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CTnT increases above reference limits during a marathon. Magnitude of cTnT rise is related to exercise intensity relative to ventilatory threshold and V˙Omax, but not individuals' absolute cardiopulmonary fitness, training state or running history.

BackgroundChronic liver disease is an escalating problem both in the United Kingdom and worldwide. In the UK mortality rates have risen sharply over the previous 50 years predominantly due to alcohol, however the increasing prevalence of non-alcohol related fatty liver disease both in the UK and elsewhere is also of concern. Liver disease develops silently hence early detection of fibrosis is essential to prevent progression. Primary care presents an opportunity to identify at risk populations, however assessment largely comprises of indirect markers of fibrosis which have little prognostic value. We hypothesised that setting up nurse-led primary care based liver clinics using additional non-invasive testing would increase the number of new diagnoses of liver disease compared to usual care.MethodsThis was a prospective, cluster randomised feasibility trial based in urban primary care in Southampton, United Kingdom. 10 GP practices were randomised to either intervention (liver health nurse) or control (care as usual). Pre recruitment audits were carried out in each practice to ascertain baseline prevalence of liver disease. Participants were subsequently recruited in intervention practices from July 2014-March 2016 via one of 3 pathways: GP referral, nurse led case finding based on risk factors or random AUDIT questionnaire mailouts. Liver assessment included the Southampton Traffic Light test (serum fibrosis markers HA and P3NP) and transient elastography (FibroScan). Cases were ascribed as ‘no fibrosis’, ‘liver warning’, ‘progressive fibrosis’ or ‘probable cirrhosis’. Post recruitment audits were repeated and incident liver diagnoses captured from July 2014-September 2016. Each new diagnosis was reviewed in a virtual clinic by a consultant hepatologist.Findings910 participants were seen in the nurse led clinic—44 (4.8%) probable cirrhosis, 141 (15.5%) progressive fibrosis, 220 (24.2%) liver warning and 505 (55.5%) no evidence of liver fibrosis. 450 (49.5%) cases were due to NAFLD with 356 (39.1%) from alcohol. In the 405 with a liver disease diagnosis, 136 (33.6%) were referred by GP, 218 (53.8%) from nurse led case finding and 51 (12.6%) from the AUDIT mailout. 544 incident cases were identified in the intervention arm compared to 221 in the control arm in the period July 2014-September 2016 (adjusted odds ratio 2.4, 95% CI 2.1 to 2.8).ConclusionsThe incorporation of a liver health nurse into GP practices was simple to arrange and yielded a much higher number of new diagnoses of liver disease compared to usual care. Nearly half of all participants recruited had a degree of liver disease. Nurse led case finding and GP referrals were most effective compared to AUDIT questionnaire mailouts in an urban population in identifying unknown disease. Utilising study and previous data allowed quick and effective virtual review by a hepatologist. Identifying those who are at risk of liver disease from harmful alcohol use remains a challenge and needs to be addressed in future work.

Multistage, ultra-endurance events in hot, humid conditions necessitate thermal adaptation, often achieved through short term heat acclimation (STHA), to improve performance by reducing thermoregulatory strain and perceptions of heat stress. This study investigated the physiological, perceptual and immunological responses to STHA prior to the Marathon des Sables. Eight athletes (age 42 ± 4 years and body mass 81.9 ± 15.0 kg) completed 4 days of controlled hyperthermia STHA (60 min·day, 45°C and 30% relative humidity). Pre, during and post sessions, physiological and perceptual measures were recorded. Immunological measures were recorded pre-post sessions 1 and 4. STHA improved thermal comfort (P = 0.02), sensation (P = 0.03) and perceived exertion (P = 0.04). A dissociated relationship between perceptual fatigue and T was evident after STHA, with reductions in perceived Physical (P = 0.04) and General (P = 0.04) fatigue. Exercising T and HR did not change (P > 0.05) however, sweat rate increased 14% (P = 0.02). No changes were found in white blood cell counts or content (P > 0.05). Four days of STHA facilitates effective perceptual adaptations, without compromising immune status prior to an ultra-endurance race in heat stress. A greater physiological strain is required to confer optimal physiological adaptations.

