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PubMed1977

Coronary heart disease in marathon runners.

Six highly trained marathon runners developed myocardial infarction. One of the two cases of clinically diagnosed myocardial infarction was fatal, and there were four cases of angiographically-proven infarction. Two athletes had significant arterial disease of two major coronary arteries, a third had stenosis of the anterior descending and the fourth of the right coronary artery. All these athletes had warning symptoms. Three of them completed marathon races despite symptoms, one athlete running more than 20 miles after the onset of exertional discomfort to complete the 56 mile Comrades Marathon. In spite of developing chest pain, another athlete who died had continued training for three weeks, including a 40 mile run. Two other athletes also continued to train with chest pain. We conclude that the marathon runners studied were not immune to coronary heart disease, nor to coronary atherosclerosis and that high levels of physical fitness did not guarantee the absence of significant cardiovascular disease. In addition, the relationship of exercise and myocardial infarction was complex because two athletes developed myocardial infarction during marathon running in the absence of complete coronary artery occlusion. We stress that marathon runners, like other sportsmen, should be warned of the serious significance of the development of exertional symptoms. Our conclusions do not reflect on the possible value of exercise in the prevention of coronary heart disease. Rather we refute exaggerated claims that marathon running provides complete immunity from coronary heart disease.

Adult↗
PubMed1993

IMA to conduct training courses in family planning.

For the last six and a half decades, the Indian Medical Association (IMA) has been actively engaged in Public Health issues, ranging from immunization, ORT, maternal and child health care, and has been cooperating with the Government of India in various National Health Programs. Recently, IMA organized a new and exciting program on India's most significantly health issue--family planning. The training is to be competency based and participatory, with the main emphasis on knowledge, attitude and skills required to provide comprehensive child spacing. IMA has developed this multilevel program to train personnel in all methods of family planning, like: participation in basic oral contraceptive training; supplementary training in other methods; clinical practice for providing information on how to select and manage non-clinical family planning services; simulated practice in IUCD; and clinical practice in IUCD training. Training can also be arranged for vasectomy practicum and minilaparotomy. The main purpose of the training program is to realize the Government's goal of 60% contraceptive prevalence usage by the year 2000. In India, less than 2% of the 132.5 million reproductives, couples use oral contraceptives, because of widespread misconceptions regarding the pill among the general populace and the medical community. This program has been designed to counter these misgivings and thus encourage the "use of modern family planning methods" to take on the menace of the population explosion.

Asia↗
PubMed1998

[Interactions between the immune system and the psyche].

Compared to well documented studies on immunosuppression "psychologically induced immunoenhancement" is a rather neglected topic in medical literature and research, even in the new established field of psychoneuroimmunology. Starting with the premise that research questions emanating from this field and from behavioural medicine may provide critical information for understanding the phenomena of immunomodulation, evidence and illustrations of psychologically induced immunoenhancement are provided in the context of psychosocial neuroimmunomodulation. Distress-reducing interventions such as progressive relaxation training, imagery, experimentally induced short-term positive mood states and mirthful laughter enhances various aspects of immune functions, i.e., primarily the phylogenetically old paraspecific parameters. Additionally, a larger variety of emotional/psychosocial factors with potentially but yet unproved immunoenhancing effects seems to exist. In particular, enhancement of phagocytosis, NK cell and T cell response to phytohemagglutinin, decrease in the number of suppressor/cytotoxic T cells and increase in the number of circulating T helper/inducer cells in peripheral blood, and enhancement of spontaneous lymphocyte blastogenesis as well as cytokines have all been shown to be associated with the above mentioned intervention techniques.

Animals↗
PubMed1997

Immunizing preschool children: beliefs and practices of pediatric residents.

Immunization practices and knowledge of vaccine contraindications among pediatric residents were assessed at five pediatric training facilities by surveying 227 pediatric residents. Residents administer vaccines even in the presence of an afebrile minor illness. They are less likely to vaccinate if a fever (< 102 degrees F) is present. Only 57% of residents report administering vaccines at the 15-month well-child checks. Many residents had difficulty recognizing true and false contraindications, though third-year residents did better than first-year residents. Failure during residency to utilize 15-month well visits and ill visits in the presence of a fever and the lack of knowledge of true and false vaccine contraindications may be causes of missed opportunities to vaccinate among residents. Immunization practices resulting in missed opportunities to vaccinate seen during during residency may influence later immunization practices.

Child, Preschool↗
PubMed2003

Immunological responses to overreaching in cyclists.

