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Londero AP, Gallina V, Cremonini F, Xholli A, Cagnacci A. Systematic review and meta-analysis of the effects of progestins on depression in post-menopausal women: An evaluation of randomized clinical studies that used validated questionnaires. Maturitas 2024; 189:108105. [PMID: 39226622 DOI: 10.1016/j.maturitas.2024.108105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 07/23/2024] [Accepted: 08/23/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE Hormone therapy (HT) can relieve symptoms of menopause and treat chronic diseases. Its effectiveness in treating psychological symptoms is still debated. Several progestins can be used in HT, but their effects on mood, in particular depressive symptoms, is still unclear. This systematic review evaluates the evidence from randomized clinical trials with postmenopausal women on the effect of adjunctive progestins on symptoms of depression assessed by validated questionnaires. The primary aim was to evaluate scores on the Center for Epidemiologic Studies Depression Scale (CESD). The secondary aim was to assess scores on the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HAMD), and the Zung Self-Rating Depression Scale (SDS). METHODS A systematic review and meta-analysis were conducted to identify the most reliable evidence of the effects of progestin on depression to inform decision-making. A PICO- and PRISMA-based framework was established to formulate explicit and reasoned recommendations. The pre-/post-treatment effect was evaluated using standardized mean change (SMC). RESULTS We selected and analyzed 16 randomized clinical trials qualitatively and 12 studies quantitatively out of 9320 items identified. Most of the studies used medroxyprogesterone acetate as progestin. The results indicate that depressive symptoms do not increase with the addition of a progestin to estrogen HT. Depressive symptoms improved over time in the progestins-estrogen HT group, independent of progestin type (SMC CES-D -0.08 CI.95-0.10/-0.06, BDI -0.19 CI.95-0.32/-0.06, HAM-D -1.13 CI.95-1.47/-0.78, and SDS -0.11 CI.95-0.82/0.60). Yet similar effects were observed with estrogens alone and did not significantly differ from control groups on placebo. In one study, the addition of fluoxetine greatly increased the reduction of depressive symptoms observed with estrogen-progestin HT. CONCLUSIONS In summary, in randomized clinical trials using validated questionnaires adjunctive progestin with estrogens did not increase depressive symptoms of postmenopausal women. Overall, depressive symptoms decreased with estrogen-progestin HT but also with estrogen alone. The decrease was not so pronounced to differ from controls on placebo. HT does not hamper the clinical efficacy of fluoxetine. The scarcity of randomized studies makes it difficult to determine the exact effect on depressive symptoms of different types of progestins. Project protocol registered in PROSPERO, registration number CRD42023454099.
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Affiliation(s)
- Ambrogio P Londero
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, GE, Italy; Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, GE, Italy.
| | - Veronica Gallina
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, GE, Italy
| | - Francesca Cremonini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, GE, Italy; Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, 16132 Genoa, GE, Italy
| | - Anjeza Xholli
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, 16132 Genoa, GE, Italy
| | - Angelo Cagnacci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, GE, Italy; Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, 16132 Genoa, GE, Italy
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Wenzler AN, van de Loo B, van der Velde N, van Schoor NM. The Effect of Genetic Variations in the Vitamin D Receptor Gene on the Course of Depressive Symptoms. J Nutr 2024; 154:2255-2263. [PMID: 38692355 DOI: 10.1016/j.tjnut.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/03/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Evidence on the association between single nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) and depressive symptoms is inconclusive. OBJECTIVES The primary aim of the study was to investigate the association between SNPs in the VDR gene and depressive symptoms. METHODS In a sample of older adults from the Longitudinal Ageing Study Amsterdam (n = 922), depressive symptoms were assessed using the Centre for Epidemiological Studies Depression scale (CES-D scale) at baseline and after 3, 6, and 10 y of follow-up. Blood samples for SNP and serum 25-hydroxyvitamin D3 (25(OH)D3) determination were obtained at baseline. The association between 13 SNPs in the VDR gene and the course of depressive symptoms were evaluated using linear mixed models. The interaction between SNPs and serum 25(OH)D3 in relation to depressive symptoms was evaluated using multiple linear regression. RESULTS No SNPs were associated with the course of depressive symptoms. Significant interactions between serum 25(OH)D3 and SNPs in the VDR gene were found. Stratified analysis revealed that within the GG genotype strata, 10 nmol/L higher serum 25(OH)D3 was associated with 0.27 (95% CI: -0.50, -0.04) and 0.23 (95% CI: -0.48, 0.02) lower scores on the CES-D scale for Cdx-2 and 1b-G-886A, respectively. This association was not found in persons having the GA or AA genotype. CONCLUSIONS No SNPs are associated with the course of depressive symptoms. Stratified analysis shows that the effect of serum 25(OH)D3 concentrations on depressive symptoms is different among genotypes of Cdx-2 and 1b-G-886A. Future research should elucidate on the function of Cdx-2 and 1b-G-886A to describe their effect.
