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Introduction: The COVID-19 pandemic has significantly impacted global healthcare systems. Vaccination is an effective strategy to battle the disease. Policies and distribution frameworks have varied widely across countries. The paper aims to highlight the global vaccination trends in these nations, based on their economic classification, which will illuminate key takeaways that will allow for better pandemic management policies., Methods: A list of the most populated countries across each income slab was drawn up, and information on their vaccination campaigns was collected from national government portals and official health department websites of these countries in a structured manner. Data collected for the attributes was qualitatively described and converted into binary responses for quantitative analysis. ANOVA test, Chi-square test, and regression models were employed., Results: A consistent decreasing trend was noted in the percentage of the population vaccinated as the spectrum from higher-income countries to lower-income countries was traversed for all dose statuses. Fewer types of vaccines were available in the lower-income countries. Though compliance with the CDC vaccination strategies guide was largely noted, a linear regression univariate analysis of vaccination drive parameters carried out for single-dose vaccination yielded statistically significant results for medical provider vaccine standardization ( P -value = 0.002), vaccination requirements ( P -values <0.001), and provider recommendation. ( P -values <0.001) Vaccine hesitancy was not dependent on economic status., Conclusion: Concerted global initiatives like vaccine donation would assist efforts in mitigating disease spread. Prompt busting of baseless anti-vaccine narratives and strengthening healthcare infrastructure to meet national requirements should be given due importance., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Age-related differences in twist may be mitigated with exercise training, although this remains inconclusive. Moreover, temporal left ventricular (LV) systolic twist mechanics, including early-systolic (twist early ), and beyond peak twist (twist peak ) alone, have not been considered. Therefore, further insights are required to ascertain the influence of age and training status on twist mechanics across systole. Forty males were included and allocated into 1 of 4 groups based on age and training status: young recreationally active (Y RA , n = 9; 28 ± 5 years), old recreationally active (O RA , n = 10; 68 ± 6 years), young trained (Y T , n = 10; 27 ± 6 years), and old trained (O T , n = 11, 64 ± 4 years) groups. Two-dimensional speckle-tracking echocardiography was performed to determine LV twist mechanics, including twist early , twist peak , and total twist (twist total ), by considering the nadir on the twist time-curve during early systole. Twist total was calculated by subtracting twist early from their peak values. LV twist peak was higher in older than younger men ( p = 0.036), while twist peak was lower in the trained than recreationally-active ( p = 0.004). Twist peak is underestimated compared with twist total ( p < 0.001), and when early-systolic mechanics were considered, to calculate twist total , the age effect ( p = 0.186) was dampened. LV twist was higher in older than younger age, with lower twist in exercise-trained than recreationally-active males. Twist peak is underestimated when twist early is not considered, with novel observations demonstrating that the age effect was dampened when considering twist early . These findings elucidated a smaller age effect when early phases of systole are considered, while lower LV systolic mechanics were observed in older aged trained than recreationally-active males.

This study examined the relationships between the decision-making performances of soccer referees and markers of physiological load. Following baseline measurements and habituation procedures, 13 national-level male referees completed a novel Soccer Referee Simulation whilst simultaneously adjudicating on a series of video-based decision-making clips. The correctness of each decision was assessed in relation to the mean heart rate (HR), respiratory rate (RR), minute ventilation (VE), perceptions of breathlessness (RPE-B) and local muscular (RPE-M) exertion and running speeds recorded in the 10-s and 60-s preceding decisions. There was a significant association between decision-making accuracy and the mean HR (p = 0.042; V C  = 0.272) and RR (p = 0.024, V C  = 0.239) in the 10-s preceding decisions, with significantly more errors observed when HR ≥ 90% of HR max (OR, 5.39) and RR ≥ 80% of RR peak (OR, 3.34). Decision-making accuracy was also significantly associated with the mean running speeds performed in the 10-s (p = 0.003; V C  = 0.320) and 60-s (p = 0.016; V C  = 0.253) preceding decisions, with workloads of ≥250 m·min -1 associated with an increased occurrence of decisional errors (OR, 3.84). Finally, there was a significant association between decision-making accuracy and RPE-B (p = 0.021; V C  = 0.287), with a disproportionate number of errors occurring when RPE-B was rated as "very strong" to "maximal" (OR, 7.19). Collectively, the current data offer novel insights into the detrimental effects that high workloads may have upon the decision-making performances of soccer referees. Such information may be useful in designing combined physical and decision-making training programmes that prepare soccer referees for the periods of match play that prove most problematic to their decision-making., (© 2024 The Authors. European Journal of Sport Science published by Wiley‐VCH GmbH on behalf of European College of Sport Science.)

