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Definition Somatotype is a physique classification system which recognises a body shape category, which necessarily falls between pre-determined end limits. Originally proposed as a genotypic morphology rating on a 7 point scale by Sheldon (1940), drawing from earlier work of Kretschmer (1921) who classified three poles to represent extreme physique variation, and Viola (1933) which related dimensions of the thorax, trunk and limbs to a normotype Partly influenced by an alternative methodology from Parnell (1954), Heath and Carter (1967) introduced a three numeral rating somatotype which has become the most universally applied, which involved a photoscopic and anthropometric method, later to be revised in 1990. Record height (H), humerus breadth (HB) and femur breadth (FB), max calf girth and max upper arm girth, with the arm flexed to 45? and tensed. Record height in cm and weight in kg Divide the height by the cube root of weight to calculate the reciprocal of the ponderal index or RPI. Sumo wrestlers High jumpers Discus throwers 400m runners Early training Performance peak Athletes physiques evolve according to training status and periodisation. Brain Attack rd Non Modifiable Modifiable Obesity HTN Smoking Heavy alcohol consumption Hypercoagulability Hyperlipidemia Asymptomatic carotid stenosis Diabetes mellitus Heart disease, atrial fibril.. Brain Attack Generic term for temporary or permanent disturbance of brain function due to vascular disruption (Brookshire) Also called cerebrovascular accident (CVA) 3 rd leading cause of death in t..
HARMFUL EFFECTS OF TOBACCO USE Smoking behaviors often begin in adolescence Advertisements encourage the idea that these behaviors are acceptable Smoking can have devastating effects on health Smoke.. Scientists revealed 72 per cent of songs about being old or ageing contain negative messages that are detrimental to elderly people's health. Meanwhile, Those Were The Days by Mary Hopkin paints a picture of old age being a time in which the a€?fraila€™ and a€?feeblea€™ have no choice but to wave goodbye to the pleasurable times.The Oldest Swinger in Town, by Fred Wedlock, links old age with physical decline, Leonard Cohena€™s Because Of suggests old age is associated with pitifulness in romantic situations, while Old by Dexya€™s Midnight Runners suggests the elderly feel ignored and unwanted, the Journal of Advanced Nursing reports. Such songs harm the self esteem and confidence of older people, which in turn leads to health problems. The views expressed in the contents above are those of our users and do not necessarily reflect the views of MailOnline.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. It is defined as a quantified expression and description of the present morphological conformation of a person. It comprises values, originally proposed on a 7- point scale, which summarise the physique, and can be plotted on the tri-polar somatochart.
Calculate corrected arm (AG) and calf girth (CG) by subtracting triceps and medial calf skinfolds from the respective girths. Objective (from syllabus) To understand the relationship between human body size, shape and composition, and. Pictured here, The Beatles, whose When I'm 64 hit was also found to contain negative imagesa€?While it may prove an impossible task, as well as an infringement on the freedom of expression, to censor negative portrayals of old age, it is important that awareness is raised and some efforts are made to reduce these negative stereotypes.a€™She said most of the offending lyrics were written by young people trying to imagine what it was like to be old, and so one solution could be to encourage the elderly to do more song writing. Anti-microbial proteins ~20 proteins circulating in blood plasma attack bacterial & fungal cells form a membrane attack complex perforate target c.. Methods for Classifying CP By Type Physiological By Distribution Topological By Degree of Severity Intervention Approach for CP Primary focus ..
Automatisms, which are stereotyped repetitive movements such as lip smacking, chewing, fidgeting.
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We sought to determine whether CSE predicts adverse events in the months following discharge in patients with Coronary Artery Disease (CAD). Multi-variate regression modeling was applied to explore the association between baseline CSE scores and cardiac-related hospital admissions and functional cardiac status at T2 and T3. Other outcomes included any hospital admissions, self-reported mental and physical health at follow up. While baseline CSE did not predict cardiac or other hospital admission at T2, CSE was a significant predictor of both outcomes at T3; higher CSE scores resulted in reductions in likelihood of hospital admissions.
Baseline depression explained the association between baseline CSE and any cardiac admissions, as well as baseline CSE and any hospital admissions at T3 follow up.