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Affiliation(s)
- Ana Neeltje Wenzler
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Department, Amsterdam, The Netherlands.
| | - Bob van de Loo
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Department, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine Department, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Ageing and Later Life Department, Amsterdam, The Netherlands
| | - Natalie van der Velde
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine Department, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Ageing and Later Life Department, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Department, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Ageing and Later Life Department, Amsterdam, The Netherlands
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Denham AMJ, Haracz K, Bird ML, Bonevski B, Spratt NJ, Turner A, Chow WZ, Larkin M, Mabotuwana N, Janssen H. Non-pharmacological interventions to improve mental health outcomes among female carers of people living with a neurological condition: a systematic review. Disabil Rehabil 2024:1-18. [PMID: 38859798 DOI: 10.1080/09638288.2024.2360648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 05/22/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE This systematic review aims to examine the effectiveness of non-pharmacological interventions for improving mental health outcomes among female carers of people living with a neurological condition. MATERIALS AND METHODS A narrative synthesis of English-language randomized controlled trials was undertaken. RESULTS 18 unique studies were included. Intervention components that were found to have improved mental health outcomes were: delivered in person, to groups, on an intermittent schedule with ≥10 sessions; had a duration between 3-6 months; and were facilitated by research staff or allied health professionals. As the review had few robust studies, results of mental health outcomes reported in studies assessed as low risk of bias were highlighted in the review. Psychoeducation interventions, cognitive behavioural interventions, and support group interventions were found to improve depression. Psychoeducation interventions were also found to improve burden. CONCLUSIONS There is a clear need for adequately powered, high-quality randomised controlled trials to determine the effectiveness of non-pharmacological interventions for female carers of people living with a neurological condition.
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Affiliation(s)
- A M J Denham
- School of Health Sciences, University of Newcastle, Callaghan, Australia
| | - K Haracz
- School of Health Sciences, University of Newcastle, Callaghan, Australia
| | - M L Bird
- School of Health Sciences, University of Tasmania, Hobart, Australia
| | - B Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - N J Spratt
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, Australia
| | - A Turner
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - W Z Chow
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | - M Larkin
- School of Health, Wellbeing & Social Care, The Open University, Milton Keynes, UK
| | - N Mabotuwana
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
| | - H Janssen
- School of Health Sciences, University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, Australia
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McLeod A, Bernabe BP, Xia Y, Sanchez-Flack J, Lamar M, Schiffer L, Hemphill NON, Fantuzzi G, Maki P, Fitzgibbon M, Tussing-Humphreys L. Exploring the Effects of a Mediterranean Diet and Weight Loss on the Gut Microbiome and Cognitive Performance in Older, African American Obese Adults: A Post Hoc Analysis. Nutrients 2023; 15:3332. [PMID: 37571270 PMCID: PMC10420801 DOI: 10.3390/nu15153332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
African American adults have a higher prevalence of Alzheimer's dementia (AD) than non-Hispanic Whites. The impact of a Mediterranean Diet (Med Diet) and intentional weight loss (IWL) on the gut microbiome may alter AD risk. A post hoc analysis of the Building Research in Diet and Cognition (BRIDGE) trial was performed to determine whether participation in an 8-month Med Diet lifestyle intervention with (n = 35) or without IWL (n = 31) was associated with changes in gut microbiota structure, abundance, and function and whether these changes were related to changes in cognitive performance. The results showed that family and genus alpha diversity increased significantly in both groups combined (p = 0.0075 and p = 0.024, respectively). However, there were no other significant microbially related within- or between-group changes over time. Also, an increase in Med Diet adherence was significantly associated with a decrease in alpha diversity at the phylum level only (p = 0.049). Increasing alpha diversity was associated with decreasing cognitive performance, but this association was attenuated after controlling for Med Diet adherence. In sum, an 8-month Med Diet lifestyle intervention with or without IWL did not appreciably alter the gut microbiome.
