Post Measures Research Articles

Machine-Based Resistance Training Improves Functional Capacity in Older Adults: A Systematic Review and Meta-Analysis

Background/Objectives: Resistance training (RT) can improve the functional performance of older adults, maintaining independence and quality of life. It has been proposed that training interventions should implement exercises associated with the movements needed in everyday life. However, this strength training philosophy presents challenges, specifically to older adults, and the use of resistance machines might present an efficacious alternative. The aim of this systematic review and meta-analysis was to explore the impact of machine-based RT on strength and functional capacity in older adults. Methods: The inclusion criteria were for strength training interventions to be a minimum of 6 weeks, using only resistance machines, with pre- and post-intervention measurements of functional capacity of either a timed up-and-go and/or a sit-to-stand test, and including healthy older adults (>60 years). Results: Following the screening, 17 articles met the inclusion criteria for the systematic review, 15 of which were included in the meta-analysis for functional outcomes (n = 614 participants), and 11 of which were included in the meta-analysis for strength outcomes (n = 511 participants). Analyses revealed significant standardized mean change in favor of machine-based RT for functional outcomes (0.72, 95% CIs 0.39 to 1.07) and strength outcomes (0.71, 95% CIs 0.34 to 1.08) compared to control conditions (functional = 0.09, 95% CIs − 0.1 to 0.28, strength = 0.1, 95% CIs − 0.05 to 0.24). Substantial heterogeneity was noted in the manipulation of RT variables and the magnitude of effects between studies. Conclusions: The data presented support the idea that significant strength and functional performance outcomes are attainable using uncomplicated, machine-based RT.

Antioxidant supplementation boosts the advantages of CrossFit workouts on oxidative and muscle damage markers in obese males.

Supplementing with antioxidants may be one of the most efficient means of minimizing oxidative stress during workouts in obese individuals. The aim of this study is to identify the results after twelve weeks of CrossFit workouts combined with Spinach thylakoid extract on the levels of insulin resistance (insulin and Homeostatic Model Assessment of Insulin Resistance [HOMA-IR]), fasting blood sugar (FBS), malondialdehyde (MDA), creatine kinase (CK), lactate dehydrogenase (LDH), total antioxidant capacity (TAC), and superoxide dismutase (SOD), glutathione peroxidase (GPx) in obese males. Sixty-eight males with an average age of 27 ± 8 yrs and a BMI of 32.6 ± 2.6kg.m- 2 were randomly split into four groups each consisting of seventeen individuals. : control group (CG), supplement group (SG), training group (TG), and training + supplement group (TSG). After initial assessments, the two training groups (TG and TSG) started on a 12 weeks of the CrossFit workouts program involving three sessions per week each lasting up to 60min. Participants in supplement groups ingested 30min before lunch, 5 gof Spinach thylakoid extract per day or one sachet of raw corn starch in the control group. Baseline and post-intervention measurements were performed 48h pre- and post-last session, respectively. The findings revealed noteworthy relationships between the exercise groups and timefor TAC, SOD, GPx, MDA, CK, and LDH (p < 0.001, ES: 0.88, 0.88, 0.8, 0.4, 0.7, and 0.7, respectively). In addition, there were statistically significant differences among study groups after attending the intervention program in TAC (ES: 0.88), SOD (ES: 0.92), GPX (ES: 0.85), MDA (ES: 0.5), CK (ES: 0.7) and LDH (ES: 0.8). The effect sizes of insulin (0.77), glucose (0.21), and HOMA-IR (0.44) varied significantly (p < 0.05) among the groups. The results demonstrated that CrossFit workouts for 12 weeks combined with Spinach thylakoid extract in men with obesity may prevent oxidative damage caused by obesity and CrossFit workouts.

Initial Proof-of-Concept Study on Immediate Effects of External Advanced Pneumatic Compression on Pharyngeal and Laryngeal Internal Lymphedema Using a Fluoroscopic Measurement Tool.

