Abstract
Objective
The aim of this systematic review was to identify, evaluate, and synthesize the evidence from studies that have investigated the effect of nonsurgical, nonpharmacological, pelvic ...floor muscle interventions on any type of pelvic floor dysfunction or health-related quality of life in patients after any type of treatment for gynecological cancer.
Methods
Six electronic databases (Cochrane Library 2018, CINAHL 1982–2018, MEDLINE 1950–2018, EMBASE 1980–2018, PsycINFO 1806–2018, and EMCARE 1995–2018) were systematically searched in June 2018. Reference lists of identified articles were hand searched. Randomized controlled trials (RCTs), cohort studies, and case series were included if they investigated the effects of conservative treatments, including pelvic floor muscle training or dilator training, on bladder, bowel, or sexual function in patients who had received treatment for gynecological cancer. Risk of bias was assessed using the Physiotherapy Evidence Database scale for RCTs and the Newcastle-Ottawa scale for cohort studies.
Results
Five RCTs and 2 retrospective cohort studies were included (n = 886). The results provided moderate-level evidence that pelvic floor muscle training with counseling and yoga or core exercises were beneficial for sexual function (standardized mean difference = −0.96, 95% CI = −1.22 to −0.70, I2 = 0%) and health-related quality of life (standardized mean difference = 0.63, 95% CI = 0.38 to 0.88, I2 = 0%) in survivors of cervical cancer and very low-level evidence that dilator therapy reduced vaginal complications in survivors of cervical and uterine cancer (odds ratio = 0.37, 95% CI = 0.17 to 0.80, I2 = 54%). There were insufficient data for meta-analysis of bladder or bowel function.
Conclusion
Conservative pelvic floor muscle interventions may be beneficial for improving sexual function and health-related quality of life in survivors of gynecological cancer. Given the levels of evidence reported in this review, further high-quality studies are needed, especially to investigate effects on bladder and bowel function.
Impact
This review provides moderate-level evidence for the role of pelvic floor rehabilitation to improve health outcomes in the gynecological cancer survivorship journey. Clinicians and health service providers should consider how to provide cancer survivors the opportunity to participate in supervised pelvic floor rehabilitation programs.
Aims
The aim of this systematic review and meta‐analysis was to determine the impact of lower urinary tract symptoms (LUTS) on work productivity in female workers.
Methods
A comprehensive literature ...search was conducted using eight electronic databases (MEDLINE, PEDro, CINAHL, Cochrane library, EMBASE, PubMed, Scopus, and PsycINFO) to identify articles published before July 2017 that studied the work productivity in female workers with LUTS. Two reviewers independently assessed the quality of studies using the Joanna Briggs Institute. Meta‐analyses were performed on studies having measured work productivity between females with and without LUTS, and odds ratios (ORs) or the mean differences were used.
Results
Fourteen articles (n = 48 223 females) were included in the review, and meta‐analyses were performed with six of those articles. Lower urinary tract symptoms were significantly associated with work productivity loss (OR = 1.11, 95%CI = 1.06‐1.15), presenteeism (OR = 1.10, 95%CI = 1.05‐1.14), and activity impairment (OR = 1.11, 95%CI = 1.09‐1.14). However, there was no significant difference in the probability of absenteeism between females with and without LUTS (OR = 1.03, 95%CI = 0.94‐1.13).
Conclusions
Evidence suggests that female workers with LUTS had significantly greater work productivity impairment compared to those without LUTS.
Hepatitis A virus(HAV)is one of the most common infectious etiologies of acute hepatitis worldwide.The virus is known to be transmitted fecal-orally,resulting in symptoms ranging from asymptomatic ...infection to fulminant hepatitis.HAV can also be transmitted through oral-anal sex.Residents from regions of low endemicity for HAV infection often remain susceptible in their adulthood.Therefore,clustered HAV infections or outbreaks of acute hepatitis A among men who have sex with men and injecting drug users have been reported in countries of low endemicity for HAV infection.The duration of HAV viremia and stool shedding of HAV may be longer in human immunodeficiency virus(HIV)-positive individuals compared to HIV-negative individuals with acute hepatitis A.Current guidelines recommend HAV vaccination for individuals with increased risks of exposure to HAV(such as from injecting drug use,oral-anal sex,travel to or residence in endemic areas,frequent clotting factor or blood transfusions)or with increased risks of fulminant disease(such as those with chronic hepatitis).The seroconversion rates following the recommended standard adult dosing schedule(2doses of HAVRIX 1440 U or VAQTA 50 U administered6-12 mo apart)are lower among HIV-positive individuals compared to HIV-negative individuals.While the response rates may be augmented by adding a booster dose at week 4 sandwiched between the first dose and the 6-mo dose,the need of booster vaccination remain less clear among HIV-positive individuals who have lost anti-HAV antibodies.
