Linear Mixed Model Analysis Research Articles

Non-invasive brain stimulation enhances the effect of physiotherapy for balance and mobility impairment in people with Multiple Sclerosis.

Impairment of balance and gait is common in Multiple Sclerosis (MS). Non-invasive Brain Stimulation techniques are promising adjuncts to physical therapy to improve disability. To determine if combining transcranial direct current stimulation (tDCS) with conventional exercise therapy enhances balance and mobility in people with multiple sclerosis (PwMS) compared to exercise alone. In a double-blind randomised controlled trial, PwMS were randomised into a real or sham tDCS group. All patients received individualized exercise treatment. Twelve sessions of real (intensity 2mA, bipolar) or sham tDCS was administered over the primary motor area for 20 minutes followed by one hour of physiotherapy focusing on balance, strength, and mobility, twice a week for six weeks. Outcome measures included balance (Berg Balance Score), mobility (10m Walk Test), fatigue (Fatigue Severity Scale) and quality of life (Multiple Sclerosis Quality of Life - 54) performed 1 week before intervention, at week 7 (1-week post-intervention), and at six months post-intervention. Falls questionnaire was completed 1 week before intervention and at 6 months post-intervention. Generalised linear mixed model analysis was used to compare outcomes at different time points within groups (before and after exercise treatment) and between groups (sham vs real stimulation groups). Forty participants (mean age 54 and mean EDSS 3.5) were randomly allocated to receive real (n=19) or sham (n=21) stimulation, with 36 completing the post-intervention (real 17, sham 19) and 32 completing the 6-month assessments (real 15, sham 17). All participants had significantly improved balance and mobility scores post exercise treatment (within groups comparison, p<0.05). Between groups comparison found a small but significant improvement in the Berg Balance Score (mean improvement 1.9 and 2 points, p <0.05) and 10-metre Walk Test (mean improvement of 0.09 and 0.11m/s, p <0.05) in the real tDCS group compared to the sham group after six weeks of training and at six months follow-up, respectively. There was no benefit in fatigue, falls and QOL scores in the real stimulation group compared to the control group. Our results suggest that the addition of tDCS prior to exercise treatment provides a significant improvement in walking speed and balance in people with MS which lasts longer, compared to exercise alone. Further study is needed to optimize the use of this relatively inexpensive and well tolerated device for rehabilitation. Australia and New Zealand Clinical Trial Registry (ACTRN12628001836224).

The Influence of Sex and Gender on the Level and Course of Subjective Cognitive Complaints After Percutaneous Coronary Intervention.

Cognitive complaints (e.g., health anxiety and illness disruption) are commonly experienced by patients with coronary heart disease (CHD). While it is known that sex and gender affect health, their influence on cognitive complaints remains unknown. The current study explored sex and gender differences in cognitive complaints during the first month (acute phase) and beyond, up to 2years (recovery phase) after percutaneous coronary intervention (PCI). A total of 514 (Mage = 64.2 ± 8.9, 84.2% male) completed the cognitive scale of the Health Complaints Scale (i.e., overall cognitive complaints, health worry, illness disruption) at baseline, 1, 12, and 24months post-PCI. Additional questionnaires to gauge gender identity, traits, and norms were administered in a follow-up study. General linear mixed model analyses were conducted to examine the influence of sex, gender, sex × gender, and covariates on cognitive complaints. Cognitive complaints only decreased in the first month post-PCI (all p < .01). There were no clear sex differences. However, gender generally predicted cognitive complaints in the first 2 years post-PCI: masculinity was related to less complaints, whereas feminine individuals reported higher absolute levels of complaints. The current findings reveal that gender is a valuable factor concerning health complaints and indicate the need to further elaborate on the discrepancies between sex and gender in health research.

A retrospective analysis of a clinician-initiated high-intensity locomotor training implementation project in an inpatient rehabilitation facility.

