Government of Spain

BACKGROUND: Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success. METHODS: We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030. FINDINGS: We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone. INTERPRETATION: Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030. FUNDING: Bill & Melinda Gates Foundation, US Agency for International Development.

We compared the effects of two resistance training (RT) programs only differing in the repetition velocity loss allowed in each set: 20% (VL20) vs 40% (VL40) on muscle structural and functional adaptations. Twenty-two young males were randomly assigned to a VL20 (n = 12) or VL40 (n = 10) group. Subjects followed an 8-week velocity-based RT program using the squat exercise while monitoring repetition velocity. Pre- and post-training assessments included: magnetic resonance imaging, vastus lateralis biopsies for muscle cross-sectional area (CSA) and fiber type analyses, one-repetition maximum strength and full load-velocity squat profile, countermovement jump (CMJ), and 20-m sprint running. VL20 resulted in similar squat strength gains than VL40 and greater improvements in CMJ (9.5% vs 3.5%, P < 0.05), despite VL20 performing 40% fewer repetitions. Although both groups increased mean fiber CSA and whole quadriceps muscle volume, VL40 training elicited a greater hypertrophy of vastus lateralis and intermedius than VL20. Training resulted in a reduction of myosin heavy chain IIX percentage in VL40, whereas it was preserved in VL20. In conclusion, the progressive accumulation of muscle fatigue as indicated by a more pronounced repetition velocity loss appears as an important variable in the configuration of the resistance exercise stimulus as it influences functional and structural neuromuscular adaptations.

OBJECTIVE: To evaluate the influence of a twice-weekly progressive resistance training (PRT) program, without a concomitant weight loss diet, on abdominal fat and insulin sensitivity in older men with type 2 diabetes. RESEARCH DESIGN AND METHODS: Nine older men (aged 66.6 +/- 3.1) with type 2 diabetes participated in a 16-week PRT supervised program (50-80% of the one repetition maximum), for all main muscle groups. Basal glycemia, HbA(1c), diet, habitual physical activity, body composition, and upper/lower maximal strength were measured. Insulin sensitivity was determined according to Bergman's minimal model procedure and abdominal fat was obtained by computed tomography. The measurements were taken 4 weeks before training (-4), immediately before training (0), and at 8-week intervals (i.e., weeks 8 and 16) during the 16-week training period. RESULTS: No significant variation was observed in any of the above selected parameters during the 4-week control period. After PRT, both leg and arm maximal strength increased significantly by 17.1 and 18.2%, respectively. Visceral and subcutaneous abdominal fat decreased significantly by 10.3% (from 249.5 +/- 97.9 to 225.6 +/- 96.6 cm(3), P < 0.01) and by 11.2% (from 356.0 +/- 127.5 to 308.6 +/- 118.8 cm(3), P < 0.01), respectively, while no changes were observed in body mass. PRT significantly increased insulin sensitivity by 46.3% (from 2.0 +/- 1.2 to 2.8 +/- 1.6 . 10(4) . min(-1) . muU(-1) . ml(-1), P < 0.01), whereas it significantly decreased (-7.1%, P < 0.05) fasting blood glucose (from 146.6 +/- 28.3 to 135.0 +/- 29.3 mg/dl). Finally, a 15.5% increase in energy intake (from 2,287.1 +/- 354.7 to 2,619.0 +/- 472.1 kcal/day, P < 0.05) was observed. CONCLUSIONS: Two sessions per week of PRT, without a concomitant weight loss diet, significantly improves insulin sensitivity and fasting glycemia and decreases abdominal fat in older men with type 2 diabetes.

Plyometric training improves vertical jump height (VJH). However, the effectiveness of plyometric training depends on various factors. A meta-analysis of 56 studies with a total of 225 effect sizes (ESs) was carried out to analyze the role of various factors on the effects of plyometrics on VJH performance. The inclusion criteria for the analysis were a) studies using plyometric programs for lower-limb muscles, b) studies employing true experimental designs and valid and reliable measurements, and c) studies including enough data to calculate ESs. Subjects with more experience in sport obtained greater enhancements in VJH performance (p < 0.01). Subjects in either good or bad physical condition benefit equally from plyometric work (p < 0.05), although men tend to obtain better power results than women after plyometric training (p < 0.05). With relation to the variables of performance, training volumes of more than 10 weeks and more than 20 sessions, using high-intensity programs (with more than 50 jumps per session), were the strategies that seemed to maximize the probability of obtaining significantly greater improvements in performance (p < 0.05). To optimize jumping enhancement, the combination of different types of plyometrics (squat jump + countermovement jump + drop jump) is recommended rather than using only 1 form (p < 0.05). However, no extra benefits were found to be gained from doing plyometrics with added weight. The responses identified in this analysis are essential and should be considered by strength and conditioning professionals with regard to the most appropriate dose-response trends for optimizing plyometric-induced gains.

