Thursday, March 29, 2012

"No Pay, No Play" Game Over. My editorial on professionalism in pathology

Hopefully link is fixed now.

If not, try this one to the table of contents:

Traveling, working off the cellphone.

A model for addressing college costs (HT: Dan Formanowicz)

My View: A model for addressing college costs

By Nancy L. Zimpher, Special to CNN
"But solving the budget crisis in public higher education must go beyond the standard solutions of state funding and tuition hikes. All too often, administrators see it as an "either-or" decision. Our nation’s economic crisis demands that we find new and innovative ways to manage our public institutions. The status quo is no longer an option.
When you have a large public university system – SUNY has a 64-campus umbrella – opportunities can be identified to cut costs and increase efficiency, and those savings can be redirected to expanding access and enhancing services that directly benefit students. For instance, there are significant cost savings that can be realized by consolidating information technology or human resources services, and those funds can enable universities to hire more full-time faculty, offer more courses, or expand advisement services to ensure on-time degree completion. Regional centers can centrally process payroll, purchasing, and other administrative tasks instead of duplicating these services at one or more campuses."

From Stanford U: The role of physical activity in changes in walking mechanics with age

Gait Posture. 2012 Mar 23. [Epub ahead of print]

The role of physical activity in changes in walking mechanics with age.


Mechanical Engineering, Stanford University, Stanford, CA, USA; Bone and Joint Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.


While age-related declines in walking mechanics have been documented, it remains unclear if changes in walking mechanics with age occur as a natural consequence of aging and to what extent these changes are related to a reduction in fitness andphysical activity with aging. The study aim was to determine if the walking mechanics of an older (>50) yet highly active population are different from a younger population (<40). Gait mechanics data for 79 middle-aged (50-64yrs) and 54 older (65-80yrs) individuals with ≥7500 steps/day, based on a 7 day activity monitoring history, and 33 younger adults (ages 18-40) were collected. The older subjects did not reduce self-selected walking speed relative to the younger subjects. However, the walking speed was maintained by increasing cadence while reducing stride-length for middle-aged and older subjects. Middle-aged and older adults had less ankle dorsi-flexion landing at heel-strike and older adults also had less plantar flexion at toe-off. Small decreases in the ankle dorsi-flexion moments (p=0.019, p=0.008) and increases in the hip extension moments (p=0.004, p=0.005) were found for two normalized walking speeds for the middle-aged and older adults compared to the young adults. These results provide quantitative evidence that increased activity with aging can mitigate declines in walking performance and mechanics with age. The high volume of walking activity in the older subjects did not fully prevent changes in gait mechanics, but may have minimized the magnitude of age-related changes on ambulatory function relative to other reports of older inactive subjects.

Irksome that the phrase "poor cardiorespiratory fitness in youth" even exists

Prev Med. 2012 Mar 17. [Epub ahead of print]

Screen time and passive school travel as independent predictors of cardiorespiratory fitness in youth.



The most prevalent sedentary behaviours in children and adolescents are engagement with small screen media (screen-time) and passive travel (by motorised vehicle). The objective of this research was to assess the independence of these behaviours from one another and from physical activity as predictors of cardiorespiratory fitness in youth.


We measured cardiorespiratory fitness in n=6819 10-16year olds (53% male) who self-reported their physicalactivity (7-day recall) school travel and screen time habits. Travel was classified as active (walking, cycling) or passive; screen time as <2h, 2-4h or >4h.


The multivariate odds of being fit were higher in active travel (Boys: OR 1.32, 95% CI: 1.09-1.59; Girls: OR 1.46, 1.15-1.84) than in passive travel groups. Boys reporting low screen time were more likely to be fit than those reporting >4h (OR 2.11, 95% CI: 1.68-2.63) as were girls (OR 1.66, 95% CI: 1.24-2.20). These odds remained significant after additionally controlling for physical activity.


Passive travel and high screen time are independently associated with poor cardiorespiratory fitness in youth, and this relationship is independent of physical activity levels. A lifestyle involving high screen time and habitual passive school travel appears incompatible with healthful levels of cardiorespiratory fitness in youth.