External and internal head and neck cancer related lymphedema (HNCRL) is a common consequence of radiation treatment (RT). Currently, internal HNCRL can be clinically assessed endoscopically using a visuoperceptual, ordinal rating scale. Use of fluoroscopy to identify and measure internal HNCRL has been explored but is not widely used in clinical practice. Advanced Pneumatic Compression (APC) has shown external HNCRL reduction after a single treatment, whereas internal HNCRL reduction has not yet been assessed. Fluoroscopic lateral scouts and TIMS Review software (TIMS Medical) were used to assess immediate internal HNCRL measures of 30 HNC patients with RT history following a single APC treatment. Pre and post external measures were also obtained. Paired t-test was used to assess changes in pre and post measures. A post-treatment survey was completed. All 30 patients had both immediate external and internal HNCRL reductions, and all reductions were statistically significant. All reported positive benefit. A single, external APC treatment immediately impacted the extent of pharyngeal and laryngeal edema in post-radiated HNC survivors. Fluoroscopy can be a clinically useful and complementary modality to detect, surveil, and measure internal HNCRL.

Impact of an educational program on oncology nurses' attitudes and behaviors toward care of the dying.

Care of the dying is an essential part of holistic cancer nursing. Improving nurses' attitudes and behaviors regarding care of the dying is one of the critical factors in increasing the quality of nursing service. This study aims to examine the impact of an educational program based on the CARES tool on nurses' attitudes and behaviors toward care of the dying. A quasi-experimental study with pre- and post-intervention measures was conducted. A total of 222 oncology nurses from 14 hospitals in Beijing, China, were enrolled using a convenient sampling method. This online educational course developed based on the CARES framework comprised 7 modules and 10 sessions. Each session was carried out twice a week over 30-60 min. Data were collected using a sociodemographic characteristics questionnaire, the Frommelt Attitude Towards Care of the Dying Scale (FATCOD) and the Nurses' Practice Behavior Toward Care of the Dying Questionnaire (NPBTCOD). Reassessment of attitudes and behaviors was conducted when completed the learning and 6 months after the learning, respectively. The sociodemographic characteristics of the nurses were analyzed using descriptive statistics, and differences in attitudes and behaviors were reported and compared by the paired t-test. All the 222 oncology nurses completed educational courses, and 218 nurses (98.20%) completed the pre- and post-attitudes evaluation and 213 (95.9%) nurses completed the pre- and post-behaviors evaluation. The mean (SD) FATCOD score before and after the educational program was 108.83 (12.07) versus 115.09 (14.91), respectively (t = -8.546, p ≥ 0.001). The mean (SD) NPBTCOD score before and after the educational program was 69.14 (17.56) versus 73.40 (18.96), respectively (t = -3.231, p = 0.001). This educational intervention was found to be an effective method for improving oncology nurses' attitudes and behaviors toward caring for dying patients.

Evocation of positive memories as complement to trauma-focused cognitive–behavioural therapy for intimate partner violence against women

ABSTRACT Background: Focusing on positive memories as a complement to trauma-focused interventions for intimate partner violence against women (IPVAW) could contribute to enhancing the recovery from trauma with the development of a more integrated and emotionally modulated autobiographical narrative. Objective: To test the effectiveness of a trauma-focused cognitive behavioural therapy (CBT) tailored for IPVAW that incorporates the evocation of positive memories. Methods: Female survivors of IPVAW entered a randomized controlled trial comparing trauma-focused CBT for IPVAW (CBT; n = 35) to a version that incorporates the evocation of positive memories (CBT-M+; n = 44) and to a waitlist (WL; n = 12) control group. Pre and post measures were obtained for: posttraumatic stress, meaning of trauma, affect, emotional regulation, associated symptoms, self-concept and overall functioning. Results: A total of 43.04% of women who entered treatment dropped out, without significant treatment differences. Pre–post changes were not significant for the WL; both treatments resulted in significant improvements, with good effect sizes, for posttraumatic stress (g = 0.78 and g = 1.00 for CBT and CBT-M+, respectively), meaning of trauma, affect, associated symptoms, self-concept and overall functioning, but not in emotional regulation. There were no significant differences between CBT and CBT-M+ in the direct comparisons; however, the effect sizes showed better effects of CBT for centrality of the IPVAW, whereas they favoured CBT-M+ for PTSD, depression, self-esteem and impairment measures. No clinically significant change was reached for the WL, while both treatments significantly reduced the percentage of women with PTSD and self-esteem problems; additionally, the percentage of women with depression and impairment problems in the CBT-M+ group was significantly decreased. Conclusions: Although there were few differences between both treatments, CBT-M+ seemed to have a greater effect, pointing to the potential of the inclusion of the evocation of positive memories that should be further researched.

