Vitamin E and memantine in Alzheimer's disease: Clinical trial methods and baseline data

BackgroundAlzheimer's disease (AD) has been associated with both oxidative stress and excessive glutamate activity. A clinical trial was designed to compare the effectiveness of (i) alpha-tocopherol, a vitamin E antioxidant; (ii) memantine (Namenda), an N-methyl-D-aspartate antagonist; (iii) their combination; and (iv) placebo in delaying clinical progression in AD.MethodsThe Veterans Affairs Cooperative Studies Program initiated a multicenter, randomized, double-blind, placebo-controlled trial in August 2007, with enrollment through March 2012 and follow-up continuing through September 2012. Participants with mild-to-moderate AD who were taking an acetylcholinesterase inhibitor were assigned randomly to 2000 IU/day of alpha-tocopherol, 20 mg/day memantine, 2000 IU/day alpha-tocopherol plus 20 mg/day memantine, or placebo. The primary outcome for the study is the Alzheimer's Disease Cooperative Study/Activities of Daily Living Inventory. Secondary outcome measures include the Mini-Mental State Examination; the Alzheimer's Disease Assessment Scale, cognitive portion; the Dependence Scale; the Neuropsychiatric Inventory; and the Caregiver Activity Survey. Patient follow-up ranged from 6 months to 4 years.ResultsA total of 613 participants were randomized. The majority of the patients were male (97%) and white (86%), with a mean age of 79 years. The mean Alzheimer's Disease Cooperative Study/Activities of Daily Living Inventory score at entry was 57 and the mean Mini-Mental State Examination score at entry was 21.ConclusionThis large multicenter trial will address the unanswered question of the long-term safety and effectiveness of alpha-tocopherol, memantine, and their combination in patients with mild-to-moderate AD taking an acetylcholinesterase inhibitor. The results are expected in early 2013.     

Test-retest reliability of stability outcome measures during treadmill walking in patients with balance problems and healthy controls

BackgroundImprovement of balance control is an important rehabilitation goal for patients with motor and sensory impairments. To quantify balance control during walking, various stability outcome measures have described differences between healthy controls and patient groups with balance problems. To be useful for the evaluation of interventions or monitoring of individual patients, stability outcome measures need to be reliable.Research questionWhat is the test-retest reliability of six stability outcome measures during gait?MethodsPatients with balance problems (n = 45) and healthy controls (n = 20) performed two times a two-minute walk test (2MWT). The intraclass correlation coefficient (ICC) and Bland-Altman analysis (coefficient of repeatability; CR) were used to evaluate the test-retest reliability of six stability outcome measures: dynamic stability margin (DSM), margin of stability (MoS), distance between the extrapolated centre of mass (XCoM) and centre of pressure (CoP) in anterior-posterior (XCoM-CoP_AP) and medial-lateral (XCoM-CoP_ML) direction, and inclination angle between centre of mass (CoM) and CoP in anterior-posterior (CoM-CoP_AP-angle) and medial-lateral (CoM-CoP_ML-angle) direction. A two way mixed ANOVA was performed to reveal measurement- and group-effects.ResultsThe ICCs of all stability outcome measures ranged between 0.51 and 0.97. Significant differences between the measurements were found for the DSM (p = 0.017), XCoM-CoP_AP (p = 0.008) and CoM-CoP_AP-angle (p = 0.001). Significant differences between controls and patients were found for all stability outcome measures (p < 0.01) except for the MoS (p = 0.32). For the XCoM-CoP distances and CoM-CoP angles, the CRs were smaller than the difference between patients and controls.SignificanceBased on the ICCs, the reliability of all stability outcome measures was moderate to excellent. Since the XCoM-CoP_ML and CoM-CoP_ML-angle showed no differences between the measurements and smaller CRs than the differences between patients and controls, the XCoM-CoP_ML and CoM-CoP_ML-angle seem the most promising stability outcome measures to evaluate interventions and monitor individual patients.     