Introduction: This study evaluates feasibility of telemedicine to deliver diabetic care among different regions of the country., Materials and Methods: Medical interns affiliated with Rotaract Club of Medicrew (RCM) organized a Free Diabetes Screening Camp called " Diab-at-ease" at multiple sites across the country. Of all beneficiaries of the camp >18 years of age, patients previously diagnosed with diabetes and undiagnosed patients with a random blood sugar level of more than 200 mg/dL were interviewed regarding their knowledge, attitude, and practice regarding diabetes care and preparedness and vigilance to receiving care through telemedicine. Random blood sugar, height, weight, and waist circumference were also documented., Results: About 51.1% ( N = 223) of female patients aged 57.57 ± 13.84 years (>18 years) with body mass index (BMI) =26.11 ± 4.63 were the beneficiaries of the health camps. About 75.3% ( n = 168) of them were on oral hypoglycemic agents (OHAs), 15.7% ( n = 35) were on insulin preparations, and 59.6% ( n = 156) and 88.5% ( n = 31) of which were highly compliant with treatment, respectively. About 35% ( n = 78) and 43.9% ( n = 98) of them were unaware of their frequency of hypoglycemic and hyperglycemic episodes, respectively. About 64.6% ( n = 144) of the patients were equipped for receiving teleconsultation. Glucometer was only possessed by 51.6% (115) of which only 46.95% ( n = 54) can operate it independently. Only 80 patients (35.9%) were aware of the correct value of blood glucose levels., Conclusion: While a majority of the population is compliant with treatment and aware about diabetes self-care, they lack adequate knowledge and resource equipment for the same leading to very limited utilization., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Background: Pregnancy is associated with a number of physical, emotional, and biological changes that can exacerbate maternal psychological disturbances, such as body image concerns and depression. Sleep disturbances during pregnancy can also have adverse impacts. This study aimed to determine the prevalence of depression, sleep disturbances, and body image concerns among pregnant women. The study also examined the relationship between these factors and pregnancy-related variables, such as bad obstetric history and whether the pregnancies were unplanned., Methods: A cross-sectional study of 146 pregnant patients was conducted at a tertiary care center over 15 months. The patients were administered the Beck Depression Inventory, Pittsburgh Sleep Quality Index, and Body Image Concern Inventory questionnaires. Contingency tables, Fisher exact test, and Spearman correlation were used to identify underlying relationships., Results: The prevalence of depression was 22.6%. Although body image disturbance was noted in only 2.7% of patients, 46.6% had poor sleep quality. Poor sleep was associated with primigravida status. Bad obstetric history and unplanned pregnancy were associated with depression. Depression was found to be significantly correlated with body image disturbances and poor sleep quality., Conclusion: Psychiatric disorders were prevalent during pregnancy. This study highlights the importance of screening for depression in pregnant patients. Counselling and caregiver education can be useful for mitigating psychological disturbances. Management of pregnancies by multidisciplinary teams that include psychiatrists could be immensely useful in improving the pregnancy experiences of patients.

Evidence suggests a limited contribution to the total research output in leading obstetrics and gynaecology journals by researchers from the developing world. Editorial bias, quality of scientific research produced and language barriers have been attributed as possible causes for this phenomenon. The aim of this study was to understand the prevalence of editorial board members based out of low and lower-middle income countries in leading journals in the field of obstetrics and gynaecology. The top 21 journals in the field of obstetrics and gynaecology were selected based on their impact factor, SCImago ranking and literature search. The composition of the editorial boards of these journals was studied based on World Bank Income Criteria to understand the representation status of researchers from low and lower-middle income countries. A total of 1315 board members make up the editorial composition of leading obstetrics and gynaecology journals. The majority of these editors belong to high-income countries ( n  = 1148; 87.3%). Low ( n  = 6; 0.45%) and lower-middle income ( n  = 55; 4.18%) countries make up for a very minuscule proportion of editorial board members. Only a meagre 9 out of 21 journals have editorial board members from these countries (42.85%). Low and low-middle countries have poor representation in the editorial boards of leading obstetrics and gynaecology journals. Poor representation in research from these countries has grave consequences for a large proportion of the global population and multidisciplinary collaborative efforts must be taken to rapidly change this statistic with immediate effect., Competing Interests: Competing InterestsThe authors declare no competing interests., (© National University of Singapore and Springer Nature Singapore Pte Ltd. 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

There is an increase in the prevalence of elite youth sports academies, whose sole aim is to develop future elite athletes. This involves the exposure of the child and adolescent athlete to high-volume training during a period of volatile growth. The large amount of data in this area has been garnered from the resting echocardiographic left ventricular (LV) evaluation of the youth athlete; while this can provide some insight on the functional adaptations to training, it is unable to elucidate a comprehensive overview of the function of the youth athletes' LV during exercise. Consequently, there is a need to interrogate the LV responses in-exercise. This review outlines the feasibility and functional insight of capturing global indices of LV function (Stroke Index-SVIndex and Cardiac Index-QIndex), systolic and diastolic markers, and cardiac strain during submaximal and maximal exercise. Larger SVI and QI were noted in these highly trained young athletes compared to recreationally active peers during submaximal and maximal exercise. The mechanistic insights suggest that there are minimal functional systolic adaptions during exercise compared to their recreationally active peers. Diastolic function was superior during exercise in these young athletes, and this appears to be underpinned by enhanced determinants of pre-load.