The Academy of Neurologic Physical Therapy's Intensity Matters campaign recommends the implementation of high-intensity locomotor training for all patients with neurologic dysfunction with goals to improve walking. Retrospectively determine the effectiveness of a clinician-initiated implementation project on the adoption, reach, and fidelity of high-intensity locomotor training for patients with stroke during inpatient rehabilitation and, determine whether the project led to changes in patient outcomes. Retrospective analysis of electronic medical records from 1 year before and after the project. Patients admitted with a stroke diagnosis were included. Demographic information, the number of high-intensity sessions, the percentage of time spent in the target heart rate zone, standardized assessment scores for motor function, functional mobility, balance, gait speed and endurance, and discharge destination were extracted for descriptive and linear mixed model analysis. Clinician reach was 75%, and adoption of high-intensity training varied between clinicians from 47.1% and 83.3%. Of eligible patients, 55% received the target intervention at least once, reflecting the patient reach. Implementation fidelity was 18.84%. Linear mixed effects modeling revealed a statistically significant effect of time (p < .001) but not group allocation or group × time interaction. Although statistically significant differences in patient outcomes compared to pre-implementation were not found, results highlight the limitations associated with adopting high-intensity locomotor training for patients post-stroke in this setting .It remains unclear whether the implementation fidelity achieved was sufficient to impact patient outcomes. Further research is needed to establish fidelity targets and identify barriers to successful implementation projects by clinicians.

A biopsychosocial approach to phenotyping people with knee osteoarthritis awaiting total knee arthroplasty: A secondary cohort analysis

BackgroundPrevious research showed chronic post-total knee arthroplasty (TKA) pain in 20% of people with knee osteoarthritis (KOA). Various preoperative biopsychosocial-related factors have been described, but phenotyping people with KOA awaiting TKA based on these factors is still lacking. This could be relevant to understanding differences in TKA surgery responses. ObjectiveTo identify phenotypes in people with KOA awaiting TKA and differences in post-TKA pain based on preoperative biopsychosocial factors. MethodsPeople with KOA awaiting TKA in 4 hospitals in Belgium and the Netherlands were included. A cross-sectional latent profile analysis was conducted on structural, metabolic, functional, pain-related, psychological and social variables. Concurrent validity was tested using 3-step multinomial logistic regression. The difference in one-year post-TKA pain was examined with linear mixed model analysis. ResultsTwo hundred and seventeen participants were included in the latent profile analysis with a mean (SD) age of 65.5 (7.7) years, including 109 women. A model with 2 phenotypes differed in 14 out of 21 variables. Participants with phenotype 2 (28%) had a higher body mass index (BMI), higher chance of having less structural damage (KOA grade), lower mean quadriceps strength and physical function (Knee Society Scoring System functional and 30-second chair stand test), higher pain intensity, number of pain locations, and indices of central sensitisation (temporal summation, central sensitisation inventory score, and lower pressure pain thresholds), higher pain catastrophising, anxiety and depression, and higher post-TKA pain intensity compared to phenotype 1 (72%). Concurrent validity was confirmed in 3 out of 4 variables. ConclusionsPhenotype 2 (28%) with nociplastic pain characteristics in combination with worse psychological factors, BMI, functional and structural factors, and phenotype 1 (72%) not representing these characteristics were identified. Phenotype 2 had worse pain intensity scores after TKA compared to phenotype 1. Attention to the characteristics of phenotype 2 is warranted concerning post-TKA pain. Database registrationThe protocol is registered at ClinicalTrials.gov (NCT05380648).

Efficacy and safety of low-frequency repetitive transcranial magnetic stimulation in adolescents with first-episode major depressive disorder: A randomized, double-blind, sham-controlled pilot trial

BackgroundA few sham-controlled studies have examined the efficacy, safety, and tolerability of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) in adolescents with first-episode major depressive disorder (FE-MDD). MethodsForty adolescents (aged 13–17 years) with FE-MDD were randomly assigned to receive active rTMS (n = 20) or sham rTMS (n = 20) for 10 sessions over two weeks. The severity of baseline depressive symptoms and their improvement on the day immediately after the second, fourth, sixth, eighth, and tenth sessions were assessed with the 17-item Hamilton Depression Rating Scale (HAMD-17). Results: After completing 10 rTMS treatment sessions, there was no significant difference in antidepressant response (70.0 % vs. 60.0 %, p > 0.05) and antidepressant remission (55.0 % vs. 35.0 %, p > 0.05) between rTMS groups. The linear mixed model analysis did not show a significant group-by-time interaction (F = 1.26; p > 0.05) in the HAMD-17 scores. There was a significant time main effect on the speed of processing (F = 13.61; p < 0.05), but this did not differ significantly between groups (p > 0.05). There were no other main effects and group-by-time interactions in the other MATRICS Consensus Cognitive Battery domains (all p > 0.05). All adverse event categories, such as fatigue and headache, were similar in the two groups (all p > 0.05). ConclusionsIn this study that compared a combination of LF-rTMS + medication with sham + medication, LF-rTMS had higher response and remission rates than a sham procedure in adolescents with FE-MDD, but the change was not statistically significant. LF-rTMS is generally safe, with mild adverse effects and no negative impact on neurocognitive performance for adolescents with FE-MDD. Registration numberChiCTR2000037878.

