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Development of 'rural week' for medical students: impact and quality report.

INTRODUCTION: The Rural Undergraduate Support and Coordination program funds medical schools to provide all medical students some time in rural Australia throughout their course. The University of Adelaide has developed a rural week program for both first and second year students to fulfill part of this objective. METHODS: First year students' rural week is an introduction to a range of rural health issues, Indigenous culture and rural lifestyle issues. Second year students choose either a clinical rural week with a general practitioner or a week of Indigenous cultural learning with the Adnyamathanha people in the Flinders ranges, South Australia. Evaluation data were collected from students, practitioners and university staff during rural weeks in 2003 and 2004 using quantitative and qualitative methods. RESULTS: First year students increased their knowledge of and interest in rural medicine and enjoyed their (limited) clinical interaction with patients. Second year students appreciated the clinical experience and valued the welcome they received from doctors and practice staff. Those who chose Indigenous cultural programs appreciated the opportunity to interact with and learn from Indigenous people. General practitioners valued contributing to student knowledge and skills and the opportunity to promote rural practice. Volunteer community members were very enthusiastic about meeting the students and their generosity had a significant impact on the students' ideas about rural lifestyle. University academic and administrative staff found rural week very intensive work but experience and thorough preparation now ensures that few problems occur. CONCLUSION: Rural weeks are now an established part of the first year and second year curriculum at the University of Adelaide Medical School. The ability to provide small groups of students with an intense introduction to rural practice and/or Indigenous culture results in a positive change in opinion about this aspect of medical education. Students now have first-hand experience to positively influence their choice of rural education or Indigenous health options in the medical course. Problems do occur with students being away from the traditional classroom, and protocols have been put in place for behaviour of all parties. Despite the rural weeks program being very demanding on staff energy, financial resources, general practices and rural communities, we feel that this program is valuable and sustainable. Further experience will determine if rural weeks function effectively as a recruitment strategy for the long rural placements offered by the Rural Clinical School.

Attitude of Health Personnel↗

[Arginine aspartate and muscular activity. II].

We measured the effect of a 4-weeks treatment with arginine aspartate on 21 athletes. By a double blind methodology, we were able to show that the treatment group had an enhanced maximal oxygen consumption as well as a significantly decreased plasma lactate concentration at a work intensity of 200, 300 and 400 W on the treadmill. By the same token, 5 and 20 minutes after completion of the test run, blood lactate levels were significantly lower in the group receiving arginine aspartate. Nevertheless, at the 4 mmol lactate threshold, power and total work output were the same for both controls and treatment groups. These results show a favourable effect of arginine aspartate on blood lactate levels.

Adult↗

Plasma testosterone during treadmill exercise.

Five male volunteers performed 20 min of steady-state submaximal exercise on a motor-driven treadmill at five intensities (30, 45, 60, 75, and 90% VO2 max) as well as several maximal aerobic capacity tests. Peripheral venous plasma testosterone concentrations increased above resting values in proportion to exercise intensity. However, this increase in plasma testosterone concentration was virtually equal in magnitude to the decrease in plasma volume observed consequent to the exercise bouts, resulting in no change in total testosterone contents. There was an unexpected anticipatory elevation in resting preexercise control testosterone concentration and content with increasing work intensity. The possibility that testosterone has a direct role in the organism's response to whole-body exercise is questioned.

Adult↗

[The use of antiadhesins--a new prospective trend in preventing and treating infectious diseases (a foundation for the technologies for creating drugs in the 21st century)].

The state and prospects of research on creation of antiadhesins--new generation drugs for preventing and treatment of infectious diseases, are analyzed in the paper. The elaboration of such drugs is based on the profound knowledge about the nature of viral, bacterial, fungal and other infectious agents of diseases, molecular mechanisms of their interactions with the affected organs and tissues which are based on the processes of carbohydrate-protein recognizing. Rapid development of such fields of science as glycobiology and lectinology has created the preconditions for artificial synthesis of oligosaccharides which mimicked the receptors and can interact with adhesive structures of the disease agents more intensively than their natural analogs and block them. This makes the interaction of the latter with the affected organs impossible. The intensive work on elaboration of natural drugs: antiadhesins, is carried out in most countries. Adhesins are not harmful for people and cannot provoke the development of resistance to them in the disease agents. Till recently Ukraine belonged to the number of countries where the fields of science mentioned above were intensively developed but, in connection with the present stagnation of science and even the artificial hindering of its development, the country gradually losses the position of a leader. Hence, one can conclude that when 10-15 years later the market of pharmaceutical products will be filled with antiadhesins, our country will not be on the list of their producers, if the authorities will spend funds to buy foreign drugs as before instead of stimulating the development and production of the home ones.