Background: Patients of thalassemia major require frequent hospitalization. Caregivers are more affected than the patient themselves as they better appreciate the magnitude of illness and treatment, resulting in increased risks for psychiatric illness., Aims and Objectives: The purpose of the study was to assess the prevalence of psychiatric morbidity in the caregivers of patients with thalassemia major. The study also examined the quality of life of the caregivers, their coping strategies, and its association with sociodemographic variables., Methodology: A cross-sectional study with 100 caregivers, recruited by convenience sampling technique, attending the thalassemia daycare center, was carried out over 12 months in a tertiary care hospital. They were administered a semistructured proforma along with General Health Questionnaire 12 (GHQ 12), WHO-Quality of Life-BREF (WHO-QOL-BREF), and Coping Inventory for Stressful Situations 21 scale. The GHQ 12 was used for screening and those scoring three or more underwent a clinical psychiatric interview. Those who were diagnosed with psychopathology were ascribed diagnosis as per ICD-10. Descriptive analysis was done. Associations were studied using Fischer's exact test. Comparison of quality of life with blood transfusion variables was done using Mann-Whitney U test., Results: The prevalence of psychiatric morbidity amongst the caregivers was found to be 35% with depressive episode (22%) being the most common. Psychiatric morbidity was found to have a significant association with both, the frequency (P = 0.037) and total number of blood transfusions (P = 0.012). Coping was found to have a strong association with psychiatric morbidity (P = 0.001) and employment (P = 0.009)., Conclusions: Caregivers of children with thalassemia major face psychological burden like depression or anxiety, for which treatment is not sought. Improved psychological health of the caregivers will ensure better care of the child and guarantee better adherence to the treatment.

Considering the perceived benefit of early recruitment and the time and resources spent developing youth players, individuals released from talent development programmes are often re-recruited by rival academies. However, due to the contractual nature of many talent development programmes, limited empirical data exists on players deselected from (or reselected to) youth soccer academies. Adopting a novel case study approach, differences in skill, psychological, and physical attributes associated with reselection following closure of a junior-elite soccer academy were explored. Overall subjective coach ratings for skill, psychological, and physical abilities; subjective coach ratings for skill and psychological attributes; and physical fitness test performance of 79 junior-elite soccer players (U11-U17) were assessed as part of regular scheduled testing and monitoring practices prior to the academy closure. Reselection status was monitored and recorded for all players in the 6 months following the academy closure and was classified as a persistence/progression ("Reselected") or attrition ("Deselected") in playing level. Of the 79 released players, a total of 60 players (76%) were re-signed to a junior-elite academy within 6 months. Differences were observed for overall ratings of skill, psychological, and physical abilities in favor of the "Reselected" player group. "Reselected" players were also rated higher by coaches for all attributes categorized as skill and psychological, as well as performing better at all physical fitness tests. However, "Reselected" players were lesser in stature and body mass and less mature than "Deselected" players. Our findings suggest that reselection is not a product of anthropometric criteria and, therefore, a pathway for selection remains open for later maturing players. We also inform upon desirable qualities associated with player reselection and provide a case study approach of a unique, yet highly relevant, scenario for talent identification and development in youth soccer., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Dugdale, McRobert and Unnithan.)

Significant structural, developmental, and financial constraints exist in Scottish soccer that may predicate a different approach to talent identification and development. To our knowledge, no published reports exist evaluating the prevalence of the relative age effect (RAE) in Scottish soccer players. Consequently, the aim of this study was to investigate the prevalence of the RAE among varied playing levels and ages of male Scottish youth soccer players. Birthdates of male youth players ( n = 1,230) from U10 to U17 age groups and from playing levels: "Amateur" ( n = 482), "Development" ( n = 214), and "Performance" ( n = 534), alongside a group of male Scottish senior professional players ( n = 261) were recorded and categorized into quartiles (Q1 = January-March; Q2 = April-June; Q3 = July-September; and Q4 = October-December) and semesters (S1 = January-June and S2 = July-December) from the start of the selection year. Birthdates were analyzed for: (a) each playing level and (b) each age group irrespective of playing level. For the varied playing levels examined, an RAE was evident in "Development" and "Performance" playing levels only at youth level. When examining each age group, an RAE was observed in U12-U17 players only. While there was a slight asymmetry favoring Q1 born senior professional players, the RAE was not present within this group of our sample. Results from our study suggest that a bias in selecting individuals born earlier in the selection year may exist within male soccer academy structures, but not at amateur level. The asymmetry favoring chronologically older players at youth but not professional level questions the efficacy of this (un)conscious bias within male Scottish soccer players., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Dugdale, McRobert and Unnithan.)

Introduction: Burns is one of the foremost causes of worldwide morbidity. Changes in appearance and functional impairment causes stigmatisation, impacting socio-occupational engagement and causing discomfort., Aims and Objectives: The study examined prevalence of psychiatric morbidity in post-burn patients, their perceived social support and self-esteem. It further assessed quality of life amongst post-burn patients., Materials and Methods: A cross-sectional study was performed in a tertiary care centre where 100 patients were interviewed using purposive sampling technique over six months. Patients were administered a semi-structured questionnaire along with Mini International Neuropsychiatric Interview (MINI), Rosenberg's Self-Esteem Scale (RSES), Multidimensional Scale of Perceived Social Support (MSPSS) and WHO Quality Of Life - BREF (WHOQOL- BREF) scales. Contingency tables and Spearman's correlation helped to examine associations and correlations. Fischer's exact test, Mann Whitney test and ANOVA test were also used for statistical analysis., Results and Discussion: There is high prevalence of psychiatric morbidity among patients with burns. The most common disorder was major depressive episode. Low self-esteem was found in one-third of patients with burns. Patients having low self-esteem had eleven times higher prevalence of suicidality. Patients with burns had high perceived social support. Quality of life in patients with burns depends on self-esteem, perceived social support and presence of psychiatric illnesses., Conclusion: This study illustrates the need for thorough evaluation and screening in patients with burns for psychopathology and self-esteem issues by primary physicians. Behaviour therapy, supportive psychotherapy, counselling and adequate socio-occupational rehabilitation of the patient should be done. Spreading awareness and organising support groups for patients with burns at the primary health centre level can be effective., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family Medicine and Primary Care.)

