Physical Rest Research Articles

Concussion Assessment and Management Self-efficacy Among Irish Clinicians.

This study explored concussion assessment and management self-efficacy and practices of allied healthcare professionals in Ireland. (1) Self-efficacy levels and practices vary across different concussion assessment and management skills, (2) the ability to practice skills impacts self-efficacy most. Cross-sectional. Level 3. Survey of allied healthcare professionals (285 responders), investigating (1) demographics, (2) concussion assessment (immediate and office) and management (postconcussion advice and management/rehabilitation) self-efficacy levels and practices, and (3) factors affecting self-efficacy. Levels of self-efficacy among clinicians were 64.5 ± 26.6 (immediate assessment) and 56.6 ± 25.4 (postconcussion advice) (highest scores: concussion symptom checklist [80 ± 28.4], physical rest advice [80.1 ± 27.8]; lowest: Child Sport Concussion Assessment Tool [44.6 ± 41.2] and nutrition advice [34.1 ± 33.7]). Overall levels of self-efficacy among Certified Athletic Therapists and Chartered Physiotherapists were 51.5 ± 20.1 (assessment) and 62.1 ± 20.9 (management) (highest scores: history/clinical evaluation nonspecific to concussion [86.6 ± 16.2], physical rest advice [86.3 ± 20]; lowest: paper/pencil neuropsychological test [16.7 ± 28.6], advice on medication use [39.2 ± 35]). A strong positive correlation was observed between clinician self-efficacy and frequency of use of overall (r = 0.795; P < 0.01) and immediate (r = 0.728; P < 0.01) assessment, advice (r = 0.805; P < 0.01), and management (r = 0.812; P < 0.01) skills. Factors with greatest positive impact on clinician self-efficacy were the ability to practice skills during clinical placement (3.3 ± 0.9) and remaining emotionally (3.3 ± 0.8) and physically (3.3 ± 0.8) calm while practicing. Clinicians in Ireland had moderate self-efficacy in concussion care. Those who used concussion-relevant skills frequently in practice displayed higher self-efficacy for those skills. Concussion-related self-efficacy can be enhanced through practice in a clinical environment and through experiencing composure while practicing.

Validation of the CRAVE-C scale in Chinese adults: a four-study examination of competing motivations for physical activity versus rest.

The study aimed to validate the Cravings for Rest and Volitional Energy Expenditure (CRAVE) scale among Chinese adults with different health conditions (healthy control, chronic illnesses, and psychiatric disorders) and skill levels (athletes vs. non-athletes). In Study 1, a confirmatory factor analysis (CFA) using the Maximum Likelihood Method (MLM) was performed on a Chinese sample of emerging adults (N = 481) to evaluate the structural validity of the Cravings for Rest and Volitional Energy Expenditure-Chinese version (CRAVE-C). In Study 2, differences in "Move" and "Rest" desires were examined among patients with psychiatric disorders, patients with chronic illnesses, and healthy controls. In study 3, investigated the relationship between cardiorespiratory fitness and exercise motivation using the CRAVE-C (N = 83). In Study 4, the changes in "Move" desire from baseline to post-training were compared between athletes and non-athletes. Results from Study 1 indicated that the 10-item CRAVE-C showed good fit indices ( Chi2 (34) = 118.769, CFI = 0.95, TLI = 0.934, SRMR = 0.053, RMSEA = 0.072). "Move" positively correlated with various factors of the Affective Exercise Experiences Questionnaire-Chinese and the Physical Effort Scale-Chinese, while "Rest" correlated negatively. In Study 2, Patients with psychiatric disorders had a significantly higher "Move" desire than healthy controls. Patients with chronic illnesses had a significantly higher "Rest" desire than healthy controls. In Study 3, higher cardiorespiratory fitness was associated with a slight increase in "Move" desire (3.26% ± 37.35%) and a decrease in "Rest" desire (18.94% ± 66.99%). Lower fitness was linked to a significant decline in "Move" desire (-54.61% ± 111.33%) and an increase in "Rest" desire (43.62% ± 63.64%). In Study 4, the athlete group demonstrated a significant increase in "Move" desire from baseline to post-training, whereas the non-athlete group reported a significant decrease in "Move" desire from baseline to post-training. The 10-item CRAVE-C has good reliability and validity in the Chinese cultural context and can be used among Chinese adults with different health conditions and skill levels.