Comparison of 45-min nap versus no-nap during simulated night shift work on endothelial function: a randomized crossover feasibility trial.

Night shift workers face increased risk of cardiovascular disease (CVD) compared to non-shift workers. Evidence supports on-shift napping and regular non-invasive monitoring of endothelial function for risk mitigation, yet neither strategy is widely used. We evaluated the feasibility of non-invasive assessment of peripheral arterial tone (PAT) to assess the effect of napping during simulated night shift work on endothelial function. We used a single-site, randomized crossover trial of simulated night shift work with a 45-min nap condition versus a control, no-nap condition (ClinicalTrials.gov NCT05436951). Theprimary outcome was the number of participants with ≥ 70% of endothelial function assessments. Secondary outcomes included mean reactive hyperemia index (RHI), BP, and cognitive performance with the brief psychomotor vigilance task (PVT-B). Of the 10 consented, 9 completed both conditions. All participants exceeded feasibility benchmarks. Mean RHI did not differ by nap condition, and the delta from pre- to post measure did not differ (difference in delta = - 0.26, 95% CI - 1.09, 0.58). Hourly PVT-B assessments from 19:00 to 07:00h did not differ by nap condition. Compared to pre-nap measures, cognitive performance on the PVT-B was poorest at + 0min post-nap. Our findings can inform larger studies evaluating the effects of night shift work and napping on endothelial function. ClinicalTrials.gov (NCT05436951, registered on June 23, 2022).

Evaluation of the Pregnancy to Parenthood program: A dyadic intervention for mothers with perinatal mental disorders and their infants.

Dyadic interventions targeting maternal mental health and the mother-infant relationship in the perinatal period are critical due to the potential consequences of perinatal mental illness and relational disturbance for the mother, the infant, and their family. This paper describes the Pregnancy to Parenthood (P2P) model of care, a dyadic mother-infant community-based program designed to support vulnerable families in Western Australia in the context of an identified need to build workforce capacity. A pragmatic service evaluation study was conducted by analyzing routine clinical data collected from 105 dyads who completed pre- and post-intervention measures, including the Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS), and the Mother Object Relations Scale-Short Form (MORS-SF). Reliable change index and cut-off analyses indicated a clinically reliable pre-post reduction in perinatal depressive and anxiety symptoms for 71% and 68% of the sample, respectively. Significant pre-post improvements with medium effect sizes (r=-.46, r=-.32) were found for caregiving representations on the MORS-SF, suggesting representations became more balanced. These results provide provisional evidence that the P2P model of care may be effective in improving maternal mental health and caregiving representations. Further research is required to evaluate the efficacy of P2P in relation to enhancing family well-being, and to inform policy and mental health service development.

Investigating the Effect of Dry Needling on Myofascial Trigger Point in Soleus Muscle of Soccer Players with Medial Tibial Stress Syndrome

Introduction: This study investigates the impact of dry needling on myofascial trigger points in the soleus muscles among soccer players with medial tibial stress syndrome (MTSS). Materials and Methods: Soccer players diagnosed with MTSS were enlisted and randomly divided into two groups (11 participants in the experimental group [Group 1] and 11 participants in the control group [Group 2]). Pre-intervention measurements included repeated shuttle sprint ability, MTSS score, and pain pressure threshold (PPT) for both groups. In the experimental group, dry needling was performed on the soleus muscle, followed by active stretching and cryotherapy. The control group underwent active stretching of the soleus muscle and cryotherapy exclusively. Post-intervention measurements of repeated shuttle sprint ability, MTSS score, and PPT were taken for both groups after 2 days. Results: The experimental group exhibited a statistically significant improvement in PPT, MTSS score, and repeated shuttle sprint ability. Conversely, within the control group, statistically significant changes were observed only in PPT values through paired t-test assessment. Between-group analysis using an independent t-test revealed significant enhancement in PPT (P=0.000) and MTSS score (P=0.01) within the experimental group compared to the control group. Conclusion: Addressing myofascial trigger points in the soleus muscle through dry needling offers a more effective approach to treating MTSS than relying solely on muscle stretching.