Purpose: This study aimed to inform the energy requirements of highly trained adolescent soccer players. Total energy expenditure (TEE) was quantified in academy soccer players from the English Premier League (EPL)., Methods: Twenty-four male adolescent soccer players from an EPL academy (under (U) 12/13 (U12/13), n = 8; U15, n = 8; U18, n = 8) were assessed for baseline maturity (maturity offset), body composition (dual-energy x-ray absorptiometry), and resting metabolic rate (indirect calorimetry). Subsequently, TEE, energy intake (EI) and physical loading patterns were assessed over a 14-d in-season period using doubly labeled water, the remote food photographic method, and global positioning system technology, respectively., Results: U18 players presented with greater resting metabolic rate (2236 ± 93 kcal·d) and TEE (3586 ± 487 kcal·d; range, 2542-5172 kcal·d) than did both U15 (2023 ± 162 and 3029 ± 262 kcal·d, respectively; TEE range, 2738-3726 kcal·d) and U12/13 players (1892 ± 211 and 2859 ± 265 kcal·d, respectively; TEE range, 2275-3903 kcal·d; all, P < 0.01), although no difference in TEE was apparent between the U12/13 and U15 age groups. Fat-free mass was significantly different between all comparisons in a hierarchal manner (U18: 57.2 ± 6.1 kg > U15: 42.9 ± 5.8 kg > U12/13: 31.1 ± 3.5 kg; all, P < 0.01). Within age groups, no differences were apparent between EI and TEE (U12/13: -29 ± 277 kcal·d, P = 0.78; U15: -134 ± 327 kcal·d, P = 0.28; U18: -243 ± 724 kcal·d, P = 0.37), whereas U18 players (3180 ± 279 kcal·d) reported higher EI than did both U15 (2821 ± 338 kcal·d; P = 0.05) and U12/13 players (2659 ± 187 kcal·d; P < 0.01)., Conclusions: The TEE of male academy soccer players progressively increase as players progress through the academy age groups. In some individuals (evident in all age groups), TEE was greater than that previously observed in adult EPL soccer players.

Background and Aim: Physical frailty has been regarded as a precursor state to disability and dependence on others for daily activities. Frail individuals are considered to be the group of patients that presents the most complex and challenging problems to health care professionals. The purpose of this study was to evaluate whether a 12-week functional circuit training program (FCT) could reduce self-reported fear of falling and improve health status in a group of physically frail community-dwelling older individuals., Methods: Fifty-one individuals (31 F, 20 M), mean age (SD) 84 (2.9) years old, were considered frail and tested at week 0 and randomly assigned into two groups (intervention group, FCT = 26; control group, CG = 25). FCT underwent a structured 12-week FCT program, which focused on a combination of functional balance and lower-body strength-based exercises. CG met once a week for health education meetings. Measures of self-reported fear of falling (Activities-specific Balance Confidence scale) and health status (SF-12) were assessed at week 0, 12 and 36. All longitudinal analyses for continuous variables that were measured at the three time points (week 0, 12 and 36) were performed using linear mixed modeling., Results: FCT participants had greater improvements than those in the CG in fear of falling and self-reported physical function, physical composite score and mental composite score; these improvements were maintained in the week 36 follow-up, with significant group-by-time interactions by the end of the study., Conclusions: These data indicate that a FCT program is effective in improving self-reported measures of fear of falling and health status in a group of physically frail individuals.

Objective: To compare the phase II oxygen uptake time constant (τV'O(2)) and V'O(2) mean response time (V'O(2)MRT) in overweight (OW) and non-OW (NO) children during moderate intensity exercise., Design: Between subjects where participants completed a maximal ramp exercise test on an electromagnetically braked cycle ergometer to determine peak V'O(2) (V'O(2peak)) and gas exchange threshold (GET). Gas exchange was measured breath-by-breath using a mass spectrometer. On subsequent visits, 6 square-wave transitions (2 per day) from 0 W to 90% GET were completed. Individual phase II τV'O(2) and V'O(2)MRTs were estimated from time aligned average V'O(2) traces., Subjects: Eleven OW (11.8±0.4 years) and 12 NO (11.9±0.4 years) children were recruited to the study. The OW group was significantly heavier (62.9±9.7 vs 39.4±5.8 kg, P<0.001), taller (1.58±0.05 vs 1.47±0.07 m, P<0.001) and had a higher body mass index (25.8±3.4 vs 18.3±1.8 kg m(-2), P<0.001)., Results: Both τV'O(2) (30.2±9.6 vs 22.8±7.1 s, P<0.05) and V'O(2)MRT (43.5±10.7 vs 36.3±5.3 s, P<0.05) were significantly slower in OW compared with NO children; absolute V'O(2peak) was higher in the OW compared with NO group (2.23±0.04 vs 1.74±0.04 l min(-1), P<0.05); mass relative V'O(2peak) was lower in OW compared with NO children (35.9±8.3 vs 43.8±6.2 ml kg(-1) min(-1), P<0.05); allometrically scaled V'O(2peak) was similar between OW and NO groups whether relative to body mass(0.67) (139.8±29.1 vs 147.2±23.9 ml kg(-67) min(-1)) or stature(3) (576.0±87.2 vs 544.9±84.9 ml m(-3) min(-1)) (P>0.05); absolute V'O(2) at GET was similar between OW and NO groups (0.94±0.24 vs 0.78±0.27 l min(-1), P>0.05); GET expressed as percentage of V'O(2peak) was similar between the groups (42.0±0.1 vs 44.8±0.1%, P>0.05)., Conclusion: These findings demonstrate impairment in the factors determining V'O(2) kinetics in OW children at a relatively young age. Furthermore, assessment of cardiorespiratory fitness using peak exercise values is likely to be misleading and not useful when designing exercise programmes for OW children.