Aerobic Exercise as an Intervention for Mild Traumatic Brain Injury: A Critically Appraised Topic.

As of 2020, the lifetime prevalence of at least one self-reported concussion is 24.6%. Athletic trainers in all settings work with patients who are at risk of sustaining a concussion or mild traumatic brain injury (mTBI) and developing persistent postconcussive symptoms. Aerobic exercise is emerging as an intervention for decreasing symptoms in patients who have sustained mTBI; however, the majority of research has been performed on pediatric patients. It is of interest whether aerobic exercise is an effective intervention for adult patients with mTBI. In adults who have sustained mTBI, does traditional therapy decrease symptoms more than aerobic exercise? Summary of Search: A systematic search of 4 databases was performed to answer this question. Three randomized controlled trials were identified that compared aerobic exercise to traditional therapy, which consists of physical and cognitive rest. Two studies found no significant differences in symptoms between the 2 groups while 1 study found decreased symptoms in the aerobic exercise group. The current evidence is clear that there is no decrease in mTBI symptoms with traditional therapy as compared withaerobic exercise, with 1 study showing decreased symptoms with aerobic exercise. Strength of Evidence: Based on the Center for Evidence-Based Medicine grades of evidence, the clinical bottom line is based on grade A evidence.

Choosing Wisely in Physical Medicine and Rehabilitation: Developing Canadian Recommendations for Resource Stewardship

ABSTRACT Choosing Wisely Canada (CWC) aims to reduce potentially harmful or unnecessary diagnostic investigations and practices in health care delivery. A committee of the Canadian Association of Physical Medicine &amp; Rehabilitation (PM&amp;R) surveyed the general membership seeking suggestions on new or revised PM&amp;R CWC recommendations. Draft recommendations were revised and refined with an emphasis on resource stewardship and alignment with the CWC mission. The updated 2023 CWC recommendations for PM&amp;R are to avoid: (1) investigating and treating asymptomatic bacteriuria in patients with neurogenic bladder; (2) recommending more than a brief period of physical and cognitive rest after mild traumatic brain injury; (3) starting opioid treatment for chronic noncancer pain without exhausting other approaches; (4) ordering diagnostic imaging for low back pain in the absence of red flags; (5) repeating injections without evaluating patients’ responses to them; and, (6) recommending carpal tunnel release without first confirming nerve entrapment with electrodiagnostic studies or ultrasonography. We present unique implementation tools to equip practitioners with quality improvement strategies to adopt these recommendations into their practices. Future work will include developing recommendations that consider planetary health co-benefits, creating knowledge translation tools, and assessing the impact of recommendation adoption into clinical practice.

Team Cohesion and Student Athlete Well-Being in A Normal University in Jiangxi Province

This study aims to gain a deeper understanding of the relationship between team cohesion and WELL-BEING among college athletes. This study adopts a quantitative research design, with a sample of 627 college athletes from a regular university in Jiangxi Province, China. A survey was conducted on the basic information of student respondents in terms of gender, age, grade, and years of experience, as well as their self-evaluation of athlete well-being, including physical health, mental health, emotions, balance, socialization, achievement, recovery and rest, and support systems. The relationship between team cohesion and self-evaluation of well-being was studied by analyzing the differences in personal characteristics and self-evaluation of well-being. This study also evaluated the positive effects of team cohesion, coach behavior, and athlete well-being on physical, psychological, emotional, and social health, and recommended promoting open and transparent communication within the team, strengthening leadership, establishing conflict resolution mechanisms, cultivating common values and goals, focusing on mental health, balancing lifestyles, and promoting internal respect and team spirit through team building and support networks to increase athlete well-being and team cohesion.

Combined associations of visceral adipose tissue and adherence to a Mediterranean lifestyle with T2D and diabetic microvascular complications among individuals with prediabetes