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Affiliation(s)
- Andrew McLeod
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL 60612, USA; (G.F.); (L.T.-H.)
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.S.-F.); (L.S.); (M.F.)
| | | | - Yinglin Xia
- Department of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.X.); (M.L.)
| | - Jennifer Sanchez-Flack
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.S.-F.); (L.S.); (M.F.)
- Department of Pediatrics, University of Illinois Chicago, Chicago, IL 60612, USA
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Melissa Lamar
- Department of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.X.); (M.L.)
- Rush Alzheimer’s Disease Center, Rush University, Chicago, IL 60612, USA
| | - Linda Schiffer
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.S.-F.); (L.S.); (M.F.)
| | | | - Giamila Fantuzzi
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL 60612, USA; (G.F.); (L.T.-H.)
| | - Pauline Maki
- Departments of Psychology and Psychiatry, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Marian Fitzgibbon
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.S.-F.); (L.S.); (M.F.)
- Department of Pediatrics, University of Illinois Chicago, Chicago, IL 60612, USA
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Lisa Tussing-Humphreys
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL 60612, USA; (G.F.); (L.T.-H.)
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.S.-F.); (L.S.); (M.F.)
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA
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Beach B, Steptoe A, Zaninotto P. Depression and anxiety in people with cognitive impairment and dementia during the COVID-19 pandemic: Analysis of the English Longitudinal Study of Ageing. PLoS Med 2023; 20:e1004162. [PMID: 37093859 PMCID: PMC10124844 DOI: 10.1371/journal.pmed.1004162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Some studies have identified declines in mental health during the Coronavirus Disease 2019 (COVID-19) pandemic in different age groups, including older people. As anxiety and depression are common neuropsychiatric symptoms among people with cognitive impairment, the mental health experiences of older people during the pandemic should take cognitive function into consideration, along with assessments made prior to the pandemic. This study addresses evidence gaps to test whether changes in depression and anxiety among older people through the COVID-19 pandemic were associated with cognitive impairment. It also investigates whether associations varied according to key sources of sociodemographic inequality. METHODS AND FINDINGS Using data from the English Longitudinal Study of Ageing (ELSA) collected from 2018/2019 to November/December 2020, we estimated changes in depression and anxiety for people aged 50+ in England across 3 cognitive function groups: no impairment, mild cognitive impairment, and dementia. Conditional growth curve models were estimated for continuous measures over 3 time points (N = 5,286), with mixed-effects logistic regression used for binary measures. All models adjusted for demographics (age, gender, ethnicity, and cohabiting partnership), socioeconomics (education, wealth, and employment status), geography (urban/rural and English region), and health (self-rated and the presence of multimorbidity). We found that depression (measured with CES-D score) worsened from 2018/2019 to November/December 2020 for people with mild cognitive impairment (1.39 (95% CI: 1.29 to 1.49) to 2.16 (2.02 to 2.30)) or no impairment (1.17 (95%CI: 1.12 to 1.22) to 2.03 (1.96 to 2.10)). Anxiety, using a single-item rating of 0 to 10 also worsened among those with mild cognitive impairment (2.48 (2.30 to 2.66) to 3.14 (2.95 to 3.33)) or no impairment (2.20 (2.11 to 2.28) to 2.85 (2.77 to 2.95)). No statistically significant increases were found for those with dementia. Using a clinical cutoff for likely depression (CES-D ≥4), we found statistically significant increases in the probability of depression between 2018/2019 and November/December 2020 for those with no impairment (0.110 (0.099 to 0.120) to 0.206 (0.191 to 0.222)) and mild impairment (0.139 (0.120 to 0.159) to 0.234 (0.204 to 0.263)). We also found that differences according to cognitive function that existed before the pandemic were no longer present by June/July 2020, and there were no statistically significant differences in depression or anxiety among cognitive groups in November/December 2020. Wealth and education appeared to be stronger drivers for depression and anxiety, respectively, than cognitive impairment. For example, those with no impairment in the richest two-thirds scored 1.76 (1.69 to 1.82) for depression in June/July, compared to 2.01 (1.91 to 2.12) for those with no impairment in the poorest third and 2.03 (1.87 to 2.19) for those with impairment in the poorest third. Results may be limited by the small number of people with dementia and are generalizable only to people living in the community, not to those in institutional care settings. CONCLUSIONS Our findings suggest a convergence in mental health across cognitive function groups during the pandemic. This suggests mental health services will need to meet an increased demand from older adults, especially those not living with cognitive impairment. Further, with little significant change among those with dementia, their existing need for support will remain; policymakers and care practitioners should ensure this group continues to have equitable access to mental health support.