Adhesins, Bacterial↗

Influence of muscle temperature during fatiguing work with the first dorsal interosseous muscle in man: a 31P-NMR spectroscopy study.

Six healthy subjects rapidly lifted and lowered a small (250 g) weight with the first dorsal interosseous muscle (FDI) of one hand while the work performed was recorded continuously until fatigue (defined as losing the ability to continue lifting). Work was recorded in units of chart recorder trace displacement from baseline (centimeters) as an isotonic transducer followed the movement of the weight. In all experiments, the temperature of the hand was first adjusted by immersion in a controlled-temperature water bath. In the warmest condition, the skin surface temperature over the FDI was 30.5(0.30) degrees C [mean (SE)]. After moderate cooling, this surface temperature was 21.5(0.16) degrees C. Cooling significantly reduced the time taken to reach fatigue and more than halved the work capacity. An intermediate degree of cooling was also used in four subjects, showing that most of the effects seen were changing incrementally. Before work, and at fatigue, intracellular metabolic conditions in the FDI were studied by phosphorus nuclear magnetic resonance (31P-NMR) spectroscopy, with occlusion of the blood flow maintained during measurements. The mean intracellular pH of the FDI was also calculated. The changes observed were all consistent with the fact that intense work requires energy which must be derived largely from intracellular stores of phosphocreatine and glycogen. Less work made less demand upon reserves, and created lower concentrations of waste products and by-products. The observations did not, however, allow us to explain why fatigue occurred at a particular point or why work capacity was reduced by cooling.

Adult↗

Physiological and metabolic responses of triathletes to a simulated 30-min time-trial in cycling at self-selected intensity.

The aim of this study was to investigate the metabolic and physiological responses to a laboratory-based simulated 30-min individual time-trial (ITT 30 ) in cycling at a self-selected intensity. Twelve experienced triathletes (n = 4 women) performed a progressive incremental exercise test on a cycle ergometer to determine .VO2max (52 +/- 5 ml x min -1 x kg -1), maximum power output (300 +/- 12 W), and the second ventilatory threshold. Then, the subjects completed an ITT30 at self-selected work intensity on a stationary ergometer equipped with the SRM Training System. In all subjects, during the ITT30, heart rate and minute ventilation increased (p < 0.05) progressively whereas oxygen consumption and power output remained unchanged. Triathletes rode at consistent pacing corresponding to their highest steady state of blood lactate concentration that increased by no more than 1.0 mmol x l -1 during the final 20-min of ITT30. The self-selected intensity of triathletes during ITT30 represented 88 +/- 5 % (mean +/- SD) of .VO2max and was not significantly different to the energy demand corresponding to the second ventilatory threshold (84 +/- 5 % of .VO2max). Our data suggest that ITT 30 at a self-selected intensity is a good predictor of individual endurance capacity and may be used to estimate racing pace for training purposes. This performance test for the identification of the exercise intensity that demarcate "steady state" is less troublesome than some of the traditional methods, limiting testing to a single session.

Adult↗

Maximal oxygen uptake in young women with training, inactivity, and retraining.

Six young, healthy, sedentary females performed intense endurance training at a constant training stimulus (HR = 170 beats x min-1) twice a week in two 7-week periods separated by seven weeks of inactivity. Inactivity was defined as a period without scheduled exercise but with necessary daily activities. An increase in Vo2max (10-14%) and in training intensity at target heart rate (24%) were observed in both periods (p less than 0.001). Considering the intensity and duration of the program these gains are similar to those reported previously in women and men. The training response was the same in the two periods. Thus, there was no indication of beneficial effects during retraining from the previously performed activity. After the inactivity period Vo2max, as well as the work intensity at target heart rate, did not differ significantly from the pretraining observations. Thus seven weeks with no training was sufficient to neutralize the effect of a conditioning program of similar duration.

