Activity Levels In Patients Research Articles

Triaxial accelerometer-measured physical activity and functional behaviours among people with High Grade Glioma: The BrainWear Study.

High-grade gliomas (HGG) account for 60-75% of all adult gliomas. The complexity of treatment, recovery and survivorship creates a need for novel monitoring approaches. Accurate assessment of physical function plays a vital role in clinical evaluation. Digital wearable tools could help us address unmet needs by offering unique advantages such as scale, cost and continuous real-world objective data. We present data from 42 patients enrolled into the BrainWear study. An AX3 accelerometer was worn by patients from diagnosis or at recurrence. Age-, sex-matched UK Biobank control groups were chosen for comparison. 80% of data were categorised as high-quality demonstrating acceptability. Remote, passive monitoring identifies moderate activity reduces both during a course of radiotherapy (69 to 16 minutes/day) and at the time of progressive disease assessed by MRI (72 to 52 minutes/day). Mean acceleration (mg) and time spent walking daily (h/day) correlated positively with the global health quality of life and physical functioning scores and inversely with the fatigue score. Healthy controls walked on average 2.91h/day compared to 1.32h/day for the HGG group on weekdays and 0.91h/day on the weekend. The HGG cohort slept for longer on weekends (11.6h/day) than weekdays (11.2h/day) compared to healthy controls (8.9h/day). Wrist-worn accelerometers are acceptable and longitudinal studies feasible. HGG patients receiving a course of radiotherapy reduce their moderate activity by 4-fold and are at least half as active as healthy controls at baseline. Remote monitoring can provide a more informed and objective understanding of patient activity levels to help optimise health related quality of life (HRQoL) among a patient cohort with an extremely limited lifespan.

The relationship between physical activity, structural deformity, and spinal mobility in adolescent idiopathic scoliosis patients.

Adolescent idiopathic scoliosis (AIS) patients experience structural spinal deformity, but the impact of AIS on physical activity is not widely studied. Reports of physical activity levels between children with AIS and their peers are mixed. This study sought to characterize the relationship between spinal deformity, spinal range of motion, and self-reported physical activity in AIS patients. Patients aged 11-21 completed self-reported measures of physical activity using the HSS Pedi-FABS and PROMIS Physical Activity questionnaires. Radiographic measures were obtained from standing biplanar radiographic imaging. Surface topographic (ST) imaging data was obtained using a whole-body ST scanning system. Hierarchical linear regression models analyzed the relationship between physical activity, ST, and radiographic deformity while controlling for age and BMI. 149 patients with AIS (mean age 14.5 ± 2.0years, mean Cobb angle 39.7° ± 18.9°) were included. In the hierarchical regression predicting physical activity from Cobb angle, no factors were significant predictors of physical activity. When predicting physical activity from ST ROM measurements, age and BMI served as covariates. No covariates or ST ROM measurements were significant predictors of physical activity levels for either activity measure. Physical activity levels of patients with AIS were not predicted by levels of radiographic deformity or surface topographic range of motion. Although patients may experience severe structural deformity and range of motion limitations, these factors do not appear to be associated with decreased physical activity level utilizing validated patient activity questionnaires. Level II.

Ceramic-on-Ceramic Total Hip Arthroplasty for Avascular Necrosis: 13-Year Average Follow-Up of Patients Under 50 Years Old