Feasibility of Home-Based Early Infant Hybrid Therapy in Children with Unilateral Cerebral Palsy

Background: The first stage of childhood is characterized by great neuronal plasticity. In Unilateral Cerebral Palsy (UCP), it is essential to carry out early treatment, with family involvement. The aim of this study was to investigate the feasibility of Early Infant Hybrid Therapy (eI-Hybrid) applied at home with family involvement in children with UCP aged 9–18 months, and to assess its preliminary effectiveness on bimanual functional performance. Methods: A single group of 10 children (12.8 months, SD = 3.4) performed the eI-Hybrid therapy. The main outcome was measured with the mini Assisting Hand Assessment scale (mini-AHA), functional goals were measured with the Goal Attainment Scale (GAS), and satisfaction expectations on intensive therapy were also recorded. Three measures were performed (week 0, week 10, and month 6). A repeated-measures ANOVA test was performed on the mini-AHA in order to observe the statistically significant differences in pairwise comparison. Results: Ten children completed the study and the parents’ expectations were fulfilled, indicating high caregiver compliance and high adherence to the treatment. Clinically relevant changes were observed between pre- and post-intervention measurements in BFP (pre: 41.9 (SD: 7.7), post: 50.9 (SD: 6.0) and in the follow-up at 6 months (50.3 (SD:5.6); p &lt; 0.001). Families reported a high satisfaction. Conclusions: infant hybrid treatment is feasible to be performed at home with the family’s involvement, obtaining improvements in the affected upper limb for early-age UCP.

A COMPARATIVE STUDY ON THE IMMEDIATE EFFECTIVENESS OF MULLIGAN BENT LEG RAISE TECHNIQUE VS PNF HOLD-RELAX WITH AGONIST CONTRACTION IN IMPROVING HAMSTRING RANGE OF MOTION AND MUSCLE PERFORMANCE: A LITERATURE REVIEW.

Background: Hamstring tightness is a common issue that can hinder athletic performance and increase the risk of injury. Effective interventions are needed to enhance hamstring range of motion (ROM) and muscle performance. This study aims to compare two manual therapy techniques: the Mulligan Bent Leg Raise technique and the PNF Hold-Relax with Agonist Contraction technique. Objective: The primary objective is to compare the immediate effects of these two techniques on hamstring ROM and muscle performance. Secondary objectives include evaluating participants’ perceived comfort during the interventions and exploring the practical application of both techniques in clinical settings. Methods: A review of literature, focusing on randomized controlled trials involving participants aged 18–35 years, was conducted. Participants were divided into two groups: one receiving the Mulligan Bent Leg Raise technique and the other undergoing PNF Hold-Relax with Agonist Contraction. Pre- and post-intervention measurements of hamstring ROM and muscle performance were collected. Immediate effects were recorded and analyzed to compare outcomes between the two techniques. Results: Preliminary results indicate significant immediate improvements in hamstring flexibility and muscle performance for both techniques. Literature supports the effectiveness of both the Mulligan and PNF techniques in enhancing hamstring function. Conclusion: Evidence suggests that both the Mulligan Bent Leg Raise and PNF Hold-Relax with Agonist Contraction techniques effectively improve hamstring flexibility and muscle performance. Implications: This study provides valuable insights for physiotherapy practice, equipping clinicians with evidence-based strategies to address hamstring tightness and dysfunction. By integrating these techniques, physiotherapists can achieve rapid improvements and enhance overall treatment outcomes.

Effects of various laser applications on surface roughness and bond strength to veneering composites of polyether ether ketone (PEEK) and polyether ketone ketone (PEKK) materials.