Adult↗

Circulatory responses to progressive exercise: insights from positional differences.

The influence of body position on cardiac responses to progressive exercise was examined in 13 healthy circumpubertal boys. The subjects (mean age 12.5 +/- 1.4 y) performed a progressive cycle test with an identical protocol in the sitting and supine positions. Stroke volume and left ventricular dimensions were assessed with Doppler and two-dimensional echocardiography, respectively. During supine exercise, no changes were seen in stroke volume or left ventricular preload (end-diastolic dimension) with increasing exercise intensity. At rest, mean values for stroke volume and cardiac output were 16.4 % and 27.1 % lower, respectively, with subjects upright compared to supine. With upright exercise these variables rose to become insignificantly different than supine values. Stroke volume while cycling upright rose by 29 % by the second workload but remained stable at higher work intensities. The initial increase in stroke volume observed only when cycling upright presumably reflects mobilization of dependent blood in the lower extremities. The mechanisms governing cardiac responses to exercise when supine and upright are otherwise identical.

Adolescent↗

Evaluation of exercise and training on muscle lipid metabolism.

To evaluate the hypothesis that endurance training increases intramuscular triglyceride (IMTG) oxidation, we studied leg net free fatty acid (FFA) and glycerol exchange during 1 h of cycle ergometry at two intensities before training [45 and 65% of peak rate of oxygen consumption (V(O2) peak)] and after training [65% pretraining V(O2) peak, same absolute workload (ABT), and 65% posttraining V(O2) peak, same relative intensity (RLT)]. Nine male subjects (178.1 +/- 2.5 cm, 81.8 +/- 3.3 kg, 27.4 +/- 2.0 yr) were tested before and after 9 wk of cycle ergometer training, five times per week at 75% V(O2) peak. The power output that elicited 66.1 +/- 1.1% of V(O2) peak before training elicited 54.0 +/- 1.7% after training due to a 14.6 +/- 3.1% increase in V(O2) peak. Training significantly (P < 0.05) decreased pulmonary respiratory exchange ratio (RER) values at ABT (0.96 +/- 0.01 at 65% pre- vs. 0.93 +/- 0.01 posttraining) but not RLT (0.95 +/- 0.01). After training, leg respiratory quotient (RQ) was not significantly different at either ABT (0.98 +/- 0.02 pre- vs. 0.98 +/- 0.03 posttraining) or RLT (1.01 +/- 0.02). Net FFA uptake was increased at RLT but not ABT after training. FFA fractional extraction was not significantly different after training or at any exercise intensity. Net glycerol release, and therefore IMTG lipolysis calculated from three times net glycerol release, did not change from rest to exercise or at ABT but decreased at the same RLT after training. Muscle biopsies revealed minor muscle triglyceride changes during exercise. Simultaneous measurements of leg RQ, net FFA uptake, and glycerol release by working legs indicated no change in leg FFA oxidation, FFA uptake, or IMTG lipolysis during leg cycling exercise that elicits 65% pre- and 54% posttraining V(O2) peak. Training increases working muscle FFA uptake at 65% V(O2) peak, but high RER and RQ values at all work intensities indicate that FFA and IMTG are of secondary importance as fuels in moderate and greater-intensity exercise.

Adult↗

Effects of increased intensity of intermittent training in runners with differing VO2 kinetics.