AbstractThe long-term survival of ceramic-on-ceramic bearings in young, active patients with osteonecrosis undergoing total hip arthroplasty (THA) is unknown. A previously published study demonstrated a high activity level in these young patients at 5-year follow-up, and this is a second follow-up report on this previously reported series. The purpose of this study is to determine whether high activity level is associated with ceramic-on-ceramic THA failure at long-term follow-up. This is a retrospective review of a single-surgeon consecutive series of index cases performed between 2003 and 2010. Inclusion criteria were ceramic-on-ceramic THA articulations in patients younger than 50 with a diagnosis of osteonecrosis. Mean follow-up was 12.5 years (range 9–17). Data were collected by survey via mail, telephone, e-mail, and social media. Preoperative and postoperative Western Ontario and McMaster University (WOMAC) Arthritis Index and University of California at Los Angeles (UCLA) activity scores were collected. Student t-tests were used as appropriate. There were 97 patients in this series. Mean age at THA was 36 (range 14–50). Since the prior report, four more patients have been confirmed deceased, and four more have been lost to follow-up. We confirmed that six patients were deceased and 42 were otherwise lost to follow-up. The response rate was 54%. The vast majority of patients were highly active at latest follow-up (73% with UCLA scores between 7 and 10). UCLA scores (1–10 scale) improved from a preoperative mean of 3.4 to postoperative 7.1 (p < 0.001). WOMAC scores (1–100 scale) increased from preoperative mean of 38.7 to postoperative 86.1 (p < 0.001). At latest follow-up, four patients had undergone revision surgery. There were no ceramic component failures. One patient underwent early revision for femoral component loosening, one was revised for chronic pain at another institution. Since the prior report there have been two additional revisions; one patient was revised for instability at 5-year postop, and one patient was revised for periprosthetic fracture at 10 years. Despite additional loss to follow-up and lack of clinical and radiographic measures, this survey study suggests that at long-term follow-up ceramic bearings accommodate high activity level with excellent component survivorship (93%) in young patients undergoing THA.

Impact of physical activity on self-reported health parameters in peripheral artery disease in two periods of the COVID-19 pandemic

BackgroundProlonged social isolation intended to mitigate the spread of Coronavirus 2019 (COVID-19), may potentially affect the physical activity level and health of patients with peripheral artery disease (PAD). ObjectivesTo analyze the impact of physical activity practice on longitudinal changes in self-reported health parameters during the COVID-19 pandemic in patients with PAD. DesignLongitudinal study. SettingThe database of studies developed by our group involving patients with PAD from public hospitals in São Paulo, Brazil. MethodsIn this longitudinal study, 99 patients with PAD were evaluated in two periods during the COVID-19 pandemic (i.e., May to August 2020 and May to August 2021). Patients were interviewed by telephone, and information was obtained regarding physical activity practice and self-reported health (i.e., current global, physical, and mental health). Patients were divided into two groups: the physically inactive group (patients who were or became physically inactive, n=76, 51.3% male, 67±10 years old, 8±7 years of disease duration) and the physically active group (patients who started or continued practicing physical activity, n=23, 65.2% male, 71±8years old, 7±6 years of disease). ResultsThe physically inactive group more frequently self-reported their current health as poor (6.6 vs. 17.1%, P=0.045) and were more frequently hospitalized for reasons other than COVID-19 (6.6 vs. 27.6%, P=0.001) between the two periods evaluated during the COVID-19 pandemic. The physically active group self-reported lower declines in walking capacity (13.0 vs. 43.5%, P=0.022) between the two periods evaluated. We did not observe any differences in other parameters in either group between the two periods evaluated (p>0.05). ConclusionsThe practice of physical activity during the COVID-19 pandemic can help maintain or mitigate the negative impacts on self-reported global and physical health parameters in patients with PAD.

Walking a day in a pachyonychia congenita patient's shoes: Impact on plantar pain and activity levels measured with wristband activity trackers.

Background Plantar keratoderma is a common finding in pachyonychia congenita, significantly impairing ambulation and quality of life. Due to the variation of pain reporting in pachyonychia congenita clinical studies, it is difficult to evaluate the efficacy of treatment outcomes for painful plantar keratodermas. Objectives To objectively analyse associations between plantar pain and activity levels in pachyonychia congenita patients using a wristband tracker. Methods Pachyonychia congenita patients and matched normal controls wore wristband activity trackers and completed a daily digital survey to record their highest and total pain scores (0-10 scale) each day for 28 consecutive days during four different seasons. Results Twenty four participants (12 pachyonychia congenita patients and 12 matched normal controls) completed the study. Pachyonychia congenita patients walked 1801.30 fewer steps/day (95% CI, -3666.4, 64.1) than normal controls (P = 0.072) and had greater average total [5.26; SD, 2.10] and highest (6.92; SD, 2.35) daily pain than normal controls [0.11 (SD, 0.47), 0.30 (SD, 0.22), respectively] (P < 0.001, both). On average, for each one unit increase in daily highest pain level, pachyonychia congenita activity decreased 71.54 steps/day (SE, 38.90, P = 0.066). Limitation The study had a small number of participants, limiting statistical power. Only pachyonychia congenita patients, ages 18 years or older, with keratin 6a, keratin 16, and keratin 17 mutations were included, limiting generalizability. Conclusion Pachyonychia congenita patients were less active with significantly higher pain than normal controls. There was an inverse correlation between pain and activity. Our findings suggest that wristband tracker technology may be used to evaluate treatment efficacy in future trials on severe plantar pain; therapeutic interventions that decrease plantar pain should correlate with significant increases in activity using wristband trackers.