OBJECTIVE: Diabetes is a common cause of shortened life expectancy. We aimed to assess the association between diabetes and cause-specific death. RESEARCH DESIGN AND METHODS: We used the pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79 years old. Diabetes status was self-reported or defined as glycemia >125 mg/dL at baseline. Vital status and causes of death were ascertained by medical records review and linkage with the official death registry. The hazard ratios and cumulative mortality function were assessed with two approaches, with and without competing risks: proportional subdistribution hazard (PSH) and cause-specific hazard (CSH), respectively. Multivariate analyses were fitted for cardiovascular, cancer, and noncardiovascular noncancer deaths. RESULTS: We included 55,292 individuals (15.6% with diabetes and overall mortality of 9.1%). The adjusted hazard ratios showed that diabetes increased mortality risk: 1) cardiovascular death, CSH = 2.03 (95% CI 1.63-2.52) and PSH = 1.99 (1.60-2.49) in men; and CSH = 2.28 (1.75-2.97) and PSH = 2.23 (1.70-2.91) in women; 2) cancer death, CSH = 1.37 (1.13-1.67) and PSH = 1.35 (1.10-1.65) in men; and CSH = 1.68 (1.29-2.20) and PSH = 1.66 (1.25-2.19) in women; and 3) noncardiovascular noncancer death, CSH = 1.53 (1.23-1.91) and PSH = 1.50 (1.20-1.89) in men; and CSH = 1.89 (1.43-2.48) and PSH = 1.84 (1.39-2.45) in women. In all instances, the cumulative mortality function was significantly higher in individuals with diabetes. CONCLUSIONS: Diabetes is associated with premature death from cardiovascular disease, cancer, and noncardiovascular noncancer causes. The use of CSH and PSH provides a comprehensive view of mortality dynamics in a population with diabetes.

BACKGROUND: We aimed to investigate the association of metabolic syndrome (MetS) and its single components with cardiovascular risk and estimated their impact on the prematurity of occurrence of cardiovascular events using rate advancement periods (RAPs). METHODS: We performed prospective analyses among 3976 participants (age range: 35-84, 55% female) in the Vascular Risk in Navarre (RIVANA) Study, a Mediterranean population-based cohort. MetS was defined based on the modified criteria of the American Heart Association/National Heart, Lung, and Blood Institute and the International Diabetes Federation. The primary endpoint was major cardiovascular event (a composite of myocardial infarction, stroke, or mortality from cardiovascular causes). Secondary endpoints were incidence of non-fatal myocardial infarction and non-fatal stroke, cardiovascular mortality, and all-cause mortality. Cox proportional hazards models, adjusted for potential confounders, were fitted to evaluate the association between MetS and its single components at baseline with primary and secondary endpoints. RESULTS: During a median follow-up of 12.8 years (interquartile range, 12.5-13.1), we identified 228 primary endpoint events. MetS was associated with higher risk of incidence of major cardiovascular event, cardiovascular and all-cause mortality, but was neither associated with higher risk of myocardial infarction nor stroke. Compared with participants without MetS, the multivariable hazard ratio (95% confidence interval [CI]) among participants with MetS was 1.32 (1.01-1.74) with RAP (95% CI) of 3.23 years (0.03, 6.42) for major cardiovascular event, 1.64 (1.03-2.60) with RAP of 3.73 years (0.02, 7.45) for cardiovascular mortality, and 1.45 (1.17-1.80) with RAP of 3.24 years (1.21, 5.27) for all-cause mortality. The magnitude of the associations of the single components of MetS was similar than the predicted by MetS. Additionally, for each additional trait of MetS, incidence of major cardiovascular event relatively increased by 22% (1.22, 95% CI 1.09-1.36) with RAP of 2.31 years (0.88, 3.74). CONCLUSIONS: MetS was independently associated with CVD risk, cardiovascular and all-cause mortality. Components of the MetS were associated with similar magnitude of increased CVD, which suggests that MetS was not in excess of the level explained by the presence of its single components. Further research should explore the association of different combinations of the components of MetS with CVD.