Factors determining the invasion pattern of Ageratina adenophora Spreng. in Kumaun Himalaya India

Factors such as topography, soil composition, and nutrient availability significantly influence the density patterns of Ageratina adenophora. Understanding these dynamics addresses a gap in our knowledge of the species' adaptive mechanisms in mountainous regions. Furthermore, the impact of habitat features along road corridors on the population dynamics of invasive plants remains underexplored, particularly regarding the effects of disturbance levels, light availability, and soil properties on their establishment. A species-specific rapid ecological assessment was conducted using stratified random sampling, with parallel transects of 50 × 2m established in triplicates at 20m intervals. This resulted in 43 main transects across the identified plots and 67 parallel transects in adjacent habitats. The number of individuals of A. adenophora and its clumps were recorded from each quadrat. Chemical and physical parameters of soil were measured for soil collected from 0-15cm depth. Linear Mixed Model analysis revealed a significant negative effect of elevation (p<0.05) on the density of clumped individuals (Estimate: -0.31, t-value: -3.05), total individuals (Estimate: -0.27, t-value: -2.61), and clump number (Estimate: -0.30, t-value: -4.78). Western aspect also showed a significant decrease in clumped individuals (Estimate: -1.83, t-value: -2.80), total individuals (Estimate: -2.24, t-value: -3.47), and clump number (Estimate: -0.81, t-value: -1.97). Total A. adenophora density was highest near settlements (133 ind. m², Estimate: 1.19) and grasslands (103 ind. m², Estimate: 1.16), but lowest in broadleaf forests (26 ind. m²). Density decreased significantly with increasing distance from road verges (Estimate: -0.24, t-value: -2.34). Soil moisture content positively influenced total individuals (Estimate: 0.19, t-value: 2.75), clumped individuals (Estimate: 0.23, t-value: 3.20), clump numbers (Estimate: 0.05, t-value: 1.09), and individuals per clump (Estimate: 0.37, t-value: 3.28). Available nitrogen positively influenced non-clumped individuals (Estimate: 0.17, t-value: 2.04) but negatively affected individuals per clump (Estimate: -0.25, t-value: -2.21), indicating that lower nitrogen levels correlate with higher individual density per clump. Hence, effective restoration efforts are needed including soil improvement, invasive species removal and control, and the planting of native species.

Recovery patterns of low-frequency fatigue in elite youth soccer players after official match

This study aimed to analyze the associations between recovery of low-frequency fatigue, jump height and perceptual responses following official soccer matches. Forty-two male youth elite soccer players (age: 17.13±0.70 years; height: 179.17±5.94 cm; weight: 69.74±4.91 kg) participated in this study. Low-frequency fatigue, countermovement jump, perceived fatigue, muscle soreness and perceived recovery were assessed at -2h, +30 min, +24h and +48h relative to the match. Linear mixed models analysis showed that low-frequency fatigue was reduced at the match-end (ES=-0.679 [95% CI = -1.01; -0.34]; p&lt;.001) but returned to baseline after 24h (ES=0.149 [95% CI = -0.26; 0.56]; p=1.00). Perceptual responses were impaired for up to 48 hours following the match (ES=-0.868–1.174; p&lt;.001). Countermovement jump did not differ between any time point (ES=-0.204–0.216; p&gt;0.05). Additionally, the within-subject correlation analysis showed that low-frequency fatigue pre- to post-match changes presented moderate to large associations with perceived fatigue (rm[57]=-0.43; p&lt;.001), muscle soreness (rm[57]=-0.52; p&lt;.001) and perceived recovery (rm[57]=0.38; p=.003). The assessment of low-frequency fatigue could serve as an additional objective measurement for monitoring post-match fatigue, as findings suggest that young elite soccer players experience transient reductions following match-play, which are strongly correlated with subjective markers of recovery.