From U Porto-Portugal: Among adolescent girls 23.2% have negative self-rated health

J Phys Act Health. 2012 Mar;9(3):378-81.

Associations between self-rated health with cardiorespiratory fitness and obesity status among adolescent girls.


Research Centre in Physical Activity, Health, and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.



The main goal of this study was to analyze the associations between cardiorespiratory fitness (CRF) and body mass index (BMI) with self-rated health (SRH) of adolescent girls.


This was a cross-sectional study of 533 adolescents girls, aged from 10 to 18 years old. CRF was predicted by maximal multistage 20-m shuttle-run test according to procedures described from FITNESSGRAM. Girls' obesity status was classified according to International Obesity Task Force and Self-rated health (SRH) was assessed by questionnaire.


The findings showed that among adolescent girls 23.2% had negative SRH. Girls who were classified as unfit were more likely to report negative SRH in both univariate logistic (OR: 3.05; CI: 1.91-4.87; P < .05) and multivariate (OR: 2.93; CI: 1.82-4.72; P < .05) regression analyses compared with their fit peers. Obese girls were more likely to report negative SRH (OR: 2.30; CI: 1.14-4.62; P < .05) compared with their normal-weight counterparts. However such association was lost in multivariate analyses suggesting an effect of CRF.


Negative perception of health was associated with lower CRF and weight status although such association it is mediated by CRF condition.

Deep water running for non-specific low back pain

Clin Rheumatol. 2012 Mar 29. [Epub ahead of print]

Deep water running and general practice in primary care for non-specific low back pain versus general practice alone: randomized controlled trial.


Department of Physical Therapy, School of Medicine, University of Málaga, 29071, Málaga, Spain,


There is equivocal evidence regarding the benefits of aquatic aerobic exercise for non-specific chronic low back pain (NSCLBP) in addition to standard care in general practice consisting of education and advice. The purpose of this study was to compare the addition of deep water running (DWR) to standard general practice (GP) on NSCLBP versus GP care alone on pain, physical and mental health and disability. In this single-blind randomised controlled trial, 58 subjects with NSCLBP were recruited from primary care. The control group received GP care consisting of a physician's consultation and educational booklet only. The experimental group received additional 30-min sessions of DWR three times a week for 15 weeks at the individualized aerobic threshold. Measurements were made pre- and post-intervention and at 1-year follow-up. Both groups showed improvement. The difference between treatment effects at longest follow-up of 1 year was -26.0 (-40.9 to -11.1) mm on the VAS (p < 0.05), -2.5 (-5.7 to -0.2) points in RMQ for disability (p < 0.05), 3.3 (10.0 to 24.7) points on physical health in the physical summary component of the Spanish Short Form 12 (SF-12; p < 0.05) and 5.8 (8.6 to 34.7) points on the mental summary component of the SF-12 (p < 0.05), in favour of the DWR group. For patients with NSCLBP, the addition of DWR to GP was more effective in reducing pain and disability than standard GP alone, suggesting the effectiveness and acceptability of this approach with this group of patients.

Predictions: Health care law will survive...or not...

Predictions: Health care law will survive...

3/29/2012 @ 12:30PM |2,359 views

Obamacare Will Survive The Supreme Court. Here's Why.

Daniel Fisher, Forbes Staff

"ThePatient Protection and Affordable Care Act will survive Supreme Court review on a 6:3 vote, with Justice Anthony Kennedy writing the opinion."

...or not...

On health care, is the GOP ready for victory?

By Thursday, March 29, 11:10 AM

"Three days of oral arguments at the Supreme Court have given Republicans reason for optimism that President Obama’s health-care law could be heading for a legal defeat in a few months."

A comparison of low- and high-impact forced exercise: Effects of training paradigm on learning and memory

Physiol Behav. 2012 Feb 28. [Epub ahead of print]

A comparison of low- and high-impact forced exercise: Effects of training paradigm on learning and memory.


