Purpose
Evidence from cross-sectional studies suggests that higher levels of light-intensity physical activity (LPA) are associated with better health-related quality of life (HRQoL) in colorectal ...cancer (CRC) survivors. However, these associations have not been investigated in longitudinal studies that provide the opportunity to analyse how within-individual changes in LPA affect HRQoL. We investigated longitudinal associations of LPA with HRQoL outcomes in CRC survivors, from 6 weeks to 2 years post-treatment.
Methods
Data were used of a prospective cohort study among 325 stage I–III CRC survivors (67% men, mean age: 67 years), recruited between 2012 and 2016. Validated questionnaires were used to assess hours/week of LPA (SQUASH) and HRQoL outcomes (EORTC QLQ-C30, Checklist Individual Strength) at 6 weeks, and 6, 12 and 24 months post-treatment. We applied linear mixed regression to analyse longitudinal confounder-adjusted associations of LPA with HRQoL.
Results
We observed statistically significant longitudinal associations between more LPA and better global quality of life and physical, role and social functioning, and less fatigue over time. Intra-individual analysis showed that within-person increases in LPA (per 8 h/week) were related to improved HRQoL, including better global quality of life (
β
= 1.67, 95% CI 0.71; 2.63; total range scale: 0–100) and less fatigue (
β
= − 1.22, 95% CI − 2.37; − 0.07; scale: 20–140). Stratified analyses indicated stronger associations among participants below the median of moderate-to-vigorous physical activity (MVPA) at diagnosis.
Conclusion
Higher levels of LPA were longitudinally associated with better HRQoL and less fatigue in CRC survivors up to two years post-treatment. Further prospective studies using accelerometer data are necessary to inform development of interventions targeting LPA.
Neuromuscular disorders are characterised by muscle weakness that limits upper extremity mobility, but can be alleviated with dynamic arm support devices. Current research highlights the importance ...and difficulties of evidence-based recommendations for device development. We aim to provide research recommendations primarily concerning upper extremity body functions, and secondarily activity and participation, environmental and personal factors.
Evidence was synthesised from literature, ongoing studies, and expert opinions and tabulated within a framework based on a combination of the International Classification of Functioning, Disability and Health (ICF) model and contextual constructs.
Current literature mostly investigated the motor capacity of muscle function, joint mobility, and upper body functionality, and a few studies also addressed the impact on activity and participation. In addition, experts considered knowledge on device utilisation in the daily environment and characterising the beneficiaries better as important. Knowledge gaps showed that ICF model components and contextual constructs should be better integrated and more actively included in future research.
It is recommended to, first, integrate multiple ICF model components and contextual constructs within one study design. Second, include the influence of environmental and personal factors when developing and deploying a device. Third, include short-term and long-term measurements to monitor adaptations over time. Finally, include user satisfaction as guidance to evaluate the device effectiveness.
IMPLICATIONS ON REHABILITATION
Synthesized evidence will support future research and development of dynamic arm supports.
Tabulated evidence stresses the importance of integrating ICF model components and contextual constructs to fill the knowledge gaps.
Presented knowledge gaps and proposed steps guide the set up of future studies on dynamic arm supports
•Altered vertical ground reaction forces in patients after calcaneal fractures.•Lower minim peak force during midstance.•Lower maximum peak force during push-off phase.•Significant correlations with ...questionnaires, radiographic findings and kinematics.
Vertical ground reaction forces (VGRFs) are altered in patients after foot trauma. It is not known if this correlates with ankle kinematics. The aim of this study was to analyze VGRFs in patients after calcaneal trauma and correlate them to patient-reported outcome measures (PROMs), radiographic findings and kinematic analysis, using a multi-segment foot model. In addition, we determined the predictive value of VGRFs to identify patients with altered foot kinematics.
Thirteen patients (13 feet) with displaced intra-articular calcaneal fractures, were included an average of two years after trauma surgery. PROMs, radiographic findings on postoperative computed tomography scans, gait analysis using the Oxford foot model and VGRFs were analysed during gait. Results were compared with those of 11 healthy subjects (20 feet). Speed was equal in both groups, with healthy subjects walking at self-selected slow speed (0.94±0.18m/s) and patients after surgery walking at self-selected normal speed (0.94±0.29m/s). ROC curves were used to determine the predictive value.
Patients after calcaneal surgery showed a lower minimum force during midstance (p=0.004) and a lower maximum force during toe-off (p=0.011). This parameter correlated significantly with the range of motion in the sagittal plane during the push-off phase (r 0.523, p=0.002), as well as with PROMs and with postoperative residual step-off (r 0.423, p=0.016). Combining these two parameters yielded a cut-off value of 193% (p<0.001), area under the curve 0.93 (95%confidence interval 0.84–1.00).
Patients after calcaneal fracture showed lower minimum force during midstance and lower maximum force during toe-off compared to healthy subjects. This lower maximum force during push-off correlated significantly with PROMs, range of motion in the sagittal plane during push-off and radiographic postoperative residual step-off in the posterior facet of the calcaneal bone. VGRFs are a valuable screening tool for identifying patients with altered gait patterns.