INTRODUCTION: Acute bouts of prolonged strenuous exercise are often associated with immune suppression and an increased risk of infection. However, few studies have examined immunological responses to intensified training that results in overreaching or overtraining. We investigated the effects of intensified training on plasma cytokines, glutamine, glutamate, and other related immunological variables in endurance-trained cyclists. METHODS: Eight male subjects (age 27.0 +/- 3.0 yr, [OV0312]O(2max) 58.0 +/- 1.7 mL.kg-1.min-1, mass 73.7 +/- 2.1 kg) completed 6 wk of training: 2 wk each of normal training (N, 7 +/- 2 h.wk-1), intensified training (ITP, 14 +/- 5 h.wk-1) and recovery training (R, 3.5 +/- 2.5 h.wk-1). During the study period, subjects completed six graded cycle ergometer tests to exhaustion (MT), six simulated time trial tests (TT), and eight 2 x 10-min maximal effort bouts (IT). Subjects also completed questionnaires to assess mood state. Plasma concentrations of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6), salivary IgA, plasma glutamine, glutamate, ammonia, urea, creatine kinase activity, and routine hematological measures were determined once per week. RESULTS: ITP resulted in overreaching in all subjects identified by a significant decline in performance and disturbances of mood state. Significant increases during the ITP were observed in creatine kinase activity and glutamate, whereas the glutamine/glutamate ratio (Gln/Glu ratio), red blood cell numbers (RBC), hemoglobin concentration (Hb), and packed cell volume (PCV) declined after ITP. No significant changes were observed in TNF-alpha, IL-6, salivary IgA, glutamine, ammonia, urea and various routine hematological measures. CONCLUSION: Alterations in plasma cytokines do not appear to be related to the decline in performance and increased mood state characteristic of overreaching; however, the Gln/Glu ratio may be of use as a marker of overreaching and/or overtraining.

Adult↗
PubMed2005

Polio eradication: mobilizing and managing the human resources.

Between 1988 and 2004, the Global Polio Eradication Initiative grew to become the largest international health effort in history, operating in every country of the world. An estimated 10 million health workers and volunteers have been engaged in implementing the necessary polio supplementary immunization activities (SIAs) on a recurring basis, and at least 35,000 well-trained workers have been conducting polio surveillance. A combination of task simplification, technological innovations and adaptation of strategies to fit local circumstances has allowed the Initiative to use a wide range of workers and volunteers, from both inside and outside the health sector, to deliver the polio vaccine during SIAs and to monitor progress in virtually every area of every country, regardless of the health infrastructure, conflict, geography and/or culture. This approach has required sustained political advocacy and mass community mobilization, together with strong management and supervisory processes. Non-monetary incentives, reimbursement of costs and substantial technical assistance have been essential. Given the unique features of eradication programmes in general, and polio eradication in particular, the implications of this approach for the broader health system must continue to be studied if it is to be replicated for the delivery and monitoring of other interventions.

Community Health Planning↗
PubMed1986

[Status of immunity against poliomyelitis in Germany].

Neutralizing antibodies against poliovirus types 1, 2 and 3 were determined in serum of 4,039 persons of different ages and of 879 persons at the beginning of their training (male recruits at their initial examination; female teaching trainees and student nurses). The sera were supplied by eleven institutions. Compared with similar studies in 1969, 1972 and 1978, the immunity against individual poliovirus types as well as that against the three types in the different age groups has improved. About three quarters of those older than seven years have antibodies against types 1, 2 and 3. The present study, which for the first time used a more sensitive neutralization test, revealed that about 85% of probands had antibodies against all three types. The trivalent immunity of those aged from 0 to six years has improved by 11 percent points since 1978. There was no decrease in immunity among those older than 20 years.

Adolescent↗
PubMed1984

Neonatal tetanus in the world today.

Neonatal tetanus is an important cause of avoidable morbidity and mortality. In the past this disease was overlooked by the health services of many developing countries, but recently the extent and magnitude of neonatal tetanus has become clearer and shown that it is a very serious health problem in the developing countries. The results of community-based surveys show that neonatal tetanus mortality rates range from less than 5 to more than 60 per 1000 live births; these deaths represent between 23% and 72% of all neonatal deaths. The results so far suggest that this disease claims the lives of over half a million new-born children every year. All forms of tetanus, and especially neonatal tetanus, remain substantially under-reported in many countries, and routine reporting systems identify only about 2-5% of the estimated number of tetanus cases (based on the results of community surveys). More reliable and accurate estimates of the incidence and mortality from tetanus are therefore required.The elimination of neonatal tetanus is an essential and attainable goal. It may be achieved by combining two approaches: (1) increasing the immunization coverage of women of child-bearing age, and especially pregnant women, with tetanus toxoid, and (2) improving maternity care, with particular emphasis on increasing the proportions of deliveries that are attended by trained persons.Neonatal tetanus mortality should serve as an index of the quality and the extent of utilization of the maternal health services, of the impact of immunization programmes, and of the progress being made in achieving the WHO goal of "Health for All by the Year 2000".The elimination of neonatal tetanus calls for a full commitment by governments and by other bodies, public and private, with a responsibility for the care of women and children. The occurrence of even a single case of neonatal tetanus is witness to failures in the health system, for prevention is possible through the actions of trained health staff in contact with the mother.