Background: Inspiratory muscle training (IMT) has been shown to improve inspiratory muscle function, lung volumes (vital capacity [VC] and total lung capacity [TLC]), work capacity, and power output in people who are healthy; however, no data exist that demonstrate the effect of varying intensities of IMT to produce these outcomes., Objectives: The purpose of this study was to evaluate the impact of IMT at varying intensities on inspiratory muscle function, VC, TLC, work capacity, and power output in people who are healthy., Design: This was a randomized controlled trial., Setting: The study was conducted in a clinical laboratory., Participants: Forty people who were healthy (mean age=21.7 years) were randomly assigned to 4 groups of 10 individuals., Interventions: Three of the groups completed an 8-week program of IMT set at 80%, 60%, and 40% of sustained maximum inspiratory effort. Training was performed 3 days per week, with 24 hours separating training sessions. A control group did not participate in any form of training., Measurements: Baseline and posttraining measurements of body composition, VC, TLC, inspiratory muscle function (including maximum inspiratory pressure [MIP] and sustained maximum inspiratory pressure [SMIP]), work capacity (minutes of exercise), and power output were obtained., Results: The participants in the 80%, 60%, and 40% training groups demonstrated significant increases in MIP and SMIP, whereas those in the 80% and 60% training groups had increased work capacity and power output. Only the 80% group improved their VC and TLC. The control group demonstrated no change in any outcome measures., Limitations: This study may have been underpowered to demonstrate improved work capacity and power output in individuals who trained at 40% of sustained maximum inspiratory effort., Conclusion: High-intensity IMT set at 80% of maximal effort resulted in increased MIP and SMIP, lung volumes, work capacity, and power output in individuals who were healthy, whereas IMT at 60% of maximal effort increased work capacity and power output only. Inspiratory muscle training intensities lower than 40% of maximal effort do not translate into quantitative functional outcomes.

Unlabelled: Exercise training results in a speeding of pulmonary oxygen uptake (VO2) kinetics at the onset of exercise in adults; however, only limited research has been conducted with children and adolescents., Purpose: The aim of the present study was to examine VO2 and muscle deoxygenation kinetics in trained and untrained male adolescents., Methods: Sixteen trained (15 +/- 0.8 yr, VO2peak = 54.7 +/- 6.2 mL x kg-1 x min-1, self-assessed Tanner stage range 2-4) and nine untrained (15 +/- 0.6 yr, VO2peak = 43.1 +/- 5.2 mL x kg-1 x min-1, Tanner stage range 2-4) male adolescents performed two 6-min exercise transitions from a 3-min baseline of 10 W to a workload equivalent to 80% lactate threshold separated by a minimum of 1 h of passive rest. Oxygen uptake (breath-by-breath) and muscle deoxygenation (deoxyhemoglobin signal from near-infrared spectroscopy) were measured continuously throughout baseline and exercise transition., Results: The time constant of the fundamental phase of VO2 kinetics was significantly faster in trained versus untrained subjects (trained: 22.3 +/- 7.2 s vs untrained: 29.8 +/- 8.4 s, P = 0.03). In contrast, neither the time constant (trained: 9.7 +/- 2.9 s vs untrained: 10.1 +/- 3.4 s, P = 0.78) nor the mean response time (trained: 17.4 +/- 2.5 s vs untrained: 18.3 +/- 2.3 s, P = 0.39) of muscle deoxygenation kinetics differed with training status., Conclusions: The present data suggest that exercise training results in faster VO2 kinetics in male adolescents, although inherent capabilities cannot be ruled out. Because muscle deoxygenation kinetics were unchanged, it is likely that faster VO2 kinetics were due to adaptations to both the cardiovascular system and the peripheral musculature.

