A comparison of the reproducibility and the sensitivity to change of visual analogue scales, Borg scales, and Likert scales in normal subjects during submaximal exercise

Acupuncture for dyspnea and breathing physiology in chronic respiratory diseases: A systematic review and meta-analysis of randomized controlled trials

Background

Dyspnea, a common symptom of chronic respiratory diseases (CRDs), is closely linked to higher levels of functional impairment and death, leading to significant societal and financial challenges. Despite numerous clinical trials and systematic reviews suggested the potential benefits of acupuncture for chronic obstructive pulmonary disease (COPD) and lung cancer, there is currently insufficient evidence to conclusively prove its effectiveness in alleviating dyspnea in patients with CRDs.

Methods

To compile and evaluate the existing data on the effectiveness and safety of acupuncture for managing dyspnea in CRDs. Randomized controlled trials investigating acupuncture for the treatment of dyspnea in patients with CRDs, such as COPD, lung cancer, asthma, bronchiectasis, interstitial lung disease, chronic pulmonary heart disease and bronchitis, were searched and retrieved from five electronic databases in English or Chinese.

Results

A total of 23 studies meeting the inclusion criteria were found in databases, covering various CRDs such as COPD, lung cancer, and asthma. A meta-analysis that compared acupuncture to a control group (which included no acupuncture and sham acupuncture) found significant advantages for acupuncture in reducing dyspnea severity (P = 0.0003), increasing 6MWD (P < 0.00001), improving quality of life measured by St. George's Respiratory Questionnaire (P = 0.03) and karnofsky performance status score (P < 0.00001). No significance was found in breathing physiology represented by FEV1 (P = 0.34) and FVC (P = 0.15). There was a comparable incidence of negative outcomes in both groups (P = 0.07). Results were consistent when compared to sham acupuncture. In addition, subgroup analyses were also consistent when different diseases or types of acupuncture were analyzed.

Conclusions

Acupuncture may be an effective and safe non-pharmacological complementary intervention to relief dyspnea for patients with CRDs. Nevertheless, research with high quality and large sample sizes is needed for further investigation.

Validation of the Borg CR10 Scale for the evaluation of shoulder perceived fatigue during work-related tasks

Work-related upper extremity disorders (WRUEDs) are highly prevalent and costly. Development of fatigue is thought to be one of the causes of WRUEDs. Perceived fatigue can be assessed with the Borg CR Scale® (Borg CR10). The objective was to validate the Borg CR10 for the evaluation of shoulder perceived fatigue during lifting tasks. Seventy adults in working age performed three rhythmic lifting tasks with two loads (15% and 30% of maximal voluntary contraction). Using generalized repeated-measures ANOVA (Generalized Estimating Equations), statistically significant Task and Load effects (p < 0.001), as well as Task × Load interaction effects (p < 0.0001) were observed on Borg CR10, without any influence of sex. The Borg CR10 is a valid tool to assess shoulder perceived fatigue as it can discriminate between tasks of different difficulty levels in term of complexity, height, and resistance, regardless of sex.

Excellent survival of two anatomically adapted hydroxyapatite coated cementless Total Hip Arthroplasties. A mean follow-up of 11.3 years

There are many different types of cementless anatomically adapted Total Hip Arthroplasties (THAs) on the market, the Anatomic Benoist Gerard (ABG) I and II are such types of cementless THAs. In this retrospective single-centre study we evaluated the overall survival with revision for any reason and aseptic loosening as endpoint at more than 11 years follow-up. Between 2000 and 2004, 244 cementless THAs were performed in 230 patients in a primary care hospital. At a mean of 11.3 years follow-up (range 9.8 - 12.8 years) clinical examination, plain radiography and Patient Reported Outcome Measures (PROMs) were obtained and analysed. The PROMs consisted of the Oxford Hip Score (OHS) and the Western Ontario and McMaster University Index (WOMAC). At a mean of 11.3 years follow-up 32 patients (13.1%) had died of unrelated causes. Of the remaining cohort all 198 patients (212 THAs) have been reached for evaluation. There were no patients considered as lost to follow-up. At a mean of 11.3 years 11 patients (11 THAs) have had a revision of either the femoral implant or acetabular component resulting in an overall survival of 95.5%. There was no statistically significant difference (p=0.564) in survival between the ABG I and II THAs. Radiographic there were no changes between the ABG I and II last follow up. The ABG II performed statistically significant better in PROMs. We concluded that both anatomically adapted hydroxyapatite coated cementless THAs show excellent survival at more than 11 years follow-up.

A single-session VR intervention addressing self-compassion and self-criticism with and without perspective change: Results of a randomized controlled experiment

Excessive self-criticism is an important transdiagnostic psychological factor. In contrast, self-compassion can contribute to the resilience and recovery of clinical populations, making this an important target for treatment. Virtual Reality (VR) has the potential to improve existing interventions as it allows for personalized roleplays that can be experienced from different perspectives, by using the novel VR technique of perspective change. We investigated the effects of a VR intervention on self-criticism and self-compassion, and the added value of changing perspectives. In total, 68 undergraduate students with high levels of self-criticism were randomized to either the perspective change condition or the control condition. Participants played two roleplays in which they had to react compassionately toward a virtual character that expressed the participants' own self-critical thoughts. In the perspective change condition, after each roleplay perspective change was used to receive one's own compassionate words. Results showed that self-compassion increased and self-criticism decreased significantly in both conditions. No significant differences were found for negative and positive affect. Furthermore, no differences were found between the conditions. Thus, receiving compassionate words through perspective change had no additional effect. Expressing compassion to someone with similar self-criticism showed to be sufficient to reduce self-criticism and increase self-compassion.

Electromyogram Power Spectrum and Cardiac Function Changes After Combined Aerobic Interval Training and Inspiratory Muscle Training in Chronic Heart Failure Patients

Exercise intolerance and dyspnea are the major symptoms of patients with chronic heart failure (CHF) and are associated with a poor quality of life. In addition to impaired central hemodynamics, symptoms may be attributed to changes in peripheral skeletal muscles. This study aimed to evaluate the effects of aerobic interval training (AIT) combined with inspiratory muscle training (IMT) on cardiac and skeletal muscle function and on functional capacity and dyspnea in patients with CHF and inspiratory muscle weakness.Left ventricle ejection fraction was improved significantly after AIT and AIT & IMT with a high percentage of amelioration (17%, P < 0.042) in the combined group compared to the control group. Therefore, we showed a significant improvement in maximal voluntary isometric force, isometric endurance time, root mean square, and frequency median in both strength and endurance manipulations in the aerobic and combined group; however, the improvement was superior in the combined group compared to the control group. Significant amelioration was proved in functional capacity and dyspnea after all types of training but was performed at 18% higher in 6 minutes' walk test and 43% lower in dyspnea for the combined group compared to the control group.Combining AIT to IMT had optimized exercise training benefits in reversing the cardiac remodeling process and improving skeletal muscle function, functional capacity, and dyspnea in patients with CHF.

Acute orthostatic responses during early mobilisation of patients with acquired brain injury - Innowalk pro versus standing frame

Introduction

Early mobilisation is paramount in the rehabilitation of patients with acquired brain injuries. However, the effectiveness of mobilisation to standing combined with passive leg movement in mitigating orthostatic intolerance remains uncertain. Hence, we investigated whether participants exhibited better tolerance standing in a motorized standing device with passive leg movements, Innowalk Pro, compared to a traditional standing frame.

Methods

17 patients with acquired brain injury (<1 year post-injury) performed two sessions in each standing device on four separate days. Maximum standing time was 30 min, less when symptoms of syncope or volitional exhaustion occurred. Besides total standing time, electromyography of thigh muscles, and changes in mean arterial pressure and heart rate were monitored at rest and during standing.

Results

No significant differences were found in standing time, changes in mean arterial pressure or heart rate between standing in Innowalk Pro and the standing frame. However, participants had significantly more thigh muscle activation (p = 0.006) when standing in Innowalk Pro.

Conclusions

Mobilising participants with a subacute acquired brain injury in a standing frame with motorised passive movements of the lower limbs did, despite higher thigh muscle activation, not lead to better orthostatic tolerance or prolonged standing time compared to a traditional standing frame.

