The loading moment of force on the hip, knee, and ankle joints of nine healthy men rising from four different types of stools were compared, together with the levels of myoelectrical activity (EMG) in four leg muscles. Two types of stool (stand stools) had higher seats than a normal chair. The other two were of ordinary seat height, but one also had armrests. The bodyweight carried by the different stools when sitting was also measured, and the subject estimated the effort required for each trial. The mean maximum knee moment was over 60% lower when rising from the high stool than from 'ordinary' seat height. The difference between the high and low stand stool was also significant (p less than 0.001). Using the high stool or help of the arms reduced the mean maximum hip moment by about 50%. The mean maximum ankle moment was only marginally influenced by the different stools. Knee moment was influenced more by seat height than was hip moment. Vastus lateralis activity was significantly higher when subjects rose from 'ordinary' height than when rising from either stand stool (p less than 0.001). The rectus femoris muscle was little activated and the semitendinosus muscle was activated earlier when rising from higher seat heights. All subjects estimated the effort of rising from the higher stand stool to be lower than from the lower stand stool or from 'ordinary' height without arm rests. It was concluded that stand stools are good alternatives for workers who change frequently between sitting and standing work.

Aims Factors influencing follow-up referral decisions and their prognostic implications are poorly investigated in patients with heart failure (HF) with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction (EF). We assessed (i) the proportion of, (ii) independent predictors of, and (iii) outcomes associated with follow-up in specialty vs. primary care across the EF spectrum. Methods and resultsWe analysed 75 518 patients from the large and nationwide Swedish HF registry between 2000-2018. Multivariable logistic regression models were fitted to identify the independent predictors of planned follow-up in specialty vs. primary care, and multivariable Cox models to assess the association between follow-up type and outcomes. In this nationwide registry, 48 115 (64%) patients were planned for follow-up in specialty and 27 403 (36%) in primary care. The median age was 76 [interquartile range (IQR) 67-83] years and 27 546 (36.5%) patients were female. Key independent predictors of planned follow-up in specialty care included optimized HF care, that is follow-up in a nurse-led HF clinic [odds ratio (OR) 4.60, 95% confidence interval (95% CI) 4.41-4.79], use of HF devices (OR 3.99, 95% CI 3.62-4.40), beta-blockers (OR 1.39, 95% CI 1.32-1.47), renin-angiotensin system/angiotensin-receptor-neprilysin inhibitors (OR 1.21, 95% CI 1.15-1.27), and mineralocorticoid receptor antagonists (OR 1.31, 95% CI 1.26-1.37); and more severe HF, that is higher NT-proBNP (OR 1.13, 95% CI 1.06-1.20) and NYHA class (OR 1.13, 95% CI 1.08-1.19). Factors associated with lower likelihood of follow-up in specialty care included older age (OR 0.29, 95% CI 0.28-0.30), female sex (OR 0.89, 95% CI 0.86-0.93), lower income (OR 0.79, 95% CI 0.76-0.82) and educational level (OR 0.77, 95% CI 0.73-0.81), higher EF [HFmrEF (OR 0.65, 95% CI 0.62-0.68) and HFpEF (OR 0.56, 95% CI 0.53-0.58) vs. HFrEF], and higher comorbidity burden, such as presence of kidney disease (OR 0.91, 95% CI 0.87-0.95), atrial fibrillation (OR 0.85, 95% CI 0.81-0.89), and diabetes mellitus (OR 0.92, 95% CI 0.88-0.96). A planned follow-up in specialty care was independently associated with lower risk of all-cause [hazard ratio (HR) 0.78, 95% CI 0.76-0.80] and cardiovascular death (HR 0.76, 95% CI 0.73-0.78) across the EF spectrum, but not of HF hospitalization (HR 1.06, 95% CI 1.03-1.10). Conclusions In a large nationwide HF population, referral to specialty care was linked with male sex, younger age, lower EF, lower comorbidity burden, better socioeconomic environment and optimized HF care, and associated with better survival across the EF spectrum. Our findings highlight the need for greater and more equal access to HF specialty care and improved quality of primary care.

To investigate incidence, predictors and prognostic implications of longitudinal New York Heart Association (NYHA) class changes (i.e. improving or worsening vs. stable NYHA class) in heart failure (HF) across the ejection fraction (EF) spectrum.

Comnnhr Q Munkaard 1993 h n d J Med Sci S p r t s 1993, 3: 244-250 prinvd y! Lk&. Crllwrrsaved Joint moments moments of force and quadriceps muscle activity during squatting exercise. Scand J Med Sci Sports 1993: 3: 244-250.0 1993 Munksgaard.The relationship between hip and knee joint load and quadriceps muscle activity during squatting exercise to different depths was studied. Eight young national class Olympic weightlifters performed squatting exercise to 4 different knee flexion angles; 45", W, parallel and deep squats. They held a barbell acros their shoulders with a weight of 65% of their one-repetition maximum. The loading moments of force about the hip and knee joints were calculated using a semidynamic method. Video was used for motion recording and electromyograhy for recording activity from the vastus lateralis, rectus femoris and biceps femoris muscles. The loading moment on the hip joint increased significantly from the 90" squat to the parallel, but there was no difference between the parallel and the deep. For the knee joint, there was no difference between the 45', 90" and parallel, but for the deep squat the loading moment increased significantly. The muscular activity generally increased with increasing squatting depth, but there were only minor insignificant differences between the parallel and the deep squats. We conclude that knee joint load can be limited by doing parallel instead of deep squats and that this will not decrease quadriceps muscle activity. To limit hip 'Kineslology AM& GOUP,