The aim of this study was to investigate the bond strength between PEEK/PEKK and composite resins after various laser treatments and to compare the effectiveness of lasers on these polymers. 130 disc-shaped PEEK and PEKK blocks were obtained (10mm diameter-4mm height). One sample from each group (10 in total) was selected for scanning electron microscopy (SEM) analysis. The samples were randomly divided into 5 different surface treatment groups for each material (PEEK and PEKK): Er: YAG laser, Nd: YAG laser, diode laser, femtosecond laser and control (no surface treatment) (n = 12). Baseline and post-treatment surface roughness measurements were performed using a profilometer. The composite resin was bonded and SBS was measured. Comparisons among the groups were conducted via Kruskal-Wallis, one-way ANOVA; Tukey and Dunn tests were used as a post hoc test (p ≤ 0.05). All lasers significantly increased the roughness values of the PEEK and PEKK samples. In terms of shear bond strength; the Er: YAG and femtosecond laser groups had the highest values and the Nd: YAG, diode and control groups had the lowest values of the PEEK samples (p ≤ 0.05). The control group had the highest bond strength values and the femtosecond group had the lowest values for PEKK samples (p ≤ 0.05). All laser treatments increased the surface roughness of the PEEK and PEKK. Lasers increased the bond strength of PEEK to the veneering composite resin and decreased the bond strength values of PEKK. This shows that lasers behave differently in PEEK and PEKK materials.

Comparative efficacy of interpersonal psychotherapy and antidepressant medication for adult depression: a systematic review and individual participant data meta-analysis.

Interpersonal psychotherapy (IPT) and antidepressant medications are both first-line interventions for adult depression, but their relative efficacy in the long term and on outcome measures other than depressive symptomatology is unknown. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses. This IPD meta-analysis compared the efficacy of IPT and antidepressants on various outcomes at post-treatment and follow-up (PROSPERO: CRD42020219891). A systematic literature search conducted May 1st, 2023 identified randomized trials comparing IPT and antidepressants in acute-phase treatment of adults with depression. Anonymized IPD were requested and analyzed using mixed-effects models. The prespecified primary outcome was post-treatment depression symptom severity. Secondary outcomes were all post-treatment and follow-up measures assessed in at least two studies. IPD were obtained from 9 of 15 studies identified (N = 1536/1948, 78.9%). No significant comparative treatment effects were found on post-treatment measures of depression (d = 0.088, p = 0.103, N = 1530) and social functioning (d = 0.026, p = 0.624, N = 1213). In smaller samples, antidepressants performed slightly better than IPT on post-treatment measures of general psychopathology (d = 0.276, p = 0.023, N = 307) and dysfunctional attitudes (d = 0.249, p = 0.029, N = 231), but not on any other secondary outcomes, nor at follow-up. This IPD meta-analysis is the first to examine the acute and longer-term efficacy of IPT v. antidepressants on a broad range of outcomes. Depression treatment trials should routinely include multiple outcome measures and follow-up assessments.

Mindfulness improves psychological health and supports health behaviour cognitions: Evidence from a pragmatic RCT of a digital mindfulness-based intervention.

Mindfulness-based interventions can improve psychological health; yet the mechanisms of change are underexplored. This pre-registered remote RCT evaluated a freely accessible digital mindfulness programme aiming to improve well-being, mental health and sleep quality. Health behaviour cognitions were explored as possible mediators. Participants from 91 countries (N = 1247, Mage = 27.03 [9.04]) were randomized to 30 days of mindfulness practice or attention-matched control condition. Measures of well-being, depression, anxiety, stress, sleep quality, barriers self-efficacy, self-regulation and behavioural predictors (e.g., attitudes and behavioural intentions) were taken at baseline, 1-month (post-intervention) and 2-months (follow-up). Linear regression examined intervention effects between and within groups. Longitudinal mediation analyses explored indirect effects through health behaviour cognitions. Three hundred participants completed post-intervention measures. Those receiving mindfulness training reported significantly better well-being (Mdifference = 2.34, 95%CIs .45-4.24, p = .016), lower depression (Mdifference = -1.47, 95%CIs -2.38 to -.56, p = .002) and anxiety symptoms (Mdifference = -.77, 95%CIs -1.51 to -.02, p = .045) than controls. Improvements in well-being and depression were maintained at follow-up. Intervention effects on primary outcomes were mediated by attitudes towards health maintenance and behavioural intentions. Mediating effects of attitudes remained when controlling for prior scores in models of depression and well-being. Digital, self-administered mindfulness practice for 30 days meaningfully improved psychological health, at least partially due to improved attitudes towards health behaviours and stronger behavioural intentions. This trial found that digital mindfulness is a promising and scalable well-being tool for the general population, and highlighted its role in supporting health behaviours.