Acute effect of engineered thermoplastic polyurethane elastomer knockoff running footwear on foot loading and comfort during heel-to-toe running

BackgroundBetter midsole materials and comfort have been incorporated into more expensive shoes and are popular with runners. Consequently, knockoff running shoes are currently widely distributed in the Chinese market and and cost only 30%–50% of the total price of genuine branded products.Research questionUncertainty exists concerning the beneficial effects of advanced shoe material application in decreasing foot loading or impact force during running. Additionally, using comfort as a criterion to identify genuine branded running shoes may exclude brand factor.MethodsFifteen healthy male volunteers were asked to perform two different tests, including running and a comfort evaluation. Each participant was asked to identify which footwear was the Adidas brand shoe based on their perception of comfort.ResultsTime to the first peak of the vertical ground reaction force occurred significantly later when subjects wore the genuine branded shoe compared to knockoff shoe 1 (p = 0.003) and knockoff shoe 2 (p = 0.015) footwea. The genuine branded shoe (p = 0.005) and knockoff shoe 1 (p = 0.029) were significantly more comfortable compared to the knockoff shoe 2. Only four subjects selected the genuine branded shoe, whereas six subjects selected both the genuine branded shoe and knockoff shoe 1.SignificanceKnockoff running footwear significantly increases impact loading compared to the genuine branded product, thereby posing greater risk of running injury.     

Cancer incidence due to excess body weight and leisure-time physical inactivity in Canada: Implications for prevention

ObjectiveThis analysis aimed to estimate the number of incident cases of various cancers attributable to excess body weight (overweight, obesity) and leisure-time physical inactivity annually in Canada.MethodsThe number of attributable cancers was estimated using the population attributable fraction (PAF), risk estimates from recent meta-analyses and population exposure prevalence estimates obtained from the Canadian Community Health Survey (2000). Age–sex-site-specific cancer incidence was obtained from Statistics Canada tables for the most up-to-date year with full national data, 2007. Where the evidence for association has been deemed sufficient, we estimated the number of incident cases of the following cancers attributable to obesity: colon, breast, endometrium, esophagus (adenocarcinomas), gallbladder, pancreas and kidney; and to physical inactivity: colon, breast, endometrium, prostate, lung and/or bronchus, and ovarian.ResultsOverall, estimates of all cancer incidence in 2007 suggest that at least 3.5% (n = 5771) and 7.9% (n = 12,885) are attributed to excess body weight and physical inactivity respectively. For both risk factors the burden of disease was greater among women than among men.ConclusionThousands of incident cases of cancer could be prevented annually in Canada as good evidence exists for effective interventions to reduce these risk factors in the population.     

Learning from the lived experience of functionally healthy older adults: What does it mean to be “healthy”?

BackgroundReports of older adults’ perceptions of ageing and health generally do not consider individual health status, instead presenting large cohort data or focussing on specific population groups. Moreover, qualitative studies have largely included participants with suboptimal health.AimThis study aimed to examine functionally healthy older adults’ perceptions of health and healthy ageing.MethodTwenty-two functionally healthy older adults living independently in the community (aged 61–83 years; 68% female) participated in six focus groups to explore their perceptions about “health” and “healthy ageing”. Quantitative measures were used to describe participants’ health status.FindingsSeven themes describing participants’ experiences of healthy ageing were identified: “know thyself”, “knowledge and information management”, “choices, agency, and control”, “autonomy and flexibility”, “being strategic”, “community connections”, and “getting more out of life”. Key competencies for healthy ageing were subsequently derived, drawing connections between beliefs, behaviours, and knowledge about healthy ageing.DiscussionThe identified health behaviours perceived to be important for healthy ageing align with previous reports. The subsequent overarching healthy-ageing competencies (“recognise opportunity”, “strategise”, “maximise benefits”, and “active participation”) present important pillars underpinning the process of healthy ageing that have not been previously considered in this context.ConclusionThe behaviours perceived to influence older adults’ health are varied, and the competencies identified in this study present a broad framework underpinning these behaviours. The identified competencies have the potential to inform public health initiatives, practice, and policy, empowering individuals to optimise their health.     