Neural mechanisms underlying attentional bias modification in fibromyalgia patients: a double-blind ERP study

There is a growing interest in the potential benefits of attentional bias modification (ABM) training in chronic pain patients. However, studies examining the effectiveness of ABM programs in fibromyalgia patients have demonstrated inconclusive effects on both behavioral indices and clinical symptoms. Additionally, underlying neural dynamics of ABM effects could yield new insights but remain yet unexplored. Current study, therefore, aims to investigate the effects of ABM training on known neural electrophysiological indicators of attentional bias to pain (P2, N2a). Thirty-two fibromyalgia patients were enrolled and randomly assigned to an ABM training (N = 16) or control (N = 16) condition (2 weeks duration). Within the ABM training condition participants performed five sessions consisting of a modified version of the dot-probe task in which patients were trained to avoid facial pain expressions, whereas in the control group participants performed five sessions consisting of a standard version of the dot-probe task. Potential ABM training effects were evaluated by comparing a single pre- and post-treatment session, in which event-related potentials (ERPs) were recorded in response to both facial expressions and target stimuli. Furthermore, patients filled out a series of self-report questionnaires assessing anxiety, depression, pain-related worrying, fear of pain, fatigue and pain status. After training, results indicated an overall reduction of the amplitude of the P2 component followed by an enhancement of N2a amplitude for the ABM condition compared to control condition. In addition, scores on anxiety and depression decreased in patients assigned to the training condition. However, we found no effects derived from the training on pain-related and fatigue status. Present study offers new insights related to the possible neural mechanisms underlying the effect of ABM training in fibromyalgia. Clinical trial (TRN: NCT05905159) retrospectively registered (30/05/2023).

Psychometric Properties and The Best Form of The Revised Short-Form Mc-Gill Pain Questionnaire in Iranian Burn Patients

Pain is the most important factor that forces patients to seek help from health care systems. Burn injuries are associated with severe pain and the assessment and interventions are a focus of nursing care. The aim of this study was to evaluate the psychometric properties of the revised short-form Mc-Gill Pain Questionnaire (MPQ) in burn patients. The present study is a methodological study in which 153 burn patients were included by convenience sampling. To evaluate the psychometric properties of the 22-item revised MPQ, face validity, construct validity (exploratory factor analysis), and reliability were determined by Cronbach's α coefficient and split-half method. Data analysis was performed using SPSS22.0 software. During the quantitative face validity test, four items were removed from the instrument due to the impact score of less than 1.5 by burn patients. The results of exploratory factor analysis showed five factors (emotional, neuropathic, continuous, stimulatory, and shooting), which explained 72.32% of the total variance. The overall Cronbach's instrument was 0.836 and the coefficient obtained by the split-half method was 0.81. According to the validity and reliability, the 18-item MPQ obtained in the present study can be used to assess pain in Persian-speaking adult burn patients.

Development of actinic lentigines due to multiple sub-erythemal exposure to UVA1 radiation in Asian skin

The appearance of actinic lentigines mainly found on face, back of the hands, upper back and décolleté is associated with chronic sun exposure. However, there is no study looking at the role of long UVA specifically in the development of actinic lentigines. This study was conducted in 20 Japanese adult women exposed on the upper back area three times per week for 6 weeks to incremental sub-erythemal UVA1 doses (5 J/cm2 at weeks 1 and 2, 10 J/cm2 at weeks 3 and 4 and 15 J/cm2 at weeks 5 and 6). Clinical assessment, performed on day 0 (before any exposure), and on days 14, 28 and 42, included the evaluation of skin pigmentation (pigmented spots), chromametry of the pigmented skin lesions and measurement of dyschromy. The number of pigmented spots and uniformity of the skin's pigmentation were clearly increased in comparison with baseline, statistical significance of the difference (p < 0.05) being reached at D 28 and D 42 in both cases. In conclusion, repeated sub-erythemal UVA1 exposure induces the development of actinic lentigines. Thus, a suitable protection including long UVA coverage is also needed to prevent from the damages induced by low, sub-erythemal doses of UV exposure.

Investigating Ecological Momentary Assessed Physical Activity and Core Executive Functions in 18- to 24-Year-Old Undergraduate Students

Although evidence for young children (<10) and older adults (>64) highlights an association between physical activity (PA) and executive functions (EFs), there is a paucity of research on adolescents aged 18-24 years. Thus, this study examined the associations between PA and EF and the difference in EF between individuals who achieve the moderate-to-vigorous (MVPA) guidelines and those who do not. Forty-seven participants engaged in a Stroop task, a reverse Corsi-block test, and a task-switching test, to measure inhibition, working memory, and cognitive flexibility, respectively. An ecological momentary assessment (EMA) was used to determine the participant's MVPA and step count, through the "Pathverse" app. Multiple regressions were run to predict the task-switch cost, the Stroop effect, and the backward Corsi span from time spent in MVPA. A two-way ANCOVA examined the effects of achieving the MVPA guidelines on EF. MVPA and step count did not significantly predict EF. There were no significant differences in EF between participants achieving the MVPA guidelines and those that did not. Time spent in MVPA and step count were not significantly associated with working memory, cognitive flexibility, or inhibition in adolescents. Further research is warranted to understand other factors that may significantly affect EF, within and outside an individual's control.

Exploring the Nutrition Strategies Employed by Ultra-Endurance Athletes to Alleviate Exercise-Induced Gastrointestinal Symptoms-A Systematic Review

(1) Background: Participation in ultra-endurance sports, particularly ultra-running, has increased over the previous three decades. These are accompanied by high energetic demands, which may be further exacerbated by extreme environmental conditions. Preparation is long-term, comprising of sufficient exercise management, supportive dietary habits, and nutritional intakes for optimal adaptations. Gastrointestinal symptoms are often cited as causing underperformance and incompletion of events. Though the majority do not pose serious long-term health risks, they may still arise. It has been suggested that the nutritional interventions employed by such athletes prior to, during, and after exercise have the potential to alter symptom incidence, severity, and duration. A summary of such interventions does not yet exist, making it difficult for relevant personnel to develop recommendations that simultaneously improve athletic performance by attenuating gastrointestinal symptoms. The aim of this research is to systematically review the literature investigating the effects of a nutrition intervention on ultra-endurance athletes exercise-induced gastrointestinal symptom incidence, severity, or duration. (2) Methods: A systematic review of the literature was conducted (PubMed, CINAHL, Web of Science, and Sports Discus) in January 2023 to investigate the effects of various nutrition interventions on ultra-endurance athletes' (regardless of irritable bowel syndrome diagnosis) exercise-induced gastrointestinal symptoms. Variations of key words such as "ultra-endurance", "gastrointestinal", and "nutrition" were searched. The risk of bias in each paper was assessed using the ADA quality criteria checklist. (3) Results: Of the seven eligible studies, one was a single field-based case study, while the majority employed a crossover intervention design. A total of n = 105 participants (n = 50 male; n = 55 female) were included in this review. Practicing a diet low in short-chain, poorly absorbed carbohydrates, known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), as well as employing repetitive gut challenges of carbohydrates, remain the most promising of strategies for exercise-induced gastrointestinal symptom management. (4) Conclusion: Avoiding high-FODMAP foods and practicing repetitive gut challenges are promising methods to manage gastrointestinal symptoms. However, sample sizes are often small and lack supportive power calculations.

Exercise Physiology and Cardiopulmonary Exercise Testing

Aerobic, or endurance, exercise is an energy requiring process supported primarily by energy from oxidative adenosine triphosphate synthesis. The consumption of oxygen and production of carbon dioxide in muscle cells are dynamically linked to oxygen uptake (V̇O2) and carbon dioxide output (V̇CO2) at the lung by integrated functions of cardiovascular, pulmonary, hematologic, and neurohumoral systems. Maximum oxygen uptake (V̇O2max) is the standard expression of aerobic capacity and a predictor of outcomes in diverse populations. While commonly limited in young fit individuals by the capacity to deliver oxygen to exercising muscle, (V̇O2max) may become limited by impairment within any of the multiple systems supporting cellular or atmospheric gas exchange. In the range of available power outputs, endurance exercise can be partitioned into different intensity domains representing distinct metabolic profiles and tolerances for sustained activity. Estimates of both V̇O2max and the lactate threshold, which marks the upper limit of moderate-intensity exercise, can be determined from measures of gas exchange from respired breath during whole-body exercise. Cardiopulmonary exercise testing (CPET) includes measurement of V̇O2 and V̇CO2 along with heart rate and other variables reflecting cardiac and pulmonary responses to exercise. Clinical CPET is conducted for persons with known medical conditions to quantify impairment, contribute to prognostic assessments, and help discriminate among proximal causes of symptoms or limitations for an individual. CPET is also conducted in persons without known disease as part of the diagnostic evaluation of unexplained symptoms. Although CPET quantifies a limited sample of the complex functions and interactions underlying exercise performance, both its specific and global findings are uniquely valuable. Some specific findings can aid in individualized diagnosis and treatment decisions. At the same time, CPET provides a holistic summary of an individual's exercise function, including effects not only of the primary diagnosis, but also of secondary and coexisting conditions.