Randomized Controlled Trial of Acceptance and Commitment Therapy for Fatigue Interference With Functioning in Metastatic Breast Cancer.

Fatigue is a highly prevalent and disabling symptom for patients with metastatic breast cancer (MBC). Evidence-based interventions for managing fatigue in advanced cancer populations are lacking. This phase II randomized controlled trial tested the effect of acceptance and commitment therapy (ACT) on fatigue interference with functioning in patients with MBC. Eligible patients were women with stage IV breast cancer who had moderate to severe fatigue interference. Patients completed a baseline assessment that included self-report measures of fatigue interference with activities, mood, and cognition (primary outcome) and sleep interference with functioning, engagement in daily activities, and quality of life (QOL; secondary outcomes). Then patients were randomly assigned to six weekly telephone-delivered sessions of either ACT (n = 116) or education/support (n = 120). Follow-up assessments occurred at 2 weeks, 3 months, and 6 months postintervention (means, 9.69, 20.51, and 33.59 weeks postbaseline, respectively). Linear mixed model analyses showed that compared with patients in the education/support condition, patients in the ACT condition reported significantly less fatigue interference (P = .018). These results were significant at 2 weeks and 6 months postintervention. ACT's effect on sleep interference was not statistically significant after the Sidak adjustment for multiple comparisons (P = .037). ACT patients showed a steady decline in sleep interference, a trend that was not found for education/support patients. Engagement in daily activities and QOL did not significantly differ between study groups, except for functional QOL (P = .006). Compared with education/support patients, ACT patients showed significantly better functional QOL at 2 weeks and 6 months postintervention. Results suggest that a brief, telephone-delivered ACT intervention can reduce fatigue interference with functioning in patients with MBC.

Influence of street outreach work on the lives of marginalised people

ABSTRACT This study aims to examine whether social street work (SSW), in the first eight months of contact, managed to link clients to services, influenced their self-mastery and stress, considering the working relationship and provided practical support, given clients’ characteristics and SSW metrics. At three-time points, in an eight-month period, questionnaires were filled in (n = 276). Linear mixed model analyses were performed. SSW linked 70% of clients to services. At all three-time points, clients perceived moderate levels of self-mastery and stress. The working relationship was not longitudinally associated with self-mastery or with stress. A small significant positive longitudinal association was found for practical support and stress; a small significant negative longitudinal association was found for practical support and self-mastery. In the first eight months of contact, SSW succeeds in linking most clients to services but does not influence clients’ self-mastery and stress. In this period, workers are able to establish a working relationship with clients and provide practical support, being essential conditions to solve the complex issues in the lives of their clients who frequently avoided the confrontation with their problems for years.

Exploring sex differences in auditory saliency: the role of acoustic characteristics in bottom-up attention

BackgroundSeveral cognitive functions are related to sex. However, the relationship between auditory attention and sex remains unclear. The present study aimed to explore sex differences in auditory saliency judgments, with a particular focus on bottom-up type auditory attention.MethodsForty-five typical adults (mean age: 21.5 ± 0.64 years) with no known hearing deficits, intelligence abnormalities, or attention deficits were enrolled in this study. They were tasked with annotating attention capturing sounds from five audio clips played in a soundproof room. Each stimulus contained ten salient sounds randomly placed within a 1-min natural soundscape. We conducted a generalized linear mixed model (GLMM) analysis using the number of responses to salient sounds as the dependent variable, sex as the between-subjects factor, duration, maximum loudness, and maximum spectrum of each sound as the within-subjects factor, and each sound event and participant as the variable effect.ResultsNo significant differences were found between male and female groups in age, hearing threshold, intellectual function, and attention function (all p > 0.05). Analysis confirmed 77 distinct sound events, with individual response rates of 4.0–100%. In a GLMM analysis, the main effect of sex was not statistically significant (p = 0.458). Duration and spectrum had a significant effect on response rate (p = 0.006 and p < 0.001). The effect of loudness was not statistically significant (p = 0.13).ConclusionsThe results suggest that male and female listeners do not differ significantly in their auditory saliency judgments based on the acoustic characteristics studied. This finding challenges the notion of inherent sex differences in bottom-up auditory attention and highlights the need for further research to explore other potential factors or conditions under which such differences might emerge.

