This study determined whether pre-operative exercise and education (PREHAB) improves the frailty status and physical activity behaviour of older adults undergoing elective cardiac surgery, more than standard care (StanC). Using a subset of patients from a multi-centre trial (NCT02219815), twenty-six patients over the age of sixty were randomized to receive StanC (n=12) or PREHAB (n=14). Blinded research assistants collected data at baseline prior to randomization and one week pre-operatively. Changes in frailty were assessed using a 30-item functional frailty index (FFI); whereas, changes in physical activity behaviour were assessed using accelerometers. Baseline data was not different between groups. Frailty status improved by 17%, 5% and 35% amongst StanC, PREHAB “non-completers” and PREHAB “completers”, respectively. No changes in moderate to vigorous physical activity were found pre-operatively. These data suggest that the PREHAB intervention is feasible to implement and may result in improved frailty status amongst frail older adults awaiting elective cardiac surgery. / October 2016

No description available.

5 pp. / Arizona youth livestock quality assurance and food safety: Trainers reference. Arizona youth livestock quality assurance and food safety: Youth manual. Feeding management for show lambs. Feeding management for show steers. Swine nutrition for show animals. / Illness or injury to a show animal may be preventable by following a few guidelines. Providing a clean and safe environment and properly feeding, watering, and vaccinating animals will help to reduce the risks of experiencing illnesses and injuries. Owners should also learn how to identify signs of health problems, such as sudden changes in behavior or appearance, and prepare a first aid kit for use in the event of an emergency. Also, being familiar with emergency treatment guidelines will help owners protect themselves, prevent further injury to the animal, and properly administer care to the animal if appropriate.

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Although evidence is currently available for population-based genetic screening and testing of individuals and their family members for certain hereditary chronic disease conditions (Tier 1), few states have integrated these genomic applications into chronic disease prevention programs. State and territorial chronic disease directors (CDDs) could provide the leadership needed to deliver these applications in more states. The purpose of this study was to determine whether an association exists between current chronic disease genomics funding or specific state genomic activities and the level of knowledge and interests in genomics by these directors. Rogers's diffusion of innovations (DIT) theory was used to explain the current climate of state chronic disease genomics and the need for an innovation champion to promote these evidence-based applications both in and out of the state health departments. A nonexperimental, cross-sectional, correlational survey of CDDs (N = 58) was performed using the Chronic Disease Director's Survey and results were analyzed using chi-square, independent t test, ANOVA, logistic regression, and Pearson's correlation coefficient. Results showed CDDs knowledge of genomics is unrelated to current state funding; however, CDD knowledge and interest in genomics was associated with inclusion of genetics in cancer control and cardiovascular health action plans, Tier 1 condition education, privacy and nondiscrimination laws, Behavioral Risk Factor Surveillance System (BRFSS) genomics questions, and frequent collaborations with outside entities. These results provide clear ideas to increase CDDs knowledge and interest in chronic disease genomics and potentially impact Tier 1 genomics implementation in more states.

<p>Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is the most preventable cause of death in hospitalized patients. Due to its high mortality, morbidity, and cost, health care providers are obligated to not only effectively diagnose and treat VTE, but also to prevent it if possible. This has been reinforced by a number of national and international quality initiatives to prevent hospital-acquired VTE. Despite the existence of well-accepted clinical practice guidelines on VTE prophylaxis, 1 in 3 hospitalized medical patients receives an inappropriate VTE prophylaxis strategy. Both underuse of prophylaxis in patients with VTE risk, and overuse of prophylaxis in patients without VTE risk are problems. The use of inappropriate VTE prophylaxis strategies is likely due to the complexity and heterogeneity of hospitalized medical patients, and the difficulty of applying “one size fits all” practice guidelines to this group. Institution-wide knowledge translation strategies are required to close the gap between evidence and practice, and promote evidence-based VTE prophylaxis strategies in hospitalized medical patients. The objective of this thesis is to design a cluster randomized controlled trial to determine if a standardized electronic order set, with an embedded computerized decision support system and audit and feedback component, affects the use of appropriate VTE prophylaxis in hospitalized medical patients. The unit of randomization in this study is the hospital, which serves as the cluster. The unit of observation in this study is the individual patient. The primary outcome of this study is the proportion of in-hospital days during which appropriate VTE prophylaxis is administered, in intervention versus control hospitals. Secondary outcomes are the rates of hospital-acquired VTE, major bleeding and mortality, in intervention versus control hospitals. Design, analytic and ethical challenges unique to cluster randomized trials will also be discussed. Strategies to overcome them in this trial will be presented.</p> / Master of Science (MSc)