Reproducibility of the 6-minute walk test in lung transplant recipients

PURPOSE

There is reason to believe that the favorable measurement properties of the 6‑minute walk test (6MWT) reported for retest reliability and its capability to detect a true change in healthy individuals or persons with chronic respiratory disease may not apply to lung transplant recipients (LuTXr). We therefore investigated retest reliability of the 6MWT and, in addition, made an attempt to explore whether the 6MWT was sensitive enough to detect important changes that occur with postacute rehabilitation in LuTXr after first time LuTX.

METHODS

Immediately before postacute rehabilitation, 50 LuTXr completed 6MWT testing twice, separated by 1-2 workdays (retest reliability), and were reassessed after completion of rehabilitation 2 months later (sensitivity to changes). Body function measures and health-related quality of life (HRQoL) assessments were collected at baseline.

RESULTS

Baseline retest 6‑minute walk distance (6MWD) and the age-related predicted walking distance (6MWD%pred) scores significantly increased before postacute rehabilitation. The intraclass coefficient of correlation ICC of the 6MWD was 0.93 (95% confidence interval, CI: 0.88-0.96) and its smallest real difference (SRD) 79 m (95% CI: 52;107). Receiver operating curve analyses revealed the rehabilitation associated changes in 6MWD/6MWD%pred to exceed the SRD/SRD% values in a highly accurate way.

CONCLUSION

The 6MWT overall represents a reliable functional performance tool in LuTXr that is sensitive to detect changes in physical performance as a result of medical postacute rehabilitation.

Recreational futsal provides broad-spectrum fitness and health benefits but no blood pressure effects in men with treated hypertension - a randomised controlled trial

We determined the coadjuvant effect of a recreational futsal (RF) programme versus standard care alone (CON) in men with treated arterial hypertension (TAHT). Thirty-nine men with TAHT were randomised to RF (N = 20; 48 ± 8 years; systolic blood pressure [SBP]: 122 ± 14 mmHg) with 2-3 one-hour sessions/week for 3 months, or to CON (N = 19; 51 ± 6 years; SBP: 126 ± 13 mmHg). Participants were assessed at baseline, at 3 months, and after 1 month of training cessation (4 months). Mean training attendance was 60 ± 23%. At 3-months, there were no between-group differences in BP parameters (SBP: 0.44 mmHg; 95% CI: -5.79, 6.67). However, compared to CON, RF was effective for peak oxygen uptake (2.76 mL.min-1.kg-1; 95% CI: 0.26, 5.26), time to exhaustion (1.15 min; 95% CI: 0.59, 1.69), Yo-Yo IE1 performance (365 m; 95% CI: 175, 556), resting heart rate (RHR; -5 b.min-1; 95% CI: -10, -1), glycated haemoglobin (-0.52 mmol/L; 95% CI: -0.84, -0.19), blood glucose (-0.25 mmol/L; 95% CI: -0.44, -0.06), left femur bone mineral content (1.96 g; 95% CI: 0.29, 3.65), and postural balance (-2.3 falls; 95% CI: -3.9, -0.6). Similar findings were observed after 1-month of training cessation, except for RHR and blood glucose that returned to baseline levels in the RF group. In conclusion, RF provides broad-spectrum fitness and health benefits but no BP effects in men with TAHT.

The impact of COVID-19 and socioeconomic status on psychological distress in cancer patients

Objective

We aimed to investigate the impact of the COVID-19 pandemic on psychological symptom burden against the socioeconomic background of cancer patients using data from routine assessments before and during the pandemic.

Method

In this cross-sectional study, standardised assessment instruments were applied in N = 1,329 patients to screen for symptoms of anxiety, depression, post-traumatic stress, and fatigue from 2018 to 2022. Two MANOVAs with post-hoc tests were computed. First, only time was included as predictor to examine the isolated impact of the pandemic. Second, income level and education level were included as further predictors to additionally test the predictive power of socioeconomic factors.

Results

In the final model, only income had a significant impact on all aspects of psychological symptom burden, with patients with low income being highly burdened (partial η² = .01, p = .023). The highest mean difference was found for depressive symptoms (MD = 0.13, CI = [0.07; 0.19], p < .001). The pandemic had no further influence on psychological distress.

Conclusions

Although the pandemic is a major stressor in many respects, poverty may be the more important risk factor for psychological symptom burden in cancer outpatients, outweighing the impact of the pandemic.

Using the 6-min walk test to assess the clinical response to mepolizumab and conventional therapy in severe eosinophilic asthma

Background

Severe asthma limits exercise to avoid respiratory symptoms. The objective of the present study was to investigate the role of the 6-min walk test (6MWT) in severe asthma.

Methods

Consecutive patients with severe eosinophilic asthma were enrolled. A 6MWT was performed before and after 12 months. Inhaled therapy dose, oral corticosteroids dose, pulmonary function tests, eosinophil blood count, fractional exhaled nitric oxide (FeNO), Asthma Control Test (ACT) score and responses to the Asthma Quality of Life Questionnaire (AQLQ) were also recorded.

Results

Of the 22 patients enrolled, 13 were treated with mepolizumab 100 mg every 4 weeks in addition to conventional therapy and nine with conventional therapy only. The majority of the patients were treated with high-dose inhaled corticosteroids/long-acting β-agonists/long-acting muscarinic receptor antagonists, while approximately half were on continuous oral corticosteroids. After 12 months, the mepolizumab group only showed a significant improvement in pulmonary function tests (percentage forced expiratory volume in 1 s and percentage forced expiratory flow at 25-75% forced vital capacity (FEF25-75%), both p<0.001; percentage forced vital capacity, p<0.01) and clinical laboratory parameters (eosinophil count, FeNO measured at a flow rate of 50 mL·s-1, ACT and AQLQ, p<0.001). No significant changes in the proportion of patients using continuous oral corticosteroids and high-dose inhaled corticosteroids/long-acting β-agonists/long-acting muscarinic receptor antagonists were observed in either group (p>0.05). By paired comparisons, statistically significant improvements of the mean 6-min walk distance (6MWD) were observed in the mepolizumab (p<0.001) and conventional therapy (p<0.01) groups, while no improvement was seen in dyspnoea Borg scale, heart rate, percentage oxygen saturation or systolic and diastolic blood pressure. 6MWD showed significant direct correlations with ACT (r=0.5998, p<0.001), AQLQ (r=0.3978, p=0.009) and FEF25-75% (r=0.3589, p=0.017).

Conclusions

The 6MWT could complement severe asthma assessment and be relevant in evaluating the objective response to treatment, including biological therapies like mepolizumab.

Mixed-gender small-sided recreational team handball games in middle-aged and elderly are physiologically more demanding for women than men

This study examined the physical and physiological demands and perceived experience of a multicomponent exercise mode, recreational team handball (TH), for middle-aged/elderly men and women, played as same- vs. mixed-gender 6v6 game formats. Matches' heart rate (HR), blood lactate (BL), perceived experience, activity profile, player load and accelerometer variables were assessed. Forty-one participants, with at least 12 weeks of experience with recreational TH (22 men; 69±4 years, 19 women; 66±6 years), performed 2 same- and 2 mixed-gender matches on an indoor 40x20 m TH court. A game format-by-gender interaction was observed for mean HR (%HRmax), time spent ˃80 and ˃90%HRmax, respiratory rating of perceived exertion and for several of the external load variables (p≤0.05). During mixed-gender matches, time spent ˃80 and ˃90%HRmax, was higher for women vs. men (p≤0.017). During same- and mixed-gender matches, BL was lower for women than men (p≤0.015). Time spent ˃90%HRmax was lower for women (p = 0.036), whereas time spent ˃80%HRmax was higher for men during same- vs. mixed-gender matches (p = 0.034). The frequency, %total match time and distance covered with high-demanding movements were higher for men during same-gender than during mixed-gender matches (p≤0.036), and higher for men vs. women in same- and mixed-gender matches (p≤0.046). The frequency of high-intensity actions, accelerations, time spent in the higher player load zones and total accumulated player load, were higher for men vs. women during same- and mixed-gender matches (p≤0.044). Fun levels were very high (9.1-9.3 AU, 0-10). Mixed-gender small-sided recreational TH games are physiologically more demanding for middle-aged/elderly women compared to men. Men showed higher cardiovascular and activity profile demands when playing same-gender matches, which was opposite to women. Nevertheless, TH is a high-intensity and motivating exercise mode for both genders, regardless the gender game format, meaning that exercise interventions may use same- and mixed-gender matches to promote participants' health.