Preliminary Exploration of Variations in Measures of Pharyngeal Area During Nonswallowing Tasks.

Age- and disease-related changes in oropharyngeal anatomy and physiology may be identified through quantitative videofluoroscopic measures of pharyngeal area and dynamics. Pixel-based measures of nonconstricted pharyngeal area (PhAR) are typically taken during oral bolus hold tasks or on postswallow rest frames. A recent study in 87 healthy adults reported mean postswallow PhAR of 62%(C2-4)2, (range: 25%-135%), and significantly larger PhAR in males. The fact that measures were taken after initial bolus swallows without controlling for the presence of subsequent clearing swallows was identified as a potential source of variation. A subset of study participants had completed a protocol including additional static nonswallowing tasks, enabling us to explore variability across those tasks, taking sex differences into account. Videofluoroscopy still shots were analyzed for 20 healthy adults (10 males, 10 females, Mage = 26 years) in head-neutral position, chin-down and chin-up positions, a sustained /a/ vowel vocalization, and oral bolus hold tasks (1-cc, 5-cc). Trained raters used ImageJ software to measure PhAR in %(C2-4)2 units. Measures were compared to previously reported mean postswallow PhAR for the same participants: (a) explorations of sex differences; (b) pairwise linear mixed-model analyses of variance (ANOVAs) of PhAR for each nonswallowing task versus postswallow measures, controlling for sex; and (c) a combined mixed-model ANOVA to confirm comparability of the subset of tasks showing no significant differences from postswallow measures in Step 2. Overall, PhAR measures were significantly larger in male participants; however, most pairwise task comparisons did not differ by sex. No significant differences from postswallow measures were seen for 5-cc bolus hold, chin-down and chin-up postures, and the second (but not the first) of two repeated head neutral still shots. PhAR during a 5-cc bolus hold was most similar to postswallow measures: mean ± standard deviation of 51 ± 13%(C2-4)2 in females and 64 ± 16%(C2-4)2 in males. PhAR is larger in men than in women. Oral bolus hold tasks with a 5-cc liquid bolus yield similar measures to those obtained from postswallow rest frames.

Wingate anaerobic test as a potential predictor of 500-m time in short track speed skating

ABSTRACT Short-Track Speed Skating (STSS) is an Olympic discipline in which anaerobic performance plays a central role. An established assessment tool for anaerobic performance in STSS athletes is the Wingate Anaerobic Test (WAnT). The aim of this study was to investigate whether WAnT could be used as a predictor of sport-specific performance in the STSS 500-m races. Data from 72 German national STSS athletes (33 female, 39 male) were analysed retrospectively. The statistical analyses included descriptive procedures as well as linear mixed-model analyses. The results showed significant correlations between WAnT outcomes and 500 -m performance of STSS athletes. In male athletes, the coefficients were −0.40 for relative Mean Power (rMP) and −0.32 for relative Peak Power (rPP) (p < 0.001). For female athletes, the rMP showed no significant correlation whereas rPP was significantly correlated with a coefficient of −0.41 (p < 0.001). Marginal R2 values ranged between 0% and 12%. Conditional R2 reached up to 76% depending on sex and WAnT parameter investigated. In conclusion while WAnT can be regarded as a potential predictor of time in 500-m STSS races, it should be used in conjunction with other performance metrics and individualized assessments to better predict performance.

Enhanced Recovery After Surgery Protocols in One- or Two-Level Posterior Lumbar Fusion: Improving Postoperative Outcomes.