Age Factors↗
PubMed2006

Mass immunization programs: principles and standards.

Mass immunization involves delivering immunizations to a large number of people at one or more locations in a short interval of time. Good mass immunization programs apply planning and quality standards that maximize return on resources invested and provide the greatest individual benefits when immunizing many people in a short period of time. These programs can be used to counter contagious outbreaks, adopted as a repeated means of sustained healthcare delivery, or applied where many people move through a specific place in a short interval of time. Relevant quality standards address appropriate facilities and supplies, training of professional and paraprofessional staff, education of potential vaccinees and methods to screen them for contraindications to immunization, safeguards against anaphylaxis and syncope, documentation, safety surveillance, and a quality-improvement program. Successful mass immunization programs require early planning that builds on existing competencies. As the number of available vaccines increases, prioritizing which vaccines to administer during mass campaigns requires consideration of effectiveness, safety, and a cost-benefit equation from both the individual and community perspectives. Mass immunization campaigns aim to maximize the health of a population, but such campaigns need to be customized based on individual contraindications to immunization. Mass immunization programs need to be conducted ethically, with considerations of benefit versus risk and the need for detailed education of healthcare workers and vaccinees.

Health Education↗
PubMed1995

Overtraining: consequences and prevention.

Overtraining refers to prolonged fatigue and reduced performance despite increased training. Its roots include muscle damage, cytokine actions, the acute phase response, improper nutrition, mood disturbances, and diverse consequences of stress hormone responses. The clinical features are varied, non-specific, anecdotal and legion. No single test is diagnostic. The best treatment is prevention, which means (1) balancing training and rest, (2) monitoring mood, fatigue, symptoms and performance, (3) reducing distress and (4) ensuring optimal nutrition, especially total energy and carbohydrate intake.

Affect↗
PubMed2006

Oxidative stress : relationship with exercise and training.

Free radicals are reactive compounds that are naturally produced in the human body. They can exert positive effects (e.g. on the immune system) or negative effects (e.g. lipids, proteins or DNA oxidation). To limit these harmful effects, an organism requires complex protection - the antioxidant system. This system consists of antioxidant enzymes (catalase, glutathione peroxidase, superoxide dismutase) and non-enzymatic antioxidants (e.g. vitamin E [tocopherol], vitamin A [retinol], vitamin C [ascorbic acid], glutathione and uric acid). An imbalance between free radical production and antioxidant defence leads to an oxidative stress state, which may be involved in aging processes and even in some pathology (e.g. cancer and Parkinson's disease). Physical exercise also increases oxidative stress and causes disruptions of the homeostasis. Training can have positive or negative effects on oxidative stress depending on training load, training specificity and the basal level of training. Moreover, oxidative stress seems to be involved in muscular fatigue and may lead to overtraining.

Antioxidants↗
PubMedDate not supplied

Problems in the diagnosis of invasive fungal diseases.

Invasive mycoses are escalating in frequency in contemporary medicine; most dramatic is the rise in the prevalence of opportunistic fungal infections among immunocompromised hosts. Despite increased awareness among physicians and greater mycologic acumen, morbidity and mortality remain substantial. In part, this situation is due to the difficulties encountered in the diagnosis of fungal infections by both the clinician and the laboratorian. Some of the factors contributing to these difficulties include the abrogation of the immune response associated with improved medical technology, the impact of AIDS, the invasion of the immunocompromised host by fungi previously considered to be saprobic, and the minimal mycologic training of medical personnel. Research efforts are under way that may be expected to improve the diagnosis and treatment of invasive mycotic diseases in the near future. For the present, it is recommended that mycologic training be encouraged and improved for all health care professionals.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Energy restriction but not protein source affects antioxidant capacity in athletes.

The primary purpose of this study was to examine the effect of energy restriction on antioxidant capacity in trained athletes. Secondly, our study determined whether dietary protein source influenced the antioxidant response, performance, and immunity. Twenty male cyclists consumed either whey or casein supplement (40 g/day) in addition to their diet for 17 days. All subjects subsequently underwent 4 days of energy restriction using a formula diet (20 kcal/kg) while continuing protein supplementation. Energy restriction caused 2.7 +/- 0.3 kg weight loss, increased lymphocyte total glutathione (tGSH) 37%, red blood cell glutathione peroxidase 48%, plasma cysteine 12%, and decreased whole blood reduced to oxidized GSH (rGSH/GSSG) ratio by 52%. The only immunity factor altered by energy restriction was an increase in stimulated phagocytosis (65%). Acute submaximal exercise reduced blood tGSH but increased glutathione peroxidase. Performance of a high intensity cycle test following 45 min of moderate exercise tended to be reduced by energy restriction (P = 0.06) but was unaffected by protein source. Energy restriction caused a negative nitrogen balance with no difference from dietary protein source. In conclusion, acute energy restriction increased plasma cysteine and several markers of the glutathione antioxidant system in trained athletes. A high cysteine dietary protein source did not influence these responses.