Determining the Appropriate Support for Older Adults with Different Levels of Vitality and Health-Related Quality of Life: An Explanatory Study

Vitality and health-related quality of life are often assessed in older adults. However, these assessments do not provide guidance on support for older adults with different levels of vitality and health-related quality of life. This guidance can be established through segmentation. The Subjective Health Experience model segments individuals and indicates support for each segment. By examining how older adults with different levels of vitality and health-related quality of life correspond with each segment and by specifying the indicated support to older adults, guidance can be established. This was examined by administering a questionnaire to 904 older adults and interviewing 8. Analysis was performed using one-way ANOVA and the matrix method. In segment 1, older adults sustained higher levels of vitality and health-related quality of life relative to other segments. They need information and certainty. In segment 2, older adults sustained lower levels of vitality and health-related quality of life relative to segment 1, and higher levels relative to segment 3 or 4. They need planning and structure. In segment 3, older adults sustained lower levels of vitality and health-related quality of life relative to segment 1 or 2, and higher levels relative to segment 4. They need emotive assistance. In segment 4, older adults sustained lower levels of vitality and health-related quality of life relative to other segments. They need personal coaching. As levels of vitality and health-related quality of life correspond with the segments, deploying vitality and health-related quality of life measures together with the model might be beneficial.

Optimal gingival display on smiling based on different facial vertical patterns in Iranians

INTRODUCTION

This study aimed to determine the optimal gingival display on smiling on the basis of different facial vertical patterns in Iranians from the perspective of laypeople, maxillofacial surgeons, and orthodontists.

METHODS

Photographs were obtained from short-faced, normal-faced, and long-faced males and females (1 male and 1 female from each group) aged 18-30 years. The original photographs were then modified to have 6, 4, 2, 0, -2, -4, and -6 mm gingival display. Three groups of raters (n = 40), including laypeople, orthodontists, and maxillofacial surgeons, were requested to score each photograph regarding smile attractiveness using a 5-point Likert scale. Data were analyzed using analysis of variance and the Kruskal-Wallis test.

RESULTS

Regarding the photographs of the normal-faced female model, all 3 rater groups gave the highest score to a 2 gingival display. In the normal-faced male model, all 3 rater groups gave the highest and lowest scores to 0 and 6 mm gingival display, respectively. In the long-faced female model, all 3 rater groups gave the same score to 0, 4, and 6 gingival display. In the long-faced male model, the 3 rater groups gave the same score to 0, 2, 4, and 6 gingival display. In the short-faced female model, all 3 rater groups gave the highest score to 0 gingival display. In the short-faced male model, the 3 rater groups gave the same score to all values of gingival display except -4 mm.

CONCLUSIONS

The laypeople, maxillofacial surgeons, and orthodontists all gave the highest score to the photograph of a short-faced Iranian female model with 0 gingival display.

Patient Reported Outcome Following the Skoog Unilateral Cleft Lip Repair among Adults- a Long-Term Cohort Study and Comparison to a Non-cleft Population

OBJECTIVE

The study primarily aimed to compare satisfaction with lip appearance among adults treated for unilateral cleft lip and palate (UCLP) with Skoog's primary lip repair procedure to those without clefts. The secondary aim was to determine whether satisfaction with lip appearance and the desire to change the lip/face appearance correlated with the number of secondary lip revisions performed.

DESIGN

Long-term follow-up.

PATIENTS/SETTINGS

All UCLP patients treated at the Uppsala University Hospital born between 1960- and 1987 (n  =  109) were invited. At an average of 37 years following the primary lip repair, the participation rate was 76% (n  =  83). A control group of adults without cleft (n  =  67) completed the same study protocol for comparison.

MAIN OUTCOME MEASURES

Satisfaction with appearance was measured with The Satisfaction with Appearance Questionnaire (SWA) and a modified version of the Body Cathexis -Scale was used to assess the desire to change the lip and facial appearance.

RESULTS

UCLP patients were less satisfied with their lip, face, and overall appearance and reported a greater desire to change the appearance of their lips and face than non-cleft controls (p < 0.001). Dissatisfaction with lip appearance correlated to a greater willingness to change the appearance of the lip and face. No correlation was found between satisfaction with appearance and the number of the previously performed secondary lip revisions.

CONCLUSION

Adults treated for UCLP are less satisfied with the appearance of their lips compared to the non-cleft population. The number of secondary revisions does not necessarily correlate to greater satisfaction with lip appearance.

Using Arterial Pulse and Laser Doppler Analyses to Discriminate between the Cardiovascular Effects of Different Running Levels

BACKGROUND AND AIMS

Running can induce advantageous cardiovascular effects such as improved arterial stiffness and blood-supply perfusion. However, the differences between the vascular and blood-flow perfusion conditions under different levels of endurance-running performance remains unclear. The present study aimed to assess the vascular and blood-flow perfusion conditions among 3 groups (44 male volunteers) according to the time taken to run 3 km: Level 1, Level 2, and Level 3.

METHODS

The radial blood pressure waveform (BPW), finger photoplethygraphy (PPG), and skin-surface laser-Doppler flowmetry (LDF) signals of the subjects were measured. Frequency-domain analysis was applied to BPW and PPG signals; time- and frequency-domain analyses were applied to LDF signals.

RESULTS

Pulse waveform and LDF indices differed significantly among the three groups. These could be used to evaluate the advantageous cardiovascular effects provided by long-term endurance-running training, such as vessel relaxation (pulse waveform indices), improvement in blood supply perfusion (LDF indices), and changes in cardiovascular regulation activities (pulse and LDF variability indices). Using the relative changes in pulse-effect indices, we achieved almost perfect discrimination between Level 3 and Level 2 (AUC = 0.878). Furthermore, the present pulse waveform analysis could also be used to discriminate between the Level-1 and Level-2 groups.

CONCLUSIONS

The present findings contribute to the development of a noninvasive, easy-to-use, and objective evaluation technique for the cardiovascular benefits of prolonged endurance-running training.

Multicomponent recreational team handball training improves global health status in postmenopausal women at long term - a randomised controlled trial

ABSTRACTWe studied the long-term effects of a multicomponent exercise training protocol (recreational team handball training, RTH) on global health status in inactive postmenopausal women. Participants (n = 45; age 65 ± 6 years, stature 157 ± 6 cm, body mass 66.2 ± 9.4 kg, fat mass 41.4 ± 5.5%, VO_2peak 25.7 ± 3.6  mL/min/kg) were randomized into a control group (CG; n = 14) and a multicomponent exercise training group (EXG; n = 31, performing 2-3 weekly 60-min RTH sessions). Attendance was 2.0 ± 0.4 sessions/week (first 16 weeks) and 1.4 ± 0.5 (following 20 weeks) and mean heart rate (HR) loading was 77 and 79% of maximal HR (p = 0.002) for the first 16 and the following 20 weeks, respectively. Cardiovascular, bone, metabolic health, body composition and physical fitness markers were evaluated at baseline, and after 16 and 36 weeks. An interaction (p ≤ 0.046) was shown for the 2-h oral glucose tolerance test, HDL, Yo-Yo intermittent endurance level 1 test (YYIE1) and knee strength, in favour of EXG. At 36 weeks YYIE1 and knee strength were higher (p ≤ 0.038) for EXG vs CG. Also, within-group improvements (p ≤ 0.043) were observed after 36 weeks for EXG in VO_2peak, lumbar spine bone mineral density, lumbar spine bone mineral content, P1NP, osteocalcin, total cholesterol, HDL, LDL, body mass, android fat mass, YYIE1, knee strength, handgrip strength and postural balance. At 36 comparatively to 16 weeks, EXG showed an increase (p ≤ 0.036) in fasting blood glucose, HDL, knee strength and handgrip strength, and a decrease (p ≤ 0.025) in LDL. Collectively, this multicomponent exercise training (RTH) induces beneficial changes in global health status in postmenopausal women. ClinicalTrials.gov ID:NCT05292261.

The Effect of Guided Imagery on Postoperative Pain Management in Patients Undergoing Lower Extremity Surgical Operations: A Randomized Controlled Trial

Guided imagery distracts patients from disturbing feelings and thoughts, positively affects emotional well-being, and reduces pain by producing pleasing mental images. This study aimed to determine the effects of guided imagery on postoperative pain management in patients undergoing lower extremity surgery. This randomized controlled study was conducted between April 2018 and May 2019. This study included 60 patients who underwent lower extremity surgery. After using guided imagery, the posttest mean Visual Analog Scale score of patients in the intervention group was found to be 2.56 (1.00 ± 6.00), whereas the posttest mean score of patients in the control group was 4.10 (3.00 ± 6.00), and the difference between the groups was statistically significant (p <.001). Guided imagery reduces short-term postoperative pain after lower extremity surgery.

Perceptions of fatigue and neuromuscular measures of performance fatigability during prolonged low-intensity elbow flexions

NEW FINDINGS

What is the central question of this study? What is the predictive relationship between self-reported scales to quantify perceptions of fatigue during exercise and gold standard measures used to quantify the development of neuromuscular fatigue? What is the main finding and its importance? No scale was determined to be substantively more effective than another. However, the number of ongoing contractions performed was shown to be a better predictor of fatigue in the motor system than any of the subjective scales.