Background/Objectives: Enhanced recovery after surgery (ERAS) protocols optimize perioperative care and improve recovery. This study evaluated the effectiveness of ERAS in one- or two-level posterior lumbar fusion surgeries, focusing on perioperative medication use, pain management, and functional outcomes. Methods: Eighty-eight patients undergoing lumbar fusion surgery between March 2021 and February 2022 were allocated into pre-ERAS (n = 41) and post-ERAS (n = 47) groups. Outcomes included opioid and antiemetic consumption, pain scores (numerical rating scale (NRS)), functional recovery (Oswestry Disability Index (ODI) and EuroQol 5 Dimension (EQ-5D)), and complication rates. Pain was assessed daily for the first four postoperative days and at 6 months. Linear Mixed Effects Model analysis evaluated pain trajectories. Results: The post-ERAS group showed significantly lower opioid (p = 0.005) and antiemetic (p < 0.001) use. No significant differences were observed in NRS pain scores in the first 4 postoperative days. At 6 months, the post-ERAS group reported significantly lower leg pain (p = 0.002). The time:group interaction was not significant for back (p = 0.848) or leg (p = 0.503) pain. Functional outcomes at 6 months, particularly ODI and EQ-5D scores, showed significant improvement in the post-ERAS group. Complication rates were lower in the post-ERAS group (4.3% vs. 19.5%, p = 0.024), while hospital stay and fusion rates remained similar. Conclusions: The ERAS protocol significantly reduced opioid and antiemetic use, improved long-term pain management and functional recovery, and lowered complication rates in lumbar fusion patients. These findings support the implementation of ERAS protocols in spinal surgery, emphasizing their role in enhancing postoperative care.

Effectiveness of Injury Prevention Program Using a Global Systems Approach on High-Risk Movement Mechanics for Noncontact ACL Injury.

Injury prevention training using a global systems approach was designed to develop integrated trunk-lower extremity neuromuscular control using whole-body, rotational forces about the vertical Z-axis during simulated sports movements. Compared with traditional hip-focused exercises, injury prevention training using a global systems approach could improve kinetic and kinematic measures related to anterior cruciate ligament injury. Controlled laboratory study. Level 3. A total of 39 male and female athletes received 6 weeks of either global systems approach (n = 20), or hip-focused strengthening, balance, and plyometrics training (n = 19) exercises. Before and after the training program, participants performed a single-leg vertical drop jump task on their dominant leg. Peak vertical ground-reaction forces (GRFs), peak knee abduction, internal rotation moments, peak hip flexion, hip adduction, knee flexion, knee abduction, contralateral pelvic drop, and lateral trunk flexion angles were assessed. Biomechanical data were compared between the 2 groups using a random-intercept linear mixed-models analysis. A significant group × time interaction effect was found for vertical GRFs (P = 0.01; change difference relative to baseline: 4.5%), knee abduction moment (P = 0.01; 14.8%), hip adduction (P < 0.01; 16.7%), knee abduction (P < 0.01; 13.8%), contralateral pelvic drop (P < 0.01; change difference: 26.6%), and lateral trunk flexion (P = 0.04; 20.37%) angles, favoring the global systems approach group after 6 weeks of training. Participants who trained using the global systems approach had significantly decreased lateral trunk flexion, hip adduction, knee abduction and contralateral pelvic drop angles, peak vertical GRFs, and peak knee abduction moment during a single-leg vertical drop jump compared with participants who trained with hip-focused exercises. Incorporating additional external resistance at the proximal trunk results in improved biomechanics compared with conventional hip-focused exercises.

Fostering social-emotional competencies to improve social functioning, social inclusion, and school well-being: Results of a cluster non-randomized pilot study

BackgroundThe development of social competencies is key for enhancing both cognitive and non-cognitive skills among students. These competencies are central to students' ability to function socially, feel included, and experience overall well-being within the school environment. Schools can play an active role in promoting and shaping these outcomes by implementing various strategies. This study presents and reports on the outcomes of a six-week social-emotional intervention program implemented by class teachers. MethodsThe pilot study employed a two-arm cluster non-randomized trial with a pretest-post-test design. The study evaluates students' social competencies as the primary outcome and social functioning, social inclusion, and school well-being as the secondary outcomes. Students in the intervention group participated in a six-week social-emotional learning intervention, attending two sessions each week, while the control classes followed the regular curriculum. ResultsData were collected from both teachers and students. Student-reported data were collected from 266 students (n = 124 girls, n = 142 boys) aged 8 to 14 (M = 9.84) and from teachers on 212 students (n = 92 girls; n = 115 boys). Results of the linear mixed model analysis showed for teacher reporting on students’ outcomes a decrease in internalizing (β = -0.85, p = 0.035) and externalizing behavior problems for students in intervention classes (β = -6.84, p = 0.020). No significant changes were observed in social-emotional competencies, social inclusion and school well-being. ConclusionAfter the social-emotional intervention program reduced internalizing and externalizing behavior problems were observed, with age moderating both outcomes. The results are consistent with previous research; however, they also suggest that the intervention could benefit from adjustments, such as a longer implementation period and follow-up evaluation. External factors such as the COVID-19 pandemic and repeated school closures at the time of the study may have impacted the results additionally.