Effects of adding core stability training to conventional rehabilitation protocol on shoulder function after rotator cuff repair

Background. Rotator cuff tear (RCT) is a prevalent cause leading to shoulder disability and is widely recognized as one of the primary causes of pain as well as dysfunction in the shoulder. The core stabilization exercise program improved the strength of the shoulder muscles. The core stability training (CST) may be utilized during the early phases of shoulder rehabilitation. Purpose. To assess the impacts of adding CST to the conventional rehabilitation protocol on function, proprioception, as well as range of motion (ROM) of shoulder joint following rotator cuff repair (RCR). Methods. Fifty-two participants after RCR were assigned to two groups in a random manner; group I (n = 26) and group II (n = 26). Participants in groups I and II were engaged in a conventional rehabilitation protocol for 12 weeks after RCR. Group II additionally performed CST after the 8th week until the 12th week of RCR. Outcome measures were shoulder function using the Arabic shoulder pain and disability index (SPADI), shoulder joint position sense (JPS) (proprioception accuracy through detecting absolute angle of error) using digital inclinometer, ROM in shoulder flexion, abduction, internal rotation, as well as external rotation using the digital inclinometer. Unpaired t-test, chi square, and MANOVA test were implemented for data analysis. Results. Compared to the pre-treatment condition, the post treatment results revealed that there were statistical substantial improvements (p &lt; 0.05) in SPADI score, absolute angle of error, and ROM flexion, abduction, external rotation and internal rotation) in both groups, even though there were substantial differences among both groups at all post-treatment measures (p &lt; 0.05) in favor of group II. Conclusion. Incorporating CST into the conventional rehabilitation protocol after RCR leads to notable enhancements in shoulder joint function, proprioception, and ROM for flexion, abduction, internal rotation, as well as external rotation.

Comparative Efficacy of Quadratus Lumborum Muscle Energy Technique with Gluteus Medius Strengthening Versus Gluteus Medius Strengthening Alone in Sacroiliac Joint Dysfunction: A Randomized Controlled Trial.

Pain in the sacroiliac joint is the most prevalent and often overlooked. The sacroiliac joints are thought to be sources of pain in roughly 10% to 25% of patients with chronic lower back pain. Due to the biomechanical nature of the joint, muscle imbalance is the most important cause of sacroiliac joint dysfunction. The hamstring and gluteus medius are the primary muscles involved in postural dysfunction-related muscle imbalance; however, the quadratus lumborum's role in the compensatory mechanism is becoming more apparent, and its potential for treatment in conjunction with gluteus medius strengthening has not yet been investigated. Gluteus medius exercises, along with conventional treatment, are routinely given to patients with sacroiliac joint dysfunction; however, the aim of this study is to explore the additional effects of the muscle energy technique (MET) on the quadratus lumborum along with strengthening of the gluteus medius on pain, disability and quality of life of patients with sacroiliac joint dysfunction. Using a computer-generated random number table, seventy patients with unilateral sacroiliac joint pain were divided equally and randomly into two groups. Prior to initiating treatment, baseline measurements were taken using a hand-held dynamometer, visual analog scale (VAS), Oswestry Disability Index (ODI-U) and short form 36-item survey (SF-36v2) to assess strength, pain, functional disability and quality of life, respectively. Over the course of four weeks, all patients received twelve sessions, and both the pre- and post-intervention outcome measures were documented. After 4 weeks of treatment, both groups showed statistically significant (p < 0.005) mean improvements in muscle strength, pain, disability and quality of life before and after intervention. However, the mean improvements in post-intervention on a dynamometer, VAS, ODI and SF-36 were better in the MET with exercise group (METGME) as compared to the conventional group with exercise (CTGME), with a larger effect size. The muscle energy technique, applied to the quadratus lumborum in combination with gluteus medius strengthening, is more effective clinically and significantly in improving pain, disability and quality of life in comparison to conventional treatment of sacroiliac joints with gluteus medius exercises.

Isometric handgrip versus aerobic exercise: a randomized trial evaluating central and ambulatory blood pressure outcomes in older hypertensive participants.