BackgroundIt’s unclear if excess visceral adipose tissue (VAT) mass in individuals with prediabetes can be countered by adherence to a Mediterranean lifestyle (MEDLIFE). We aimed to examine VAT mass, MEDLIFE adherence, and their impact on type 2 diabetes (T2D) and diabetic microvascular complications (DMC) in individuals with prediabetes.Methods11,267 individuals with prediabetes from the UK Biobank cohort were included. VAT mass was predicted using a non-linear model, and adherence to the MEDLIFE was evaluated using the 25-item MEDLIFE index, encompassing categories such as “Mediterranean food consumption,” “Mediterranean dietary habits,” and “Physical activity, rest, social habits, and conviviality.” Both VAT and MEDLIFE were categorized into quartiles, resulting in 16 combinations. Incident cases of T2D and related DMC were identified through clinical records. Cox proportional-hazards regression models were employed to examine associations, adjusting for potential confounding factors.ResultsOver a median follow-up of 13.77 years, we observed 1408 incident cases of T2D and 714 cases of any DMC. High adherence to the MEDLIFE, compared to the lowest quartile, reduced a 16% risk of incident T2D (HR: 0.84, 95% CI: 0.71–0.98) and 31% for incident DMC (0.69, 0.56–0.86). Conversely, compared to the lowest quartile of VAT, the highest quartile increased the risk of T2D (5.95, 4.72–7.49) and incident any DMC (1.79, 1.36–2.35). We observed an inverse dose-response relationship between MEDLIFE and T2D/DMC, and a dose-response relationship between VAT and all outcomes (P for trend < 0.05). Restricted cubic spline analysis confirmed a nearly linear dose-response pattern across all associations. Compared to individuals with the lowest MEDLIFE quartile and highest VAT quartile, those with the lowest T2D risk had the lowest VAT and highest MEDLIFE (0.12, 0.08–0.19). High MEDLIFE was linked to reduced T2D risk across all VAT categories, except in those with the highest VAT quartile. Similar trends were seen for DMC.ConclusionHigh adherence to MEDLIFE reduced T2D and MDC risk in individuals with prediabetes, while high VAT mass increases it, but MEDLIFE adherence may offset VAT’s risk partly. The Mediterranean lifestyle’s adaptability to diverse populations suggests promise for preventing T2D.

A controlled early-exercise rehabilitation program commencing within 48 hours of a Sports-Related Concussion improves recovery in UK student-athletes: A prospective cohort study

ObjectivesExplore if implementing an individualised Sub-Symptom Heart Rate Threshold (SSHeRT) rehabilitation program within 48 hours versus physical rest for 14 days affects recovery following SRC in university-aged student-athletes. DesignProspective, observational cohort study. MethodsTwo UK university-aged student-athlete rugby union cohorts were compared (Physical Rest Group (PRG), n = 140, July 2019–March 2020 and Controlled Early-Exercise Group (CEG), n = 167, July 2021–April 2023). Both groups completed the test battery (Post-Concussion Symptom Scale (PCSS), Immediate Post-Concussion and Cognitive Test (ImPACT), Vestibular-Ocular Motor Screening Tool (VOMS)) during pre-season to provide a baseline and within 48 hours, at 4, 8, 14-days post-SRC and at Return to Play (RTP). The PRG (n = 42) physically rested for 14 days as per the nationwide community guidelines. The CEG (n = 52) followed the SSHeRT rehabilitation program. Individual change to baseline was used in all analyses. ResultsThe CEG performed better on ImPACT's verbal memory at 4 (PRG; −5.5 (−10.8–0.0), CEG; 1.0 (−2.0–10.5), p = 0.05) and 14 days (PRG; −2.0 (−10.0–3.0), CEG; 4.0 (−1.0–11.0), p = 0.05) and on the VOMS at 4 (PRG; 3.0 (0.0–12.0), CEG; 0.0 (0.0–5.0), p = 0.03, OR; 2.910) and 14-days post-SRC (PRG; 0.0 (0.0–1.0), CEG; 0.0 (0.0–0.0), OR; 5.914). Near point convergence was better at all time points for the CEG. The CEG was 26.7 % more likely to have RTP within 30 days, and 6.7 and 5.1 times more likely to have resumed non-contact and contact academic activities by 4 days. ConclusionsSSHeRT is safe, can be used within 48 hours of a SRC and may hasten university-aged student-athletes recovery following an SRC.

