Citations

Purpose Low-dose computed tomography (CT) has been suggested for lung cancer screening. Several observational trials have published their preliminary results, and some investigators suggest that this technique will save lives. There are no mortality statistics, however, and the current study used published data from these trials to estimate the disease-specific mortality in this high-risk population. Patients and Methods Two nonrandomized CT screening trials were selected from the literature for analysis. The number of trial participants, the number of lung cancers diagnosed per year, and stage distribution of the cancers was recorded. Previously published 5-year survival data were used to calculate the number of predicted lung cancer deaths and estimate the overall lung cancer mortality per 1,000 person-years among participants screened. These statistics were then compared to the previous Mayo Lung Project, which used chest radiographs and sputum cytology for screening high-risk individuals. Results This study estimates the lung cancer mortality is 4.1 deaths per 1,000 person-years in the Mayo Clinic CT screening trial, and is 5.5 deaths per 1,000 person-years in the Early Lung Cancer Action Program trial. These data are similar to the lung cancer mortality of 4.4 deaths per 1,000 person-years in the interventional arm, and 3.9 deaths per 1,000 person-years in the usual-care arm of the previous Mayo Lung Project. Conclusion These data suggest that CT screening could produce similar outcomes to prior chest radiographic trials in this high-risk group. Results from randomized trials are required, however, before the true utility of mass screening with CT for lung cancer can be determined.

There has been increasing recognition of the detrimental impact of peripheral arterial disease (PAD) on the health of Americans, and yet there is no common national program of public PAD education designed to diminish this impact. To heighten awareness of this problem, a 2-day PAD Public Education Strategy Meeting was recently attended by representatives of 17 professional societies and public health associations whose missions support the prevention, diagnosis, treatment, and rehabilitation of vascular diseases. This Public Education Strategy Meeting was intended to provide the rationale and structure to create a national PAD public awareness campaign to diminish the health impact of PAD, and to improve cardiovascular outcomes in the USA. This paper: (1) provides the rationale for creation of a national PAD public education program; (2) reviews the development and success of national hypertension, hypercholesterolemia, and Women’s Heart Health public education programs as models of educational efficacy; (3) elucidates how the work of many vascular professionals has led to a national consensus for creation of a national PAD public educational program; (4) provides an overview of the National Heart, Lung and Blood Institute PAD education meeting; and (5) outlines the ‘next steps’ required to accomplish these goals. This meeting achieved consensus that we share responsibility for developing accurate, unified messages to promote PAD awareness and improved care. Participants agreed that the creation of such messages should be linked to plans to disseminate them to all Americans at risk. A consensus was reached that such messages, when commonly created and offered to the public, are most likely to achieve the rewards in better health that all Americans deserve. The Vascular Disease Foundation, a not-for-profit foundation whose mission includes public education regarding the prevention, diagnosis, treatment, and rehabilitation of PAD, will devote its resources to guide a new coalition in this process and to create a national PAD awareness campaign. During 2003 and 2004, the coalition will create the organizational underpinnings and timeline for what will undoubtedly be a multi-year effort. In conclusion, participants of the Public Education Strategy Meeting agreed to create a broad coalition to develop a national PAD public awareness program, with the objectives to develop and disseminate public education messages on PAD. A successful national PAD education program will contribute to the creation of a broader mandate to improve global cardiovascular health in the USA.

The pathogenic mechanisms by which physical exercise influences atherosclerotic lesion formation remain poorly understood. Because vigorous physical training increases oxidative stress, this study tested the hypothesis that graduated and moderate physical exercise together with metabolic intervention ( l -arginine and antioxidants) may contribute to increased vascular protection. Exercise training in mice was induced by graduated swimming. In hypercholesterolemic male mice on an atherogenic high-cholesterol diet, graduated and moderate exercise lowered plasma cholesterol and decreased atherosclerotic lesions compared with sedentary control mice. Antioxidants (1.0% vitamin E added to the chow and 0.05% vitamin C added to the drinking water) and l -arginine (6% in drinking water) supplementation to exercising hypercholesterolemic mice further and synergistically reduced atherosclerosis compared with untreated exercised mice. Arterial oxidation-specific epitopes and systemic oxidative stress were reduced by metabolic intervention. Graduated chronic exercise elicited an increase in production of nitric oxide through increased endothelial nitric oxide synthase expression and ameliorated scavenger activities. Thus, metabolic intervention with l -arginine and antioxidants together with graduated and moderate exercise training reduce atherosclerotic lesion formation.

Abstract Studying goalies, who play a key position in hockey requires examining psychophysiologic variables and their relationship to performance during games when the outcome is important [15]. This investigation tested all three aspects of emotion (subjective, physiologic changes, and performance). Nine male goalies completed questionnaires and provided salivary cortisol before, during, and after each game. Heart rate (ECG signal) was integrated with the goalie's performance video. Goalies rated on Likert Scales; headaches, stomach aches, insomnia, nervousness, and awareness of heart pounding. Data from 16 games were obtained. Of nine, two goalies provided data on three games each; one goalie was classified as a responder and the other a non-responder, based on salivary cortisol levels (SCL). The responder's SCL increased 572 % between baseline and post-period assessments, whereas SCL in the non-responder increased 50 % above baseline. The responder's SCL increased eight times baseline when he faced 16 shots in a period. The responder goalie's game heart rates (HRs) were 160, 152, and 167 beats per minute (bpm) and the non-responder's HRs were 147, 132, and 142 bpm for three games. Game performance was similar for both goalies.

Abstract In the sport of ice hockey, the incidence of injury has been investigated at multiple levels of participation based on collective player exposure, which assumes equal playing time among participants. However, playing time varies enormously between individual players on a given team because of variability in the number and length of shifts. Individual player monitoring, although laborintensive, more accurately identifies risk factors for sustaining injuries. Specific player exposure data are necessary for detailed analysis of factors such as style of play, illegal activities, equipment, player size, and officiating. In addition, prospective, uniform and accurate collection of exposure data may permit meaningful comparison of injury rates between levels of participation in ice hockey and also among different sports. Refinement of data collection tools that determine individual player injury exposure will increase the power of the denominator and facilitate prevention of ice hockey injuries.

Abstract The purpose of this investigation was to examine the components of intimidation in ice hockey and to determine their effects on players, coaches, and referees. In a pilot test, hockey coaches (N = 17) from three levels of participation were invited to an informal, exploratory symposium to assess their opinions on the role of intimidation in ice hockey. The following themes emerged: a) coaches' behavior and expectations, b) observable behavior, c) player's perceived role, and d) sociological factors. A preliminary intimidation model was developed. A survey including 80 open-ended questionnaires designed to stimulate discussion on the definition of intimidation, methods used to intimidate, and factors perceived as intimidating, was distributed to players (N = 66), coaches (N = 8), and referees (N = 6). The data were analyzed using qualitative methods [1,2] and intimidation was defined. Results support a theoretical model, which serves as a point of departure for future research and visually depicts the components of intimidation and their interactions.