In this study we compared two types of forced exercise-a low impact paradigm to minimize stress, which included speeds up to 10m/min and a stressful high impact paradigm, with speeds up to 21m/min. 150 male C57BL/6J mice were randomly assigned to the low impact, high impact, or sedentary control conditions and were tested on the rotorod and Morris water maze (MWM) as indices of motor learning and spatial memory. We found that 5weeks of stressful high speed forcedexercise led to significant improvement in rotorod performance, as high impact runners outperformed both low impact runners and controls at 15 and 25rpm speeds. These differences were the result of improved physical fitness due to exercise and likely do not reflect enhanced learning in these mice. In the MWM, 5weeks of stressful high impact exercise led to significant impairment in spatial memory acquisition compared to low impact runners and controls. Low impact exercise for 10weeks significantly improved retention of spatial memory compared to high impact exercise. Results suggested that these two paradigms produced different effects of forced exercise on learning and memory. The low impact paradigm led to some improvements, whereas the stressful high impact program caused significant impairment. Comparison of these two paradigms begins to address the window between the beneficial and detrimental effects of forced exercise, and have suggested a boundary of exercise intensity that leads to impairment in learning.

Measuring exercise capacity in patients with chronic lung disease

J Bras Pneumol. 2012 Feb;38(1):116-124.

The use of step tests for the assessment of exercise capacity in healthy subjects and in patients with chronic lung disease.

[Article in English, Portuguese]


Faculdade Maurício de Nassau, Recife, PE, Brasil.


Step tests are typically used to assess exercise capacity. Given the diversity of step tests, the aim of this review was to describe the protocols that have been used in healthy subjects and in patients with chronic lung disease. Step tests for use in healthy subjects have undergone a number of modifications over the years. In most step tests, the duration is variable (90 s-10 min), but the step height (23.0-50.8 cm) and stepping rate (22.5-35.0 steps/min) remain constant throughout the test. However, the use of a fixed step height and constant stepping rate might not provide adequate work intensity for subjects with different levels of fitness, the workload therefore being above or below individual capacity. Consequently, step test protocols have been modified by introducing changes in step heights and stepping rates during the test. Step tests have been used in patients with chronic lung diseases since the late 1970s. The protocols are quite varied, with adjustments in step height (15-30 cm), pacing (self-paced or externally paced), and test duration (90 s-10 min). However, the diversity of step test protocols and the variety of outcomes studied preclude the determination of the best protocol for use in individuals with chronic lung disease. Shorter protocols with a high stepping rate would seem to be more appropriate for assessingexercise-related oxygen desaturation in chronic lung disease. Symptom-limited testing would be more appropriate for evaluating exercise tolerance. There is a need for studies comparing different step test protocols, in terms of their reliability, validity, and ability to quantify responses to interventions, especially in individuals with lung disease.

"Participants made limited and likely inadequate use of wellness opportunities."

J Occup Environ Med. 2012 Mar 14. [Epub ahead of print]

Free Choice Access to Multipoint Wellness Education and Related Services Positively Impacts Employee Wellness: A Randomized and Controlled Trial.


From the Department of Exercise & Sport Sciences (Drs Sforzo and Kaye), Ithaca College, Ithaca, NY; and Department of Health Promotion & Clinical Integration (Mr Calleri and Ms Ngai), Plus One Health Management, New York, NY.



Examine effects of voluntary participation in employer-sponsored, multipoint wellness education programming on employee wellness.


A randomized and controlled design was used to organize 96 participants into an education + access group; an access-only group, and control group. Outcome measures were made at start and end of a 12-week intervention period.


Education + access improved wellness knowledge, which, in turn, enhanced life satisfaction, employee morale, and energy, and nearly improved stress level. Those who received facility access without educational programming did not reap health benefits. Employees voluntarily used the fitness facility and healthy meal cards only 1.3 and 1.5 times per week, respectively.


Participants made limited and likely inadequate use of wellness opportunities. As a result, physical health benefits (eg, blood pressure, fitness parameters) were not seen in the present study. However, multipoint wellness education resulted in psychosocial health benefits in 12 weeks.