Early detection of patients at risk of sternal complications is essential to facilitate prevention and optimize timely intervention. A systematic review and meta-analysis was conducted to identify ...risk factors associated with sternal complications. The review included 17 full-text studies, of which 10 were entered into meta-analyses. Female gender, diabetes mellitus, obesity, bilateral internal mammary artery grafts, reoperation for postoperative complications, and blood product requirement were reported as significant predictors of sternal infection. The compilation of these risk factors may help to screen and stratify patients at risk of impaired sternal healing and warrants further investigation.
A growing body of research indicates that poor functional status before chemotherapy may be correlated with the severity of chemotherapy-induced peripheral neuropathy (CIPN) after the neurotoxic ...treatment. However, little is known about the associations between pre-chemotherapy physical function and CIPN in patients with pancreatic cancer.
To identify the predictors of CIPN in relation to pre-chemotherapy physical function in patients with pancreatic cancer.
This secondary analysis included data from patients with pancreatic cancer who participated in a longitudinal research study at National Cheng Kung University Hospital, Tainan, Taiwan. Four physical function tests (i.e., grip strength, Timed Up and Go (TUG), 2-minute step test (2MST), and Romberg test) and two questionnaires (The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 EORTC QLQ-C30 and Chemotherapy-Induced Peripheral Neuropathy Module CIPN20) were assessed at baseline (i.e., before first chemotherapy session) and 2-, 3-, 4-, and 6-month follow-up. Multiple linear regression with adjustment for confounding factors was used to assess the associations between the four functional tests at baseline and the CIPN20 total score and individual subscale scores (sensory, motor, and autonomic) at 6-month follow-up.
Data from a total of 209 pancreatic cancer patients (mean age: 64.4 years, 54.5% male) were analyzed. The findings showed that the severity of CIPN at 6-month follow-up was significantly associated with the baseline TUG completion time (β = 0.684, p = 0.003). The TUG completion time was also positively correlated with the 6-month CIPN sensory and autonomic subscales. In addition, a baseline positive Romberg test (β = 0.525, p = 0.009) was a significant predictor of the severity of motor neuropathy at 6-month follow-up.
The TUG completion time and positive Romberg test before chemotherapy may be predictive factors of the CIPN severity 6 months after the commencement of chemotherapy. Accordingly, the incorporation of TUG and Romberg tests into the clinical assessment protocol emerges as imperative for individuals diagnosed with pancreatic carcinoma undergoing chemotherapy regimens.
This study aimed to explore the prevalence of work-related musculoskeletal disorders (WMSDs) and to investigate factors associated with WMSDs in commercial motorcyclists in Indonesia. This ...cross-sectional study involved commercial motorcyclists operating in Indonesia. Data were collected using an anonymous questionnaire, including the Indonesian Version of the Nordic Musculoskeletal Questionnaire, occupational driving posture questionnaire, and occupational factor-related questions. The questionnaire was distributed at four rest stops located in Central Jakarta, Indonesia. The result showed that 40% of participants (129/322) were having WMSDs. Older age, overweight body mass index (BMI), obese body mass index, nonregular physical activity, driving duration (> 8 h/day), seniority (≥5 years), and poor driving posture were significant risk factors for WMSDs in commercial motorcyclists. Based on the risk factors identified in this study, the development of preventive strategies among commercial motorcyclists is warranted.