Kenneth H. Cooper is considered to be a noted scholar in the field of wellness and fitness. This study explored his contributions to the preventive medicine and wellness movement in community college physical education programs in the United States. It examined Cooper's influence on the development of preventive medicine and wellness from its inception and growth to its impact on changes and factors affecting curriculum in community college programs. A random sample of436 physical education division directors from the nation's 1,400 community colleges yielded a 62% survey response. For purposes of comparison, the sample was stratified into two regions taken fromeast and west of the Mississippi River. Chi-square analysis at the .01 level of significance found no difference between variables due to geographic region. The findings of this study indicate that Kenneth Cooper's contributions to preventive medicine and wellness in community college physical education curriculum are overshadowed by state and local governing bodies that are the force behind curricular development in the nation's 2-year community colleges. However, as an individual contributor, Cooper ranks highly in influencing the wellness and physical education curriculum primarily in the areas of aerobic exercise, physical fitness, and cardiovascular disease. The extent of Cooper's impact on community college physical education programs is recognized by the wide utilization of the 1.5 mile run test and 12-minute run test developed by Cooper. Two areas of Cooper's research—antioxidants and spiritual fitness—are not priorities in physical education programming. Changes in physical education programs in the past 10 years show an increased emphasis and popularity in aerobic fitness courses. It was also found that 40% of the community colleges responding to the present study indicated no physical education programming and that credit hours for physical education are decreasing.

Accounting for nearly 19% of the United States population in 2020, Latinos and Hispanics represent the second largest racial/ethnic group in the United States, totaling roughly 62.1 million people. Given the growing population size and longer life expectancy estimates amongst the U.S. Latino/Hispanic community, healthcare practitioners and public health officials are increasingly emphasizing the healthcare needs and outcomes of this population. Alarmingly, current literature has highlighted significant disparities in cardiovascular disease (CVD) incidence and risk factors among U.S. Latinos/Hispanics. As CVD continues to be one of the leading causes of death amongst all racial/ethnic groups across the United States, risk reduction through preventative care utilization remains of utmost importance for mitigating potential risk factors and eventual diagnosis of CVD. The purpose of the study was to quantify healthcare engagement through preventive care utilization for cardiovascular disease and associated risk factors among U.S. Latino/Hispanics. This research study used a cross-sectional design with secondary data from the 2017- March 2020 National Health and Nutrition Examination Survey (NHANES). Variables related to sociodemographic characteristics, knowledge of CVD/risk factor history, and preventive service utilization for CVD were collected from a sample of N=2122 adult Latino/Hispanic participants, representing 40,412,679 U.S. Latinos/Hispanics. All 9 demographic variables were found to have significant associations with the 7 preventive service use variables (p<.001-.016). Similarly, most of the 11 variables related to knowledge of CVD history were found to have significant associations with the 7 preventive service use variables (p<.001). No significant associations were found between knowledge of high blood pressure history with medication use, and knowledge of diabetes history with A1C testing use. Findings from this study reveal various disparities in CVD preventive care utilization amongst the study participants. Limitations of this study included lack of disaggregated ethnic data, possible bias in self-reported data, and missing responses. Results from this study can be utilized to inform clinicians and public health officials in establishing personalized preventive care interventions and increasing community engagement with cardiovascular preventive care services.