The purpose of this study was to test the hypothesis that athletes having a slower oxygen uptake ( VO(2)) kinetics would benefit more, in terms of time spent near VO(2max), from an increase in the intensity of an intermittent running training (IT). After determination of VO(2max), vVO(2max) (i.e. the minimal velocity associated with VO(2max) in an incremental test) and the time to exhaustion sustained at vVO(2max) ( T(lim)), seven well-trained triathletes performed in random order two IT sessions. The two IT comprised 30-s work intervals at either 100% (IT(100%)) or 105% (IT(105%)) of vVO(2max) with 30-s recovery intervals at 50% of vVO(2max) between each repeat. The parameters of the VO(2) kinetics (td(1), tau(1), A(1), td(2), tau(2), A(2), i.e. time delay, time constant and amplitude of the primary phase and slow component, respectively) during the T(lim) test were modelled with two exponential functions. The highest VO(2) reached was significantly lower ( P<0.01) in IT(100%) run at 19.8 (0.9) km(.)h(-1) [66.2 (4.6) ml(.)min(-1.)kg(-1)] than in IT(105%) run at 20.8 (1.0) km(.)h(-1) [71.1 (4.9) ml(.)min(-1.)kg(-1)] or in the incremental test [71.2 (4.2) ml(.)min(-1.)kg(-1)]. The time sustained above 90% of VO(2max) in IT(105%) [338 (149) s] was significantly higher ( P<0.05) than in IT(100%) [168 (131) s]. The average T(lim) was 244 (39) s, tau(1) was 15.8 (5.9) s and td(2) was 96 (13) s. tau(1) was correlated with the difference in time spent above 90% of VO(2max) ( r=0.91; P<0.01) between IT(105%) and IT(100%). In conclusion, athletes with a slower VO(2) kinetics in a vVO(2max) constant-velocity test benefited more from the 5% rise of IT work intensity, exercising for longer above 90% of VO(2max) when the IT intensity was increased from 100 to 105% of vVO(2max).

Adaptation, Physiological↗

Characterization of VO2 kinetics during heavy exercise.

Characterizing oxygen uptake (VO2) kinetics yields valuable information regarding both a) the effectiveness of the coupling of O2 delivery to tissue metabolic demands, and b) the ability of the muscle itself to utilize O2 for oxidative phosphorylation. During moderate exercise VO2 reaches a new steady state within 3 min in normal subjects, with little or no sustained rise in blood lactate. The steady state VO2 increases linearly with work rate. The time constant for VO2 in Phase 2 (after first 15-20 s) is constant across work intensities, and appears to reflect muscle oxygen utilization kinetics. However, when heavier exercise is performed, which elevates blood lactate throughout the exercise, the VO2 response becomes more complex. The predominant, Phase 2 response continues to rise exponentially with about the same time constant as for moderate exercise, and the amplitude continues to be linearly related to work rate. However, an additional, slowly developing rise in VO2 is also usually observed, beginning 100-200 s into exercise. This additional VO2 delays attainment of a steady state, increases the overall O2 "cost" of the exercise, and is statistically associated with the rate and magnitude of increase in blood lactate. Interestingly, in children, neither the slow component nor blood lactate rise as much during heavy exercise.

Exercise↗

Effects of moderate intensity treadmill exercise on triglyceride production in the laying fowl.

1. Sustained aerobic exercise in domestic fowl has previously been shown to enhance lipid utilization by the skeletal muscles. The present study examined the possibility that such increased lipid oxidation in the laying female might lower the production of plasma triglycerides destined for transfer to the developing oocytes. 2. Following an intravenous injection of 25 muCi of 14C-labelled glycerol trioleate, the experimental birds performed 90 min of treadmill exercise at a work intensity approximately equivalent to 2.5 times the resting metabolic rate. 3. There was no evidence of either glycogen or triglyceride depletion in either the leg muscles or the viscera of the exercised birds. The specific activity of triglyceride TG-SRA found in the tissues was also the same in control and experimental birds. The time-course of the changes in plasma TG-SRA throughout the experimental period gave no indication that TG production had been affected by exercise. 4. It is concluded that the increased energy substrate demand arising from moderate-intensity, aerobic exercise is almost fully met by the liberation of fatty acids from adipose tissue TG stores, and has minimal impact on the hepatic manufacture of egg lipids.

Animals↗

Effect of enhanced preload with head-out water immersion on exercise response in men with healed myocardial infarction.

Head-out water immersion shifts venous blood to the central vasculature and heart and subsequently increases cardiac preload. In healthy men, cardiac output and stroke volume are greater during upright leg cycle exercise in water than on land. Heart rate is similar during work loads < 50% of peak oxygen consumption but is decreased in water at higher work intensities. To determine if men with myocardial infarction (MI) show a similar response, 15 men with a documented MI exercised upright on a leg cycle ergometer on land and immersed in water (31 +/- 1 degree C) to the level of the shoulders. Heart rate, cardiac output (carbon dioxide rebreathing procedure) and oxygen consumption were measured at rest and at work loads corresponding to approximately 40, 60 and 75% of peak oxygen consumption in both environments. At rest, cardiac output and stroke volume were elevated (p < 0.05) in water. During exercise, heart rate, cardiac output and stroke volume did not differ between water and land. When subjects were given beta-blocking medications (n = 8) and subjects with exercise-induced ST-segment depression (n = 5) were separately excluded from the analysis, water immersion still did not significantly change exercise responses. These results suggest that MI alters the normal cardiac response to increased preload during exercise. The alteration may involve reduced myocardial compliance or near-complete use of the Frank-Starling reserve, or both, during land exercise.