In this issue of The Journal of Infectious Diseases, Hofmeister and colleagues 6 investigated the multistate outbreaks of hepatitis A that have continued in the United States since 2016. Because the ...outbreaks spanned 33 states, the study was conducted using data from a random sample of hepatitis A outbreak-associated cases in 3 severely affected states. Through case investigations performed by public health staff and medical records requested from hospitals, the information from 817 incident cases provides a thorough evaluation of epidemiological features and clinical outcomes. Notably, the difficulty in reaching the most heavily affected populations during the outbreaks (eg, people with substance use and experiences of homelessness) precludes clear identification of potential sources and hinders timely public health responses. Nevertheless, risk behaviors for acquiring hepatitis A can still be clearly categorized into injection drug use, noninjection drug use, homelessness, MSM status, incarceration, international travel, and epidemiological linkage. In addition, the data on clinical outcomes, including hospitalization, fulminant hepatitis, liver transplantation, and death offer valuable insights into the associated burden to health care system.
Abstract
Objective
For people with hematological malignancies treated with bone marrow transplantation (BMT), this systematic review aimed to identify, evaluate, and synthesize the evidence examining ...the effect of exercise training on the outcomes of exercise capacity, health-related quality of life (HRQoL), and hospital length of stay (LOS) and to identify any difference in the effect on people treated with allogeneic versus autologous transplantation.
Methods
Five electronic databases were systematically searched from inception to December 5, 2020. Prospective studies with a comparator group, with or without randomization, were included if they investigated the effects of an exercise intervention compared with usual care or another intervention in adults who had a hematological malignancy and were undergoing BMT. Primary outcomes of interest were functional exercise capacity and HRQoL; secondary outcomes included strength, fatigue, hospital LOS, and feasibility. Only randomized controlled trials were included in the meta-analyses. Risk of bias was evaluated using the Physiotherapy Evidence Database or Newcastle-Ottawa Scale; the quality of evidence for meta-analyses was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.
Results
Twenty-four randomized controlled trials and 3 prospective nonrandomized experimental trials were included (n = 2432). There was moderate-quality evidence that exercise improves functional exercise capacity (mean difference MD = 29 m; 95% CI = 12.59 to 45.4), global HRQoL (MD = 3.38 points; 95% CI = 0.37 to 6.39), and fatigue (MD = 2.52 points; 95% CI = 0.42 to 4.63) and low-quality evidence for reduced hospital LOS (MD = 2.07 days; 95% CI = 0.43 to 3.72). These effects were more pronounced in recipients of allogeneic transplantation. No serious adverse events were associated directly with exercise in the included studies.
Conclusion
Exercise is safe and improves outcomes, including functional exercise capacity, HRQoL, and hospital LOS in adults undergoing BMT.
Impact
The results of this systematic review support the implementation of exercise programs in adults undergoing BMT, particularly recipients of allogeneic transplantation.
To establish the impact of pelvic floor (PF) symptoms (urinary incontinence UI, anal incontinence AI and pelvic organ prolapse POP) on exercise participation in women.
Observational, cross-sectional ...survey.
Australian, 18- to 65-year-old women with self-identified PF symptoms during exercise (current, past or fear of) were included. This survey included validated questionnaires: Questionnaire for female Urinary Incontinence Diagnosis, Incontinence Severity Index, Pelvic Floor Bother Questionnaire, International Physical Activity Questionnaire and purpose-designed questions on the impact of PF symptoms on sport/exercise participation. Analysis utilised descriptive statistics. Chi-square tests for independence and t-tests were used to explore differences between groups.
Of 4556 women, 46% stopped exercise they had previously participated in due to their PF symptoms. Urinary incontinence had the largest impact; 41% with UI, followed by 37% with POP and 26% with AI stopped at least one form of exercise. Forty-two percent of women who experienced symptoms in high-impact sports stopped participation (versus low-impact: 21%). Sports commonly ceased included volleyball (63%), racquet-sports (57%) and basketball (54%). Exercise cessation was reported amongst younger (18–25 years: 35%) and nulliparous women (31%). Common exercise modifications included lowering the intensity (58%) or frequency (34%) of participation or changing to a low-impact form of sport/exercise (45%).
Pelvic floor symptoms stop women of all ages and levels of participation from exercising. High-impact sports were most affected but low-impact sports were also ceased. Symptomatic women also modify exercise to less vigorous/frequent participation, which may place them at risk of physical inactivity, and chronic illness.
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