Longitudinal associations of diurnal rest-activity rhythms with fatigue, insomnia, and health-related quality of life in survivors of colorectal cancer up to 5 years post-treatment

BackgroundThere is a growing population of survivors of colorectal cancer (CRC). Fatigue and insomnia are common symptoms after CRC, negatively influencing health-related quality of life (HRQoL). Besides increasing physical activity and decreasing sedentary behavior, the timing and patterns of physical activity and rest over the 24-h day (i.e. diurnal rest-activity rhythms) could also play a role in alleviating these symptoms and improving HRQoL. We investigated longitudinal associations of the diurnal rest-activity rhythm (RAR) with fatigue, insomnia, and HRQoL in survivors of CRC.MethodsIn a prospective cohort study among survivors of stage I-III CRC, 5 repeated measurements were performed from 6 weeks up to 5 years post-treatment. Parameters of RAR, including mesor, amplitude, acrophase, circadian quotient, dichotomy index, and 24-h autocorrelation coefficient, were assessed by a custom MATLAB program using data from tri-axial accelerometers worn on the upper thigh for 7 consecutive days. Fatigue, insomnia, and HRQoL were measured by validated questionnaires. Confounder-adjusted linear mixed models were applied to analyze longitudinal associations of RAR with fatigue, insomnia, and HRQoL from 6 weeks until 5 years post-treatment. Additionally, intra-individual and inter-individual associations over time were separated.ResultsData were available from 289 survivors of CRC. All RAR parameters except for 24-h autocorrelation increased from 6 weeks to 6 months post-treatment, after which they remained relatively stable. A higher mesor, amplitude, circadian quotient, dichotomy index, and 24-h autocorrelation were statistically significantly associated with less fatigue and better HRQoL over time. A higher amplitude and circadian quotient were associated with lower insomnia. Most of these associations appeared driven by both within-person changes over time and between-person differences in RAR parameters. No significant associations were observed for acrophase.ConclusionsIn the first five years after CRC treatment, adhering to a generally more active (mesor) and consistent (24-h autocorrelation) RAR, with a pronounced peak activity (amplitude) and a marked difference between daytime and nighttime activity (dichotomy index) was found to be associated with lower fatigue, lower insomnia, and a better HRQoL. Future intervention studies are needed to investigate if restoring RAR among survivors of CRC could help to alleviate symptoms of fatigue and insomnia while enhancing their HRQoL.Trial registrationEnCoRe study NL6904 (https://www.onderzoekmetmensen.nl/).

CONCUSSION REHABILITATION INTERVENTIONS

Sports-related concussions (SRC) are a common injury among athletes. Despite our growing understanding of concussion pathophysiology, comprehensive rehabilitation programs remain a clinical challenge. The accepted view of SRC rehabilitation emphasizes physical and cognitive rest. However, some conflicting studies report rest may facilitate prolonged symptoms. In this review article, we report on alternative SRC rehabilitation strategies to address the complex symptom variations, including physical activity, neuro-visual training, vestibular training, music therapy, speech-language therapy, and hyperbaric oxygen chamber therapy. The mass of published works supports the utility of these alternative therapies to aid recovery, but more research is vital to clarifying these relationships. In this review, we explore the relationships between symptoms and therapies. As there is a growing body of evidence to support these alternative therapies, many questions remain when concerning the role these alternative methods play in the bigger picture of standardizing a thorough SRC rehabilitation program.

Teacher Stress During Educational Processes with Physical and Remote Attendance Regarding the Covid-19 Pandemic – A Secondary Publication

The integration of new technologies and the increase in workload have influenced teaching performance, thereby affecting the development of teaching-learning activities. The balance between time dedicated to professional practice and time available for physical and psychological rest is analyzed based on the definition of stress as a collection of daily situations that impact the personal and professional development of an individual, which escalated during the COVID-19 pandemic with the rise of virtual educational practices. The study, conducted in two educational units in Quito, Ecuador, involved administering the Maslach Burnout Inventory questionnaire to 155 participants, alongside collecting data on sociodemographic variables. Statistical analysis was performed using the JASP 0.15 program. The results indicate the level of work stress experienced by teachers, depending on various sociodemographic variables including rural or urban setting, gender, age, level of education, marital status, and cohabitation arrangements. A statistically significant correlation (&lt; 0.001) was observed, particularly regarding the challenge faced by over half of the participants (0.51) in finding time for postgraduate studies. Additionally, a moderate correlation was found between inattention and various symptoms: frustration (0.46), guilt (0.36), weariness (0.26), tiredness (0.51), lack of attention (0.26), and the importance of work (0.43). These findings prompt a discussion on the allocation of time and workload for teachers, irrespective of their location in rural or urban areas.