Citrus tamurana Hort. ex Tanaka (Hyuganatsu orange)-derived arabinogalactan suppresses bone turnover in postmenopausal women: A randomized placebo-controlled study.

To evaluate Hyuganatsu oranges (Citrus tamurana Hort. Ex Tanaka) derived arabinogalactan for bone turnover, we performed a randomized placebo-controlled trial. Sixty-three postmenopausal women were age-stratified and randomly assigned to receive arabinogalactan-rich hyuganatsu juice (study group) or a placebo drink (control group) for 90 days. We measured blood tartrate-resistant acid phosphatase 5b (TRACP5b), type I procollagen N-terminal propeptide (P1NP), and other bone turnover biomarker levels at baseline, days 45 and 90 (T90) of the intervention, and day 30 of recovery. Cumulative effects were compared between groups using repeated-measures linear mixed model analysis. The primary endpoint was the difference between the pre- and post-intervention TRACP5b and P1NP levels. Using repeated measures linear mixed model analysis, the study group had significantly lower TRACP5b and P1NP levels at day 90 than the control group (mean [95% confidence interval]; TRACP5b: 310.0 [269.2-350.9] vs. 386.4 [341.2-431.6] mU/dL; P1NP: 53.7 [48.6-58.7] vs. 70.3 [64.1-76.4] ng/mL), whereas other biomarker levels showed no change. Arabinogalactan-rich Hyuganatsu juice suppressed bone mineral turnover and potentially improved ovarian hormone deficiency-induced osteoporosis in postmenopausal women.

Handgrip Strength and Cognitive Recovery in Older Stroke Survivors: A Prospective Study

Background and Objectives: Handgrip strength (HGS) is an important indicator of overall physical capability and is linked to various health outcomes in older adults. Despite extensive research on the relationship between HGS and cognitive decline, longitudinal studies on poststroke cognitive changes in relation to HGS are scarce. This study aimed to observe whether HGS at discharge from acute stroke rehabilitation affects cognitive function 6–12 months after stroke onset and to compare cognitive outcomes between patients with normal and low HGS at discharge. Materials and Methods: This prospective cohort study was conducted in the Department of Rehabilitation Medicine at a tertiary care hospital. In agreement with the Asian Working Group for Sarcopenia 2019 criteria, low muscle strength was defined as an HGS of less than 28 kg for men and less than 18 kg for women, and participants were categorized into normal and low HGS groups. Neuropsychological evaluations were conducted before discharge (approximately one month after stroke onset) and between 6 and 12 months after stroke onset. Results: The low HGS group was older and had lower Montreal Cognitive Assessment scores. However, after adjusting for covariates, the linear mixed model analysis showed no significant differences between the groups in global cognition or specific cognitive domains, except for psychomotor speed during the subacute phase. Notable improvements in language ability were observed in both groups over time, while significant improvements in executive function were observed exclusively in the low HGS group. Conclusions: This longitudinal study is the first to explore the relationship between HGS and changes in cognitive function in older adults with stroke, providing insights into physical strength and cognitive recovery during stroke rehabilitation.

Insulin requirement trajectories during COVID-19 versus non-COVID-19 critical illness-A retrospective cohort study.