It remains unclear whether the hemodynamic effects of isometric handgrip exercise (IHG) are comparable to those of aerobic exercise (AE). This study investigated the efficacy of IHG in reducing central and ambulatory blood pressure in older hypertensive participants and compared its effects with AE. In a three-arm randomized controlled trial, 54 older hypertensive participants (age range: ≥60; mean age: 69 years) underwent 12 weeks of either IHG training (n = 17), AE training (n = 19), or were part of a no-exercise control group (n = 18). IHG participants engaged in bilateral handgrips using a digital device, four times for 2 min each at 30% of maximal voluntary contraction. AE participants undertook brisk walking and cycling exercises at moderate intensity for 30 min, thrice weekly. Baseline and postintervention measurements included resting office, central, and 24-h ambulatory blood pressures. Both IHG and AE interventions led to significant reductions in office and ambulatory systolic blood pressure compared to control group (P < 0.05 for both), with no marked difference in the magnitude of systolic blood pressure reductions between the two groups. Notably, the IHG group exhibited greater reductions in office, central, and ambulatory diastolic blood pressure compared to the AE group and control group. While both IHG and AE effectively lowered ambulatory systolic blood pressure, IHG demonstrated superior efficacy in reducing central and ambulatory diastolic blood pressure. Consequently, IHG training presents a promising alternative antihypertensive therapy for hypertensive participants over the age of 60.

Defibrillator shocks and their effect on objective asian patient outcomes: results of the painfree SST clinical trial

Abstract Background The implantable cardioverter defibrillator (ICD) reduces mortality in patients at risk of sudden cardiac death. However, the effect of ICD shock on device-measured activity is unknown. The aim of this analysis was to analyze the acute and long-term effects of ICD shock on objective behavioral data. Methods The PainFree SST study was a prospective, multicenter, global study that enrolled 2770 patients including 225 from from Asia (181 from Japan, 25 from India, and 19 from Malaysia). Patient physical activity was determined from the device built-in accelerometer. The device translates the accelerometer output into a count of active minutes, which is stored as a daily total value in device memory for a rolling window of 425 days. Obviously, activity is measured only after device implantation. Early after implant, activity is reduced due to the procedure and thus not representative. Therefore, no baseline can be reported for activity. The follow-up activity data was analyzed with a linear mixed model, with a random effect for patient and an auto-regressive correlation matrix for subsequent measurements of individual patients. Results Figure 1 shows average daily activity between 90 days before and 90 days after a shock. The dashed vertical line indicates the day of shock. Both patients from Asia and from other countries show a drop in activity after a shock with recovery in the subsequent 30-60 days. The curve for Asian patients is more variable than the curve for other countries due to the lower number of patients (there were 33 Asian patients with shocks contributing data). Figure 2 shows average daily activity before and after ATP therapy. Any post shock measurement is excluded. Contrary to the temporary reduction in activity around a shock (Figure 1), ATP therapies do not seem to have an impact on activity. In patients from the other countries, activity is significantly reduced when patients are hospitalized (-66.3 minutes/day, p&amp;lt;0.0001), but not in Asian patients (-5.1 minutes/day, p=0.71). Both in Asian and other countries, activity is significantly reduced after an ICD shock (Asian: -47.5 minutes/day, p=0.0002; Other countries: -21.5 minutes/day, p&amp;lt;0.0001). The effect of shock for Asian is greater than the other countries (p=0.054). In the month after the shock there is a significant recovery, +34.8 minutes/day in Asian patients (p=0.0077) and +7.7 minutes/day in patients from other countries (p=0.031). The recovery is trended to be bigger in Asian patients (p=0.058). Conclusions ICD shocks have a lasting adverse impact on objective, device-measured physical activity, particularly among Asian individuals. Successful management of patients with an ICD necessitates specific attention to clinically relevant behavioral outcomes, aiming to expedite recovery and facilitate a return to activities of daily living, with a particular focus on the Asian population.

Effects of electroconvulsive therapy on inflammatory markers and depressive symptoms in adolescents with major depressive disorder.