Cardiac Output↗

Effect of walking distance on the change in ankle-brachial pressure index in patients with intermittent claudication.

OBJECTIVES: The ankle-brachial pressure index (ABPI) responses to different exercise intensities on a treadmill were evaluated to clarify the relationship between intermittent claudication and the haemodynamics in the leg. PATIENTS AND METHODS: Thirty patients with intermittent claudication (32 symptomatic legs) due to peripheral arterial occlusive disease were exercised on a treadmill to determine their pain-free walking distance, maximum walking distance (MWD) and recovery time. Each subject was exercised at 25% and 50% of the MWD to determine the effect of work intensity on the drop in ABPI, and the recovery time. RESULTS: In the claudicating legs, 25% of the MWD resulted in almost the same reduction in ABPI as 50% of the MWD, and the MWD. In contrast, the ABPI in the asymptomatic legs (13) was significantly decreased in proportion to the walking distance. The recovery time increased linearly in both the groups, as the walking distance increased. CONCLUSION: The recovery time of the ABPI correlated well with the intensity of workload, while the drop in ABPI did not.

Aged↗

Obesity, diabetes mellitus and physical activity--metabolic responses to physical training in adipose and muscle tissues.

The demand of the untrained skeletal muscle to produce additional mechanical work by utilizing more nutrients is the origin of the structural and metabolic adaptation of the muscle. The expanding capillary surface, in response to a lower vascular resistance during repeated contraction, enables the different fibre types to increase their oxygen extraction, and to adapt their uptake of substrates (glucose, FFA). The muscle fibre types in humans are selectively recruited for differing work intensity but the oxidative potential (SDH) increases in all types with long-term physical training. Details of the mechanism by which insulin promotes glucose uptake are unclear but there is some evidence that the hormonal stimulation involves cellular uptake of the insulin-receptor complex of the membrane. Hypoxia and raised cytoplasmic levels of calcium in muscle cells after work exert an insulin-like action on glucose uptake, which may be ascribed to the intracellular acidity.--The interrelationship between glucose and FFA oxidation is in part regulated by known key enzymes of the contracting muscle, but the exact extramuscular substrate mobilization appears to require both hormonal and supplementary feed-back control in storage organs.--During prolonged muscular exercise, the successive utilization of carbohydrate and fat from endogenous and exogenous stores can, however, in principle be attributed to known hormonal regulation.--Oral intake of glucose solution before and during work evokes a prolonged glucose utilization with relative hyperinsulinemia and hypoglucagonemia, preventing hepatic glycogenolysis. A prerequisite for successful endurance training is the improved capacity to use FFA as substrate. The necessary lipolysis in adipocytes is mainly mediated by an increased cellular exposure and sensitivity to catecholamines, but the delayed adaptation of the fat cells to their hormonal environment, especially insulin, in relation to the progress of the training is likely to modify the lipolytic response.

Adipose Tissue↗

Oxygen consumption in adult and AGED C57BL/6J mice during acute treadmill exercise of different intensity.

Submaximal and maximal oxygen consumption was determined in untrained adult and aged male C57BL/6J mice during treadmill running. Each of 12-month-old (ADULT) and 24-month-old (AGED) male mice was tested on a motor-driven treadmill once at different speeds. VO2 was measured before, during, and after exercise by means of indirect calorimetry in metabolic treadmill chambers. The resting VO2 averaged 3064.67 +/- 87.71 mL/kg/h for ADULT mice and 2472.95 +/- 69.41 mL/kg/h for AGED mice. During exercise, VO2 increased linearly with work intensity (running speed): ADULT mice--from 5908.06 +/- 422.35 mL/kg/h at 3 m/min to 10861.99 +/- 174.03 mL/kg/h at 25 m/min; AGED mice--from 5217.25 +/- 263.26 mL/kg/h at 3 m/min to 7817.32 +/- 290.28 mL/kg/h at 20 m/min. Further increase of the running speed resulted in a decline of VO2 in ADULT and refusal to run in AGED mice. The results of this study demonstrated that in untrained C57BL/6J mice VO2max and maximal exercise capacity declined with age. At the same absolute and relative workloads, VO2 was lower in AGED mice.