PO-02-137 ASSOCIATION OF PHYSICAL ACTIVITY WITH THE RISK OF MAJOR ADVERSE CARDIAC AND CEREBROVASCULAR EVENTS AND MORTALITY IN PATIENTS WITH CONCOMITANT ATRIAL FIBRILLATION AND CORONARY ARTERY DISEASE

Although regular physical activity benefits cardiovascular health, there is a concern that intense exercise is linked to the promotion of atrial fibrillation (AF) and coronary plaque rupture. However, the impact of physical activity on the outcomes of patients with concomitant AF and coronary artery disease (CAD) remains unclear. This study aimed to evaluate the association with clinical outcomes according to the level of physical activity in patients with concomitant AF and CAD. We assessed 551 patients with AF and CAD (mean age, 67.1±9.8 years) who completed a self-reported questionnaire for physical activity from 2015 to 2020 in a single tertiary-care hospital. Physical activity levels were converted into metabolic equivalent of task (MET) per week and categorized to correspond with multiple public health recommendations. We examined the association between physical activity, all-cause mortality, and major adverse cardiac and cerebrovascular events (MACCE). The risks of all-cause mortality (P for linear trend=0.017) and MACCE (P for linear trend=0.05) were appeared inverse trend with a greater level of physical activity. Compared with inactive patients, patients who met the recommended target range of physical activity (500–1,000 MET-min/week: unadjusted hazard ratio [HR]=0.58, 95% confidence interval [CI]=0.36–0.99) and highly active patients who exceeded the minimum recommended level (≥1,000 MET-min/week: unadjusted HR=0.47, 95% CI=0.25–0.88) had a lower risk of all-cause mortality in the unadjusted model; however, these associations did not remain significant after adjusting for the model. There was no evidence of increased risk of all-cause mortality and MACCE at levels of physical activity above the recommended target range, even with vigorous intensity physical activity exceeding the recommended target range. There appears to be an inverse trend between physical activity levels and all-cause mortality and MACCE in patients with concomitant AF and CAD. No excess risk of mortality or MACCE was found at exercise levels above the recommended target range. Further large-scale studies are warranted to create an improved evidence base concerning the effects of physical activity in patients with AF and CAD.

Analysis of Energy Balance in Obese Healthcare Workers

Obesity is a global health challenge that seriously affects developing countries, including Indonesia. Although the determining factors of obesity are complex, energy balance and lifestyle play a very important role. Unbalanced dietary patterns and sedentary behavior are still the most important factors in the occurrence of obesity. Therefore, it is important to discover the energy balance calculated from energy intake and energy expenditure in obese patients. This study aimed to analyze the balance of energy intake and expenditure, body composition, and physical activity level in obese patients at Exercise Center IMERI FKUI. A cross-sectional study was held at Exercise Center IMERI FKUI. Study participants (patients) were screened by measuring body composition and obesity status was determined based on BMI data (≥25 kg/m2). The selected subjects were then administered to data collection on body composition using the MF-BIA instrument, energy intake using the MyFitnessPal (MFP) application, as well as energy expenditure and physical activity level using the IPAQ-SF tool. From a total of 12 patients with obesity at the Exercise Center, 11 (91.67%) patients had a negative energy balance and 1 (8.33%) patient had a positive energy balance during a 7-day period of data collection. A majority of the obese patients at the Exercise Center reported a negative energy balance.

