Principally, the role of masculine beliefs and the similarities and differences between men of differing background requires further attention, particularly given the health inequalities that exist between men of differing socio-economic status and ethnicity. Further research using heterogeneous samples is required in order to gain a greater understanding of the triggers and barriers associated with the decision making process of help seeking behaviour in men who experience illness.

This investigation examined the relationship among plasma catecholamines, the blood lactate threshold (TLa), and the ventilatory threshold (TVE) in highly trained endurance athletes. Six competitive cyclists and six varsity cross-country runners performed a graded exercise test via two different modalities: treadmill running and bicycle ergometry. Although maximal oxygen consumption (VO2 max) did not differ significantly for the cyclists for treadmill running and cycling (64.6 +/- 1.0 and 63.5 +/- 0.4 ml O2.kg-1-min-1, respectively), both TLa and TVE occurred at a relatively earlier work load during the treadmill run. The opposite was true for the runners as TLa and TVE appeared at an earlier percent of VO2max during cycling compared with treadmill running (60.0 +/- 1.7 vs. 75.0 +/- 4.0%, respectively, TLa). The inflection in plasma epinephrine shifted in an identical manner and occurred simultaneously with that of TLa (r = 0.97) regardless of the testing protocol or training status. Although a high correlation (r = 0.86) existed for the shift in TVE and TLa, this relationship was not as strong as was seen with plasma epinephrine. The results suggest that a causal relationship existed between the inflection in plasma epinephrine and TLa during a graded exercise test. This association was not as strong for TVE and TLa.

Objective-To investigate whether physiological cardiac reserve can be measured in man without invasive procedures and whether it is a major determinant of exercise capacity. Design-Development of method of measurement and an observational study. Setting-A regional cardiothoracic centre. Subjects-70 subjects with a wide range of cardiac function, from heart failure patients to athletes. Methods-Subjects underwent treadmill, symptom limited cardiopulmonary exercise tests to measure aerobic exercise capacity (represented by Ṽ O 2 max) and cardiac reserve. Cardiac output was measured non-invasively using the CO 2 rebreathing technique. Results-Cardiac power output (CPO max ) at peak exercise was found to be significantly related to aerobic capacity: CPO max (W) = 0.35 + 1.5Ṽ O 2 max (l/min), r = 0.87, p < 0.001. It also correlated well with exercise duration (r = 0.62, p < 0.001), suggesting that cardiac reserve is a major determinant of exercise capacity. In the study, cardiac reserve ranged from 0.27 to 5.65 W, indicating a 20-fold diVerence between the most impaired cardiac function and that of the fittest subject. Conclusions-A non-invasive method of estimating physiological cardiac reserve was developed. The reserve was found to be a major determinant of exercise capacity in a population of normal subjects and patients with heart disease. This method may thus be used to provide a clearer definition of the extent of cardiac impairment in patients with heart failure. (Heart 1998;79:289-294)

This study examines the effectiveness of symptom validity measures to detect suspect effort in cognitive testing and invalid completion of ADHD behavior rating scales in 268 adults referred for ADHD assessment. Patients were diagnosed with ADHD based on cognitive testing, behavior rating scales, and clinical interview. Suspect effort was diagnosed by at least two of the following: failure on embedded and free-standing SVT measures, a score > 2 SD below the ADD population average on tests, failure on an ADHD behavior rating scale validity scale, or a major discrepancy between reported and observed ADHD behaviors. A total of 22% of patients engaged in symptom exaggeration. The Word Memory test immediate recall and consistency score (both 64%), TOVA omission errors (63%) and reaction time variability (54%), CAT-A infrequency scale (58%), and b Test (47%) had good sensitivity as well as at least 90% specificity. Clearly, such measures should be used to help avoid making false positive diagnoses of ADHD.