Imagine your perfect park: a qualitative study on adolescents’ usage of green spaces, perceived benefits and preferences

ABSTRACT Green spaces are essential urban infrastructures. They represent cost-effective interventions to reduce health inequities and contribute to climate-resilient cities and adolescents’ health and well-being. Nevertheless, evidence suggests they are underused by adolescents, especially in Southern Europe. We explored the perspectives of adolescents on their use of green spaces (including frequency of use, activities performed, and types of space), perceived benefits, and preferences regarding green spaces’ characteristics. We performed seven online focus groups with 34 adolescents (15–16 years old) recruited from the Generation XXI cohort (a population-based birth cohort from the Porto Metropolitan Area, Portugal), stratified by socioeconomic status. Data were analyzed thematically by a deductive-inductive approach. Participants reported regular use of green spaces to perform physical activity, rest, and socialize. They perceived associated benefits for their general well-being and respiratory and mental health. The views shared by the participants suggest that the perfect park was idealized as large and multifunctional, providing a diversity of equipment and sufficient vegetation. It should be close to school and residential neighborhoods, upkeep, and made dynamic by the organization of cultural or sports events. Youth-led perspectives in urban planning might improve adolescents’ use of green spaces and encourage sustainable and equitable health-promoting urban environments.

Dyad motor learning in a wrist-robotic environment: Learning together is better than learning alone

ObjectiveDyad motor practice is characterized by two learners alternating between physical and observational practice, which can lead to better motor outcomes and reduce practice time compared to physical practice alone. Robot-assisted therapy has become an established neurorehabilitation tool but is limited by high therapy cost and access. Implementing dyad practice in robot-assisted rehabilitation has the potential to improve therapeutic outcomes and/or to achieve them faster. This study aims to determine the effects of dyad practice on motor performance in a wrist-robotic environment to evaluate its potential use in robotic rehabilitation settings. MethodsForty-two healthy participants (18–35 years) were randomized into three groups (n = 14): Dyad practice, physical practice with rest and physical practice without rest. Participants practiced a 2 degree-of-freedom gamified wrist movement task for 20 trials using a custom-made wrist robotic device. A motor performance score (MPS) that captured temporal and spatial time-series kinematics was computed at baseline, the end of training and 24 h later to assess retention. ResultsMPS did not differ between groups at baseline. All groups revealed significant performance gains by the end of training. However, dyads outperformed the other groups at the end of training (p < 0.001) and showed higher retention after 24-h (p = 0.02). Median MPS improved by 46.5% in dyads, 25.3% in physical practice-rest, and 33.6% in physical practice-no rest at the end of training compared to baseline. ConclusionCompared to physical practice alone, dyad practice leads to superior motor outcomes in a robot-assisted motor learning task. Dyads still outperformed their counterparts 24-h after practice. Impact statementImproving motor function in complex motor tasks without increasing required practice time, dyad practice can optimize therapeutic resources. This is particularly impactful in robot-assisted rehabilitation regimens as it would help to improve patients' outcomes and increase care efficiency.

Stem Cell Therapy for Rotator Cuff Injuries

Rotator cuff injuries are a common issue among athletes and the aging population that have significant impacts on athlete’s performance and individuals’ quality of life. Traditional treatment options for rotator cuff injuries include physical therapy, surgery, medication and rest. Unfortunately, these traditional treatments options provide limited success in tissue regeneration and restoring function in the injured rotator cuff. Stem cell therapy has emerged as a potential treatment for rotator cuff injuries, offering the promise of enhanced healing and functional recovery. This literature review aims to synthesize the current state of research on stem cell therapy for rotator cuff injuries. The review encompasses a range of studies, including clinical trials and animal case studies. The potential of Mesenchymal Stem Cells (MSCs) derived from adipose tissue and other sources to promote tendon repair and mitigate muscle atrophy and fatty infiltration is a central focus. Studies have explored various approaches, such as intratendinous injection of bone marrow derived MSCs, adipose-derived stem cells loaded with fibrin gel and bone marrow stimulation. Overall, this literature review provides a comprehensive overview of the current landscape of stem cell therapy for rotator cuff injuries, highlighting both the progress made and the areas that require further exploration, as well as the ethical and safety concerns.