Physical activity level and sedentary behavior in patients with bronchiectasis: A systematic review of outcome measures and determinants

BackgroundChanges in respiratory functions negatively affect the physical activity (PA) levels of patients with bronchiectasis. Therefore, detecting the most frequently used assessments of PA is essential as determining related factors and improving PA. This review study aimed to investigate the PA levels, compare levels with the recommended PA guidelines, determine the outcome measurements of PA and examine the determinants related to PA in patients with bronchiectasis. MethodThis review was conducted using databases of MEDLINE, Web of Science, and PEDro. The searched terms were the variations of the words "bronchiectasis" and "physical activity". Full texts of cross-sectional studies and clinical trials were included. Two authors independently screened the studies for inclusion. ResultThe initial search identified 494 studies. A hundred articles were selected for full-text review. Following the application of the eligibility process, 15 articles were included. Twelve studies used activity monitors and five studies used questionnaires. The studies that used activity monitors presented daily step counts. The mean number of steps ranged between 4657 and 9164 for adult patients. It was approximately 5350 steps/day in older patients. One study investigated children's PA level reported 8229 steps/day. The functional exercise capacity, dyspnea, FEV1 and, quality of life as related determinants with PA have been reported in the studies. ConclusionPA levels of patients with non-cystic fibrosis bronchiectasis were lower than the recommended levels. The objective measurements were frequently used in PA assessment. In further studies, it is needed to investigate the related determinants of PA in patients.

EVALUATION OF THE PHYSICAL ACTIVITY LEVELS OF COVID-19 PATIENTS IN TURKEY

Purpose: Covid-19 is a viral infection that affects either the respiratory system or the other systems. Studies about the effects of Covid-19 on physical activity are still scarce. This study aims to compare the changes in the physical activity levels of patients before and six months after Covid-19 in Turkey.&#x0D; Methods: One hundred and six participants that have been six months after Covid-19 contraction were included in the study. Along with the Patient Assessment Questionnaire, the International Physical Activity Questionnaire Short Form was used to assess physical activity energy consumption (vigorous-intensity physical activities, moderate-intensity physical activities, walking, and total physical activities).&#x0D; Results: Participants became either less physically active or more sedentary six months after Covid-19 (p=0.019). Vigorous-intensity physical activity levels were significantly decreased (Mean±SD: 341±854 vs. 109±331 Metabolic Equivalent Task minutes/week, p=0.015), and perceived fatigue during exercise was significantly increased between before and six month after infection (Mean±SD: 4.76±2.17 vs 6.17±2.27, p=0.001). Participants who had dyspnea (n=12) during the period of Covid-19, did more moderate-intensity physical activity (p=0.020) and walking (p =0.021) after Covid-19, compared to those who had not.&#x0D; Conclusion: Particularly changes in vigorous-intensity physical activity levels and perceived fatigue during exercise were seen in Covid-19 infected patients. We recommend supporting gradually increased tailor-based exercise programs by health professionals in public health agencies, not only for protecting the individuals from Covid-19 outcomes, but also for returning to their preinfection fitness levels.

The impact of the COVID-19 pandemic on physical activity and anxiety levels of young mental health patients and their parents

Abstract: Introduction: One restriction measure during the COVID-19 pandemic period was the closure of sport-related facilities, generating substantial anxiety. This study analyzed longitudinal changes in anxiety and physical activity (PA) levels in young people (YP) attending a community child and adolescent mental health service, and their parents/caregivers from 2020 to 2022. Method: This quantitatively driven convergent mixed-methods cohort study utilized validated scoring tools (GAD-7/GLTEQ) as the core quantitative component, and open-ended questions as the supplementary qualitative component. The quantitative and qualitative data were statistically analyzed, and both results were integrated. Questionnaires were distributed in August–October 2020 (Phase 1: At the peak of restriction period), August–October 2021 (Phase 2: During gradual removal of restrictions) and August–October 2022 (Phase 3: When all restrictions were removed). Results: Parent/caregiver’s anxiety levels significantly reduced from Phase 1 to Phase 3. Results revealed non-significant improvements in YP’s PA levels from Phase 1 to Phase 3. PA levels in YP were significantly higher than those of parents/caregivers throughout all Phases. A significant negative correlation was revealed between PA and anxiety levels in parents/caregivers throughout all Phases. The fear of getting infected, lifting of restrictive measures, vaccination benefits, and pandemic-induced social/financial struggles were common themes generated from the qualitative comments. Conclusion: The authors recommend PA promotional campaigns and incentives during such restrictive periods, helping the population’s mental well-being. The high attrition rates in this study may decrease its generalizability. However, the results generated from this innovative study may serve as a platform for future research carried out during traumatic periods.