The purpose of this study was to examine the efficacy of 11 wk of resistance training to failure vs. nonfailure, followed by an identical 5-wk peaking period of maximal strength and power training for both groups as well as to examine the underlying physiological changes in basal circulating anabolic and catabolic hormones. Forty-two physically active men were matched and then randomly assigned to either a training to failure (RF; n = 14), nonfailure (NRF; n = 15), or control groups (C; n = 13). Muscular and power testing and blood draws to determine basal hormonal concentrations were conducted before the initiation of training (T0), after 6 wk of training (T1), after 11 wk of training (T2), and after 16 wk of training (T3). Both RF and NRF resulted in similar gains in 1-repetition maximum bench press (23 and 23%) and parallel squat (22 and 23%), muscle power output of the arm (27 and 28%) and leg extensor muscles (26 and 29%), and maximal number of repetitions performed during parallel squat (66 and 69%). RF group experienced larger gains in the maximal number of repetitions performed during the bench press. The peaking phase (T2 to T3) after NRF resulted in larger gains in muscle power output of the lower extremities, whereas after RF it resulted in larger gains in the maximal number of repetitions performed during the bench press. Strength training leading to RF resulted in reductions in resting concentrations of IGF-1 and elevations in IGFBP-3, whereas NRF resulted in reduced resting cortisol concentrations and an elevation in resting serum total testosterone concentration. This investigation demonstrated a potential beneficial stimulus of NRF for improving strength and power, especially during the subsequent peaking training period, whereas performing sets to failure resulted in greater gains in local muscular endurance. Elevation in IGFBP-3 after resistance training may have been compensatory to accommodate the reduction in IGF-1 to preserve IGF availability.

Much biodiversity data is collected worldwide, but it remains challenging to assemble the scattered knowledge for assessing biodiversity status and trends. The concept of Essential Biodiversity Variables (EBVs) was introduced to structure biodiversity monitoring globally, and to harmonize and standardize biodiversity data from disparate sources to capture a minimum set of critical variables required to study, report and manage biodiversity change. Here, we assess the challenges of a 'Big Data' approach to building global EBV data products across taxa and spatiotemporal scales, focusing on species distribution and abundance. The majority of currently available data on species distributions derives from incidentally reported observations or from surveys where presence-only or presence-absence data are sampled repeatedly with standardized protocols. Most abundance data come from opportunistic population counts or from population time series using standardized protocols (e.g. repeated surveys of the same population from single or multiple sites). Enormous complexity exists in integrating these heterogeneous, multi-source data sets across space, time, taxa and different sampling methods. Integration of such data into global EBV data products requires correcting biases introduced by imperfect detection and varying sampling effort, dealing with different spatial resolution and extents, harmonizing measurement units from different data sources or sampling methods, applying statistical tools and models for spatial inter- or extrapolation, and quantifying sources of uncertainty and errors in data and models. To support the development of EBVs by the Group on Earth Observations Biodiversity Observation Network (GEO BON), we identify 11 key workflow steps that will operationalize the process of building EBV data products within and across research infrastructures worldwide. These workflow steps take multiple sequential activities into account, including identification and aggregation of various raw data sources, data quality control, taxonomic name matching and statistical modelling of integrated data. We illustrate these steps with concrete examples from existing citizen science and professional monitoring projects, including eBird, the Tropical Ecology Assessment and Monitoring network, the Living Planet Index and the Baltic Sea zooplankton monitoring. The identified workflow steps are applicable to both terrestrial and aquatic systems and a broad range of spatial, temporal and taxonomic scales. They depend on clear, findable and accessible metadata, and we provide an overview of current data and metadata standards. Several challenges remain to be solved for building global EBV data products: (i) developing tools and models for combining heterogeneous, multi-source data sets and filling data gaps in geographic, temporal and taxonomic coverage, (ii) integrating emerging methods and technologies for data collection such as citizen science, sensor networks, DNA-based techniques and satellite remote sensing, (iii) solving major technical issues related to data product structure, data storage, execution of workflows and the production process/cycle as well as approaching technical interoperability among research infrastructures, (iv) allowing semantic interoperability by developing and adopting standards and tools for capturing consistent data and metadata, and (v) ensuring legal interoperability by endorsing open data or data that are free from restrictions on use, modification and sharing. Addressing these challenges is critical for biodiversity research and for assessing progress towards conservation policy targets and sustainable development goals.