Introduction
Bilateral vestibulopathy (BVP) can affect visual acuity in dynamic conditions, like walking. This can be assessed by testing Dynamic Visual Acuity (DVA) on a treadmill at different ...walking speeds. Apart from BVP, age itself might influence DVA and the ability to complete the test. The objective of this study was to investigate whether DVA tested while walking, and the drop-out rate (the inability to complete all walking speeds of the test) are significantly influenced by age in BVP-patients and healthy subjects.
Methods
Forty-four BVP-patients (20 male, mean age 59 years) and 63 healthy subjects (27 male, mean age 46 years) performed the DVA test on a treadmill at 0 (static condition), 2, 4 and 6 km/h (dynamic conditions). The dynamic visual acuity loss was calculated as the difference between visual acuity in the static condition and visual acuity in each walking condition. The dependency of the drop-out rate and dynamic visual acuity loss on BVP and age was investigated at all walking speeds, as well as the dependency of dynamic visual acuity loss on speed.
Results
Age and BVP significantly increased the drop-out rate (
p
≤ 0.038). A significantly higher dynamic visual acuity loss was found at all speeds in BVP-patients compared to healthy subjects (
p
< 0.001). Age showed no effect on dynamic visual acuity loss in both groups. In BVP-patients, increasing walking speeds resulted in higher dynamic visual acuity loss (
p
≤ 0.036).
Conclusion
DVA tested while walking on a treadmill, is one of the few “close to reality” functional outcome measures of vestibular function in the vertical plane. It is able to demonstrate significant loss of DVA in bilateral vestibulopathy patients. However, since bilateral vestibulopathy and age significantly increase the drop-out rate at faster walking speeds, it is recommended to use age-matched controls. Furthermore, it could be considered to use an individual “preferred” walking speed and to limit maximum walking speed in older subjects when testing DVA on a treadmill.
Essentials
Few data exist on outcome of upper extremity deep and superficial vein thrombosis (UEDVT and UESVT).
We followed 102 and 55 patients with UEDVT or UESVT, respectively, for a median of 3.5 ...years.
Risk of recurrent venous thromboembolism was low in both diseases, and the mortality high.
Postthrombotic symptoms were infrequent and cancer patients had a higher risk of recurrent VTE.
Summary
Background
There is scant information on the optimal management and clinical outcome of deep and superficial vein thrombosis of the upper extremity (UEDVT and UESVT).
Objectives
To explore treatment strategies and the incidence of recurrent venous thromboembolism (VTE), mortality, postthrombotic symptoms, and bleeding in patients with UEDVT and UESVT and to assess the prognosis of cancer patients with UEDVT.
Patients/methods
Follow‐up of patients with UEDVT or UESVT, who were enrolled previously in a diagnostic management study.
Results
We followed 102 and 55 patients with UEDVT and UESVT, respectively, both for a median of 3.5 years. Anticoagulant treatment was started in 100 patients with UEDVT (98%) and in 40 (73%) with UESVT. Nine patients with UEDVT (9%) developed recurrent VTE, 26 (26%) died, 6 (8%) of 72 patients had moderate postthrombotic symptoms, and 5 (5%) experienced major bleeding. One patient with UESVT had a recurrent VTE, 18 (33%) died, none had moderate postthrombotic symptoms, and none had major bleeding. Of the cancer patients with UEDVT, 18% had recurrent VTE vs. 7.5% in non‐cancer patients (adjusted hazard ratio 2.2, 95%CI 0.6–8.2). The survival rate was 50% in cancer patients with UEDVT vs. 60% in those without (adjusted HR 0.8, 95%CI 0.4–1.4).
Conclusions
The risk of recurrent VTE was low in patients with UEDVT, and negligible for UESVT. Mortality was high for both diseases. Postthrombotic symptoms were infrequent and mild. Anticoagulant therapy of UEDVT carried a substantial risk of major bleeding. Cancer patients had a significant risk of recurrent VTE.
Summary
Background
High von Willebrand factor (VWF) levels are an established risk factor for arterial thrombosis, including coronary heart disease and ischemic stroke. It has been hypothesized that ...von Willebrand disease (VWD) patients are protected against arterial thrombosis; however, this has never been confirmed in clinical studies.
Objectives
To investigate the prevalence of arterial thrombosis in VWD patients relative to the general population.
Patients/Methods
We included 635 adult patients with VWF levels ≤ 30 U dL−1, aged 16–85 years, from the nationwide cross‐sectional ‘Willebrand in the Netherlands’ (WiN) study and compared the prevalence of arterial thrombosis with two reference populations from the general Dutch population adjusted for age and sex as standardized morbidity ratios (SMRs).
Results
Twenty‐nine arterial thrombotic events occurred in 21 patients (3.3%). Five patients suffered an acute myocardial infarction and three an ischemic stroke. Unstable angina pectoris was recorded 12 times, transient ischemic attack nine. The prevalence of all arterial thrombotic events combined (acute myocardial infarction, ischemic stroke and coronary heart disease) was 39% and 63% lower than in the two reference populations. The prevalence of cardiovascular disease in VWD was lower than in the general population, SMR 0.60 (95% CI, 0.32–0.98) for coronary heart disease and SMR 0.40 (95% CI, 0.13–0.83) for acute myocardial infarction. For ischemic stroke the prevalence was 35–67% lower compared with two reference populations, SMR 0.65 (95% CI, 0.12–1.59) and 0.33 (95% CI, 0.06–0.80), respectively.