The role of patient activation in self-care behaviours of Korean older adults with heart failure.

This study was aimed at investigating the level of patient activation, and its association with self-care behaviours in older people with heart failure. Cross-sectional secondary data analysis was conducted. We included a total of 182 Korean patients with heart failure who were aged ≥65 years for a cardiovascular outpatient clinic visit. Baseline characteristics, the Patient Activation Measure (PAM), health literacy, disease knowledge and self-care behaviours were collected via a self-administered questionnaire. The proportion of patient activation at Levels 1 and 2 was 22.5% and 14.3%, respectively. Highly activated patients had a high level of health literacy, disease knowledge and self-care behaviours. After adjusting for confounding factors, we observed that patient activation was the only statiscally significant predictor of self-care behaviours among older people with heart failure. Healthcare professionals should help patients take active roles in their self-care through a comprehensive needs assessment including health literacy and disease knowledge.

Effect of multidisciplinary interventions on the quality of life of individuals with multiple sclerosis: a systematic review

Introduction: The study aims to review published literature on multidisciplinary interventions and their effect on quality of life of individuals with multiple sclerosis to produce state-of-the-art recommendations and consistent discipline combinations for optimal holistic patient car Methods: The study thoroughly analyzed papers published between January 2010 and February 2022. The publications are gathered from five critical databases: Cochrane, JSTOR, PEDro, PubMed, and ScienceDirect. With Rayyan, the data is analyzed. Independent reviewers evaluate the quality of the papers included in the review using the PEDro Scale and the Cochrane Collaboration tool. Results: The review includes ten studies with an average of 129 participants for each of the 513 identified articles. In QOL domains, multidisciplinary rehabilitation programs address limits in physical role (p = 0.016), emotional role (p = 0.010), mental wellbeing composite (p = 0.017), and cardiorespiratory fitness (p = 0.017). In addition, it improves Fatigue, as measured by the Chalder Fatigue Scale, the SF-36 vitality subscale, and Fatigue self-efficacy. Only one study found no statistically significant differences in its primary outcome. With 19 individuals, the Level of Activity improved, notably the Timed 50 Meter Walk (p = 0.014), walking speed (p = 0.034), 2- (p = 0.204), and 6-Minute Walk (p = 0.027). Discussion: In terms of quality of life and decrease in fatigue, multidisciplinary interventions have a remarkable impact on the activity level of MS patients. Findings suggest that Multidisciplinary interventions and other treatment combinations are best recommended in patients with MS to improve multicomponents of QoL and different outcomes such as fatigue.

Lower donor site morbidity with hamstring and quadriceps tendon autograft compared with bone-patellar tendon-bone autograft after anterior cruciate ligament reconstruction: a systematic review and network meta-analysis of randomized controlled trials.

To perform a meta-analysis of RCTs evaluating donor site morbidity after bone-patellar tendon-bone (BTB), hamstring tendon (HT) and quadriceps tendon (QT) autograft harvest for anterior cruciate ligament reconstruction (ACLR). PubMed, OVID/Medline and Cochrane databases were queried in July 2022. All level one articles reporting the frequency of specific donor-site morbidity were included. Frequentist model network meta-analyses with P-scores were conducted to compare the prevalence of donor-site morbidity, complications, all-cause reoperations and revision ACLR among the three treatment groups. Twenty-one RCTs comprising the outcomes of 1726 patients were included. The overall pooled rate of donor-site morbidity (defined as anterior knee pain, difficulty/impossibility kneeling, or combination) was 47.3% (range, 3.8-86.7%). A 69% (95% confidence interval [95% CI]: 0.18-0.56) and 88% (95% CI: 0.04-0.33) lower odds of incurring donor-site morbidity was observed with HT and QT autografts, respectively (p < 0.0001, both), when compared to BTB autograft. QT autograft was associated with a non-statistically significant reduction in donor-site morbidity compared with HT autograft (OR: 0.37, 95% CI: 0.14-1.03, n.s.). Treatment rankings (ordered from best-to-worst autograft choice with respect to donor-site morbidity) were as follows: (1) QT (P-score = 0.99), (2) HT (P-score = 0.51) and (3) BTB (P-score = 0.00). No statistically significant associations were observed between autograft and complications (n.s.), reoperations (n.s.) or revision ACLR (n.s.). ACLR using HT and QT autograft tissue was associated with a significant reduction in donor-site morbidity compared to BTB autograft. Autograft selection was not associated with complications, all-cause reoperations, or revision ACLR. Based on the current data, there is sufficient evidence to recommend that autograft selection should be personalized through considering differential rates of donor-site morbidity in the context of patient expectations and activity level without concern for a clinically important change in the rate of adverse events. Level I.

