Current Issue : January - March Volume : 2016 Issue Number : 1 Articles : 7 Articles
Background: Regular exercise can have positive effects on both the physical and mental health of individuals with\nschizophrenia. However, deficits in cognition, perception, affect, and volition make it especially difficult for people\nwith schizophrenia to plan and follow through with their exercising intentions, as indicated by poor attendance and high\ndrop-out rates in prior studies. Mental Contrasting and Implementation Intentions (MCII) is a well-established strategy to\nsupport the enactment of intended actions. This pilot study tests whether MCII helps people with schizophrenia in highly\nstructured or autonomy-focused clinical hospital settings to translate their exercising intentions into action.\nMethods: Thirty-six inpatients (eleven women) with a mean age of 30.89 years (SD = 11.41) diagnosed with schizophrenia\nspectrum disorders from specialized highly structured or autonomy-focused wards were randomly assigned to\ntwo intervention groups. In the equal contact goal intention control condition, patients read an informative\ntext about physical activity; they then set and wrote down the goal to attend jogging sessions. In the MCII\nexperimental condition, patients read the same informative text and then worked through the MCII strategy. We\nhypothesized that MCII would increase attendance and persistence relative to the control condition over the course\nof four weeks and this will be especially be the case when applied in an autonomy-focused setting compared to when\napplied in a highly structured setting.\nResults: When applied in autonomy-focused settings, MCII increased attendance and persistence in jogging group\nsessions relative to the control condition. In the highly structured setting, no differences between conditions were\nfound, most likely due to a ceiling effect. These results remained even when adjusting for group differences in the\npre-intervention scores for the control variables depression (BDI), physical activity (IPAQ), weight (BMI), age, and\neducation. Whereas commitment and physical activity apart from the jogging sessions remained stable over the\ncourse of the treatment, depression and negative symptoms were reduced. There were no differences in pre-post\ntreatment changes between intervention groups.\nConclusions: The intervention in the present study provides initial support for the hypothesis that MCII helps patients to\ntranslate their exercising intentions into real-life behavior even in autonomously-focused settings without social control....
Background: We undertook a cluster randomised controlled trial to assess the effectiveness of a staff training\nintervention to improve patient engagement in activities in inpatient mental health rehabilitation units.\nConcurrently, we undertook a qualitative study to investigate the experiences of staff within the intervention units\nand the contextual issues that may have influenced the effectiveness of the intervention.\nMethod: We conducted focus groups with staff working in the inpatient units that received the intervention,\nsampled using a maximum variation strategy.\nResults: The intervention was accepted by staff. However, the skills gained, and changes to the unit�s processes\nand structures that were agreed with the intervention team were not sustained after they left. The main reasons\nfor this were a) external factors (economic recession, resource limitations); b) organisation level factors (lack of\nsenior staff support; competing priorities); c) limitations of the intervention itself (length of intensive training period;\nreinforcement of skills).\nConclusion: This study illustrates some of the inter-related factors which operate at different levels within and\noutside of NHS organisations that may impact on the success of complex interventions. These factors need to\nbe considered when designing interventions to ensure adequate buy-in from senior staff....
Background: Although depression and anxiety disorders are very common in people with epilepsy; there are no\nstudies that assessed the magnitude and associated factors among epileptic people in Ethiopia. Therefore, this\nstudy determined prevalence and associated factors of depression and anxiety disorders in people with epilepsy.\nMethod: An institution based cross-sectional study was conducted from April to May, 2013, among 423 people\nwith epilepsy from the outpatient department of Amanuel Mental Specialized Hospital. Depression and anxiety\nwere assessed using the Hospital Anxiety and Depression Scale. Logistic regression analysis was used to assess\npredictors of depression and anxiety.\nResults: The prevalence of anxiety and depression among epileptic people were 33.5 and 32.8 %, respectively.\nMonthly income, frequency of seizure and side effects of anti convulsants were found to be significantly associated\nwith both depression and anxiety. Being divorced/widowed was associated with anxiety while using poly-therapy\nof anti convulsants, perceived stigma, and inability to read or write were associated with depression.\nConclusion: The prevalence of co-morbid anxiety and depression was found to be high among people with\nepilepsy. Early identification of co-morbid depression and anxiety in people with epilepsy and managing epilepsy\nto become seizure free should be of great concern for health care providers....
