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Factors associated with poor sleep quality in midlife Singaporean women: The Integrated Women's Health program (IWHP). Sleep Med X 2022; 5:100060. [PMID: 36568060 PMCID: PMC9772553 DOI: 10.1016/j.sleepx.2022.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/18/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022] Open
Abstract
Objective To examine factors associated with poor sleep quality in community-dwelling midlife women. Methods Healthy women (aged 45-69 years) of Chinese, Malay and Indian ethnicities attending well-women clinics at the National University Hospital, Singapore, completed the Pittsburgh Sleep Quality Index (PSQI). A PQSI score >5 denoted poor sleep quality. The women filled out validated questionnaires covering menopausal and genito-urinary symptoms, and mental health. Physical performance was measured. Bone mineral density and visceral adiposity were assessed by dual energy X-ray absorptiometry. Binary logistic regression analyses assessed independent factors for poor sleep. Results Poor sleep quality was reported in 38.2% of women (n = 1094, mean age: 56.4 ± 6.2 years). Indian women had higher sleep disturbance scores than Chinese women (mean ± SD: 1.33 ± 0.58 vs 1.17 ± 0.49). Malays experienced more daytime dysfunction (0.54 ± 0.60 vs 0.33 ± 0.55) and had a higher overall PSQI score (6.00 ± 3.31 vs 5.02 ± 2.97) than the Chinese. A low education level (aOR: 1.76, 95% CI: 1.01-3.05), feelings of irritability (2.67, 1.56-4.60) and vaginal dryness (1.62, 1.03-2.54) were associated with poor sleep quality in the adjusted multivariable model. Women with moderate to severe disability were ∼3 times (2.99, 1.20-7.44) more likely to experience less than ideal sleep quality, while urinary incontinence (1.53, 1.08-2.17) and breast cancer history (2.77, 1.36-5.64) were also associates of poor sleep quality. Conclusion Self-reports of education level, irritability, vaginal dryness, disability, urinary incontinence, and breast cancer history were independently related to poor sleep. Ethnic differences suggest the need for targeted interventions among the ethnic groups.
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Development of a Coaching Protocol to Enhance Self-efficacy Within Outpatient Physical Therapy. Arch Rehabil Res Clin Transl 2022; 4:100198. [PMID: 35756988 PMCID: PMC9214325 DOI: 10.1016/j.arrct.2022.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To describe the development of the Specific, Measurable, Action-Oriented, Realistic, and Timed (SMART) Coaching Protocol to increase exercise self-efficacy in middle-aged and older adults participating in Live Long Walk Strong (LLWS) Rehabilitation Program. LLWS Rehabilitation Program is an innovative physical therapist (PT) delivered outpatient intervention for middle- and older-aged adults with slow gait speed. Design Phase II randomized controlled trial (RCT) with masked outcome assessment. We applied the Knowledge to Action Framework to develop and implement the LLWS SMART Coaching Protocol within an RCT for the LLWS Rehabilitation Program. Data will be collected at baseline and post intervention at 2, 8 and 16 weeks. Setting Outpatient; VA Boston Healthcare System. Participants Community-dwelling veterans (N=198) (older than 50 years) with slow gait speed (<1.0 m/s). Interventions Participants will be randomized to the LLWS Rehabilitation Program, an 8-week (10-session) PT-delivered intervention, or wait-list control group. Each study visit will introduce a new SMART Coaching module focused on goal setting, exercise adherence, and addressing internal and external barriers to meeting exercise goals. Main Outcome Measures Primary outcome is gait speed and secondary outcome is the Self-Efficacy for Exercise Scale. Conclusions Incorporating cognitive behavioral tools in physical therapy intervention research is critical for targeting motivational processes needed for exercise behavior change.
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Key Words
- Exercise
- LLWS, Live Long Walk Strong
- PT, physical therapist
- Physical therapy modalities
- RCT, randomized controlled trial
- Rehabilitation
- SCT, social cognitive theory
- SMART, Specific, Measurable, Action-Oriented, Realistic, and Timed
- SPPB, Short Physical Performance Battery
- VA, Veterans Affairs
- Walking speed.