Health-related quality of life and physical activity in Ukrainian pediatric patients with heterozygous familial hypercholesterolemia

Introduction. Familial hypercholesterolemia (FH) is a genetically determined disease characterized by elevated low-density lipoprotein levels since birth and predisposes a person to develop atherosclerosis-induced cardiovascular disease. Healthcare providers should monitor the health status and physical activity level in pediatric patients with FH, as a high-risk group for cardiovascular disease. Purpose - to investigate the self-reported health-related quality of life (HRQoL) and physical activity energy expenditure based on the questionnaire data (PAEEq) in children with heterozygous FH compared with healthy peers to assess the health status. Materials and methods. The HRQoL scores were assessed using the KINDLR questionnaire in 15 patients with FH and 21 healthy peers. The physical activity level was evaluated using the C(Y)PAQ questionnaire. The KINDLR data together with other variables such as age, weight, height, sex, BMI and the PAEEq scores were analyzed in SAS® OnDemand for Academics. Results. HRQoL scores in FH children were similar to those of the control group (p&gt;0.05). There was no association between PAEEq and the HRQoL scores in the FH (r=0.37, p=0.29) and the control group (r=0.43, p=0.20). The KINDLR Physical well-being score in the 5-9 years age group was significantly higher for FH children than for controls (p&lt;0.01), while the total HRQoL score was not significantly different between FH children and controls. The group of FH children aged 5-9 with an intermediate level of PAEEq was the most physically active among the surveyed children. The controls aged 15-18 with low levels of PAEEq was the least active. All other age groups were characterized by a low intermediate level of PAEEq. Conclusions. Children with FH have HRQoL scores that are comparable to those of healthy peers. The FH and control groups were relatively satisfied with their quality of life. Thus, FH children consider themselves to be healthy, and from this underestimation of their cardiovascular risk they may have low adherence. Most FH children were found to have the low intermediate levels of PAEEq, which may indicate a lack of exercise and poor quality of life later on. Children with FH may have significant health problems in adulthood if they are not treated early and appropriately. In a similar manner, low PAEEq levels were demonstrated by the controls, so they should be also informed about the significance of regular physical activity and properly motivated. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patients was obtained for conducting the studies. No conflict of interests was declared by the authors.

The effects of message framing on self-management behavior among people with type 2 diabetes: A randomized controlled trial

BackgroundMessage framing describes how information is communicated and demonstrated to influence its effect on future attitudes and behaviors. Message content can be structured as ‘gain-framed’, emphasizing the benefits of engagement as recommended, whereas ‘loss-framed’ describes the negative consequences of not engaging as recommended. However, the impact of message framing on behavior change in people with chronic diseases like diabetes is not well understood. ObjectiveAnalyze the impact of message framing in diabetes education on self-management in people with type 2 diabetes, and identify potential moderating effects of patient activation on message framing. DesignA three-arm randomized controlled trial was performed. Setting(s)Participants were recruited from inpatients in the endocrine and metabolic unit of a university-affiliated hospital in Changchun. ParticipantsA total of 84 adults with type 2 diabetes were equally randomized into gain-, loss-, or no-message framing groups and received a 12-week intervention. MethodsBoth the message framing groups received 30 video messages. One group of participants received the gain-framed messages emphasizing desirable outcomes from effective diabetes self-care. The other group of participants received the loss-framed messages emphasizing the undesirable consequences of ineffective diabetes self-care. The control group received 30 videos about diabetes self-care without message framing. Self-management behavior, self-efficacy, patient activation, diabetes knowledge, attitudes, and quality of life were measured at baseline and 12 weeks. ResultsCompared with the control group, participants who watched either gain or loss-framed messages had significant increases in self-management behavior and quality of life after the intervention. The scores of self-efficacy, patient activation, knowledge, and attitudes of the loss-framing group were considerably higher than the control group. Further analysis revealed an interaction between patient activation and message framing (P = 0.002), with gain and loss message framing interventions more effective in increasing self-management behaviors in people with type 2 diabetes who had a higher and lower activation level, respectively. ConclusionsUsing message framing in diabetes education is a promising strategy to build and foster self-management behavior. It also suggests that appropriate message framing be chosen to enhance self-management behavior based on the level of patient activation. Registration numberChiCTR2100045772.