Background: In myasthenia gravis (MG) patients, the dysfunction of CD4+CD25+ regulatory T cells (CD4+CD25+ Tregs)\nmay be one of the important pathogenesis of MG. Currently, the role of IFN-Ã?³ in autoimmune diseases is still controversial\nand needs further exploration. In this study, whether IFN-Ã?³ can induce CD4+CD25âË?â?? T cells into CD4+CD25+ Tregs in MG in\nvitro was investigated systematically.\nMethods: Flow cytometry was used to analyze the number of CD4+CD25+ Tregs in MG patients and healthy controls\n(HCs). CD4+CD25âË?â?? T cells were separated from the peripheral blood mononuclear cells of MG patients and HCs, and the\nCD4+CD25+ Tregs were separated from HCs by Magnetic cell sorting (MACS). IFN-Ã?³ with different concentrations\nwas used to stimulate CD4+CD25âË?â?? T cells. The percentages of the induced CD4+CD25+ T cells were detected by flow\ncytometry. The FoxP3 expression of the induced CD4+CD25+ T cells in MG patients was detected by real-time PCR at\nmRNA level. The induced CD4+CD25+ T cells were co-cultured with autologous CD4+CD25âË?â?? T cells to estimate the\nsuppressive ability of the induced CD4+CD25+ T cells to CD4+CD25âË?â?? T cells.\nResults: It shows the percentages of CD4+CD25+ T cells among CD4+ T cells have no significant difference in MG\npatients compared with those in HCs. There is also merely no difference in the percentages of CD4+CD25+ T cells\nbetween thymectomized and non-thymectomized MG patients. CD4+CD25âË?â?? T cells can be induced to CD4+CD25+ T\ncells after applying IFN-Ã?³ in MG patients and HCs. The proportion and FoxP3 expression of the induced CD4+CD25+ T\ncells are the highest at the level of 40 ng/ml IFN-Ã?³, and the suppressive function of the CD4+CD25+ T cells induced by\n40 ng/ml IFN-Ã?³ is the strongest in MG patients.\nConclusions: This subject will further reveal the role of IFN-Ã?³ in the pathogenesis of MG from a new perspective. It will\nalso provide the scientific basis for the clinical targeted therapy of MG....
Background: Chronic inflammatory airway disease (CIAD) has emerged as independent risk factor for cardiovascular\nmortality and ischemic stroke but the impact of co-existing CIAD in patients with ischemic stroke is less clear.\nMethods: We retrospectively analyzed 1013 patients with acute ischemic stroke who were consecutively admitted to\nthe Department of Neurology, CharitÃ?© - UniversitÃ?¤tsmedizin Berlin, Germany within one year. Mean follow-up was\n80 months (IQR 32ââ?¬â??85 months). Using multivariable regression models we analyzed the impact of CIAD (defined as\nchronic obstructive pulmonary disease or asthma bronchiale) on stroke severity and outcome.\nResults: Co-existing CIAD was evident in 7.1 % (n = 72) of all patients with acute ischemic stroke. Baseline characteristics\nof stroke patients with CIAD did not differ significantly from ischemic stroke patients without CIAD. Age (OR 1.17 [95 % CI\n1.03-1.37] per decade), atrial fibrillation (OR 3.43 [95 % CI 2.47-4.78]) and coronary artery disease (OR 1.51 [95 % CI\n1.07ââ?¬â??2.14]) but not a history of CIAD (p = 0.30) were associated with severe stroke (NIHSSââ?°Â¥11) on hospital\nadmission. Age (HR 1.70 [95 % CI 1.53-1.87] per decade), peripheral artery disease (HR 1.91 [95 % CI 1.35-2.7]),\nstroke severity at hospital admission (NIHSS per point HR 1.08 [95 % CI 1.06-1.10]), and history of CIAD (HR 1.43\n[95 % CI 1.02-2.00]) were independently associated with mortality during long-term follow-up. However, CIAD was\nnot significantly associated with short-term mortality after stroke.\nConclusion: Co-existing CIAD showed no significant association with stroke severity at hospital admission and\nearly mortality after ischemic stroke. CIAD was negatively associated with long-term survival after ischemic stroke....