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Untangling the Web of Malnutrition, Sarcopenia, and Frailty in Chronic Liver Disease. J Clin Exp Hepatol 2022; 12:268-271. [PMID: 35535088 PMCID: PMC9077231 DOI: 10.1016/j.jceh.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Key Words
- 6MWT, 6-minute walk test
- ADL, Activities of Daily Living
- BIA, Bioelectrical Impedance analysis
- BMC, Bone Mineral Content
- CFS, Clinical Frailty Score
- DEXA, dual-energy X-ray absorptiometry
- FFC, Fried Frailty Criteria
- FFM, Fat-Free Mass
- FM, Fat Mass
- HE, hepatic encephalopathy
- KPS, Karnofsky Performance Score
- LFI, Liver Frailty Index
- LM, Lean Mass
- MAMC, mass and mid-arm muscle circumference
- MELD, model for end-stage liver disease
- SMI-L3, skeletal muscle index at the 3rd lumbar vertebra
- SPPB, Short Physical Performance Battery
- TSFT, triceps skinfold thickness
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A Comparison of Different Frailty Scores and Impact of Frailty on Outcome in Patients With Cirrhosis. J Clin Exp Hepatol 2022; 12:398-408. [PMID: 35535083 PMCID: PMC9077184 DOI: 10.1016/j.jceh.2021.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
Background & aims There is no "gold standard" tool for the assessment of frailty in cirrhosis. This study compares Liver Frailty Index (LFI), Short Physical Performance Battery (SPPB), Fried Frailty Criteria (FFC), and Clinical Frailty Scale (CFS) for frailty assessment and ascertains its impact on predicting mortality and hospitalizations in a cohort of outpatients with cirrhosis. Methods 116 patients were enrolled in this prospective observational cohort study. Frailty assessment was done using LFI, SPPB, FFC, and CFS. All patients were followed up for 6 months. The primary outcome was the first of either all-cause unplanned hospitalization or all-cause mortality occurring within 6 months of the study period. Results 100 (86.2%) males and 16 (13.8%) females with a mean age of 50.2 (48.4-51.9, 95% CI) years were included. The most common cause of cirrhosis was alcoholic liver disease (47.4%) followed by hepatitis C (12.9%) and Nonalcoholic steatohepatitis (NASH) (10.3%). There was no significant difference in prevalence of frailty based on LFI (43.1%), FFC (36.2%), CFS (44%), and SPPB (47.4%) (P > 0.05). Frail patients had worse outcomes compared to the Not frail group. At 6 months, the mortality rate in Frail patients was 42% versus 1.5% for the Not frail; hospitalization in Frail patients occurred in 92% versus 6% in the Not frail. On multivariable analysis, independent predictors of mortality were Frailty [OR 14 (1.4-54.2)], alcohol-related cirrhosis [OR 4.2 (1.1-16.3)], Child-Turcotte-Pugh (CTP) [OR 2.1 (1.4-2.9)] and Chronic liver disease questionnaire (CLDQ) [OR 0.1 (0.1-0.4)] scores. Conclusions LFI, SPPB, FFC, and CFS are comparable in frailty assessment in patients with cirrhosis. Importantly, comparability of the commonly used scores for frailty assessment and prediction of hospitalization and mortality allows flexibility for clinical application.
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Key Words
- AKI, Acute Kidney Injury
- ANOVA, Analysis Of Variance
- AUC, Area Under the Curve
- CFS, Clinical Frailty Scale
- CI, Confidence Interval
- CLDQ, Chronic liver disease questionnaire
- CT, Computerized Tomography
- CTP, Child-Turcotte-Pugh
- FFC, Fried Frailty Criteria
- FSS, Fatigue severity scale
- HCC, Hepatocellular Carcinoma
- HE, Hepatic Encephalopathy
- HU, Hounsfield Units
- IBM, International Business Machines
- LFI, Liver Frailty Index
- MELD, Model for End-Stage Liver Disease
- MELDNa, Model for End-Stage Liver Disease with Sodium
- MMSE, Mini-Mental State Examination
- NASH, Nonalcoholic Steatohepatitis
- NPV, Negative Predictive Value
- PGIMER, Post Graduate Institute of Medical Education and Research
- PPV, Positive Predictive Value
- ROC, Receiver Operating Characteristic Curve
- SBP, Spontaneous Bacterial Peritonitis
- SPPB, Short Physical Performance Battery
- SPSS, Statistical Package for Social Sciences
- UTI, Urinary Tract infection
- cirrhosis
- frailty
- hospitalization
- mortality
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Feasibility of simple exercise interventions for men with osteoporosis - A prospective randomized controlled pilot study. Bone Rep 2021; 15:101099. [PMID: 34258330 PMCID: PMC8255176 DOI: 10.1016/j.bonr.2021.101099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/03/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background Aging is associated with progressive loss of musculoskeletal performance. Exercise interventions can improve physical function in the elderly but there is a paucity of comparative assessments in order to understand what specific goals can be achieved particularly with less demanding exercise interventions readily accessible for untrained men. Methods Prospective randomized, controlled, single center exploratory trial to compare four distinct exercise interventions, i.e. Resistance Training (RT), Whole Body Vibration Exercise (WBV), Qi