ABSTRACT

The purpose of this study was to determine the relationship between transcranial magnetic stimulation (TMS) measures of performance fatigability and commonly used scales that quantify perceptions of fatigue during exercise. Twenty healthy participants (age 23 ± 3 years, 10 female) performed 10 submaximal isometric elbow flexions at 20% maximal voluntary contraction (MVC) for 2 min, separated by 45 s of rest. Biceps brachii muscle electromyography and elbow flexion torque responses to single-pulse TMS were obtained at the end of each contraction to assess central factors of performance fatigability. A rating of perceived exertion (RPE) scale, Omnibus Resistance scale, Likert scale, Rating of Fatigue scale and a visual analogue scale (VAS) were used to assess perceptions of fatigue at the end of each contraction. The RPE (root mean square error (RMSE) = 0.144) and Rating of Fatigue (RMSE = 0.145) scales were the best predictors of decline in MVC torque, whereas the Likert (RMSE= 0.266) and RPE (RMSE= 0.268) scales were the best predictors of electromyographic amplitude. Although the Likert (RMSE = 7.6) and Rating of Fatigue (RMSE = 7.6) scales were the best predictors of voluntary muscle activation of any scale, the number of contractions performed during the protocol was a better predictor (RMSE = 7.3). The ability of the scales to predict TMS measures of performance fatigability were in general similar. Interestingly, the number of contractions performed was a better predictor of TMS measures than the scales themselves.

Associations of Socioeconomic Status With Disease Progression in African Americans With Early Rheumatoid Arthritis

OBJECTIVE

In prior cross-sectional analyses of African American patients with rheumatoid arthritis (RA), measures of socioeconomic status (SES) were associated with clinical joint damage and poorer patient-reported outcome scores. The purpose of this study was to determine whether SES measures are associated with disease progression in a cohort of African American patients with early RA (<2 years duration).

METHODS

We analyzed baseline SES and change in 60-month clinical radiographs and patient-reported outcomes data (n = 101 and 177, respectively) in individuals with early RA. SES measures were educational attainment, occupation, homeownership, household income, and block group poverty. Outcomes were based on radiographs (total erosion and joint space narrowing [JSN] scores on hands and feet) and patient-reported outcomes (pain, fatigue, disability, and learned helplessness). We used logistic regression with mixed effects accounting for study site to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs).

RESULTS

Both low education and occupation status were associated with worsening pain (adjusted OR 5.86 [95% CI 3.05-11.3] and adjusted OR 2.55 [95% CI 1.54-4.21], respectively). Patients without a high-school diploma were more likely to have worsened reports of learned helplessness (OR 1.92 [95% CI 1.37-2.67]). Community measures of SES were also significantly associated with patient-reported outcomes score changes. Patients living in areas of block group poverty ≥20% were twice as likely to experience increased disability scores over 60 months of disease duration (OR 1.95 [95% CI 1.17-3.25]). We found no association between SES measures and erosion or JSN score progression.

CONCLUSION

Low educational attainment and nonprofessional occupation status were associated with increased worsening of patient-reported outcomes. However, there were no corresponding increases in radiographically assessed erosion or JSN score progression.

Heel riser height and slope gradient influence the physiology of ski mountaineering-A laboratory study

In ski mountaineering it is the goal to reach the top of a mountain by sheer muscle force. The specific equipment (flexible boot, only toe fixated binding, and a skin on the ski to prevent from slipping backwards) enables the skier to move up the hill ergonomically, where the heel part of the binding offers a special adaptation possibility. The so-called riser height supports the heel standing height and can be adjusted to individually preferred settings. General recommendations suggest using lower heel support in flat ascents and higher heel support in steep ascents to maintain upright posture and lower the strain. Still, it remains unclear whether the application of riser height affects the physiological response during ski mountaineering. This study was designed to investigate the effects of riser height on physiological response during indoor ski mountaineering. Nineteen participants took part in the study and walked on a treadmill with ski mountaineering equipment. The three available riser heights (low, medium, and high) were applied randomized at 8%, 16%, and 24% gradient. Results show that global physiological measurements like heart rate (p = 0.34), oxygen uptake (p = 0.26) or blood lactate (p = 0.38) values were not affected by changes in riser height. But local measurements of muscle oxygen saturation were affected by the riser height. Additionally comfort and rating of perceived exertion were also prone to changes in riser height. These results suggest differences on local measurements and perceived parameters, while global physiological measurements did not change. The results are in line with the existing recommendations but need to be confirmed in an outdoor setting as well.

Photobiomodulation Therapy for the Symptoms Related to Temporomandibular Joint Disk Displacement

Pain related to temporomandibular disorders (TMD) is a common problem that can significantly influence a patient's quality of life. Laser photobiomodulation (PBM) has been reported as a promising method in medicine for wound and bone healing, pain relief, and treatment of the temporomandibular joint (TMJ). Our clinical case aimed to demonstrate the effectivity of PBM using 1064 nm Nd:YAG laser for the treatment of pain and restricted mandible movement in a patient with anterior disk displacement of the left TMJ, using subjective (pain on visual analogue scale - VAS) and objective outcome measures [dynamic magnetic resonance imaging (MRI)]. PBM was performed on the left condyle in four sessions using a 1064 nm Nd:YAG laser with a flat-top handpiece. Results after 10 weeks showed an increase in mouth opening and a painless joint on palpation, with no reported adverse effects. An MRI of the TMJ confirmed the left disk displacement, however, with no signs of inflammation or effusion and with less pronounced disk deformity as compared with the first MRI examination. Use of PBM with Nd:YAG laser may be an efficient method for the management of orofacial pain in patients with acute and chronic TMJ disk displacements and may reduce the recovery time.

A short course of high-resistance, low-volume breathing exercise extends respiratory endurance and blunts cardiovascular responsiveness to constant load respiratory testing in healthy young adults

Our objective was to evaluate the effects of 6-weeks high-resistance, low-volume inspiratory muscle strength training (IMST) on respiratory endurance, blood pressure (BP) and heart rate (HR) responsiveness to high respiratory workloads. Ten healthy young adults completed two constant-load resistive breathing tests to exhaustion (T_lim) (target pressure =65 % maximal inspiratory pressure [PI_max]; duty cycle = 0.7; breathing frequency matched to eupnea) separated by 6-weeks high-resistance (75 % maximal inspiratory pressure, PI_max), low-volume (30 inspiratory efforts/day, 5 days/week) IMST. Throughout resistive breathing trials we measured beat-to-beat changes in BP and HR, mouth pressure, inspiratory muscle work and perceived exertion. POST resistive breathing tests revealed significant gains in endurance (PRE: 362.0 ± 46.6 s vs. POST: 663.8 ± 110.3 s, p = 0.003) and increases in respiratory muscle work (PRE: -9445 ± 1562 mmHg.s vs. POST: -16648 ± 3761 mmHg.s, p = 0.069). Conversely, systolic and diastolic BP responses, HR and ratings of perceived exertion all declined. Consistent with previous observations, 6 weeks high resistance, low volume IMST lowered casual resting SBP (p = 0.002), DBP (p = 0.007) and mean arterial pressure (p = 0.001) and improved static inspiratory pressure. High resistance, low volume inspiratory muscle strength training extends respiratory endurance and attenuates BP responsiveness in healthy, recreationally-active young adults. The outcomes have implications for improved athletic performance and for attaining and/or maintaining cardiorespiratory fitness.

A noninvasive method to quantify the impairment of spinal motion ability in Parkinson's disease

PURPOSE

There is a high demand on spinal surgery in patients with Parkinson's disease (PD) but the results are sobering. Although detailed clinical and radiological diagnostics were carried out with great effort and expense, the biodynamic properties of the spine of PD patients have never been considered. We propose a noninvasive method to quantify the impairment of motion abilities in patients with PD.

METHODS

We present an analytical cross-sectional study of 21 patients with severe PD. All patients underwent a biodynamic assessment during a standardized movement-choreography. Thus, individual spinal motion profiles of each patient were objectively assessed and compared with a large comparative cohort of individuals without PD. Moreover, clinical scores to quantify motor function and lumbar back pain were collected and X-ray scans of the spine in standing position were taken and analysed.

RESULTS

Biodynamic measurement showed that 36.9% of the assessed motions of all PD patients were severely impaired. Men were generally more functionally impaired than women, in 52% of all motion parameters. The neurological and radiological diagnostics recorded pathological values, of which UPDRS-III ON correlated with findings of the biodynamics assessment (R = 0.52, p = 0.02).

CONCLUSIONS

The decision to operate on a PD patient's spine is far-reaching and requires careful consideration. Neurological and radiological scores did not correlate with the biodynamics of the spine. The resulting motion profile could be used as individual predictive factor to estimate whether patients are eligible for spinal surgery or alternative therapies.