PURPOSE: Fifteen elite male handball players were studied to examine the effects of an entire season of play on physical fitness and throwing velocity. METHODS: One repetition maximal bench press (1RMBP), jumping explosive strength, power-load relationship of the leg and arm extensor muscles, 5- and 15-m sprint running time, endurance running, and handball throwing velocity (standing and three-step running throw) were assessed on four times (T1, T2, T3, and T4), during a 45-wk season. Individual volumes and intensities of training and competition were quantified for 11 activities. RESULTS: From T1 to T3, significant increases occurred in free fatty mass (1.4%), 1RMBP (1.9%), standing throwing velocity (6.5%), and three-step throwing velocity (6.2%). No significant changes were observed throughout the season in endurance running and explosive strength-related variables. Significant correlations (P < 0.05-0.01) were observed between strength training time and changes in standing throwing velocity as well as between high-intensity endurance training time and changes in endurance running. In addition, linear inverse relationships were observed between low-intensity endurance training time and changes in muscle power output of the lower extremities. CONCLUSION: The handball season resulted in significant increases in maximal and specific strength of the upper-extremity but not in the lower-extremity actions. The correlations observed suggest that training time at low intensity should be given less attention, whereas the training stimuli for high-intensity endurance running and leg strength training should be given more careful attention in the full training season program.

CONTEXT: Bone has recently been described as exhibiting properties of an endocrine organ by producing osteocalcin that increases insulin sensitivity and secretion in animal models. OBJECTIVE AND DESIGN: We aimed to evaluate circulating osteocalcin in association with insulin sensitivity and insulin secretion in three different studies in nondiabetic subjects: one cross-sectional study in 149 men (using minimal model), and two longitudinal studies in two independent groups (one formed by 26 women, and the other by 9 men and 11 women), after a mean of 7.3 and 16.8% weight loss, and after a mean of 8.7% weight loss plus regular exercise. RESULTS: In the cross-sectional study, circulating osteocalcin was associated with insulin sensitivity, mainly in lean subjects, and with insulin secretion (only in lean subjects). A mean of 16.8%, but not 7.3% weight loss, led to significant increases in circulating osteocalcin. However, a mean of 8.7% weight loss plus regular exercise led to the more pronounced effects on the serum osteocalcin concentration, which increased in parallel to reduced visceral fat mass, unchanged thigh muscle mass, and increased leg strength and force. The postintervention serum levels of osteocalcin were associated with both insulin sensitivity (r = 0.49; P = 0.03) and fasting triglycerides (r = -0.54; P = 0.01). The change in visceral fat was the parameter that best predicted the change in serum osteocalcin, once age, body mass index, and insulin sensitivity changes were controlled for (P = 0.002). CONCLUSION: Circulating osteocalcin could mediate the role of bone as an endocrine organ in humans.

AIMS: The aim of this review was to focus on the knowledge of the cardiovascular benefits of moderate alcohol consumption, as well as to analyze the effects of the different types of alcoholic beverages. METHODS: Systematic revision of human clinical studies and meta-analyses related to moderate alcohol consumption and cardiovascular disease (CVD) from 2000 to 2012. RESULTS: Heavy or binge alcohol consumption unquestionably leads to increased morbidity and mortality. Nevertheless, moderate alcohol consumption, especially alcoholic beverages rich in polyphenols, such as wine and beer, seems to confer cardiovascular protective effects in patients with documented CVD and even in healthy subjects. CONCLUSIONS: In conclusion, wine and beer (but especially red wine) seem to confer greater cardiovascular protection than spirits because of their polyphenolic content. However, caution should be taken when making recommendations related to alcohol consumption.