The glycemic response to critical COVID-19 remains uncertain. We aimed to assess the association between COVID-19, insulin requirements, glycemic control, and mortality in intensive care unit (ICU) patients. We conducted a retrospective observational study of 350 COVID-19 patients and 1067 non-COVID-19 patients admitted to the ICU. Insulin requirement was defined as the total units of exogenous insulin required to cover one gram of administered carbohydrates (insulin-to-carbohydrate ratio, ICR). We used multivariable generalized linear mixed-model (GLMM) analysis to assess the association of the interaction between COVID-19 and ICU-day with daily ICR, adjusted for fixed and time-dependent covariates. Glycemic control was assessed after stratification on diabetes and COVID-19. We used multivariable logistic regression analysis to assess the association between ICR and 90-day mortality. The mean (95% CI) of the mean daily ICR among patients without diabetes was 0.09 (0.08-0.11) U/g and 0.15 (0.11-0.18) U/g in the non-COVID-19 group and COVID-19 group (p = .01), respectively. In diabetes patients, the corresponding ICRs were 0.52 (0.43-0.62) U/g and 0.59 (0.50-0.68) U/g (p = .32). In multivariable GLMM analysis, the interaction between COVID-19 and ICU-day was independently associated with ICR (risk estimate 1.22, 95% CI 1.15-1.31, p < .001). COVID-19 was associated with higher hypoglycemia prevalence irrespective of diabetes status, higher average glucose levels, more pronounced glucose variability, and a lower proportion of glucose values within target range among patients without diabetes. On multivariable logistic regression analysis, the adjusted odds ratio for 90-day mortality was 1.77 (95% CI 0.94-3.34, p = .076) per one unit increase in mean ICR. In our cohort of ICU patients, COVID-19 was associated with higher daily insulin requirements per gram of administered carbohydrates, and worse glycemic control. We found no robust association between ICR and increased odds of death at 90 days.

Energy Expenditure in Critically Ill Patients with Aneurysmal Subarachnoid Hemorrhage, Intracerebral Hemorrhage, and Traumatic Brain Injury-A Prospective Observational Study.

Energy expenditure (EE) in patients with aneurysmal subarachnoid hemorrhage (SAH) may differ from other intracranial pathologies, such as intracerebral hemorrhage (ICH) or traumatic brain injury (TBI), due to an activation of the sympathetic nervous system. Indirect calorimetry (IC) is recommended, but is not always available. We study EE, catabolism, and metabolic stress in patients with SAH, TBI, ICH, and sepsis as controls. A prospective observational study was conducted in the intensive care units of the University Medical Center Hamburg-Eppendorf, Germany. IC was used to measure EE on days 2-3, 5-7, and 10-15 post-admission. Urinary catecholamines, metabolites, and urine urea were also measured. Statistical analysis included t-tests, Chi-square tests, and generalized mixed models. We included 110 patients-43 SAH patients (13 with the surgical securing of the aneurysm and 30 with coil embolization of the aneurysm), 22 TBI patients, 23 ICH patients, and 22 controls. The generalized linear mixed model analysis for groups and timepoints including age, height, and weight as covariates revealed a significantly lower EE at timepoint 1 for ICH versus SAH-interventional (p = 0.003) and versus the control (p = 0.004), as well as at timepoint 2 for ICH versus SAH-interventional (p = 0.002) and versus SAH-surgical (p = 0.013) with a lower EE in ICH patients. No significant differences between groups were found for EE at the other timepoints, or concerning urine urea and measurements of catecholamines in urine. In patients with SAH, ICH, and TBI, no meaningful differences in EE were detected compared to septic critically ill patients, except for a lower EE in ICH patients in the early phase.

Health-related quality of life and utility of maternity health states amongst post-partum Australians.

This study aimed to measure patient-reported health-related quality of life amongst post-partum women in Queensland, Australia. Patient-reported health-related quality of life data was prospectively collected from 134 post-partum women using the EQ-5D-5L at weekly intervals during the first six weeks following birth. Data across the five health domains of the EQ-5D-5L was converted to a single health utility value to represent overall health status. Linear mixed modelling and regression analysis were used to examine changes in utility over the first six weeks post-birth and determine associations between utility and clinical and demographic characteristics of post-partum women. Gestation at birth and weeks post-partum were significantly associated with utility values when considered in a multivariate linear mixed model. Mean utility values increased by 0.01 for every week increase in gestation at birth, and utility values were 0.70 at one week post-partum and increased to 0.85 at six weeks post-partum, with the largest increase occurring between one- and two-weeks post-birth. When controlling for variables that were found to predict utility values across the first six weeks post-partum, no single state of health predicted utility values at one-week post-partum. Maternity services can use our data and methods to establish norms for their own service, and researchers and maternity services can partner to conduct cost-effectiveness analysis using our more relevant utility values than what is currently available. Time since birth and gestational age of the woman's baby should be considered when selecting post-partum health state utility values for maternity services cost-effectiveness analyses.