INTRODUCTIONSelf efficacy is a psychological construct which describes how one’s subjective belief in their ability to perform a task in a desired manner affects their physical engagement and subsequent completion of that task [1, 2] .
It follows that Cardiac Self Efficacy (CSE) is a cardiac-specific measure of a person’s belief in their ability to perform activities which relate to the symptoms and challenges imposed by their cardiovascular disease (CVD) [3] .
CSE motivates individuals to make healthy lifestyle choices in regards to their CVD by creating a desire and willingness to adopt such behaviours [4] . Self efficacy has been shown to affect health-related behaviours and health-related outcomes in the management of chronic disease patients [5] , and is a very strong predictor of behavioural modification amongst patients of any age and state of health [6]. Measurements of self efficacy in CVD have been demonstrated to be better predictors of outcomes including the use of analgesia, physical activity, and return to work than other variables such as age or medical status [3] . Following an acute coronary event, patients are suddenly confronted with a number of difficult challenges and questions, including the imposition of lifestyle changes, the future management of any recurring chest pain and uncertainty about their health status in the future [7] . CSE is particularly important in these patients as the idea of cardiac self management can often be foreign to many patients who have previously expected that their conditions would be solely managed by their physicians, and indeed may be linked to the person seeing their own past behaviours as causative, leading to denial or other maladaptive behaviours [8] .A patient’s CSE has been shown to directly influence their level of commitment, effort, and perseverance towards making suggested lifestyle changes [9]. Patients perceptions’ of their illness and the expectations of their roles in the management of their conditions can often differ from those held by their healthcare providers [10]. Patients who feel powerless due to the effects of their illness, or who have previously expected healthcare providers to provide the majority of care may be shown to have worse CSE, are more likely to develop poorer coping strategies, and are less likely to make significant changes to their lifestyles following an acute coronary event [11]. Amongst patients with CVD, an individual’s attitude towards maintaining a normal level of function and their ability to control symptoms predicts their ability to adhere to diet and exercise regimes in the long term rehabilitation of their illness [12]. A person’s confidence in their ability to make changes to their lifestyle, coupled with their perception of barriers to these changes, can significantly impact their ability to adhere to a management plan [13].


As the management of CVD is a chronic process, patients who have self confidences in their abilities to manage their illness are more likely to make beneficial changes and are more likely to experience better long term health outcomes [14] .
Studies amongst patients who enter cardiac rehabilitation programs following acute coronary events have demonstrated that a patient’s sense of self efficacy in relation to returning to physical exercise improves after their participations in such rehabilitation programs, and portends a better prognosis [15]. Furthermore, the likelihood of patients engaging in programs which employ physical exercise is determined more by their own CSE than it is any objective measures of exercise tolerance [10].Previous studies have also shown that patients with a low sense of self efficacy are more likely to have worse health outcomes [12]. Analyses of data from the Heart and Soul study, comprising patients with heart failure (HF), have shown that those with low self efficacy perform worse on four health outcomes of disease specific and general health domains, including a greater symptom burden, greater physical limitation, a worse quality of life and worse overall health [5,16] . Reduced self efficacy has also been linked to the development of mood disturbances amongst patients with CVD [14,17] which may occur in 15% - 20% of patients with coronary artery disease (CAD) [18]. Given that CSE is at least as important as cardiac function in the determination of health in patients with CAD, it is crucial to study its effects on the outcomes of patients following an acute coronary event [16]. Previous studies that have looked at CSE and its role in the outcomes of patients with CVD have mostly done so in the context of adherence to physical activity and motivation for behavioural change within patients enrolled in cardiac rehabilitation programs.
Those that have looked specifically at CSE and its outcomes in CVD have either been cross-sectional in design [16], or prospective studies amongst patients with HF [5] .
These studies have shown an association between CSE and clinical outcomes independent of depressive symptoms. Briefly, participants were recruited from a major metropolitan hospital in regional Australia between May 2005 and 2006 after admission for percutaneous transluminal coronary angioplasty (PTCA), myocardial infarction (MI), or coronary artery bypass graft surgery (CABG). This catchment area has been shown to be representative of the broader Australian community [20].
Inclusion criteria included: proficiency in English, permanently residing in Australia and provision of informed consent.
Patients with diagnoses of PTCA, MI and CABG were regarded as homogenous based on evidence of similar prognostic effects for both cardiac [21] and self-rated health [22] outcomes.