Despite the well-recognized benefits of exercise, Americans are gaining weight in astounding proportions and levels of physical activity are on the decline. The purpose of this study was to investigate a relationship between physical fitness, self-concept and sexual health. There is a dearth of knowledge on this relationship specifically in the context of sex-negative curricula, which is the dominate discourse in the United States. One hundred and thirty-three participants between the ages of 18 - 50 volunteered for fitness testing and data collection. Physical fitness was assessed through body fat, resting metabolic rate, cardiovascular endurance, muscular strength, muscular endurance and flexibility. Self-reported exercise was measured using the International Physical Activity Questionnaire. Self-concept was measured by the Six Factor Self-Concept Scale, which presented a total self-concept score and as six individual concepts of self (likability, morality, task accomplishment, giftedness, power and vulnerability). Additionally, sexual function was measured by Derogatis Interview for Sexual Functioning and presented as both an aggregate score and five separate constructs of sexual functioning (fantasy/cognition, arousal, orgasm, behavior/experience, and drive/desire). Questions pertaining to sexual partners, sex education, and demographic information were also included. The results of the General Linear Model indicated significant relationships between physical fitness, self-concept and total sexual functioning. The sexual behavior/experience of men was predicted by body fat percentage and flexibility. In women, behavior/experience was predicted by body fat percentage and arousal was predicted by cardiovascular endurance. Total self-concept was related to muscular endurance. When men were isolated in the analysis, likability was positively related to sexual behavior/experience, and task accomplishment was inversely related to sexual behavior/experience. In women, giftedness was related to cognition/fantasy, arousal, orgasm and total sexual functioning. No relationships were found between physical fitness and the number of sexual partners in men; however, both muscular strength and the power self-concept were significantly related to number of sexual partners in women. As a result of these findings, women may be inclined to exercise to improve arousal and sexual functioning. Furthermore, educators should note the findings of a positive relationship between physical and psychological health and sexual well-being because they provide support for the development and adoption of sex-positive curricula that incorporate potential benefits of sexual activity.

Events around conception such as maternal undernutrition and twinning may have effects on offspring physiology and disease risk in adulthood. Periconceptional undernutrition alters offspring physiology and adult pathology without affecting birth size, while twinning affects birth size and physiology but with inconsistent effects on adult pathology. We investigated the effects of these two periconceptional events and their interaction on maternal cardiovascular adaptation to pregnancy and fetal growth, physiology and endocrinology in late gestation in sheep. Pre and/or postconception undernutrition resulted in increased uterine blood flow in late gestation, but no change in maternal blood volume. Preconception undernutrition alone resulted in a relatively large placenta with a small, slow-growing fetus in late gestation. In contrast, postconception undernutrition alone resulted in a fetus with rapid late-gestation growth that was maintained through a maternal fast. Fetuses of ewes undernourished throughout both periods were similar in growth rate and size to controls. Maternal fasting also demonstrated that plasma levels of C-type natriuretic peptide are acutely and independently regulated by nutrient supply in mother and fetus. Fetuses of ewes undernourished both pre- and postconception had increased glucose disposal following a glucose challenge. Hypothalamic-pituitary-adrenal axis tests in these fetuses showed decreased pituitary adrenocorticotropin hormone response to direct stimulation but increased adrenal response to decreased cortisol negative feedback. Twin fetuses grew more slowly in late gestation than singletons. Twins also had a smaller insulin response to arginine and a greater insulin response to glucose, but periconceptional undernutrition abolished this difference. Twins had suppressed baseline hypothalamic-pituitary-adrenal axis function and decreased adrenal sensitivity compared to singletons, but increased fetal pituitary adrenocorticotropin hormone response to direct stimulation and decreased cortisol negative feedback. These studies suggest that firstly, fetal size is a poor reflection of fetal growth trajectory, physiology and endocrinology. Secondly, pre- and postconception undernutrition affect late-gestation fetal growth in different ways, while undernutrition in both periods alters fetal endocrine status in late gestation. Thirdly, the biology of twin fetal development is fundamentally different from that of singletons, which may explain the inconsistency of the relationship between birth weight and adult disease risk in twins. / Auckland Medical Research Foundation, Health Research Council of New Zealand