Acute physiological response to different recreational team handball game formats in over 60-year-old inactive men

This study described the physical and physiological demands, activity profile and fun levels of recreational team handball (TH) game formats in over 60-year-old men with no previous experience with this sport (n = 17, 67.4±3.3 years). The participants performed 5v5, 6v6 and 7v7 matches (3x15-min periods) with fixed pitch size (40x20 m). In all testing sessions, heart rate (HR), differential ratings of perceived exertion and blood lactate were evaluated to measure internal load. Locomotor profile, game actions and accelerometer data were used to access external load. Also, fun levels were registered at the end of all testing sessions. Mean (76–77%HR_max) and peak HR (84–86%HR_max) decreased from the first to the third match period, in 6v6 and 7v7 (p≤0.034, d = 0.730). Blood lactate increased from baseline to the first period and decreased from the first to the third period in all game formats (p<0.001, d = 1.646). The participants covered longer total distances in 6v6 vs 5v5 (p≤0.005, d = 0.927) and spent more time in fast running in 6v6 vs 5v5 and 7v7 (p<0.001, d = 1.725) and in 5v5 vs 7v7 (p = 0.007, d = 0.912). A higher number of throws was performed in 5v5 vs 6v6 and 7v7 (p<0.001, d = 1.547), and in 6v6 vs 7v7 (p = 0.031, d = 0.779). The number of stops and total actions in 7v7 was significantly lower vs 5v5 and 6v6 (p≤0.003, d = 1.025). Recreational TH is a high-intensity and motivating exercise mode for middle-aged and older men, regardless the game format. However, higher high-intensity demands were observed during 5v5 and 6v6 game formats. Therefore, it is suggested a multiple game format (5v5, 6v6 and 7v7) training plan, with more use of 5v5 and 6v6 game formats, with training sessions lasting up to 15-min of warm-up and 3x15-min periods of match-play, when prescribing recreational TH to improve cardiovascular and musculoskeletal health in this population.

Modern Approaches to the Management of Children with Mucopolysaccharidosis Type I

This article presents modern data on epidemiology, etiology, and clinical manifestations of mucopolysaccharidosis (MPS) type I in children. MPS develops due to deficiency of particular lysosomal enzyme which determines the disease type. The article considers in details disease's pathogenesis and classification. Evidence-based approaches to diagnosis (differential diagnosis included) are covered, moreover, special attention is paid to pathogenetic, symptomatic, and surgical treatment of MPS.

Effects of exertional dyspnea on early mobilization of patients with acute decompensated heart failure

[Purpose] In this study, we investigated the association between exertional dyspnea and length of the mobilization program in patients with acute decompensated heart failure. [Participants and Methods] We recruited all consecutive patients with heart failure who were hemodynamically stabilized after administration of intravenous medication and were able to walk >10 m before admission. Exertional dyspnea was evaluated using the visual analog scale in all patients after the 10-m walk during each session of the mobilization program. Multiple regression analysis was used to determine the factors associated with length of the mobilization program. [Results] Our study included 52 patients. Multiple regression analysis showed that the length of the mobilization program was significantly associated with the visual analog scale on day 3 and the length before the start of the mobilization program; however, the length of the mobilization program showed no significant association with age and blood urea nitrogen levels. The standardized coefficients for the visual analog scale scores on day 3 and the length before the start of the mobilization program were 0.49 and 0.33, respectively. [Conclusion] Exertional dyspnea is a good predictor of the length of the mobilization program. Our findings highlight the importance of evaluation of exertional dyspnea.

Mini-Percutaneous Nephrolithotomy With an Endoscopic Surgical Monitoring System for the Management of Renal Stones: A Retrospective Evaluation

Purpose

To compare the outcomes and postoperative quality of life of patients with renal calculi who underwent standard percutaneous nephrolithotomy (sPNL), mini-invasive percutaneous nephrolithotomy (mPNL) or mPNL with an endoscopic surgical monitoring system (ESMS) using a retrospective clinical trial.

Methods

Eighty-six adult patients with renal stones who were treated with sPNL were retrospectively compared to ninety-two patients who were treated with mPNL between July 2014 and December 2017. Next, further studies were retrospectively conducted using a matched paired method. The ninety-two patients treated with mPNL were divided into two groups based on whether the endoscopic surgical monitoring system (ESMS) was used (ESMS-mPNL vs. non-ESMS-mPNL). The ESMS used strain gauge transducers to measure the inflow and outflow of irrigation solution. Bleeding and fluid absorption during endoscopic surgery could be accurately calculated by computer program in ESMS.

Results

The fluoroscopy time, complication rate, stone-free status and clinically insignificant residual fragment (CIRF) rate were not significantly different between the two groups (sPNL vs. mPNL). The mPNL group had a significantly longer operation time than the sPNL group, and the mPNL group exhibited a markedly reduced 12-h postoperative visual analogue pain scale (VAS) score, mean hospitalization time, and return to work time, had slightly reduced haemoglobin loss, and underwent more tubeless operations. Moreover, among the 92 patients who underwent mPNL, the operation time (P = 0.090), complication rate (P = 0.996), stone-free status (P = 0.731), CIRF rates (P = 0.125) and number of tubeless operations (P = 0.760) were not significantly different between the two subgroups (non-ESMS-mPNL vs. ESMS-mPNL); however, the patients in the ESMS-mPNL group had significantly longer irrigation times than those in the non-ESMS-mPNL subgroup, along with marked reductions in irrigation fluid, blood loss, haemoglobin loss, 12 h postoperative VAS score, mean hospitalization time, and return to work time.

Conclusions

mPNL is less painful than sPNL in patients undergoing treatment for 20–40 mm renal stones. Similar stone-free rates were achieved by the two procedures, but mPNL was superior to sPNL in terms of blood loss, discomfort, hospitalization time and return to work time. We think that ESMS-mPNL is less painful for patients and more efficacious than non-ESMS-mPNL, and ESMS-mPNL achieves a stone-free rate that is similar to non-ESMS-mPNL in patients receiving treatment for 20–40 mm kidney stones.

Understanding components of embodiment: Evidence from the mirror box illusion

Past studies have examined embodiment in the rubber hand illusion, using principal components analysis (PCA) to identify factors from questionnaire responses during synchronous and asynchronous stroking. To better understand the phenomenology of embodiment, we used PCA in the mirror box illusion to examine performance across conditions that varied in movement synchrony to examine multisensory integration and movement type to vary the amount of multisensory congruence. We found three dissociable components in all conditions: embodiment, deafference and attentiveness. We also examined how these embodiment ratings varied across the four conditions. As hypothesized, embodiment ratings were highest for synchronous movement, with feelings of deafference highest for asynchronous movement. Furthermore, there was a movement by timing interaction, such that sliding resulted in greater differences in synchronous versus asynchronous ratings than tapping. These results suggest that embodiment or deafference can be changed as a function of the amount of multisensory congruence.

Dispersion of Knee Helical Axes during Walking after Maximal versus Resistant Strength Training in Healthy Subjects

Knee joint stability can be estimated during functional tasks through the analysis of the helical axes (HAs) dispersion. The study aimed at investigating (1) the test–retest reliability of knee HAs dispersion during walking and (2) the effects of maximal versus resistant strength training on knee HAs dispersion during walking. Thirty healthy subjects (age: 22.6 ± 2.1 years) randomized into a maximal training (MT) group and a resistance training (RT) group underwent a 2-week quadricep–hamstring strength training at 90% or 30% of the maximum voluntary contraction, respectively. Participants walked on a treadmill with clusters of retro-reflective markers placed on thighs and shanks to detect knee kinematics with an optoelectronic system. Knee HAs dispersion was assessed using mean distance (MD) and mean angle (MA) at 1 week before training start, before and after the first training session, and before and after the last training session. Moderate to excellent reliability was found for MD and MA on the sagittal plane (ICCs ≥ 0.70). No differences over time were found for MD and MA between MT and RT. HAs dispersion indexes resulted in reliable parameters for the quantification of knee stability on the sagittal plane during walking. Maximal and resistance strength training induced no knee HAs dispersion changes during walking.

Development and initial validation of the Visual Social Anxiety Scale (VSAS): Could a picture be worth a thousand words?

Accurate assessment is crucial for determining appropriate therapeutic interventions for social anxiety and conducting sound clinical research. While self-report measures of social anxiety are widely used in both research and clinical settings, they have several drawbacks inherent to their textual nature. Here, we describe the development and initial validation of the Visual Social Anxiety Scale (VSAS), a novel picture-based self-report measure of social anxiety, based on the well-established widely-used Liebowitz Social Anxiety Scale (LSAS). Specifically, the 24 items of the LSAS were used as the basis for social situations to be included in the VSAS. First, pictures to serve as VSAS items were selected using a rigorous two-phase process (four pilot studies; n = 225). Next, reliability (internal consistency, test-retest) and validity (convergent, discriminant) were explored with new participants (n = 304) who completed the VSAS and a battery of additional self-report questionnaires, delivered in a random order. The VSAS was completed again a month later (n = 260/304). The VSAS showed high internal consistency and test-retest reliability, and good convergent and discriminant validities. VSAS correlations with convergent measures were significantly greater than its correlations with discriminant measures. Thus, the VSAS shows initial promise as a novel picture-based self-report measure of social anxiety.