BACKGROUND: A growing interest in frailty syndrome exists because it is regarded as a major predictor of co-morbidities and mortality in older populations. Nevertheless, frailty assessment has been controversial, particularly when identifying this syndrome in a community setting. Performance tests such as the 30-second chair stand test (30-s CST) are a cornerstone for detecting early declines in functional independence. Additionally, recent advances in body-fixed sensors have enhanced the sensors' ability to automatically and accurately evaluate kinematic parameters related to a specific movement performance. The purpose of this study is to use this new technology to obtain kinematic parameters that can identify frailty in an aged population through the performance the 30-s CST. METHODS: Eighteen adults with a mean age of 54 years, as well as sixteen pre-frail and thirteen frail patients with mean ages of 78 and 85 years, respectively, performed the 30-s CST while their trunk movements were measured by a sensor-unit at vertebra L3. Sit-stand-sit cycles were determined using both acceleration and orientation information to detect failed attempts. Movement-related phases (i.e. impulse, stand-up, and sit-down) were differentiated based on seat off and seat on events. Finally, the kinematic parameters of the impulse, stand-up and sit-down phases were obtained to identify potential differences across the three frailty groups. RESULTS: For the stand-up and sit-down phases, velocity peaks and "modified impulse" parameters clearly differentiated subjects with different frailty levels (p < 0.001). The trunk orientation range during the impulse phase was also able to classify a subject according to his frail syndrome (p < 0.001). Furthermore, these parameters derived from the inertial units (IUs) are sensitive enough to detect frailty differences not registered by the number of completed cycles which is the standard test outcome. CONCLUSIONS: This study shows that IUs can enhance the information gained from tests currently used in clinical practice, such as the 30-s CST. Parameters such as velocity peaks, impulse, and orientation range are able to differentiate between adults and older populations with different frailty levels. This study indicates that early frailty detection could be possible in clinical environments, and the subsequent interventions to correct these disabilities could be prescribed before further degradation occurs.

This paper presents a power system analysis tool, called DOME, entirely based on Python scripting language as well as on public domain efficient C and Fortran libraries. The objects of the paper are twofold. First, the paper discusses the features that makes the Python language an adequate tool for research, massive numerical simulations and education. Then the paper describes the architecture of the developed software tool and provides a variety of examples to show the advanced features and the performance of the developed tool.

The purpose of this study was to examine the effect of different loads on repetition speed during single sets of repetitions to failure in bench press and parallel squat. Thirty-six physical active men performed 1-repetition maximum in a bench press (1 RM (BP)) and half squat position (1 RM (HS)), and performed maximal power-output continuous repetition sets randomly every 10 days until failure with a submaximal load (60 %, 65 %, 70 %, and 75 % of 1RM, respectively) during bench press and parallel squat. Average velocity of each repetition was recorded by linking a rotary encoder to the end part of the bar. The values of 1 RM (BP) and 1 RM (HS) were 91 +/- 17 and 200 +/- 20 kg, respectively. The number of repetitions performed for a given percentage of 1RM was significantly higher (p < 0.001) in half squat than in bench press performance. Average repetition velocity decreased at a greater rate in bench press than in parallel squat. The significant reductions observed in the average repetition velocity (expressed as a percentage of the average velocity achieved during the initial repetition) were observed at higher percentage of the total number of repetitions performed in parallel squat (48 - 69 %) than in bench press (34 - 40 %) actions. The major finding in this study was that, for a given muscle action (bench press or parallel squat), the pattern of reduction in the relative average velocity achieved during each repetition and the relative number of repetitions performed was the same for all percentages of 1RM tested. However, relative average velocity decreased at a greater rate in bench press than in parallel squat performance. This would indicate that in bench press the significant reductions observed in the average repetition velocity occurred when the number of repetitions was over one third (34 %) of the total number of repetitions performed, whereas in parallel squat it was nearly one half (48 %). Conceptually, this would indicate that for a given exercise (bench press or squat) and percentage of maximal dynamic strength (1RM), the pattern of velocity decrease can be predicted over a set of repetitions, so that a minimum repetition threshold to ensure maximal speed performance is determined.

This study analysed the effect of imposing a pause between the eccentric and concentric phases on the biological within-subject variation of velocity- and power-load isoinertial assessments. Seventeen resistance-trained athletes undertook a progressive loading test in the bench press (BP) and squat (SQ) exercises. Two trials at each load up to the one-repetition maximum (1RM) were performed using 2 techniques executed in random order: with (stop) and without (standard) a 2-s pause between the eccentric and concentric phases of each repetition. The stop technique resulted in a significantly lower coefficient of variation for the whole load-velocity relationship compared to the standard one, in both BP (2.9% vs. 4.1%; P = 0.02) and SQ (2.9% vs. 3.9%; P = 0.01). Test-retest intraclass correlation coefficients (ICCs) were r = 0.61-0.98 for the standard and r = 0.76-0.98 for the stop technique. Bland-Altman analysis showed that the error associated with the standard technique was 37.9% (BP) and 57.5% higher (SQ) than that associated with the stop technique. The biological within-subject variation is significantly reduced when a pause is imposed between the eccentric and concentric phases. Other relevant variables associated to the load-velocity and load-power relationships such as the contribution of the propulsive phase and the load that maximises power output remained basically unchanged.