Patients were initially contacted via postal invitation and subsequently followed up via telephone, six weeks post-discharge. ProcedureSelf-report questionnaires were posted to participants at baseline (T1; three months post-discharge), six months post-discharge (T2) and nine months post-discharge (T3). This time frame was chosen to minimise potential confounding effects of illness and stress associated with a cardiac related admission. Participants’ demographic and clinical variables were obtained from hospital medical records. Table 1 contains details of the instruments used to measure each variable and the time-point at which data were available.Table 1. PredictorCardiac self efficacy was measured by the Cardiac Self Efficacy Scale (CSES) [23], a self-report inventory in which respondents are asked to rate their confidence with knowing or acting on 16 statements on a 5-point Likert-type scale. The responses are not at all confident, somewhat confident, moderately confident, very confident, and completely confident. In the original validation study [23], three items were rated as not applicable by more than 25% of respondents and were omitted from additional analysis.
These items were “quit smoking if you do smoke”, “lose weight if recommended to do so,” and “change your diet if recommended to do so.” Scores are calculated by summing the responses to each set of items and dividing by the number of rated items. The scale used in the present study included the three items that were not analysed in the validation study. Discriminant and convergent validity were demonstrated for both scales in the validation study [23]. Outcomes First, we explored cross-sectional associations between CSE and cardiac status (left ventricular ejection fraction (LVEF), days in hospital and functional cardiac status (FCS) (a measure of effort tolerance) at baseline.
It was necessary to include a self-report component because participants would not necessarily attend the hospital to which they were originally admitted. Statistical AnalysesLinear regression modelling was performed to assess whether CSE scores predict adverse outcomes for continuous variables (FCS, SF-36, days in hospital).
Where negatively skewed (CSE scores), data were transformed using the appropriate log transformations (loge transformation^3).
Univariate analyses were initially conducted to explore the unadjusted relationship between the dependent and independent variables. This relationship was further explored by creating five individual models, adjusting for the aforementioned groups of variables. Measures of magnitude were presented as adjusted Coefficients and Odds Ratios (OR) with Standard Errors (SEs) and 95% confidence intervals (CIs) for each of the five models. RESULTS Of the 228 patients who were recruited, data were available for 193 participants (Figure 1). As reported previously, compared with non-participants, participants were more likely to be male, and were younger in age. This association remained after adjustment for demographics (Model 1), medical history (Model 2), psychosocial factors (Model 3), medication use (Model 4), and clinical variables (Model 5) (data not shown).
There was no relationship between baseline CSE and baseline LVEF.We next explored the role of baseline CSE on six month outcomes. Higher CSE scores predicted greater cardiac functioning; the magnitude of the association was consistent across all five models (Table 3).
Similar trends were observed for CSE and self-rated physical health and mental health, respectively, where better CSE predicted better mental and physical health functioning in all but one model. There was no statistically significant relationship between baseline CSE scores and the likelihood of cardiac-related or other hospital admission, six months post-CAD event (Table 3).Table 2.


Baseline cardiac self efficacy as a predictor of adverse outcomes, 6 months post-CAD.When this association was explored at 9 months post-CAD, however, higher CSE was shown to be a significant predictor of reduced odds of cardiac hospital admissions (Table 4).
Similarly, higher CSE was shown to protect against any hospital admission at follow up (Table 4), in all but one model. However, after adjustment for HADS depression score in the psycho-social model (Model 3), this association was no longer significant (Table 4).
While higher baseline CSE scores predicted cardiac functional status at 9 months, baseline HADS depression score was the strongest predictor of CFS; resulting in a significant decrease in cardiac functional status at 9 months (Adj. Baseline CSE also predicted physical and mental health functioning, nine months post CAD (Table 4).
These associations were observed across all five models.Finally, the role of CSE in cardiacor anyhospital admission at any timepoint was explored. However, after adjustment for psychosocial variables (Model 3), none of these associations remained.
HADS depression scores explained the association between baseline CSE and any cardiac admission, as well as baseline CSE and any hospital admission at 9 month follow up (data not shown).4.
DISCUSSIONOur findings provide some supports for cardiac self efficacy as a proxy measure for predicting subsequent cardiac functioning, and self-rated health in the months following CAD. Baseline CSE consistently predicted cardiac functioning as well as self-rated mental and physical health across all time-points.