The study aimed to identify specific health and well-being issues women firefighters may experience as part of their daily working practices. Issues identified from this under-represented population can drive future research, education and strategy to guide safety and health practices. MethodsA total of 840 women firefighters from 14 separate countries (255 United Kingdom & Ireland, 320 North America, 177 Australasia, 88 mainland Europe) completed the survey over a 4 month period.Questions related to general health and well-being and role specific health concerns, gender orientated issues and available exercise facilities. ResultsWomen firefighters in North America reported a higher prevalence of lower back (49%) and lower limb (51%) injuries, than all other groups. North America reported more heat illnesses (45%) than other places (36%). Thirty-nine percent thought their menstrual cycle and menopause effected work, with 36% concerned for their ability to meet future job demands. Sixteen percent felt confident they could complete the role after 60yrs old. Women firefighters identified a lack of strength & conditioning support (50%) or lack of gym access (21%). Availability of women specific personal protective equipment was greatest in the United Kingdom (66%) compared to others (42%). ConclusionsThere is a need for women specific strength & conditioning support and facilities to reduce injury and illness risk and improve longevity. Research and education into gynaecological issues, heat exposure, and their effects on women's fertility and cancer risk is required.

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Analysis of Fire Service Instructors (FSI) working practices and health is needed to minimise health risks related to heat illness, cardiovascular events and immunological stress. Online surveys were distributed to UK FSI and Firefighters (FF). One hundred and thirty FSI (age: 43 ± 7yrs) and 232 FF (age: 41 ± 8yrs) responded. FSI experienced 2-10 live fires per week, with 45% of FSI reporting management does not set a limit on the number of exposures. Few FSI followed hydration guidelines, or cooling methods. New symptoms of ill health were reported by 41% of FSI and 21% of FF. FSI with ≥11 Breathing Apparatus exposures per month were 4.5 times (95% CI 1.33-15.09) more likely to experience new symptoms. A large proportion of FSI are experiencing new symptoms of illness after starting their career, and guidelines on exposure and hydration are not universally in place to reduce the risk of future health problems.

BackgroundTwo meningococcal vaccines (MenB) were licensed for 10–25 year olds in 2015 and given a Category B recommendation with a preferred window of 16–18 years old without high-risk comorbidity. Little is known about uptake of MenB after a Category B recommendation.MethodsWe conducted a retrospective cohort study of 16–23 year olds presenting to 31 primary care sites in a pediatric care network October 23, 2015–April 30, 2017. Using pivot tables and chi square analysis, we examined EHR data for associations between MenB receipt and patient/provider demographics (patient age, sex, race, insurance; provider years in practice), vaccinations, care site (urban vs. suburban), and high-risk comorbidity (asplenia, sickle cell, complement deficiency).ResultsOf 45,428 patients, 51% were female, 68% were 16–18 years old, and 21% received ≥1 MenB. 43% of those patients completed the 2-dose series. Rates of MenACWY booster receipt (32%) exceeded MenB, and 28% received both vaccines. A higher proportion of patients with ≥1 MenB were Asian, older, and privately insured (Table 1). More privately insured patients completed the series (48% vs. 26% Medicaid, P < 0.001). 22% of high-risk patients received MenB, similar to their peers. MenB receipt increased with provider years in practice but declined in those practicing >30 years (Table 1). MenB initiation varied widely between sites (1–45%).ConclusionMenB uptake in this cohort was low. Variation by site, provider years in practice, and potential sociodemographic disparity suggests that advice and acceptance in the setting of a Category B recommendation is not uniform. Further study is needed to clarify how these factors influence MenB receipt in teens.Table 1:% 16–23 Year Olds With ≥1 MenB by Patient and Provider CharacteristicsTotal (%) N = 45,428% with ≥1 MenB N = 9,393 P-valueSexFemale23,167 (51)210.31Male22,261 (49)21Age16–1831,307 (69)18<0.00119–2314,121 (31)28RaceWhite26,280 (58)27<0.001Black13,186 (29)18Asian1,237 (27)22InsuranceMedicaid10,507 (23)17<0.001Private34,854 (77)22VaccinationsMenACWY14,753 (33)28HPV10,007 (22)21Tdap619 (1.4)23ComorbiditiesSickle cell543 (1.2)22Complement deficiency3 (0.007)33Asplenia19 (0.04)42Prov. years in practice≤107,564 (24)1611–209,205 (29)1821–309,330 (29)19>305,939 (17)12<0.001Care siteUrban9,845 (22)210.09Suburban35,583 (78)20Disclosures All authors: No reported disclosures.