Gong (QG) and wearing a Spinal orthosis (SO) for 6 months in men at risk for osteoporosis aged 65–90 years. Primary endpoint was change in isometric one repetition maximum force trunk strength for extension (TSE) and flexion (TSF) compared to baseline, secondary endpoints covered key parameters of geriatric functional assessment, including Handgrip Strength (HS), Chair-Rise-Test (CRT), Usual Gait Speed (UGS) and Timed-Up-and-Go (TUG). Results Altogether 47 men (mean age 77 ±6.1 years) were randomized to RT, (n = 11) WBV (n = 13), QG (n = 10) and SO(n = 13). RT, defined as reference exercise intervention, lead to significant improvements for TSE (p = 0.009) and TSF (p = 0.013) and was significantly superior in the between-group analysis for TSE (p = 0.038). Vibration exercise caused sign. Improvements in TSE (p = 0.014) and CRT (p = 0.005), the Spinal orthosis improved CRT (p = 0.003) and Gait Speed (p = 0.027), while the QG intervention did not attain any sig. Developments. Subgroup analyses revealed most pronounced musculoskeletal progress in vulnerable patients (age ≥ 80 years, pre-sarcopenia, multimorbidity ≥3chronic diseases). Irrespective of the type of exercise, participants ≥80 years experienced significant gains in TSE (p = 0.029) and CRT (p = 0.017). Presarcopenic subjects (Skeletal muscle Index (SMI) ≤10.75 kg/m2) improved in TSE (p = 0.003), CRT (p = 0.001) and UGS (p = 0.016). Multimorbid participants achieved sig. Gains in TSE (p < 0.001), TSF (p = 0.002), UGS (p = 0.036) and HS (p = 0.046). Conclusions In this exploratory trial we found that simple exercise interventions are feasible in elderly men eliciting specific benefits, i.e. improvements are attained in those tasks addressed with the respective exercise modality. While targeted resistance training is superior in increasing TSE, alternative simple exercise interventions also appear to elicit beneficial effects, even in vulnerable patients, i.e. those with low muscle mass, above 80 years of age or multimorbidity. Simple exercise interventions are safe and feasible in elderly man with elevated fracture risk. Improvements are observed in those tasks specifically addressed by the respective exercise. Simple exercise interventions are particularly effective in vulnerable patients (Presarcopenic, ≥80 years old, multimorbid). Even vulnerable patients at risk for muscular deficits can experience some benefits from exercise.
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Key Words
- 6MW, 6 min walk test
- BIA, bioimpedance analysis
- CRT, Chair-Rise-Test
- HS, handgrip strength
- Osteoporosis
- QG, Qi Gong training
- Qi gong
- ROM, range of motion
- RT, resistance training
- Resistance training
- SB, static balance
- SMI, skeletal muscle index
- SO, spinal orthosis training
- SPPB, Short Physical Performance Battery
- Sarcopenia
- Spinal Orthosis
- TSE, trunk strength for extension
- TSF, trunk strength for flexion
- TUG, timed up and go test
- UGS, usual gait speed
- WBV, Whole Body Vibration training
- Whole Body Vibration
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Zooming in on cerebral small vessel function in small vessel diseases with 7T MRI: Rationale and design of the "ZOOM@SVDs" study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 2:100013. [PMID: 36324717 PMCID: PMC9616370 DOI: 10.1016/j.cccb.2021.100013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 06/01/2023]
Abstract
Background Cerebral small vessel diseases (SVDs) are a major cause of stroke and dementia. Yet, specific treatment strategies are lacking in part because of a limited understanding of the underlying disease processes. There is therefore an urgent need to study SVDs at their core, the small vessels themselves. Objective This paper presents the rationale and design of the ZOOM@SVDs study, which aims to establish measures of cerebral small vessel dysfunction on 7T MRI as novel disease markers of SVDs. Methods ZOOM@SVDs is a prospective observational cohort study with two years follow-up. ZOOM@SVDs recruits participants with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL, N = 20), sporadic SVDs (N = 60), and healthy controls (N = 40). Participants undergo 7T brain MRI to assess different aspects of small vessel function including small vessel reactivity, cerebral perforating artery flow, and pulsatility. Extensive work-up at baseline and follow-up further includes clinical and neuropsychological assessment as well as 3T brain MRI to assess conventional SVD imaging markers. Measures of small vessel dysfunction are compared between patients and controls, and related to the severity of clinical and conventional MRI manifestations of SVDs. Discussion ZOOM@SVDs will deliver novel markers of cerebral small vessel function in patients with monogenic and sporadic forms of SVDs, and establish their relation with disease burden and progression. These small vessel markers can support etiological studies in SVDs and may serve as surrogate outcome measures in future clinical trials to show target engagement of drugs directed at the small vessels.