While CSE was shown to predict both general and cardiac-related hospital admissions, these relationships were explained by the presence of depression at baseline, suggesting that depression may be a stronger mediator in the relationship between self efficacy and subsequent health outcomes than previous studies suggest. For example, while data from the Heart and Soul Study have demonstrated that depression partially explains the relationship between CSE and poor health outcomes (both cross-sectionally and prospectively), both found it to be independent of depressive symptoms. While some elements of these studies are comparable (both used the same measure of CSE [23]), there may be other factors which explain differential findings. First, Sarkah (2009) explored the longer term effects of CSE on clinical outcomes of HF patients over a follow up period of 4.3 years, compared with 6 and 9 month follow up of CAD patients in the present study. It is possible that depression may mediate the association between CSE and clinical outcomes in the immediate post-coronary period when symptoms are likely to be elevated, and conversely, may not be as influential in long term prognosis, as symptoms can dissipate in the years following the event.Table 4. Baseline cardiac self efficacy as a predictor of adverse outcomes, 9 months post-CAD event.There are other methodological explanations for differential findings related to the role of depression in this association. Indeed the accuracy of detecting depression in cardiac populations using these types of patient-specific self-report measures has been a topic of debate, with some arguing that cardiac-specific measures of depression are required to accurately capture depression after a coronary event.
Depression following a myocardial infarction has been shown to produce a 2 to 2.5-fold increased risk for future adverse events [28] . What remains troubling is that many patients who develop depression following an acute event are not recognized during their admissions [29,30] . Proposed mechanisms for this lack of recognition include an overlap in symptomatology between the somatic symptoms of depression and those commonly found in hospitalized patients [31] or limitations in staff education and comfort in recognizing and managing depression in cardiac patients [29] . Perceived CSE has been inversely correlated with mood disorders in patients with CVD [14] . Depressed patients, who are more likely to display a lower CSE, demonstrate a longer time to return to work, poorer compliance with medication or cardiac rehabilitation regimes, and worse overall outcomes [32]. As a consequence of a lack of CSE, depressed patients can develop maladaptive coping strategies such as behavioral disengagement and avoidance [33] which may translate into a lower motivation for self care and medication adherence [34].
It is possible that confidence about self-management was reinforced by more comprehensive clinical advice that came with a longer hospital stay in comparison to those who were discharged sooner. Given that the average duration for hospitalization after a coronary event such as MI in Australia has been estimated to be between 2 - 5 days, there is clearly a role for the clinician in promoting self-management and thus self-efficacy. Further, while the role of depression in impairing cardiac self efficacy in this population is a topic for further investigation, identifying those with depression prior to discharge may highlight those with low self efficacy who are therefore at risk of poor clinical outcomes.This study has several strengths. Compared with other studies that have applied a cross-sectional approach to exploring the role of self efficacy in similar populations, this study utilized a prospective design allowing us to adequately explore prospective associations between CSE and health outcomes. Further, the study yielded sound retention rates, with minimal loss to follow up which resulted in a comprehensive dataset. It should be noted however, that several significant differences in characteristics of respondents versus non-respondents were observed, pertaining to age and gender. The issue of the under-representation of women in studies of cardiac patients is well documented [35]. For example, randomized controlled trials in this area are seldom well-represented with women. Given that depression is more common in women than men (this is also true of cardiac patients), and importantly the prognosis for women post-coronary event is often poorer than their male counterparts, future studies should further explore the role of CSE in women for improving clinical outcomes.In conclusion, this study highlights the predictive role of CSE on clinical and general health outcomes of CAD patients in the months following a coronary event. He has been a paid consultant for Astra Zeneca, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Janssen Cilag, Lundbeck and Pfizer and a paid speaker for Astra Zeneca, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Janssen Cilag, Lundbeck, Organon, Pfizer, Sanofi Synthelabo, Solvay and Wyeth.7. Morteza Mohajeri at Department of Cardiology, Barwon Health for facilitating access to patients and patient data.
Stafford was supported by a scholarship from Melbourne University while conducting this study. O’Neil is supported by an Early Career Fellowship (ECF) from the National Health and Medical Research Council (NHMRC) (1052865).



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