BACKGROUND: Polyphenols may lower the risk of cardiovascular disease (CVD) and other chronic diseases due to their antioxidant and anti-inflammatory properties, as well as their beneficial effects on blood pressure, lipids and insulin resistance. However, no previous epidemiological studies have evaluated the relationship between the intake of total polyphenols intake and polyphenol subclasses with overall mortality. Our aim was to evaluate whether polyphenol intake is associated with all-cause mortality in subjects at high cardiovascular risk. METHODS: We used data from the PREDIMED study, a 7,447-participant, parallel-group, randomized, multicenter, controlled five-year feeding trial aimed at assessing the effects of the Mediterranean Diet in primary prevention of cardiovascular disease. Polyphenol intake was calculated by matching food consumption data from repeated food frequency questionnaires (FFQ) with the Phenol-Explorer database on the polyphenol content of each reported food. Hazard ratios (HR) and 95% confidence intervals (CI) between polyphenol intake and mortality were estimated using time-dependent Cox proportional hazard models. RESULTS: Over an average of 4.8 years of follow-up, we observed 327 deaths. After multivariate adjustment, we found a 37% relative reduction in all-cause mortality comparing the highest versus the lowest quintiles of total polyphenol intake (hazard ratio (HR) = 0.63; 95% CI 0.41 to 0.97; P for trend = 0.12). Among the polyphenol subclasses, stilbenes and lignans were significantly associated with reduced all-cause mortality (HR =0.48; 95% CI 0.25 to 0.91; P for trend = 0.04 and HR = 0.60; 95% CI 0.37 to 0.97; P for trend = 0.03, respectively), with no significant associations apparent in the rest (flavonoids or phenolic acids). CONCLUSIONS: Among high-risk subjects, those who reported a high polyphenol intake, especially of stilbenes and lignans, showed a reduced risk of overall mortality compared to those with lower intakes. These results may be useful to determine optimal polyphenol intake or specific food sources of polyphenols that may reduce the risk of all-cause mortality. CLINICAL TRIAL REGISTRATION: ISRCTN35739639.

The purpose of this study was to examine the effect of 3 different plyometric training frequencies (e.g., 1 day per week, 2 days per week, 4 days per week) associated with 3 different plyometric training volumes on maximal strength, vertical jump performance, and sprinting ability. Forty-two students were randomly assigned to 1 of 4 groups: control (n = 10, 7 sessions of drop jump (DJ) training, 1 day per week, 420 DJs), 14 sessions of DJ training (n = 12, 2 days per week, 840 DJs), and 28 sessions of DJ training (n = 9, 4 days per week, 1680 DJs). The training protocols included DJ from 3 different heights 20, 40, and 60 cm. Maximal strength (1 repetition maximum [1RM] and maximal isometric strength), vertical height in countermovement jumps and DJs, and 20-m sprint time tests were carried out before and after 7 weeks of plyometric training. No significant differences were observed among the groups in pre-training in any of the variables tested. No significant changes were observed in the control group in any of the variables tested at any point. Short-term plyometric training using moderate training frequency and volume of jumps (2 days per week, 840 jumps) produces similar enhancements in jumping performance, but greater training efficiency (approximately 12% and 0.014% per jump) compared with high jumping (4 days per week, 1680 jumps) training frequency (approximately 18% and 0.011% per jump). In addition, similar enhancements in 20-m-sprint time, jumping contact times and maximal strength were observed in both a moderate and low number of training sessions per week compared with high training frequencies, despite the fact that the average number of jumps accomplished in 7S (420 jumps) and 14S (840 jumps) was 25 and 50% of that performed in 28S (1680 jumps). These observations may have considerable practical relevance for the optimal design of plyometric training programs for athletes, given that a moderate volume is more efficient than a higher plyometric training volume.