A MEDITERRANEAN LIFESTYLE AND FRAILTY INCIDENCE IN OLDER ADULTS: THE SENIORS-ENRICA-1 COHORT

Abstract Background Frailty is a geriatric syndrome that entails high risk of hospitalization, disability, and death. While adherence to Mediterranean diet has been associated with lower risk of frailty, the joint effect of diet and lifestyle is uncertain. This study examined the association between a Mediterranean lifestyle (diet, customs, and traditions) and frailty incidence in older adults. Methods We analyzed data from 1 880 individuals aged ≥ 60 from the prospective Seniors-ENRICA-1 cohort. Adherence to the Mediterranean lifestyle was assessed at baseline with the 27-item MEDLIFE index (higher scores representing better adherence), divided into 3 blocks: (1) “Mediterranean food consumption,” (2) “Mediterranean dietary habits” (practices around meals),” and (3) “Physical activity, rest, social habits and conviviality.” Frailty was ascertained as the presence of ≥ 3 of the 5 Fried criteria: (a) Exhaustion; (b) Muscle weakness; (c) Low physical activity; (d) Slow walking speed; and (e) Unintentional weight loss. Main statistical analyses were performed using logistic regression models, adjusting for the main confounders. Results After a 3.3-year follow-up, 136 incident frailty cases were ascertained. Compared with participants in the lowest tertile of the MEDLIFE score, the OR (95% CI) for frailty was 0.88 (0.58-1.34) for the second tertile, and 0.38 (0.21-0.69) for the third tertile (p-trend = .003). Blocks 1 and 3 of the MEDLIFE score were independently associated with lower frailty risk. Most items within these blocks showed a tendency to reduced frailty. Conclusions Higher adherence to a Mediterranean lifestyle was associated with lower risk of frailty.

Rib pseudoarthrosis with thoracic outlet syndrome in pediatric gymnast: a case report

BackgroundThis case study evaluates the diagnosis and treatment of a 12 year old Caucasian male gymnast who had several diagnoses including an isolated first rib fracture, resultant pseudoarthrosis of the first rib, and the development of symptomatic thoracic outlet syndrome. We discuss the causes, prevalence, and suggestions for prompt diagnosis and treatment of these conditions in pediatric patients. Although all three conditions are rare in a child, this case highlights the importance of having a high clinical index of suspicion in recurrent pain in pre-pubertal athletes.Case presentationA 12 year old Caucasian male underwent several years of conservative treatment with physical therapy and rest without resolution of his left shoulder pain. He was subsequently diagnosed with pseudoarthrosis of the first rib and thoracic outlet syndrome, which was curative by surgical removal of the first rib, and allowed him to return to his baseline activity level.ConclusionsSince each of these diagnoses are rare, especially in the pediatric population, we aim to educate the medical community on the prompt diagnosis and treatment of these conditions.

Забота о себе в контексте здорового образа жизни

Within the framework of the article, an attempt was made to consider the category of a healthy lifestyle through ontolog-ical comprehension, through the experience of being-toward-death and being as suffering. In the context of a healthy lifestyle, self-care should be based on the philosophical principles of self-care, a balanced diet, its relationship with physical activity and rest, on the ex-ample of the principles promoted in various ancient educational schools. The ontological structure of self-care, part of which is a healthy lifestyle aimed at combating human suffering and ill health, a way of self-organization, restoration of integrity, acquisition of wisdom, manifested in the existential practice of the art of life, focused on the preservation and enhancement of health

Association between a mediterranean lifestyle and Type 2 diabetes incidence: a prospective UK biobank study

BackgroundThere is mounting evidence that the Mediterranean diet prevents type 2 diabetes, but little is known about the role of Mediterranean lifestyles other than diet and among non-Mediterranean populations. This work aimed to examine the association between a comprehensive Mediterranean-type lifestyle and type 2 diabetes incidence in a British adult population.MethodsWe used data from 112,493 individuals free of cardiovascular disease and type 2 diabetes mellitus, aged 40–69 years, from the UK Biobank cohort, who were followed from 2009 to 2010 to 2021. The Mediterranean lifestyle was assessed through the 25-item MEDLIFE index, which comprises three blocks: (a) “Mediterranean food consumption”, (b) “Mediterranean dietary habits”, (c) “Physical activity, rest, social habits, and conviviality”. Diabetes incidence was obtained from clinical records. Cox proportional-hazards regression models were used to analyze associations and adjusted for the main potential confounders.ResultsAfter a median follow-up of 9.4 years, 2,724 cases of type 2 diabetes were ascertained. Compared to the first quartile of MEDLIFE adherence, the hazard ratios (95% confidence interval) for increasing quartiles of adherence were 0.90 (0.82–0.99), 0.80 (0.72–0.89) and 0.70 (0.62–0.79) (p-trend < 0.001). All three blocks of MEDLIFE were independently associated with lower risk of diabetes.ConclusionsHigher adherence to the MEDLIFE index was associated with lower risk of type 2 diabetes in the UK Biobank. A Mediterranean-type lifestyle, culturally adapted to non-Mediterranean populations, could help prevent diabetes.