Purpose: The extent that enhanced ventricular function contributes to superior aerobic fitness of trained athletes is unclear. This study compared cardiovascular responses to progressive cycle exercise in 12 adolescent soccer players and 10 untrained boys with assessment of ventricular inotropic and relaxation properties by Doppler ultrasound techniques., Methods: Resting cardiac dimensions were measured by M-mode echocardiography. Stroke volume was estimated by the Doppler technique, and systolic function by peak aortic flow velocity and ejection flow rate. Diastolic transmitral pressure gradient was assessed by pulse wave peak E-wave velocity, ventricular relaxation properties by tissue Doppler imaging (E' velocity, adjusted for ventricular size), and ventricular filling pressure by E/E' ratio., Results: Size-adjusted cardiac dimensions were significantly greater in the athletes. Peak V O2 values for the athletes and nonathletes were 57.4 +/- 4.8 and 44.4 +/- 6.6 mL.kg.min, respectively. Maximal cardiac index and stroke index were greater in the athletes (11.10+/- 1.52 vs 9.02 +/- 2.05 L.min.m; 59 +/- 8 vs 46 +/- 10 mL.m). Athletes and nonathletes demonstrated similar maximal peak aortic velocity (231 +/- 20 and 208 +/- 45 cm.s, respectively) and ejection rate (13.3 +/- 1.0 and 12.5 +/- 2.8 mL.s.cm x 10, respectively). No significant group differences were observed in Emax (155 +/- 17 and 149 +/- 23 cm.s for athletes and nonathletes, respectively), adjusted E'max (5.9 +/- 1.2 and 5.8 +/- 1.2 cm.s.mm for athletes and nonathletes, respectively), and E/E'max (265 +/- 40 and 262 +/- 56 for athletes and nonathletes, respectively)., Conclusions: This study revealed no differences between young trained athletes and nonathletes in myocardial functional responses to progressive exercise, implying that greater aerobic fitness in these athletes reflected volume expansion of the cardiovascular system without contribution of enhanced systolic or diastolic ventricular function. Such findings should be considered limited to the context of young athletes with limited duration of athletic training.

Background: Weight loss and loss of fat-free mass (FFM) are associated with peripheral muscle wasting in cystic fibrosis (CF) although whether this co-exists with loss of diaphragm mass remains unclear., Methods: FFM was determined by dual-energy X-ray absorptiometry and bioelectrical impedance in 40 adults with CF and 30 age-matched healthy subjects (HS). Diaphragm thickness at functional residual capacity (FRC) [TDIrel] and total lung capacity (TLC) [TDIcont] and thickening ratio (TR) were assessed by ultrasonography. Inspiratory muscle strength and work capacity were determined by maximal inspiratory pressure (PImax), and sustained PImax (SPImax); pulmonary function (RV, VC and TLC) and physical activity status (PAS) were also determined., Results: When the CF patients were assessed as a group (low and normal FFM) they had similar age, weight, height and PAS compared to the HS, although patients had lower FFM (p<0.05), VC and TLC than the HS (p<0.01). In addition, although PImax, TDIrel, TDIcont and TR were similar between the patients and the HS, SPImax was lower in the patients (p<0.01). When analyses were made between patients with low versus normal FFM and between patients with low FFM and HS no significant differences were found between overall weight although TDIrel, TDIcont, TR and PAS were all reduced in patients with low FFM (p<0.01)., Conclusions: PImax is relatively well preserved in adults with CF although there is a relationship between the loss of inspiratory muscle work capacity, FFM, PAS and pulmonary function. Furthermore loss of FFM is associated with loss of diaphragm muscle mass.

Objective: Obesity has been proposed to negatively impact cardiac function in overweight (OW) individuals. The relationship between diastolic dysfunction and oxygen uptake (Vo(2)) kinetics is equivocal. This exploratory investigation evaluated the relationship between resting left ventricular function and Vo(2) kinetics during cycle ergometry in OW and non-overweight (NO) children and adolescents., Research Methods and Procedures: Fourteen OW (>85 percentile for BMI for age and gender) children, 10 boys and 4 girls (age, 11.7 +/- 1.9 years; body mass, 80.6 +/- 45.5 kg) and 10 NO children (4 boys, 6 girls) volunteered to participate in the study (age, 12.5 +/- 2.1 years; body mass, 45.8 +/- 13.8 kg). Resting cardiovascular structure and function were assessed using spectral Doppler echocardiography. All subjects underwent two sub-maximal exercise stages on a cycle ergometer (3 minutes unloaded and 5 minutes at 50 W, both at a cadence of 50 rpm). Respiratory data were measured on a breath-by-breath basis at both workloads and the mean response time (MRT) was calculated., Results: Analysis of the MRT data demonstrated that there were no significant differences between OW and NO (OW, 52.6 +/- 11.7 seconds vs. NO, 45.6 +/- 7.4 seconds). Significant correlations (p < 0.05) were obtained between MRT Vo(2) and echocardiographic-derived mitral valve inflow pressure half-time (r = 0.55) and between MRT Vo(2), and mitral valve inflow deceleration time (r = 0.55)., Discussion: The evidence from this research suggests a possible link between left ventricular diastolic function at rest and oxygen uptake kinetics during sub-maximal exercise in OW and NO children and adolescents.