Limited research exists on the use of electroconvulsive therapy (ECT) for adolescents with major depressive disorder (MDD). This study investigates the effects of ECT on inflammatory markers in adolescents aged 13-18 suffering from severe MDD, evaluating its efficacy in modulating cellular inflammatory markers and ameliorating depressive symptoms. A cohort of 38 adolescents with severe MDD received standard antidepressant therapy along with 6-8 ECT sessions spanning two weeks. A control group of 29 age-matched, healthy individuals was also assessed for comparative purposes. The investigation measured variations in depressive symptomatology and inflammatory marker levels (IL-1β, IL-6, IL-10) pre- and post-intervention. Post-ECT, a substantial decrease in pro-inflammatory cytokines (IL-1β and IL-6) and an increase in the anti-inflammatory cytokine (IL-10) were noted. Participants who responded to the treatment showed a significant decline in HAMD-17 scores, which accentuates ECT's therapeutic potential. Comparative analysis indicated a significant correlation between post-treatment inflammatory marker alterations and clinical improvement, implying that shifts in inflammatory state might serve as predictors of treatment response. Moreover, the mitigation of depressive symptoms exhibited a moderate correlation with post-treatment decrements in IL-1β and IL-6 levels, underscoring MDD's intricacy and ECT's comprehensive impact. While initial inflammatory marker levels did not predict the response to ECT, the post-treatment measures appeared to be linked to clinical improvement. These findings suggest ECT's potential effectiveness in treating severe MDD in adolescents and point to the possible predictive value of inflammatory markers in therapeutic outcomes. The study contributes to our understanding of the biopsychosocial framework of MDD and indicates that ECT may be a viable treatment option for this population.

Generalized tetanus complicated with Takotsubo-cardiomyopathy in a septuagenarian following a laceration injury with soil contamination – a case report

BackgroundTetanus is a clinical rarity due to the successful globally adopted childhood vaccination programme. The rising elderly population in the United Kingdom creates a subset of individuals whom are prone to develop Tetanus as they preceded this vaccination drive.Case summaryA 76 year old Caucasian lady presented with a soil contaminated laceration injury on her knee following a fall. Though she received urgent assessment and wound care, the relevance of the injury in the backdrop of her age was not appreciated and her tetanus post exposure prophylaxis was overlooked. She readmitted seeking further management 1 week later with an infected wound with Trismus and clinical features favoring Generalized tetanus. During her stay she developed Takotsubo-cardiomyopathy with congestive cardiac failure and required prolonged care in the intensive unit with mechanical ventilation and rehabilitation before being discharged home.ConclusionFirst contact physicians should have a greater appreciation of the types of injuries and at-risk individuals who are more prone to develop tetanus upon exposure to ensure early and appropriate identification. There should be greater situational awareness with regard to the elderly in view of their heightened risk of development of tetanus specially those born before the vaccination drive. Knowledge regarding post exposure prophylaxis measures for tetanus should be regularly updated using local guidance to ensure awareness, so as to despite its rarity Tetanus remains an adequately appreciated disease.

Implementation and Evaluation of a Virtual Skills-Based Dementia Caregiver Group Intervention within a VA Setting: A Pilot Study.

This study sought to design, implement, and evaluate a 6-week skills-based telehealth group for dementia caregivers within a VA setting. The protocol was designed based on a CBT skill-building approach and was evaluated using the four levels of evaluation developed by Kirkpatrick (1998). Eight spousal caregivers of individuals with MCI or dementia participated in the pilot group within a VA geriatric clinic. Methods included comparison of pre- and post-intervention outcome measures (caregiver burden, depression, anxiety, flourishing) and inductive narrative analysis of qualitative feedback from participants. Qualitatively, the intervention was well received and participants identified several areas of subjective learning and skill implementation including increased behavioral and communication skills, knowledge, and connection with resources. However, paired-sample t-tests of group outcomes revealed no significant differences on measures of caregiver burden, depression, anxiety, and flourishing pre- and post-intervention. Based on Kirkpatrick's levels of evaluation, this study revealed positive reception of a group-based intervention for dementia caregivers within a VA setting, but further investigation of intervention effectiveness is needed given the lack of significant change found on outcome measures. A virtual skills-based group may be a feasible option for dementia caregiver intervention within VA settings that warrants further investigation.