Impact and workload are dominating on-field data monitoring techniques to track health and well-being of team-sports athletes

Participation in sports has become an essential part of healthy living in today's world. However, injuries can often occur during sports participation. With advancements in sensor technology and data analytics, many sports have turned to technology-aided, data-driven, on-field monitoring techniques to help prevent injuries and plan better player management. This review searched three databases, Web of Science, IEEE, and PubMed, for peer-reviewed articles on on-field data monitoring techniques that are aimed at improving the health and well-being of team-sports athletes. It was found that most on-field data monitoring methods can be categorized as either player workload tracking or physical impact monitoring. Many studies covered during this review attempted to establish correlations between captured physical and physiological data, as well as injury risk. In these studies, workloads are frequently tracked to optimize training and prevent overtraining in addition to overuse injuries, while impacts are most often tracked to detect and investigate traumatic injuries. This review found that current sports monitoring practices often suffer from a lack of standard metrics and definitions. Furthermore, existing data-analysis models are created on data that are limited in both size and diversity. These issues need to be addressed to create ecologically valid approaches in the future.

A randomized controlled trial of high-intensity interval training and inspiratory muscle training for chronic heart failure patients with inspiratory muscle weakness

OBJECTIVES

Chronic heart failure is a major public health problem in which supervised exercise programs are recommended as part of non-pharmacological management. There are various reports of the success of high-intensity aerobic interval training (HI-AIT) and inspiratory muscle training (IMT) in the management of chronic heart failure patients. This study tested the hypothesis that the combination of HI-AIT and IMT could result in additional benefits over the IMT and the HI-AIT alone in terms of inspiratory muscle function, exercise capacity, and quality of life in patients with chronic heart failure and inspiratory muscle weakness.

METHODS

Forty patients with ejection fraction ≤45% and inspiratory muscle weakness described by maximal inspiratory pressure <70% predicted, underwent three exercise training sessions per week for 12 weeks. Patients were randomly allocated to one of four groups: the HI-AIT group, the IMT group, the combined (HI-AIT & IMT) group, and the control group. Before and after completing their training period, all patients underwent different tests that are mentioned above.

RESULTS

No changes were detected in the control group. However, the combined group, when compared to HI-AIT and IMT groups, respectively, resulted in additional significant improvement in maximal inspiratory training (62%, 24%, 25%), exercise time (62%, 29%, 12%), the 6-minute walk test (23%, 15%, 18%), and the Minnesota Living with Heart Failure Questionnaire (56%, 47%, 36%).

CONCLUSION

In patients with chronic heart failure and inspiratory muscle weakness, the combination of the HI-AIT and the IMT resulted in additional benefits in respiratory muscle function, exercise performance, and quality of life compared to that of HI-AIT or IMT alone.Trial Registration number: NCT03538249.

Effectiveness of extracorporeal shockwave therapy for frozen shoulder in perimenopausal diabetic women

Study aim: To evaluate the effectiveness of extracorporeal shockwave therapy (ESWT) for frozen shoulder in perimenopausal diabetic women.

Materials and methods: A single blind randomized controlled trial was conducted on sixty-two perimenopausal women diagnosed with diabetic frozen shoulder. They were divided randomly into two groups. Group (A) received physiotherapy program in the form of maitland joint mobilization for shoulder joint, self-stretching exercises, range of motion exercises (ROM) and strengthening exercises. Sessions were held 3 times per week, for 4 weeks. Group (B) study group: received the same physiotherapy program in addition to ESWT, once per week, for 4 weeks. Visual analogue scale was used to measure pain intensity, shoulder pain and disability index (SPADI) was used to evaluate disability level, while an electrogoniometer was used to measure shoulder flexion, abduction and external rotation range of motion. All measurements were recorded pretreatment and posttreatment program.

Results: For intragroup comparison, significant improvement in all treatment outcomes was noted in both groups (P < 0.05). However, no significant differences were found between both groups regarding all outcome measures in case of intergroup comparison in the study (P > 0.05).

Conclusion: The use of ESWT have a positive effect in reducing pain and improving shoulder range of motion in perimenopausal women suffering from frozen.

The Role of Virtual Reality as a Psychological Intervention for Mental Health Disturbances during the COVID-19 Pandemic: A Narrative Review

The COVID-19 pandemic spread throughout the world and created many problems. The COVID-19 pandemic caused an increase in mortality and morbidity, including mental health problems. Around the world, the movement control order (MCO) was strictly enforced, but the spread of the infection epidemic was still rampant. The magnitude of the increase in mental health illnesses has caused many individuals to suffer. Given that face-to-face interventions are challenging to carry out during an outbreak, we need to address this critical problem through an online approach, such as virtual reality (VR). This approach is vital to helping patients deal with their existing problems in more pragmatic, practical, and customer-friendly ways. Thus, in the present review, we proposed the development of a virtual digital device for this noble purpose. Various challenges, improvements, and expectations for VR applications were outlined and discussed in this narrative review.

Oral health-related quality of life of patients rehabilitated with fixed and removable implant-supported dental prostheses

Dental implants have become a mainstream treatment approach in daily practice, and because of their high survival rates over time, they have become the preferred treatment option for prosthetic rehabilitation in many situations. Despite the relatively high predictability of implant therapy and high costs to patients, patient perceptions of success and patient-reported outcome measures have become increasingly significant in implant dentistry. Increasing numbers of publications deal with oral health-related quality of life and/or patient-reported outcome measures. The aim of this paper was to provide an overview of the available evidence on oral health-related quality of life of fully and partially dentate patients rehabilitated with fixed and removable implant-supported dental prostheses. A comprehensive electronic search was performed on publications in English up to 2021. A selection of standardized questionnaires and scales used for the evaluation of oral health-related quality of life were analyzed and explained. The analysis encompassed three aspects: a functional evaluation of oral health-related quality of life, an esthetic assessment of oral health-related quality of life, and a cost-related evaluation of oral health-related quality of life for rehabilitation with dental implants. The data demonstrated that the preoperative expectations of patients markedly affected the outcomes perceived by the patients. As expected, reconstructions supported by implants substantially improved the stability of conventional dentures and allowed improved function and patient satisfaction. However, from a patient's perspective, oral health-related quality of life was not significantly greater for dental implants compared with conventional tooth-supported prostheses. The connection of the implants to the prostheses with locators or balls indicated high oral health-related quality of life. The data also suggest that patient expectation is not a good predictor of treatment outcome. In terms of esthetic outcomes, the data clearly indicate that patients' perceptions and clinicians' assessments differed, with those of clinicians yielding higher standards. There were no significant differences found between the esthetic oral health-related quality of life ratings for soft tissue-level implants compared with those for bone-level implants. Comparison of all-ceramic and metal-ceramic restorations showed no significant differences in patients' perceptions in terms of esthetic outcomes. Depending on the choice of outcome measure and financial marginal value, supporting a conventional removable partial denture with implants is cost-effective when the patient is willing to invest more to achieve a higher oral health-related quality of life. In conclusion, the oral health-related quality of life of patients rehabilitated with implant-supported dental prostheses did not show overall superiority over conventional prosthetics. Clinicians' and patients' evaluations, especially of esthetic outcomes, are, in the majority of cases, incongruent. Nevertheless, patient-reported outcomes are important in the evaluation of function, esthetics, and the cost-effectiveness of treatment with implant-supported dental prostheses, and should be taken into consideration in daily practice.

Biomechanical analysis of force distribution in one-handed and two-handed child chest compression- a randomized crossover observational study

Background

Even force distribution would generate efficient external chest compression (ECC). Little research has been done to compare force distribution between one-hand (OH) and two-handed (TH) during child ECC. Therefore, this study was to investigate force distribution, rescuer perceived fatigue and discomfort/pain when applying OH and TH ECC in children.

Methods

Crossover manikin study. Thirty-five emergency department registered nurses performed lone rescuer ECC using TH and OH techniques, each for 2 min at a rate of at least 100 compressions/min. A Resusci Junior Basic manikin equipped with a MatScan pressure measurement system was used to collect data. The perceived exertion scale (modified Borg scale) and numerical rating scale (NRS) was applied to evaluate the fatigue and physical pain of delivering chest compressions.