Effect of physical activity level on orthodontic pain perception after separator placement in adult patients managed at a tertiary care teaching public sector hospital in Lahore

Background: Different behavioral therapies are used to reduce pain severity in patients undergoing separator placement apart from pharmacological treatments. However, there is limited local data.This study aimed to determine the frequency of high and low levels of activity in adult patients who needed separator placement and compared the mean pain scores with respect to baseline physical activity level following the intervention.&#x0D; Subjects and methods: It was a descriptive case series carried out at the Orthodontics Department, De’Montmorency College of Dentistry, Lahore, for a period of 3 months from 15.7. 2022 to 15.9.2022. Total 120 patients aged 18 to 40 years of both genders, who needed separator placement were included in the study. Patients were excluded if they had medical conditions or systemic diseases that was a contraindication for usage of fixed orthodontic appliances, had chronic pain or pain in the orofacial or dental region, had maxillary or mandibular fracture and who had previous history of mandibular or maxillary surgery. Baseline physical activity level was noted down as per clinical history. Patients then underwent separator placement.&#x0D; Results: Mean age of the patients was 28.67±6.312 years. There were 62 (51.7%) males and 58 (48.3%) females. Baseline low physical activity was found in 77 (64.2%) patients while high activity was found in 43 (35.8%) patients. Mean pain scores in the low physical activity group were 3.9±2.056 and in the high physical activity group were 2.26±2.094 and the difference was statistically significant i.e. p=0.001 as assessed by independent t-test.&#x0D; Conclusion: Frequency of low physical activity level was higher in patients and it was found to be associated with higher mean pain scores compared to patients who had high baseline level of physical activity.&#x0D;

Vaccine Induced Herpes Zoster in An Immunocompetent Child After 3 months of 1st Dose of Vaccination

Varicella zoster virus (VZV) is an enveloped double stranded linear virus, which belongs to the herpesvirus’s family. It can cause two clinically different forms of diseases, primary infection known as chicken pox and latent infection know as herpes zoster (Shingles). Primary infection presents with diffuse vesicular rash accompanied by fever, malaise, and pharyngitis. However, latent infection results from reactivation of dormant virus in an immunocompromised patient and presents with painful localized skin rashes called as shingles. Currently, in the US, 2 doses of live attenuated varicella vaccine are available to prevent VZV infection. One of the major side effects of vaccination are the rashes. We report a unique case of vaccine induced VZV infection in a previously healthy child that presents with vesicular rashes 3 months after 1st dose of vaccination. A 16-month-old child with past medical history of premature birth at 32 weeks, presented to the pediatric outpatient clinic with complains of well-demarcated, erythematous, dry rash on both labia. Parents denied fever, cough, or any other signs and symptoms associated with rashes. patient activity level was normal and oral intake was usual. PCR testing was performed was found to be negative for Herpes Simplex Virus-1 (HSV-1) and Herpes Simplex Virus-2 (HSV-2) and positive for VZV. Due to patient recent vaccination status, further classification of infection was needed to determine if the source of infection was wild type chicken pox or vaccine induced. A swab of one of the vesicular lesions was sent to the Ohio Department of Health, for vaccine vs wild-type strain PCR testing. The results were positive for Vaccine induced VZV infection. The patient was started on acyclovir therapy. On follow-up, the patient condition improved clinically. In pediatric populations, it is important to do extensive evaluation of rashes post vaccination as it can be occurred due to wild type, break through or it can be vaccine induced virus. Proper evaluation can significantly impact the management patients as they are maybe infectious and need to be isolated in wild type and breakthrough infection versus non-infectious in case of vaccine induced. After detailed clinical history and physical examination, it is important to investigate further through PCR testing to differentiate one category from another!