Adult↗
PubMed2001

Effects of training on resting peripheral blood and BAL-derived leucocyte function in horses.

In this study, the effects of prolonged, high intensity training on aspects of peripheral blood and bronchoalveolar lavage (BAL)-derived leucocyte function were evaluated in 8 horses. All horses undertook a 7 week endurance training programme, followed by 5 weeks of high intensity training (HIT). Thereafter, horses were divided into control (C) and overtraining (OT) groups. The frequency and intensity of training were increased more substantially for horses in the OT group. Training was terminated in week 32 when horses in the OT group demonstrated a significant performance reduction. Peripheral blood and BAL samples were collected from 4 horses in C and OT groups in training weeks 7, 11, 14, 18, 22, 28 and 32. Flow cytometric techniques were used to assess phagocytosis by peripheral blood neutrophils and pulmonary alveolar macrophages (PAM), and oxidative burst activity of neutrophils, PAM, peripheral blood and BAL-derived lymphocytes. Peripheral blood neutrophil phagocytosis (internalisation) increased during the initial HIT period and decreased from week 16 when the training workload was increased for both groups. The oxidative burst activity of peripheral blood neutrophils and lymphocytes similarly increased and then decreased in response to training. The oxidative burst activity of PAM was reduced towards the end of the overtraining phase of the programme. Pulmonary alveolar macrophage phagocytosis and oxidative burst activity of BAL-derived lymphocytes demonstrated no change throughout the course of the study. There was no difference in results obtained from C or OT group horses, suggesting that protracted HIT, rather than overtraining, was associated with impaired cell function. The detrimental effects observed in peripheral blood neitrophil and PAM function may indicate impaired nonspecific immunity which may adversely affect the health and performance of horses undergoing protracted periods of intense training.

Animals↗
PubMed1985

Assessment of circulating immune complexes by a solid-phase C1q-binding assay during the first hours and days after prolonged exercise.

A sensitive and specific solid-phase C1q-binding assay using porcine C1q and microtitre plates as a solid phase, served to assess the immune complexes in serum during the first hours and days after a 3-h running test. Fourteen moderately trained male subjects participated in the race and covered 36.3 +/- 3.7 (mean +/- SD) km in 3 h. Blood samples were drawn 1 day before, immediately before, immediately after, 1 and 3 h after and 1, 2 and 4 days after the race. When corrected for the changes of serum total protein, the apparent immune complex concentrations were 1 and 3 h after the race significantly higher (p less than 0.001 and p less than 0.05 respectively) than the pre-exercise values. Two days after the race the values were significantly lower (p less than 0.05) than before the race. These findings provide evidence for the formation of immune complexes after severe physical exercise.

Adult↗
PubMedDate not supplied

HIV - associated and non - HIV associated types of Kaposi's sarcoma in an African population in Tanzania. Status of immune suppression and HHV-8 seroprevalence.

In this study 77 patients with histologically confirmed Kaposi's sarcoma (KS) were seen at the Regional Dermatology Training Centre (RDTC) in Moshi, Tanzania. Sixty six patients (85.7%) were HIV-seropositive KS-patients (40 males, 26 females; male: female ratio 1.5:1), whereas another 11 (14.3%) KS-patients, all males, were found HIV-seronegative, thus corresponding to the endemic African KS-type. In both groups the CD4+ cell counts were generally low, the CD8+ population increased and the CD4+/CD8+ ratio inverted. Immune suppression was, however, more prominent in the HIV-seropositive group.HHV-8 seroprevalence was high in patients with HIV-associated KS (94.6%), nevertheless, 3 (5.4%) patients in this group remained HHV-8 seronegative. All nine patients with the HIV-seronegative African type of KS were found positive for HHV-8. Of the entire group seen, males were more likely to be HHV-8 seropositive than females (OR = 3.348 95% CI, 0.96-11.65; p < 0.05). The relative risk to develop KS in individuals seropositive to both HIV and HHV-8 was high (OR = 10.6, 95% CI; 2.981-37.688; p < 0.001).Overall, HIV-associated KS differed from the non-HIV-associated by its widespread clinical dissemination on the trunk, the frequent involvement of the oral mucosa and the craniofacial region, and its more rapidly progressive course. No histological differences between the two KS-groups were seen, although spindle cell infiltrates were more often found in the HIV-associated KS-group.

Adolescent↗