and modulation of both innate and specific immune parameters through cytokine regulation. The effects of long term exercise on cytokine responses and the possible impact on various facets of the immune system are also discussed, with reference to both cross-sectional and longitudinal studies of exercise training. Finally, the validity of using exercise as a model for trauma and sepsis is scruti- nised in the light of physiological changes, symptomatology and outcome, and limitations of the model are addressed. Further studies, examining the effect of exercise, trauma and infection on novel cytokines and cytokine systems are needed to elucidate the significance of cytokine regulation by physical activity and, more importantly, to clarify the health implications of short and long term physical activity with respect to overall immune function and resistance to infection.

Aging↗
PubMed2000

Effect of diazepam on the immune response of rats exposed to acute and chronic swim stress.

To examine the effect of the anti-stress agent diazepam on the immune response, rats were exposed either to acute swim stress, i.e., swimming once only for 30 minutes (non-trained swimmers), or to chronic stress with gradual progressive training for 6 weeks (trained swimmers). Both groups of animals were divided into subgroups treated before swimming with and without diazepam, 1 mg/kg, administered i.m. The phagocytic capacity and superoxide anion generation of the peritoneal macrophages was examined. In addition, the proliferative response of the splenic cells (splenocytes) to concanavalin A (Con A) and phytohemagglutinin (PHA), as well as the serum corticosterone levels were investigated. Diazepam abolished increased superoxide anion production in both non-trained and trained swimmers. In non-trained swimmers, the number of latex particles internalized by each cell was decreased and further reduced by the drug. In trained rats treated with diazepam, the percentage of phagocytosing cells remained reduced compared to controls, whereas the drug prevented a decrease in the engulfing capacity of individual cells. Diazepam lowered the suppressed proliferative response of the splenocytes to PHA found in non-trained swimmers. It is concluded that diazepam modifies the immune response of rats exposed to acute and chronic swim stress.

Animals↗
PubMed1997

Immunity in athletes.

There is a general perception among athletes, coaches and sports physicians that athletes are susceptible to infectious illness, such as upper respiratory tract infection (URTI), during intensive training and major competition; recent epidemiological evidence is consistent with this perception. Recent studies have focused on the effects of exercise on immune parameters in order to better understand mechanisms by which exercise training may influence resistance to infection. Intensive exercise has been shown to transiently alter a number of immune parameters including circulating leukocyte and subset numbers, plasma cytokine concentrations, natural killer cell activity, secretory immunoglobulin A secretion rate, and neutrophil and macrophage phagocytic activity. Many of these changes persist for several hours or even days after intensive exercise. Some athletes have been shown to exhibit low resting or postexercise values on some nonspecific immune parameters compared with clinical norms, such as complement, acute phase proteins, and neutrophil activation. In addition, extended periods of intensive exercise training have been associated with progressive decreases in some immune parameters such as neutrophil function and certain subclasses of serum and secretory immunoglobulin. These data suggest the possibility of clinically relevant immune suppression in well-trained athletes. Psychological stress associated with training and competition at the elite level may be an additive factor to the effects of intensive exercise on immune function.

Cytokines↗
PubMed2003

Physical training during intrahepatic chemotherapy.

OBJECTIVE: To evaluate the role of strength and endurance training for the muscular, cardiac, respiratory, and immune systems and the quality of life (QOL) during intrahepatic chemotherapy (folinic acid, 5-fluorouracil). DESIGN: Single case. SETTING: Teaching hospital in Germany. PARTICIPANT: An elderly athlete with liver metastasis after resection of a carcinoma of the rectum (pT3, N0, M-liver, G2). INTERVENTION: Strength and endurance training during chemotherapy. MAIN OUTCOME MEASURES: During the intervals between training cycles (14d), beginning in postoperative week 6, a strength and endurance training regimen was performed twice weekly for 13 weeks, with an intensity of 40% to 60% of the maximum postoperative individual power and endurance. Before and after chemotherapy, we checked echocardiograms, resting and exercise electrocardiograms, lung function, natural killer (NK) cells, and the Gastrointestinal Quality of Life Index (GIQLI) scores. RESULTS: The increase in strength was between 0% and 144%. The improvement in endurance expressed by reduction of heart rate and lactate concentration was 10% and 21.5%, respectively. Lung function also improved with regard to forced expiratory volume in 1 second (12.9%), forced vital capacity (11.3%), and inspiratory vital capacity (11.4%). The relative count of the NK cells increased to 27.2%. An improvement in the GIQLI was observed from 109 points (pathologic) to 129 points. CONCLUSION: Strength and endurance training was associated with an increase of physical strength and endurance with positive influence on illness-related QOL. Postoperative physical exercise during regional chemotherapy is beneficial.

Adenocarcinoma↗
PubMed1991

AIDS-related training in U.S. schools of social work.

This article presents the results of a survey of 70 master of social work (MSW) programs to determine the extent and manner in which educational curricula include instruction on acquired immune deficiency syndrome (AIDS). Most programs offer students training in foundation areas pertinent to AIDS, including health and mental health systems, practice with racial and ethnic minorities, and substance abuse prevention and treatment. However, over 40 percent of programs provide no training in such key areas as human sexuality and primary prevention. Less than 15 percent of programs offer courses specific to AIDS, although a third of programs have incorporated AIDS content into other courses. Between 20 percent and 30 percent of MSW programs offer little or no attention to AIDS in their curricula. Implications of these findings are discussed.

Acquired Immunodeficiency Syndrome↗