Conclusions
This is the first study showing that VWD patients have a reduced prevalence of arterial thrombosis and provides important insights into the role of VWF in the pathogenesis of arterial thrombosis.
Mice in buildings are a hygiene hazard because they harbour several zoonoses and animal diseases. The aim of this study was to gather information on specific bacteria in house mice caught in the ...urban environment. Mice caught in snap traps during pest control activities were collected in and around the city of Utrecht, the Netherlands, during May‐June 2014, October‐November 2015 and September‐November 2016. The gut contents were analysed for ESBL/AmpC‐producing Enterobacteriaceae, Salmonella spp., and Clostridium difficile and the buccal cavities were swabbed for methicillin‐resistant S. aureus (MRSA). In total, 109 house mice (Mus musculus) and 22 wood mice (Apodemus sylvaticus) were examined. One mouse was found positive for Enterobacter spp. Salmonella spp. and MRSA were not found. Of n = 80 mice, 35·0% carried C. difficile (ribotypes in descending order of frequency: 014/020, 258, 002, 005, 013, 056, 081 and two unknown ribotypes). In conclusion, mouse droppings are a hazard for transmission of C. difficile to humans and their environment.
Significance and Impact of the Study
This study shows that mice in buildings can carry Clostridium difficile ribotypes that are associated with clinical disease in humans. Whether the mice are the source or whether they picked up these bacteria from the human environment has not been investigated. Either way, mouse droppings in the indoor environment are a hazard for transmission of C. difficile to humans.
Significance and Impact of the Study: This study shows that mice in buildings can carry Clostridium difficile ribotypes that are associated with clinical disease in humans. Whether the mice are the source or whether they picked up these bacteria from the human environment has not been investigated. Either way, mouse droppings in the indoor environment are a hazard for transmission of C. difficile to humans.
Objective
To explore key factors for successful support in women with moderate or severe Von Willebrand disease (VWD) who are faced with heavy menstrual bleeding (HMB) and surgery.
Design
A ...qualitative study design with focus‐group interviews and thematic analysis of the discussions.
Settings and population
Eleven VWD women aged 41‐68 years (median age 58 years) who had had a hysterectomy or bipolar radiofrequency ablation (BRA) because of HMB participated in this study. Three of the 11 participants had VWD diagnosed before surgery. Two focus groups were conducted in the summer of 2012. Patients were identified through participation in a nationwide study on Von Willebrand disease in the Netherlands (WiN study). Inclusion criteria were at least 18 years of age, fluent in Dutch, diagnosed with VWD (based on Von Willebrand factor (VWF) antigen and/or activity levels < 30 IU/dL) and previous surgical therapy for HMB.
Findings
The following key factors were identified during focus‐group interviews: receiving information, proactive support from providers and considering bleeding disorders as a cause of HMB. Other topics were as follows: experiences with VWD and/or surgery, how relieved patients were when menses stopped, patients hoped that in future, providers would work better together so that women receive the best care.
Conclusions
In this focus‐group study among women with VWD who underwent surgery because of HMB, support by professionals could be improved by considering a bleeding disorder in women with HMB, providing information about different types of surgery and shared decision‐making regarding type of interventions.
Cognitive deficits, especially those of information processing speed (IPS), are common in multiple sclerosis (MS), however, the underlying neurobiological mechanisms remain poorly understood. In this ...study, we examined structural and functional brain changes separately, but also in an integrative manner, in relation to IPS performance.
IPS was measured using the symbol digit modalities test (SDMT) in 330 MS patients and 96 controls. Patients with IPS impairment (IPS-I, z-score < −1.5) were compared to patients with preserved IPS performance (IPS-P) on volumetric measures, white matter integrity loss (using diffusion tensor imaging) and the severity of functional connectivity changes (using resting-state fMRI). Significant predictors of IPS performance were used to create groups of mild or severe structural and/or functional damage to determine the relative effect of structural and/or functional changes on IPS.
IPS-I patients, compared to IPS-P patients, showed lower deep gray matter volume and less WM integrity, but stronger increases in functional connectivity. Patients with predominantly structural damage had worse IPS (z-score = −1.49) than patients with predominantly functional changes (z-score = −0.84), although both structural and functional measures remained significant in a regression model. Patients with severe structural and functional changes had worst IPS (z-score = −1.95).
The level of structural damage explains IPS performance better than functional changes. After integrating functional and structural changes, however, we were able to detect more subtle and stepwise decline in IPS. In subgroups with a similar degree of structural damage, more severe functional changes resulted in worse IPS scores than those with only mild functional changes.
•Impaired information processing in MS relates to structural and functional changes.•There is no one-to-one relation between structural and functional damage.•MS patients with severe structural and functional changes have the lowest IPS.•Structural changes affect information processing more than functional changes.•Functional changes seem to mediate the effect of structural damage on IPS.
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