Results

The maximum compression force (kg) delivered was 56.58 ± 13.67 for TH and 45.12 ± 7.90 for OH ECC (p <  0.001). The maximum-minimum force difference force delivered by TH and OH ECC was 52.24 ± 13.43 and 41.36 ± 7.57, respectively (p <  0.001). The mean caudal force delivered by TH and OH ECC was 29.45 ± 16.70 and 34.03 ± 12.01, respectively (p = 0.198). The mean cranial force delivered by TH and OH ECC was 27.13 ± 11.30 and 11.09 ± 9.72, respectively (p <  0.001). The caudal–cranial pressure difference delivered by TH and OH ECC was 19.14 ± 15.96 and 26.94 ± 14.48, respectively (p = 0.016). The perceived exertion and NRS for OH ECC was higher than that of the TH method (p < 0.001, p = 0.004, respectively).

Conclusions

The TH method produced greater compression force, had more efficient compression, and delivered a more even force distribution, and produced less fatigue and physical pain in the rescuer than the OH method.

Trial registration

The Cheng Kung University Institutional Review Board A-ER-103-387. http://nckuhirb.med.ncku.edu.tw/sitemap.php

Level of exoskeleton support influences shoulder elevation, external rotation and forearm pronation during simulated work tasks in females

Despite growing literature, limited research details the influence of passive upper limb exoskeletons on upper limb kinematics. Two bolting tasks and a tracing task were completed at two heights (overhead and between waist and overhead height) for four exoskeleton conditions (no exoskeleton, and 3 levels of exoskeleton assistance) by female participants. Motion capture data, ratings of perceived exertion and discomfort, and task duration were recorded. Exoskeleton condition increased minimum shoulder elevation by 35-36% (Δ10.5-10.7°) at 1.81 kg and 2.72 kg of support, mean shoulder external rotation by 316% (Δ24.6°) at 0.91 kg of support and mean forearm pronation by 30.9% (Δ14.6°) at 0.91 kg of support. Exoskeleton condition reduced ratings of perceived exertion and discomfort, but not significantly. Task duration was unaffected. Exoskeleton use at any of three different settings modestly affected some joint kinematics for the tasks examined, which may merit consideration when deciding on occupational exoskeleton implementation.

Association between Physical Literacy and Self-Perceived Fitness Level in Children and Adolescents

Simple Summary

Alarming data on physical inactivity and sedentary lifestyles in children and young people are increasing. The level of physical fitness is considered a predictor of morbidity and comorbidities resulting from physical inactivity. Physical literacy, which includes the assessment of physical fitness, could be considered a crucial element for understanding adolescents’ health status and physical activity-related behaviours. Moreover, the self-perceived physical fitness should also be considered. Thus, this study analysed the relationship between physical literacy and self-perceived physical fitness in children and adolescents aged 8–12 years. It could be concluded that a higher level of self-perceived physical fitness would be associated with a greater level of physical literacy.

Abstract

Background: Physical fitness is considered a predictor of mortality and comorbidities resulting from physical inactivity in children and adolescents. Physical literacy provides a robust and comprehensive assessment of physical fitness. Thus, it is considered a crucial element for understanding children and adolescents’ health status and their physical activity-related behaviours. Moreover, the self-perceived fitness should also be considered. Therefore, this study aims to analyse the relationship between physical literacy and self-perceived physical fitness in children and adolescents aged 8–12 years. Methods: A single-measure cross-sectional study was conducted with 135 children and adolescents. Anthropometric measurements and the Canadian Assessment of Physical Literacy Development (CAPL-2) were applied. Descriptive statistics and correlations were calculated. The Fitness Perception Scale for Adolescents (FP VAS A) scale was also administered to assess participants’ self-perceived fitness. Results: Moderate significant correlations were found between “physical competence”, “motivation and confidence”, and the total CAPL-2 score with FP VAS A. Conclusions: The influence of motivation on self-perceived fitness has been demonstrated. Moreover, cardiorespiratory fitness could be considered one of the most relevant and influential factors in the total CAPL-2 score. It means that higher levels of self-perceived fitness would be associated with greater levels of physical literacy.

Combination antibiotic therapy versus monotherapy in the treatment of acute exacerbations of chronic obstructive pulmonary disease: an open-label randomized trial

Background

The role of antibiotics in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations and their effectiveness in combination have not been clearly established. To determine whether using a combination of fluoroquinolones and beta-lactams improves the clinical and microbiological efficacy of antibiotics on day 20 of treatment, we conducted an open-label randomized trial based on clinical outcomes, microbiological clearance, spirometry tests, and signs of systemic inflammation in patients hospitalized with acute exacerbations of COPD.

Methods

We enrolled 139 subjects with COPD exacerbations, defined as acute worsening of respiratory symptoms leading to additional treatment. Patients were divided randomly into two groups: 79 patients using beta-lactam antibiotics alone and 60 using beta-lactam antibiotics plus fluoroquinolones. Clinical and microbiological responses, spirometry tests, symptom scores, and serum C-reactive protein (CRP) levels were evaluated.

Results

Clinical success, lung function, and symptoms were similar in patients with or without fluoroquinolone administration on days 10 and 20. Combination therapy was superior in terms of microbiological outcomes and reduction in serum CRP value. Although equivalent to monotherapy in terms of clinical success, the combination showed superiority in terms of microbiological success and a decrease in CRP. The combination therapy group had a higher microbiological success rate with gram-negative bacteria than the monotherapy group with Pseudomonas aeruginosa (100% vs. 33.3%, respectively) and Acinetobacter baumanii (100% vs. 20%, respectively) (P < 0.05).

Conclusions

Concomitant use of fluoroquinolone and beta-lactam antibiotics for bacterial infections during COPD exacerbations caused by gram-negative bacteria appear to be effective and should be applied in clinical practice.

Patient and technician perspectives following the introduction of frontloaded visual field testing in glaucoma assessment

CLINICAL RELEVANCE

Frontloaded visual field testing (twice per eye per session) is well-tolerated by patients and technicians, representing a viable strategy that can be implemented in routine clinical practice to capture enough clinical perimetry data for effective disease diagnosis, surveillance and management.

BACKGROUND

To determine the experiences of patients and technicians following the implementation of frontloaded visual field testing (multiple tests per eye within the same session) in a glaucoma service.

METHODS

This was a retrospective, cross-sectional study. A written questionnaire was administered to patients (three questions) attending the glaucoma service at the Centre for Eye Health for glaucoma assessment and to their administering perimetry technicians (two questions). The questionnaire was administered after static automated perimetry (24-2 SITA-Faster on the Humphrey Field Analyzer) was performed twice for each eye (frontloaded) within the same session. Respondents were asked to provide a 1-5 Likert scale response to questions that targeted operational issues for frontloaded visual field testing. Responses were correlated against to demographic (age, gender, ethnicity) and clinical (diagnosis, refractive error, visual field indices, test duration) parameters.

RESULTS

Approximately 90% of patient respondents agreed that frontloaded visual field testing was clearly explained to them, that they were comfortable during the test, and would prefer completing the tests at a single visit rather than returning to repeat the test. Most technician respondents were also able to keep their patients comfortable. 13% of technician respondents felt they ran late during the session, but on average, the total test duration for four visual field tests was 13 minutes, including breaks. There was no correlation found between demographic and clinical factors, and the responses.

CONCLUSIONS

Frontloaded visual field testing was well-tolerated by patients and technicians. Strategies that may be helpful for other clinics to adopt this new paradigm are described.

Defining a Severe Asthma Super-Responder: Findings from a Delphi Process

BACKGROUND

Clinicians are increasingly recognizing severe asthma patients in whom biologics and other add-on therapies lead to dramatic improvement. Currently, there is no agreed-upon super-responder (SR) definition.

OBJECTIVE

To survey severe asthma experts using a modified Delphi process, to develop an international consensus-based definition of a severe asthma SR.

METHODS

The Delphi panel was composed of 81 participants (94% specialist pulmonologists or allergists) from 24 countries and consisted of three iterative online voting rounds. Consensus on individual items, whether acceptance or rejection, required at least 70% agreement by panel members.

RESULTS

Consensus was achieved that the SR definition should be based on improvement across three or more domains assessed over 12 months. Major SR criteria included exacerbation elimination, a large improvement in asthma control (two or more times the minimal clinically important difference), and cessation of maintenance of oral steroids (or weaning to adrenal insufficiency). Minor SR criteria were composed of a 75% exacerbation reduction, having well-controlled asthma, and 500 mL or greater improvement in FEV₁. The SR definition requires improvement in at least two major criteria. In the future, the SR definition should be expanded to incorporate quality of life measures, although current tools can be difficult to implement in a clinical setting and further research is needed.

CONCLUSIONS

This international consensus-based definition of severe asthma SRs is an important prerequisite for better understanding SR prevalence, predictive factors, and the mechanisms involved. Further research is needed to understand the patient's perspective and to measure quality of life more precisely in SRs.