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Affiliation(s)
- Brian Beach
- Research Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London, United Kingdom
| | - Andrew Steptoe
- Research Department of Behavioural Science & Health, Institute of Epidemiology & Health Care, University College London, London, United Kingdom
| | - Paola Zaninotto
- Research Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London, United Kingdom
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Langlais CS, Chen YH, Van Blarigan EL, Chan JM, Ryan CJ, Zhang L, Borno HT, Newton RU, Luke A, Bang AS, Panchal N, Tenggara I, Schultz B, Lavaki E, Pinto N, Aggarwal R, Friedlander T, Koshkin VS, Harzstark AL, Small EJ, Kenfield SA. Quality of life for men with metastatic castrate-resistant prostate cancer participating in an aerobic and resistance exercise pilot intervention. Urol Oncol 2023; 41:146.e1-146.e11. [PMID: 36528473 DOI: 10.1016/j.urolonc.2022.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Following a prostate cancer diagnosis, disease and treatment-related symptoms may result in diminished quality of life (QoL). Whether exercise improves QoL in men with metastatic castrate-resistant prostate cancer (mCRPC) is not fully understood. METHODS We conducted a 3-arm pilot randomized controlled trial to assess the feasibility, acceptability, safety, and efficacy of a 12-week remotely monitored exercise program among men with mCRPC. Here we report qualitative changes in QoL, consistent with the guidelines for pilot trials. Men were randomized to control, aerobic exercise, or resistance exercise. Exercise prescriptions were based on baseline cardiorespiratory and strength assessments. QoL outcomes were evaluated using self-reported questionnaires (e.g., QLQ-C30, PROMIS Fatigue, Pittsburgh Sleep Quality Index (PSQI), EPIC-26) collected at baseline and 12 weeks. RESULTS A total of 25 men were randomized (10 control, 8 aerobic, 7 resistance). Men were predominately white (76%) with a median age of 71 years (range: 51-84) and 10.5 years (range: 0.9-26.3) post prostate cancer diagnosis. The men reported poor sleep quality and high levels of fatigue at enrollment. Other baseline QoL metrics were relatively high. Compared to the controls at 12 weeks, the resistance arm reported some improvements in social function and urinary irritative/obstruction symptoms while the aerobic arm reported some improvements in social function and urinary incontinence, yet worsening nausea/vomiting. Compared to the resistance arm, the aerobic arm reported worse urinary irritative/obstruction symptoms and self-rated QoL, yet some improvements in emotional function, insomnia, and diarrhea. CONCLUSIONS The 3-month exercise intervention pilot appeared to have modest effects on QoL among mCRPC survivors on ADT. Given the feasibility, acceptability, and safety demonstrated in prior analyses, evaluation of the effect of the intervention on QoL in a larger sample and for extended duration may still be warranted.