Purpose: The aim of this study was to evaluate the effectiveness of a strength and aerobic interval training program on arm-cranking economy, aerobic capacity, and gross motor function in children and adolescents with spastic diplegic cerebral palsy (CP)., Methods: Seven subjects (five females, two males; mean age 15.9, range 14-18 yr) participated in a 12-wk aerobic interval and strength training program, three times per week, 70 min per session. The aerobic interval training required the subjects to perform 60-m uphill walking repetitions. Six individuals (four females, two males; mean age 15.7, range 14-17 yr) who did not receive the training program served as controls. Pre- and postexercise tests were performed to assess changes in arm-cranking economy, aerobic capacity, and gross motor function., Results: The results demonstrated significant (P < 0.05) reductions in the oxygen cost of arm cranking (mean +/- SD: pre: 13.2 +/- 3.22 mL x kg(-1) x min(-1), post: 12.7 +/- 3.38 mL x kg(-1) x min(-1)) and %VO2peak (pre: 75.8 +/- 3.55%, post: 61.8 +/- 7.47%) in the training group. Significant (P < 0.05) increases in aerobic capacity (pre: 17.5 +/- 4.45 mL x kg(-1) x min(-1), post: 20.8 +/- 5.93 mL x kg(-1) x min(-1)) were also noted for the training group. Significant (P < 0.05) improvements in gross motor function measures were also noted in the training group (pre: 30.35%, post: 33.85%)., Conclusion: These findings demonstrate that the application of a 12-wk strength and aerobic interval training program reduced the oxygen cost of arm cranking, improved aerobic capacity, and improved gross motor function in children and adolescents with CP.

Purpose: To evaluate the effect of maturity status on the autonomic nervous system at rest and recovery after short-term, high-intensity exercise in adolescents., Methods: A biological maturity age was estimated in 27 males by calculating the years from peak height velocity (PHV) using a multiple regression equation. Subjects were divided into two groups: pre-PHV (years from PHV < 0.49), N = 14, mean age = 12.29 +/- 0.91 yr; post-PHV (years from PHV > 0.5, N = 13, mean age = 15.12 +/-0.76 yr). HR variability was used to evaluate autonomic function. ECG tracings were collected during 5 min at rest and recovery after a Wingate test and were analyzed in the frequency domain (low-frequency (LF), high-frequency (HF), LF/HF, total power (TP)). Data are presented as natural logarithms (LN)., Results: Changes in HR from HR(peak) during exercise to HR measured at minute 4 after exercise ([DELTA]HR4) were significantly greater in the pre-PHV group (84.31 +/-17.58 bpm) compared with the post-PHV group (69.42 +/-17.63 bpm). There were no significant differences in resting HR variability between pre- and post-PHV groups (P > 0.05). Significant group x time interactions were found for LF(LN) (ms(2)) and TP(LN) (ms(2)) measured during recovery (P < 0.05). Post hoc tests showed that the pre-PHV group had significantly higher postexercise LF(LN) (5.02 +/- 0.97 vs 4.19 +/- 0.79) and TP(LN) (6.36 +/- 1.02 vs 5.62 +/- 0.65) compared with the post-PHV group. When postexercise LF(LN) (ms(2)) was normalized for TP(LN) (ms(2)), there were no significant differences between groups (P > 0.05)., Conclusion: The pre-PHV group had higher total HR variability than the post-PHV group after a Wingate test, suggesting that maturity status significantly affects total HR variability during recovery after high-intensity exercise.

Background and Purpose: Previous investigations have demonstrated that a regimen of high-intensity inspiratory muscle training (IMT) resulted in changes in ventilatory function and exercise capacity in patients with chronic lung disease, although the effect of high-intensity IMT in subjects who are healthy is yet to be determined. The purpose of this study, therefore, was to examine whether high-intensity IMT resulted in changes in ventilatory function and exercise capacity in subjects who were healthy., Subjects: Twenty subjects were randomly assigned to 2 groups., Methods: The training group completed an 8-week program of IMT set at 80% of maximal effort. The control group did not participate in any form of training. Baseline and posttraining measures of body composition, pulmonary function, inspiratory muscle function (including maximal and sustained maximal inspiratory pressures [MIP and SMIP]), relaxed and contracted diaphragm thickness and thickening ratio (Tdi.rel, Tdi.cont, and TR), and exercise capacity were determined., Results: The training group demonstrated significant increases in MIP, SMIP, Tdi.cont, TR, VC, total lung capacity, and exercise capacity compared with the control group, which demonstrated no change from baseline measurements at 8 weeks., Discussion and Conclusion: The findings of this study suggest that high-intensity IMT results in increased contracted diaphragm thickness and increased lung volumes and exercise capacity in people who are healthy.

Objectives: A matched case-control study was carried out to evaluate biological risk indicators for recurrent non-specific low back pain in adolescents., Methods: Adolescents with recurrent non-specific low back pain (symptomatic; n = 28; mean (SD) age 14.9 (0.7) years) and matched controls (asymptomatic; n = 28; age 14.9 (0.7) years) with no history of non-specific low back pain participated. Measures of stature, mass, sitting height, sexual maturity (Tanner self assessment), lateral flexion of the spine, lumbar sagittal plane mobility (modified Schober), hip range of motion (Leighton flexometer), back and hamstring flexibility (sit and reach), and trunk muscle endurance (number of sit ups) were performed using standardised procedures with established reliability. Backward stepwise logistic regression analysis was performed, with the presence/absence of recurrent low back pain as the dependent variable and the biological measures as the independent variables., Results: Hip range of motion, trunk muscle endurance, lumbar sagittal plane mobility, and lateral flexion of the spine were identified as significant risk indicators of recurrent low back pain (p<0.05). Follow up analysis indicated that symptomatic subjects had significantly reduced lateral flexion of the spine, lumbar sagittal plane mobility, and trunk muscle endurance (p<0.05)., Conclusions: Hip range of motion, abdominal muscle endurance, lumbar flexibility, and lateral flexion of the spine were risk indicators for recurrent non-specific low back pain in a group of adolescents. These risk indicators identify the potential for exercise as a primary or secondary prevention method.