Age Factors↗

Effects of lifestyle and work-related physical activity on the degree of lumbar lordosis and chronic low back pain in a Middle East population.

The relationship between the degree of lumbar lordosis and chronic low back pain (LBP) has long been speculated. It is postulated that prolonged sitting and sedentary lifestyle might change the degree of lumbar lordosis and cause LBP. The purpose of this study was to determine the effects of lifestyle, exercise, work setting, work intensity, and other demographic factors such as age, height, weight, and gender on the degree of lumbar lordosis and occurrence of LBP. Eight hundred forty subjects between ages 20 and 65 years were equally categorized into four groups: normal male, normal female, males with LBP, and females with LBP. A questionnaire was used to obtain information about the subject's lifestyle, work setting, level of exercise, and work-related physical activity. A flexible ruler was used to measure lumbar lordosis in all subjects. The average degree of lumbar lordosis for all subjects was 37 degrees +/- 13 degrees. Females had greater lumbar lordosis (42 degrees +/- 15 degrees ) than males did (32 degrees +/- 10 degrees ). There was no significant difference in the degree of lumbar lordosis in subjects with different lifestyle (p = 0.97), level of physical activity (p = 0.36), work setting (p = 0.5), and with or without LBP (p = 0.28). The degree of lumbar lordosis was positively related with the number of pregnancies (p = 0.04, r = 0.25), age (p = 0.02, r = 0.1) and height (p = 0.0001, r = 0.31) and negatively related with weight (p = 0.04, r = 0.06) of the subjects. The likelihood of developing LBP was significantly higher in the subjects who had high work-related physical activity (p = 0.03) and those who exercised less often (p = 0.008). We found no significant relationship between LBP occurrence and the degree of lumbar lordosis (p = 0.68), work setting (p = 0.15), height (p = 0.08), weight (p =0.06), and age (p = 0.67) of the subjects. The degree of lumbar lordosis was not different between normal subjects and those with LBP. Lumbar lordosis was not affected by lifestyle, level of physical activity, or type of work setting. Although these factors have not been found to affect the degree of lumbar lordosis, some affected the occurrence of LBP. This finding indicates that the effect of these factors on LBP involves mechanisms other than changing the degree of lumbar lordosis.

Adult↗

Gender differences in work performance on the Baltimore Therapeutic Equipment work simulator.

OBJECTIVES: The purposes of this study were to (a) establish biomechanical and physiological normative data for healthy young women performing three tasks on the Baltimore Therapeutic Equipment work simulator (BTE): wheel-turn, push-pull, and overhead-reach; and (b) compare these data with previously reported values for healthy men of a similar age group. METHOD: Twenty women completed five test sessions: (a) task familiarization on the BTE to determine the work intensity that was perceived as hard on the Borg scale, (b) incremental test on an arm crank ergometer to measure peak oxygen uptake (VO2) and peak heart rate (HR), and (c) one of the three tasks in random order for 4 min during the next three sessions. Physiological responses were monitored with a metabolic cart interfaced with an electrocardiogram. RESULTS: Torque, work, and power during the three tasks were significantly higher (p < .05) in men than in women. The absolute VO2 (L.min-1) during these tasks was higher in men, but when the VO2 was calculated relative to body weight (ml.kg-1.min-1), no significant (p > .05) gender differences were observed. Computation of energy expenditure relative to body weight and power output (cal.kg-1.W-1) indicated that women expended significantly (p < .05) more energy than men. No significant (p > .05) gender differences were observed for VO2 and HR when the values were expressed as a percentage of their respective peaks. CONCLUSIONS: Findings indicated that (a) the functional work capacity is significantly lower in women than in men, (b) women are less efficient than men when the energy expenditure is expressed per unit of body weight and power output, and (c) the relative physiological stress in men and women is similar under these conditions.

Adult↗