Achilles tendon pathologies

Achilles tendon pathologies are afrequent problem in the clinical practice. Adistinction must be made between insertional and noninsertional tendinopathies. In addition to intrinsic risk factors, such as diabetes mellitus, there are also extrinsic risk factors, such as overuse and running. Sonography, X‑ray imaging and magnetic resonance imaging (MRI) are established imaging methods, depending on the question. The primary treatment includes aconservative approach. First-line treatment includes administration of nonsteroidal anti-inflammatory drugs (NSAID), physical rest and the use of assistive devices. Established conservative treatment procedures include eccentric stretching, shockwave therapy and infiltration with, e.g., platelet-rich plasma. There are numerous other conservative treatment options. After exhausting the conservative treatment options, asurgical approach can be considered. The surgical procedure depends on the clinical symptoms and findings. Established procedures are minimally invasive or endoscopic procedures or even open debridement.

Fatigue Experiences in People With Stroke.

Fatigue is a major symptom in patients with stroke. Because fatigue is an overarching multidimensional phenomenon, it is important to understand how the characteristics of fatigue change over time. The purpose of this study was to explore how fatigue characteristics change over time in patients with stroke. This study used a mixed-method observational design. This study is a secondary analysis of data from a previous study, the results of which indicated fatigue to be a prominent symptom. Participants in that study were patients with stroke who met eligibility criteria and provided informed consent. This secondary analysis used data from numeric rating scale scores for fatigue, Functional Assessment of Chronic Illness Therapy-Fatigue Scale scores, fatigue descriptors, and participant comments about fatigue gleaned from transcribed interviews. Twenty-two patients participated in the study. Thirteen characteristics of fatigue were evaluated. Seven characteristics showed significant improvement (p < .05) from admission to 1 month follow-up, and six characteristics did not change significantly. Fatigue experiences vary over time and have both physical and mental aspects to them. Nurses may consider providing a quiet environment for physical rest, which may allow the brain to not be distracted by multiple stimuli.

Investigating the circulating sphingolipidome response to a single high-intensity interval training session within healthy females and males in their twenties (SphingoHIIT): Protocol for a randomised controlled trial

Introduction: Growing scientific evidence indicates that sphingolipids predict cardiometabolic risk, independently of and beyond traditional biomarkers such as low-density lipoprotein cholesterol. To date, it remains largely unknown if and how exercise, a simple, low-cost, and patient-empowering modality to optimise cardiometabolic health, influences sphingolipid levels. The SphingoHIIT study aims to assess the response of circulating sphingolipid species to a single session of high-intensity interval training (HIIT). Methods: This single-centre randomised controlled trial (RCT) will last 11 days per participant and aim to include 32 young and healthy individuals aged 20-29 (50% females). Participants will be randomly allocated to the HIIT (n= 16) or control groups (physical rest, n= 16). Participants will self-sample fasted dried blood spots for three consecutive days before the intervention (HIIT versus rest) to determine baseline sphingolipid levels. Dried blood spots will also be collected at five time points (2, 15, 30, 60min, and 24h) following the intervention (HIIT versus rest). To minimise the dietary influence, participants will receive a standardised diet for four days, starting 24 hours before the first dried blood sampling. For females, interventions will be timed to fall within the early follicular phase to minimise the menstrual cycle's influence on sphingolipid levels. Finally, physical activity will be monitored for the whole study duration using a wrist accelerometer. Ethics and dissemination: The Ethics Committee of Northwest and Central Switzerland approved this protocol (ID 2022–00513). Findings will be disseminated in scientific journals and meetings. Trial Registration The trial was registered on www.clinicaltrials.gov (NCT05390866, https://clinicaltrials.gov/ct2/show/NCT05390866) on May 25, 2022.