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Affiliation(s)
| | | | | | | | | | - Li Zhang
- University of California, San Francisco, CA
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Skiba MB, Harker G, Guidarelli C, El-Gohary M, Horak F, Roeland EJ, Silbermann R, Hayes-Lattin B, Winters-Stone K. Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study. JMIR Cancer 2022; 8:e39271. [PMID: 36480243 PMCID: PMC9782382 DOI: 10.2196/39271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/29/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Wearable sensors could be a simple way to quantify and characterize mobility in patients with hematologic cancer scheduled to receive autologous hematopoietic stem cell transplant (autoHSCT) and how they may be related to common treatment-related symptoms and side effects of induction chemotherapy. OBJECTIVE We aimed to conduct a cross-sectional study comparing mobility in patients scheduled to receive autoHSCT with that in healthy, age-matched adult controls and determine the relationships between patient mobility and chemotherapy-related symptoms. METHODS Patients scheduled to receive autoHSCT (78/156, 50%) and controls (78/156, 50%) completed the prescribed performance tests using wearable inertial sensors to quantify mobility including turning (turn duration and number of steps), gait (gait speed, stride time, stride time variability, double support time, coronal trunk range of motion, heel strike angle, and distance traveled), and balance (coronal sway, coronal range, coronal velocity, coronal centroidal frequency, sagittal sway, sagittal range, sagittal velocity, and sagittal centroidal frequency). Patients completed the validated patient-reported questionnaires to assess symptoms common to chemotherapy: chemotherapy-induced peripheral neuropathy (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale), nausea and pain (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), fatigue (Patient-Reported Outcomes Measurement Information System Fatigue Short Form 8a), vertigo (Vertigo Symptom Scale-short form), and depression (Center for Epidemiological Studies-Depression). Paired, 2-sided t tests were used to compare mobility between patients and controls. Stepwise multivariable linear regression models were used to evaluate associations between patient mobility and symptoms. RESULTS Patients aged 60.3 (SD 10.3) years had significantly worse turning (turn duration; P<.001), gait (gait speed, stride time, stride time variability, double support time, heel strike angle, stride length, and distance traveled; all P<.001), and balance (coronal sway; P<.001, range; P<.001, velocity; P=.02, and frequency; P=.02; and sagittal range; P=.008) than controls. In patients, high nausea was associated with worse stride time variability (ß=.001; P=.005) and heel strike angle (ß=-.088; P=.02). Pain was associated with worse gait speed (ß=-.003; P=.003), stride time variability (ß=.012; P=.02), stride length (ß=-.002; P=.004), and distance traveled (ß=-.786; P=.005). Nausea and pain explained 17% to 33% and 14% to 36% of gait variance measured in patients, respectively. CONCLUSIONS Patients scheduled to receive autoHSCT demonstrated worse mobility in multiple turning, gait, and balance domains compared with controls, potentially related in part to nausea and pain. Wearable inertial sensors used in the clinic setting could provide granular information about mobility before further treatment, which may in turn benefit from rehabilitation or symptom management. Future longitudinal studies are needed to better understand temporal changes in mobility and symptoms across the treatment trajectory to optimally time, design, and implement strategies, to preserve functioning in patients with hematologic cancer in the long term.
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Affiliation(s)
- Meghan B Skiba
- Biobehavioral Health Science Division, College of Nursing, University of Arizona, Tucson, AZ, United States
- The University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
| | - Graham Harker
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Carolyn Guidarelli
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
| | - Mahmoud El-Gohary
- APDM, Inc, a division of Clario International, Portland, OR, United States
| | - Fay Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
- APDM, Inc, a division of Clario International, Portland, OR, United States
| | - Eric J Roeland
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Rebecca Silbermann
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Brandon Hayes-Lattin
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Kerri Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
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Fournier CN, James V, Glass JD. Clinically meaningful change: evaluation of the Rasch-built Overall Amyotrophic Lateral Sclerosis Disability Scale (ROADS) and the ALSFRS-R. Amyotroph Lateral Scler Frontotemporal Degener 2022; 24:311-316. [PMID: 36476010 DOI: 10.1080/21678421.2022.2153607] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate clinically meaningful change for ROADS and ALSFRS-R using a patient-defined approach. METHODS Data were reviewed from participants assessed at the Emory ALS Center from 2019-2022 with two assessments using both ROADS and ALSFRS-R and a completed patient-reported global impression of change scale at the second visit. Minimal important difference (MID), or the smallest amount of change that is clinically relevant, was assessed based on patient reported impression of change for ROADS and ALSFRS-R. Minimal detectable change (MDC), the smallest amount of change exceeding the threshold for measurement error, was assessed for ROADS and ALSFRS-R using standard deviations for participants self-rated as "unchanged". RESULTS Data were included from 162 participants. For ROADS (total possible normed score = 146), MID = 5.81 and MDC = 2.83 points. For ALSFRS-R (total possible sum-score = 48), MID = 3.24 and MDC = 1.59 points. Clinically meaningful decline during the assessment period was observed in 98/162 (60.49%) participants on ROADS and 75/162 (46.30) participants on ALSFRS-R (OR = 1.63, 95% CI [1.0009, 2.66]). CONCLUSIONS Changes that are on average less than 5.81 points (3.98%) on the normed ROADS score or less than 3.24 points (6.75%) on the ALSFRS-R sum-score may not be clinically meaningful according to a patient-defined approach. Understanding the clinical and statistical limitations of these scales is crucial when designing and interpreting ALS research studies.