A paucity of literature exists with regard to research on nutrition for the pediatric athlete. This lack of research makes the development of specific nutritional recommendations for young athletes problematic. This issue is made difficult by the macro- and micronutrient intake required for growth and development in conjunction with that required for sports. Exogenous carbohydrate drinks could be considered for the young athlete engaged in both endurance exercise and high-intensity exercise. Monitoring of the energy intake during resistance training in the pediatric athlete needs to be considered, as there is evidence to suggest that energy deficits may occur. If decrements in exercise performance are noted, then serum ferritin and hemoglobin concentrations should be monitored, as nonanemic iron deficiency is prevalent in the pediatric athlete. The pediatric athlete exercising in the heat is susceptible to voluntary dehydration and evidence exists to suggest that a carbohydrate-electrolyte drink will abolish this phenomenon.

The aim of this investigation was to provide evidence of the prevalence and consequences of recurrent low-back pain in children from Northwest England. A cross-sectional survey was conducted involving a standardized questionnaire with established reliability and validity. A cross-sectional sample of 500 boys (n = 249) and girls (n = 251) aged between 10 and 16 years participated in the study. Average lifetime prevalence of low-back pain was 40.2% [95% confidence interval (CI) = 38.7-41.6]. Most cases of low-back pain were acute episodes that did not lead to disabling consequences. In contrast, 13.1% (95% CI = 12.5-13.7) experienced recurrent low-back pain that led to disabling consequences; 23.1% visited a medical practitioner, 30.8% experienced loss of physical activity/sports and 26.2% had been absent from school because of low-back pain. Recurrent low-back pain was particularly evident during late adolescence where one in five children were cases. The health education implications of low-back pain in children are discussed. It was concluded that low-back pain is a common complaint during childhood, although most cases are acute episodes that represent little health consequence. In contrast, some children experience recurrent low-back pain that can lead to disabling consequences. Future research should focus on recurrent low-back pain cases since they often led to disabling consequences.

Liver transplantation is accepted as the standard management for end-stage liver disease in children. Pediatric heart and heart-lung transplant recipients have shown significantly diminished exercise capacities compared with age-matched, able-bodied, control subjects. The primary aim of this study is to compare the fitness levels of a group of pediatric liver transplant (LT) recipients (LT group, 20 boys, 9 girls; age, 8.9 +/- 4.8 years; 56 +/- 35 months posttransplantation) with a group of able-bodied control subjects (22 boys, 12 girls; age, 8.4 +/- 3.8 years). The secondary aim is to compare the performance of the LT group against the Fitnessgram criterion standards. We assessed muscular endurance by means of a partial curl-up, flexibility by means of the back-saver sit and reach, and cardiorespiratory fitness by means of the progressive aerobic cardiovascular endurance run (PACER). The only significant (P <.05) difference between the 2 groups was the number of shuttles run in the PACER (control, 16.8 +/- 9.8 v LT, 11.5 +/- 8.4 shuttles). Other differences between the 2 groups were not significant. With regard to satisfying the Fitnessgram criterion standards, only 35% of the LT group achieved the standards for the partial curl-up, 88% of the LT group achieved the criterion standards for flexibility, and 0% achieved the standards for the PACER. These results indicate that the LT group has diminished exercise capacity. The origins of exercise limitations deserve further investigation.

With the increased use of oxygen consumption measurements in clinical and sporting studies, measurement variability has become more important to both the paediatric clinician and the sports scientist. In this study we assessed the reproducibility of cardiorespiratory measurements during submaximal and maximal running in children. Ten healthy, physically active boys (mean(s.d.) age 10.7(0.71) years) performed two submaximal and two maximal running tests within a 4 week period. The submaximal protocol consisted of three 6 minute runs at 7.2, 8.0 and 8.8 km/h. Every attempt was made to minimize the sources of non-biological variability at each testing session. During submaximal exercise, oxygen consumption (VO2), heart rate (HR) and fractional utilization appeared to be the most reliable measures accounting for over two-thirds of the total variation (coefficients of reliability (CR) of 68%, 94% and 82% respectively). Ventilation (Ve) and respiratory exchange ratio (RER) proved to be only moderately reliable accounting for less than half of the total variation (CR 50% and 45% respectively). At maximal exercise, VO2, Ve and time to exhaustion were most reliable, accounting for approximately two-thirds of the total variation (CR 65%, 63% and 63% respectively). Within this test environment, a two visit submaximal assessment was capable of estimating VO2 with a standard error of +/- 1.25 ml/kg/min. Similarly, for maximal testing a two visit assessment estimated peak VO2 with a standard error of +/- 2.28 ml/kg/min. On the evidence of these results a two visit assessment for submaximal and maximal exercise testing seems adequate to estimate the stability of submaximal cardiorespiratory measures and peak VO2 in healthy, normally active boys.