Evaluating the relationship between patient activation and health-related quality of life (HRQOL) in patients with pancreatic cancer (PwPC).

Advanced pancreatic cancer is synonymous with a high mortality rate, debilitating symptom profile, and minimal prolongation in overall survival. Therefore, health-related quality of life (HRQOL) is important in patients with pancreatic cancer (PwPC). In chronic conditions, patient activation is positively associated and higher HRQOL. However, no known study has evaluated patient activation, HRQOL, and their association in PwPC. A 43-item cross-sectional survey assessed patient activation and HRQOL of patients with locally advanced and metastatic pancreatic cancer undergoing chemotherapy. Variables were analyzed descriptively, and relationships were assessed using bivariate statistics (sig p < 0.05). Fifty-six patients participating in the study had an average age of 69.5 ± 11.1years, and the majority were females (51.8%), Caucasians (61.8%), married/partnered (64.3%), and had at least a college degree (59%). Almost half were at stage 4 (48.2%), and most were newly diagnosed (66.1%). Mean patient activation score was 63.5 ± 17.2 (scale range: 0-100), with most at higher activation levels of 3 or 4 (66.7%). Mean HRQOL score of 41.0 ± 12.7 (scale range: 0-72) was low. Patient activation levels, age, education level, and gender explained 21% of variation in overall HRQOL scores. Patients at activation level 4 had significantly higher overall HRQOL versus those at lower activation (level 1 or 2). Higher patient activation was significantly associated with having either private insurance only or multiple insurances and being partnered. Patient activation significantly predicted HRQOL in PwPC despite the low sample size. Initiatives to increase patient activation should focus on patients of low socioeconomic status and those without partner support.

Habitual physical activity levels of adults with heart failure: systematic review and meta-analysis

ObjectiveTo conduct a systematic review and meta-analysis to quantify habitual physical activity (PA) levels of patients with heart failure (HF) and assess the quality of reporting of device-assessed PA.MethodsEight electronic...

Rucaparib or Physician’s Choice in Metastatic Prostate Cancer

BackgroundIn a phase 2 study, rucaparib, an inhibitor of poly(ADP-ribose) polymerase (PARP), showed a high level of activity in patients who had metastatic, castration-resistant prostate cancer associated with a deleterious BRCA alteration. Data are needed to confirm and expand on the findings of the phase 2 study.MethodsIn this randomized, controlled, phase 3 trial, we enrolled patients who had metastatic, castration-resistant prostate cancer with a BRCA1, BRCA2, or ATM alteration and who had disease progression after treatment with a second-generation androgen-receptor pathway inhibitor (ARPI). We randomly assigned the patients in a 2:1 ratio to receive oral rucaparib (600 mg twice daily) or a physician’s choice control (docetaxel or a second-generation ARPI [abiraterone acetate or enzalutamide]). The primary outcome was the median duration of imaging-based progression-free survival according to independent review.ResultsOf the 4855 patients who had undergone prescreening or screening, 270 were assigned to receive rucaparib and 135 to receive a control medication (intention-to-treat population); in the two groups, 201 patients and 101 patients, respectively, had a BRCA alteration. At 62 months, the duration of imaging-based progression-free survival was significantly longer in the rucaparib group than in the control group, both in the BRCA subgroup (median, 11.2 months and 6.4 months, respectively; hazard ratio, 0.50; 95% confidence interval [CI], 0.36 to 0.69) and in the intention-to-treat group (median, 10.2 months and 6.4 months, respectively; hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001 for both comparisons). In an exploratory analysis in the ATM subgroup, the median duration of imaging-based progression-free survival was 8.1 months in the rucaparib group and 6.8 months in the control group (hazard ratio, 0.95; 95% CI, 0.59 to 1.52). The most frequent adverse events with rucaparib were fatigue and nausea.ConclusionsThe duration of imaging-based progression-free survival was significantly longer with rucaparib than with a control medication among patients who had metastatic, castration-resistant prostate cancer with a BRCA alteration. (Funded by Clovis Oncology; TRITON3 ClinicalTrials.gov number, NCT02975934.)