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Key Words
- ASL, Arterial Spin Labeling
- BOLD, Blood Oxygenation Level-Dependent
- CADASIL
- CADASIL, Cerebral Autosomal Dominant Arteriopathy with Leukoencephalopathy and Subcortical Infarcts
- CDR, Clinical Dementia Rating scale
- CERAD+, Consortium to Establish a Disease Registry for Alzheimer's Disease Plus battery
- CES-D, Center for Epidemiologic Studies Depression Scale
- CO2, Carbon Dioxide
- CSF, Cerebrospinal Fluid
- Cerebral small vessel disease
- DTI, Diffusion Tensor Imaging
- EPIC, European Prospective Investigation into Cancer and Nutrition
- EtCO2, End-tidal Carbon Dioxide
- FLAIR, Fluid Attenuated Inversion Recovery
- FOV, Field Of View
- FWHM, Full-Width-at-Half-Maximum
- GE, Gradient Echo
- GM, Grey Matter
- GPRS, General Packet Radio Service
- HRF, Hemodynamic Response Function
- High field strength MRI
- LMU, Ludwig-Maximilians-Universität
- MMSE, Mini-Mental State Examination
- NAWM, Normal Appearing White Matter
- NIHSS, National Institute for Health Stroke Scale
- PI, Pulsatility Index
- ROI, Region Of Interest
- SPPB, Short Physical Performance Battery
- SVDs, Small Vessel Diseases
- SWI, Susceptibility Weighted Imaging
- Small vessel function
- Sporadic SVD
- Stroke
- TE, Echo Time
- TI, Inversion Time
- TR, Repetition Time
- TSE, Turbo Spin Echo
- UMCU, University Medical Center Utrecht
- Vmax, Maximum velocity
- Vmean, Mean velocity
- Vmin, Minimum velocity
- WM, White Matter
- WMH, White Matter Hyperintensity
- fMRI, Functional Magnetic Resonance Imaging
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Evaluating the Feasibility and Effects of a Short-Term Task Specific Power Training With and Without Cognitive Training Among Older Adults With Slow Gait Speed: A Pilot Study. Arch Rehabil Res Clin Transl 2021; 3:100118. [PMID: 34179754 PMCID: PMC8211979 DOI: 10.1016/j.arrct.2021.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To investigate the feasibility and efficacy of short-term functional power training and further examine whether the addition of cognitive training targeting sustained attention and inhibitory control would augment the effect on the outcomes. Design: Randomized pilot study. Setting: Clinical research facility. Participants: Community-dwelling primary care patients (N=25) aged >65 years with mobility limitation within the VA Boston Healthcare System. Interventions: Participants were randomly assigned to either functional power training (n=14) or functional power+cognitive training (n=11), offered 3 times a week for 6 weeks. Session durations were either 70 minutes (functional power+cognitive training) or 40 minutes (functional power training). Main Outcome Measures: We evaluated feasibility (dropouts, attendance), mobility performance (Short Physical Performance Battery [SPPB]), leg power [stair climb test]), dynamic balance [figure-of-8], and gait characteristics [gait speed, stance time, step width, swing time, step length, variabilities under single-task and dual-task conditions]). Nonparametric analyses were used to compare overall pre-post changes and between-group differences. Results: Of the 39 veterans screened, 25 were randomized and enrolled. Twenty-one men with a mean age 76±7 years completed the study; 86% were white. Participants had a mean SPPB score of 8.3±1.6 out of 12. For those completing the study, overall attendance was 79%. Among all participants, clinically relevant and/or statistically significant median change in mobility performance (∆1 point), leg power (∆25.0W), dynamic balance (∆-1.1s), and gait characteristics (gait speed [∆0.08s, ∆0.09s], step length [∆1.9cm, ∆3.8cm], and stance time [∆-0.02s, ∆-0.05s] under single- and dual-task, respectively) were observed after 6 weeks of training. There were no statistically significant group differences in dropouts, attendance rate, or any of the outcomes based on cognitive training status. Conclusions: Short-term functional power training with or without a cognitive training led to clinically meaningful improvements in mobility performance, leg power, dynamic balance, and gait characteristics. These findings add to the body of evidence supporting the benefits of functional power training on clinically relevant outcomes. Additional cognitive training did not have an added effect on the study outcomes from our study. Further research is needed.