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Affiliation(s)
- Christina N. Fournier
- Emory University Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA and
- Department of Veterans Affairs, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Virginia James
- Emory University Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA and
- Department of Veterans Affairs, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Jonathan D. Glass
- Emory University Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA and
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Winkeler A, Winkeler M, Imgart H. Infra-Low Frequency Neurofeedback in the Treatment of Patients With Chronic Eating Disorder and Comorbid Post-Traumatic Stress Disorder. Front Hum Neurosci 2022; 16:890682. [PMID: 35601900 PMCID: PMC9121895 DOI: 10.3389/fnhum.2022.890682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022] Open
Abstract
The treatment of patients suffering from an eating disorder and a comorbid post-traumatic stress disorder is challenging and often leads to poor outcomes. In a randomized control trial, we evaluated to what extent adding Infra-Low Frequency (ILF) neurofeedback could improve symptom reduction within an established inpatient treatment program. In a randomized two-group design, patients suffering from an eating disorder (anorexia nervosa, bulimia nervosa, or binge eating disorder) and comorbid post-traumatic stress disorder (N = 36) were examined while attending an inpatient treatment program in a clinic for psychosomatic disorders. The intervention group received ILF neurofeedback in addition to regular therapy, while the control group received “media-supported relaxation” as a placebo intervention. At the beginning and at the end of their treatment, all participants completed the Eating Disorder Examination-Questionnaire (EDE-Q) as a measure of eating disorder psychopathology and the Impact of Event Scale-Revised (IES-R) in order to assess symptoms of post-traumatic stress. Changes in EDE-Q and IES-R scores over time served as primary outcomes as well as an increase in body mass index in underweight patients. Secondary outcomes were the perceived benefit of the received intervention, global assessment of psychological treatment success, and complications in the course of treatment. Statistical evaluation was carried out with repeated measurement analysis of variance for the primary outcomes and with t-tests and Fisher’s exact test for the secondary outcomes. Our results indicate better treatment outcomes in the ILF neurofeedback group with regard to trauma-associated avoidance as well as with regard to restraint eating and increase in body weight. Furthermore, patients who had received ILF neurofeedback rated the intervention they received and, in tendency, their overall treatment more positively and they experienced fewer complications in the course of treatment. ILF neurofeedback is very well accepted by patients and seems to provide a relevant additional benefit in some aspects of symptom reduction. Findings confirm the feasibility of embedding this treatment approach in an inpatient setting and support the case for a larger study for greater statistical power. Clinical Trial Registration: “Infra-Low Frequency Neurofeedback training in the treatment of patients with eating disorder and comorbid post-traumatic stress disorder”; German Clinical Trials Registry (https://www.drks.de; Identifier: DRKS00027826).
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Jiskoot G, van der Kooi AL, Busschbach J, Laven J, Beerthuizen A. Cognitive behavioural therapy for depression in women with Polycystic Ovary Syndrome (PCOS): systematic review and meta-analysis. Reprod Biomed Online 2022; 45:599-607. [DOI: 10.1016/j.rbmo.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/21/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
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