PURPOSE: To compare the effects of the 16-wk training period (2 d.wk(-1)) of resistance training alone (S), endurance training alone (E), or combined resistance (once weekly) and endurance (once weekly) training (SE) on muscle mass, maximal strength and power of the leg and arm extensor muscles, and maximal workload (Wmax) by using a incremental cycling test in older men. METHODS: Thirty-one healthy men (65-74 yr) were divided into three treatment groups to train 2x wk(-1) for 16 wk: S (N = 10), E (N = 11), or SE (N = 10; 1x wk(-1) S + 1x wk(-1) E). The subjects were tested at 8-wk intervals (i.e., weeks 8 and 16). RESULTS: There were no significant differences between S- and SE-induced muscle hypertrophy (11% and 11%) and maximal strength (41% and 38%) gains of the legs as well as between E- and SE-induced Wmax (28% and 23%) gains. The increase in arm strength in S (36%) was greater than that recorded in SE (22%) and greater than that recorded in E (0%). CONCLUSIONS: Prolonged combined resistance and endurance training in older men seemed to lead to similar gains in muscle mass, maximal strength, and power of the legs as resistance training alone and to similar gains in maximal peak power output measured in an incremental cycling test as endurance training alone. These findings may have an effect on how resistance exercise is prescribed to older adults.

This study compared the effects of four-week training periods of electromyostimulation (EMS), plyometric training (P), or combined EMS and P training of the knee extensor muscles on 20 m sprint time (ST), jumping ability (Squat jump [SJ] and Countermovement jump [CMJ]), maximal isometric strength (MVC), and muscle cross-sectional area (CSA). Forty subjects were randomly assigned to one of the four treatment groups: electromyostimulation (EG), plyometric (PG), combined EMG, and P (EPG), that took place 4 times per week, and a control group (CG). Subjects were tested before and after the training program, as well as once more after 2 wk of detraining. A significant improvement (p < 0.05) in ST was observed after training (2.4 %) in EG while a significant slowing (p < 0.05) was observed (- 2.3 %) in EPG. Significant increases in EPG (p < 0.05) were observed in SJ (7.5 %) and CMJ (7.3 %) after training, while no significant changes in both jumps were observed after training and detraining for EG. A significant increase (p < 0.05) in MVC was observed after training (9.1 %) and after detraining (8.1 %) in EG. A significant increase (p < 0.05) in MVC was observed after training (16.3 %) in EPG. A significant increase (p < 0.01) in CSA was observed after training in EG (9.0 %) and in EPG (7.1 %). EMS combined with plyometric training increased the jumping height and sprint run in physically active men. In addition, EMS alone or EMS combined with plyometric training leads to increase maximal strength and to some hypertrophy of trained muscles. However, EMS training alone did not result in any improvement in jumping explosive strength development or even interfered in sprint run.

BACKGROUND: Coronary artery disease (CAD) outcomes consistently improve when they are routinely measured and provided back to physicians and hospitals. However, few centers around the world systematically track outcomes, and no global standards exist. Furthermore, patient-centered outcomes and longitudinal outcomes are under-represented in current assessments. METHODS AND RESULTS: The nonprofit International Consortium for Health Outcomes Measurement (ICHOM) convened an international Working Group to define a consensus standard set of outcome measures and risk factors for tracking, comparing, and improving the outcomes of CAD care. Members were drawn from 4 continents and 6 countries. Using a modified Delphi method, the ICHOM Working Group defined who should be tracked, what should be measured, and when such measurements should be performed. The ICHOM CAD consensus measures were designed to be relevant for all patients diagnosed with CAD, including those with acute myocardial infarction, angina, and asymptomatic CAD. Thirteen specific outcomes were chosen, including acute complications occurring within 30 days of acute myocardial infarction, coronary artery bypass grafting surgery, or percutaneous coronary intervention; and longitudinal outcomes for up to 5 years for patient-reported health status (Seattle Angina Questionnaire [SAQ-7], elements of Rose Dyspnea Score, and Patient Health Questionnaire [PHQ-2]), cardiovascular hospital admissions, cardiovascular procedures, renal failure, and mortality. Baseline demographic, cardiovascular disease, and comorbidity information is included to improve the interpretability of comparisons. CONCLUSIONS: ICHOM recommends that this set of outcomes and other patient information be measured for all patients with CAD.