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Abstract
As the cirrhosis progresses, development of complication like ascites, hepatic encephalopathy, variceal bleeding, kidney dysfunction, and hepatocellular carcinoma signify increasing risk of short term mortality. Malnutrition and muscle wasting (sarcopenia) is yet other complications that negatively impact survival, quality of life, and response to stressors, such as infection and surgery in patients with cirrhosis. Conventionally, these are not routinely looked for, because nutritional assessment can be a difficult especially if there is associated fluid retention and/or obesity. Patients with cirrhosis may have a combination of loss of skeletal muscle and gain of adipose tissue, culminating in the condition of "sarcopenic obesity." Sarcopenia in cirrhotic patients has been associated with increased mortality, sepsis complications, hyperammonemia, overt hepatic encephalopathy, and increased length of stay after liver transplantation. Assessment of muscles with cross-sectional imaging studies has become an attractive index of nutritional status evaluation in cirrhosis, as sarcopenia, the major component of malnutrition, is primarily responsible for the adverse clinical consequences seen in patients with liver disease. Cirrhosis is a state of accelerated starvation, with increased gluconeogenesis that requires amino acid diversion from other metabolic functions. Protein homeostasis is disturbed in cirrhosis due to several factors such as hyperammonemia, hormonal, and cytokine abnormalities, physical inactivity and direct effects of ethanol and its metabolites. New approaches to manage sarcopenia are being evolved. Branched chain amino acid supplementation, Myostatin inhibitors, and mitochondrial protective agents are currently in various stages of evaluation in preclinical studies to prevent and reverse sarcopenia, in cirrhosis.
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Key Words
- (PG) SGA, patient-generated SGA
- AMPK, 5′ adenosine monophosphate-activated protein kinase
- ASPEN, American Society of Parenteral and Enteral Nutrition
- ATP, adenosine triphosphate
- Akt/PKB, serine/threonine-specific protein kinase B
- BIA, bio-electric impedance analysis
- BMC, bone mineral content
- BMI, body mass index
- CT, computed tomography
- DDLT, deceased donor liver transplantation
- DRM, disease-related malnutrition
- DXA, dual X-ray absorptiometry
- ESPEN, European Society of Parenteral and Enteral Nutrition
- FFI, Fried Frailty Index
- FFM, fat free mass
- FFMI, fat free mass index
- FM, fat mass
- HE, hepatic encephalopathy
- LDLT, living donor liver transplant
- LST, lean soft tissue
- MAC, mid arm circumference
- MAMC, mid arm muscle circumference
- MELD, model for end-stage liver disease
- MNA, Mini Nutritional Assessment
- MRI, magnetic resonance imaging
- NASH, non-alcoholic steatohepatitis
- PCM, protein-calorie nalnutrition
- REE, resting energy expenditure
- RQ, respiratory quotient (or RQ or respiratory coefficient)
- SGA, Subjective Global Assessment
- SMI, Skeletal Muscle Index
- SPPB, Short Physical Performance Battery
- TIPS, trans jugular intrahepatic portocaval shunts
- TNF, tumour necrosis factor
- TSF, triceps skin fild thickness
- WHO, World Health Organisation
- YPA, total psoas area
- aKG, alfa keto glutarate
- cirrhosis
- mTORC1, mammalian target of rapamycin complex 1
- nutrition
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