Background: Postural instability is a particularly incapacitating disorder, whose loss of motor independence by\nParkinsonÃ?´s Disease (PD) patients marks a significant stage of disease onset. Evidence suggests that deficits in\nautomatic motor control, sensory integration and attention are associated with the lack of balance in PD.\nPhysiotherapy together with medication play an important role in the treatment of this state, although no\nconsensus has been reached on the best treatment modality. The aim of this randomized controlled trial protocol\nis to evaluate the effects of balance training with rhythmical (BRT), which is a motor program to improve balance\nassociated with rhythmical auditory cues (RACs). This study is ongoing in the stage 1.\nMethods and design: A total of 150 PD patients at H&Y stages IIââ?¬â??III and asymptomatic for depression and dementia\nare enrolled in a single-blind randomized study. Randomization is achieved via a computer-generated random-sequence\ntable. All patients should also present a fall history. They will be assigned into one of three groups, and their balance and\ngait will be assessed before and after 10 training sessions, and after 4 and 30 weeks subsequent to the end of the\ntraining. The BRT group will receive a motor program to improve balance associated with RACs, the MT group will\nperform motor training with the same aims as those in the BRT group but without RACs, and the control group (CG)\nwill be trained only in orientations. The exercise program specific to balance is of 5 weeksââ?¬â?¢ duration with two sessions\nper week, 45 min each, and consists of general physiotherapy exercises. Each session will be divided into five warm-up\nminutesââ?¬â?30 min for the main part and 10 min for the cool down. The training progresses and intensifies each week\ndepending on the individualââ?¬â?¢s performance. The subjects should be able to execute 10 repetitions of the exercise\nsequences correctly to progress to the next movement.\nDiscussion: This randomized study protocol will evaluate the effects of a motor program designed to improve balance\nassociated with RACs, and will also assess whether balance training leads to activation of balance reactions at the\nappropriate time. We hypothesize that if this motor program is maintained long-term, it will prevent falls....
Background: Most acute stroke patients with disabilities do not receive recommended rehabilitation following\ndischarge to the community. Functional and social barriers are common reasons for non-adherence to post-discharge\nrehabilitation. Home rehabilitation is an alternative to centre-based rehabilitation but is costlier. Tele-rehabilitation is a\npossible solution, allowing for remote supervision of rehabilitation and eliminating access barriers. The objective\nof the Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) trial is to determine if a novel telerehabilitation\nintervention for the first three months after stroke admission improves functional recovery\ncompared to usual care.\nMethods/design: This is a single blind (evaluator blinded), parallel, two-arm randomised controlled trial study\ndesign involving 100 recent stroke patients. The inclusion criteria are age �40 years, having caregiver support\nand recent stroke defined as stroke diagnosis within 4 weeks. Consenting participants will be randomized with\nvarying block size of 4 or 6 assuming a 1:1 treatment allocation with the participating centre as the stratification\nfactor. The baseline assessment will be done within 4 weeks of stroke onset, followed by follow-up assessments\nat 3 and 6 months. The tele-rehabilitation intervention lasts for 3 months and includes exercise 5-days-a-week\nusing an iPad-based system that allows recording of daily exercise with video and sensor data and weekly\nvideo-conferencing with tele-therapists after data review. Those allocated to the control group will receive usual\ncare. The primary outcome measure is improvement in life task�s social activity participation at three months\nas measured by the disability component of the Jette Late Life Functional and Disability Instrument (LLFDI).\nSecondary outcome variables consist of gait speed (Timed 5-Meter Walk Test) and endurance (Two-Minute Walk\ntest), performance of basic activities of daily living (Shah-modified Barthel Index), balance confidence (Activities-\nSpecific Balance Confidence Scale), patient self-reported health-related quality-of-life [Euro-QOL (EQ-5D)], health\nservice utilization (Singapore Stroke Study Health Service Utilization Form) and caregiver reported stress (Zarit\nCaregiver Burden Inventory)....
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