Executive function and attention in young adults with and without Developmental Coordination Disorder – A comparative study

The current research aimed at examining the executive function (EF) of young adults with Developmental Coordination Disorder (DCD) in comparison to young adults without DCD. The study used a randomized cohort (N = 429) of young adults with DCD (n = 135), borderline DCD (n = 149) and control (n = 145), from a previous study. This initial cohort was asked to participate in the current study three to four years later. Twenty-five individuals with DCD (mean age = 24 years, 1 month [SD = 0.88]; 18 males), 30 with borderline DCD (mean age = 24 years, 2 month [SD = 0.98]; 18 males) and 41 without DCD (mean age = 25 years, 2 months [SD = 1.91]; 20 males) participated in this study. Participants completed the BRIEF-A questionnaire, assessing EF abilities and the WURS questionnaire, assessing attention abilities. The DCD and borderline DCD groups had significantly lower EF profiles in comparison with the control group but no significant differences were found between the DCD and borderline DCD groups. While a high percentage of attention problems were found in both DCD groups, the executive functioning profiles remained consistent even when using the attention component as a covariate. The study results suggest that young adults with DCD have EF problems which remain consistent with or without attention difficulties.     

Fatigue in Peritoneal Dialysis Patients and an Exploration of Contributing Factors: A Cross-Sectional Study

ContextFatigue is a common and detrimental symptom in dialysis patients; however, our understanding of it and investigation of its contributing factors is still very limited, especially in peritoneal dialysis (PD) patients.ObjectivesTo assess fatigue in PD patients and identify contributing factors.MethodsOne hundred eight PD patients in a comprehensive hospital in China were recruited. The fatigue severity of the participants was assessed using the Chalder Fatigue Scale 11. Demographic factors and results of physiological tests were collected. Quality of sleep, mental health, and social support were assessed with the Pittsburgh Sleep Quality Index, Symptom Checklist 90, and Social Support Rating Scale, respectively. Multiple linear regression models were conducted with candidate variables with a P-value of less than 0.1 on univariate analysis and variables that were clinically relevant to identify contributing factors for fatigue.ResultsThe fatigue level in PD patients was significantly higher than the community population, and 78.7% of them were suffering from fatigue. The factors that were significantly associated with fatigue were quality of sleep, normalized protein nitrogen appearance, transferrin, alkaline phosphatase, and total cholesterol (adjusted R squared 0.86). Among them, quality of sleep, transferrin, alkaline phosphatase, and total cholesterol were significant contributors for physical fatigue, whereas the quality of sleep and normalized protein nitrogen appearance were contributing factors for mental fatigue.ConclusionFatigue is a common symptom in PD patients, suggesting that increased awareness of this symptom is required. The identification of correlates by extensive exploration of multidimensional factors in this study may help practitioners to identify patients at higher risk and to develop a multidimensional and targeted intervention plan.     

Safety,Effectiveness, and Uptake of Exercise Medicine Integrated Within a Cancer Care Center

ObjectivesThe aim of this study was to evaluate the safety, effectiveness, and acceptability of an exercise clinic co-located within a cancer treatment center to identify best practices for integrating exercise medicine into cancer care.Data SourcesTwo-hundred thirty-seven patients were referred to the exercise clinic and completed self-report health and demographic questionnaires. Further assessments were conducted at baseline on 67 patients and following completion of the exercise program by 46 patients. Endpoints included muscular strength, physical function, cardiorespiratory fitness, body composition, quality of life, and fatigue scores. Adverse events were tracked throughout exercise participation to evaluate program safety.ConclusionExercise programming co-located and aligned with cancer treatment in a real-world clinical setting appears to be safe with only four minor exercise-related adverse events. Effectiveness was demonstrated by all physical performance (2.9%–9.5%), strength (7.4%–27.6%), and balance (10.1%) improving and some patients reported outcomes exhibiting modest but clinically relevant benefit. Importantly, no outcomes including fatigue worsened even though the patients were undergoing radiation and/or chemotherapy. Assessment of patient physical and self-reported outcomes should be co-located where they receive oncological treatment and/or exercise medicine to increase uptake of this aspect of the service. Future work should incorporate and describe program and implementation design to help identify best practices in exercise oncology programming.Implications for Nursing PracticeNurses are a primary driver of exercise among patients receiving treatment for cancer. Their regular patient interactions offer a practical opportunity to collect and record important exercise-related information from patients. As organizations look to develop plans to implement exercise into standard practice, input from nurses is critical to ensure program feasibility.