The Effectiveness of Fluidotherapy in Poststroke Complex Regional Pain Syndrome: A Randomized Controlled Study

Objective: To evaluate whether combining fluidotherapy to conventional rehabilitation program provides additional improvements on pain severity, upper extremity functions, and edema volume in patients with poststroke complex regional pain syndrome (CRPS). Design: Randomized controlled trial. Setting: Training and research hospital. Participants: Thirty hemiplegic patients with subacute stage CRPS type-1 of the upper extremity. Interventions: The patients randomly divided into 2 groups. Both groups received a 3 week conventional rehabilitation program (5 days/week, 2-4 hours/day). Experimental group received 15 sessions additional fluidotherapy application to the affected upper extremity (40 °C, 20 minutes in continuous mode, 5 sessions/week). Main Outcome Measures: We evaluated the distal upper arm edema with a volumeter. Other used clinical assessment scales were Brunnstrom recovery stages of the arm and hand for motor recovery, motor items of the functional independence measure for functional status, visual analog scale for pain severity, and the painDETECT questionnaire for presence and the severity of neuropathic pain. Results: The mean age of the participants was 64.3 ± 11.66 (28-84). At the post-treatment evaluation, significant improvements were revealed regarding to the edema volume, pain visual analog scale, painDETECT and functional independence measure scores, and the Brunnstrom stages of upper extremity and hand in both groups (P < .05). But among the parameters mentioned above, only the decrease in edema volume and the painDETECT scores were greater in fluidotherapy group than the control group (P < .05). Conclusions: Addition of the fluidotherapy to the conventional rehabilitation program provides better improvements on neuropathic pain and edema volume in subacute stage poststroke CRPS.     

Perceived stress mediates the relationship between mindfulness and negative affect variability: A randomized controlled trial among middle‐aged to older adults

Despite the interest in mindfulness over the past 20 years, studies have only recently begun to examine mindfulness in older adults. The primary aim of this study was to evaluate pretreatment to post‐treatment change in negative affect variability (NAV) following a mindfulness training among 134 mildly stressed, middle‐aged to older adults. The secondary aim was to assess if the effects of mindfulness training on NAV would be partially explained by pretreatment to post‐treatment reductions in perceived stress, a trend that would be congruent with several stress models. In this randomized control trial, participants were assigned to either a 6‐week mindfulness meditation training programme or to a wait list control. Ecological momentary assessment, a data capturing technique that queries about present moment experiences in real time, captured NAV. Mixed‐model ANOVAs and a path analysis were conducted. Participants in the mindfulness meditation training significantly reduced NAV when compared with wait list control participants. Further, there was a significant indirect group effect on reductions in NAV through change in perceived stress. Few studies have tested mechanisms of action, which connect changes that occur during mindfulness training with psychological outcomes in older adults. Understanding the mechanisms by which mindfulness enhances well‐being may optimize interventions.     

Assessing sleep architecture in dementia caregivers at home using an ambulatory polysomnographic system

Findings from previous research assessing sleep quality in caregivers are inconsistent due to differences in sleep assessment methods. This study evaluated sleep in dementia caregivers using a comprehensive sleep assessment utilizing an ambulatory polysomnography (PSG) device. A total of 20 caregivers and 20 noncaregivers rated their perceived sleep quality, stress, and depressive symptoms; provided samples of cortisol and inflammatory biomarkers; and completed an objective sleep assessment using a portable PSG device. Caregivers reported greater perceived stress than noncaregivers. Next, the groups had different sleep architecture: caregivers spent less proportion of their sleep in restorative sleep stages compared to noncaregivers. Further, levels of C-reactive protein and awakening salivary cortisol were greater in caregivers than in noncaregivers, and these measures were related to sleep quality. Our findings indicate that sleep disruption is a significant concomitant of caregiving and may affect caregiver's health. Sleep quality of caregivers might be a useful target for a clinical intervention.     

Associations of physical activity and inactivity before and during pregnancy with glucose tolerance

OBJECTIVE: To investigate associations of physical activity and television viewing before and during pregnancy with risk of gestational diabetes mellitus (GDM) and abnormal glucose tolerance, the combination of GDM with less severe impaired glucose tolerance. METHODS: We assessed duration and intensity of physical activity and time spent viewing television both before and during pregnancy among 1,805 women enrolled in Project Viva, a cohort study in eastern Massachusetts. We identified 1,493 (83%) women with normal glucose tolerance and 312 (17%) with abnormal glucose tolerance, including 91 (5%) with GDM based on clinical glucose tolerance test results. RESULTS: After adjustment for age, race or ethnicity, history of GDM, family history of diabetes, and prepregnancy body mass index, our data suggest that women who engaged in any vigorous physical activity in the year before pregnancy experienced a reduced risk of GDM (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.33-0.95) and abnormal glucose tolerance (OR 0.76, 95% CI 0.57-1.00). Women who reported vigorous activity before pregnancy and light-to-moderate or vigorous activity during pregnancy appeared to have a lower risk of both GDM (OR 0.49, 95% CI 0.24-1.01) and abnormal glucose tolerance (OR 0.70, 95% CI 0.49-1.01) compared with women reporting these activities in neither time period. Walking and total physical activity provided modest benefits. We observed no association of television viewing before or during pregnancy with risk of GDM or abnormal glucose tolerance. CONCLUSION: Physical activity, especially vigorous activity before pregnancy and at least light-to-moderate activity during pregnancy, may reduce risk for abnormal glucose tolerance and GDM. LEVEL OF EVIDENCE: II-2.     

Fish consumption, methylmercury and child neurodevelopment

PURPOSE OF REVIEW: To summarize recent evidence regarding associations of early life exposure to mercury from maternal fish consumption during pregnancy, thimerosal in vaccines and dental amalgam with child neurodevelopment. RECENT FINDINGS: Recent publications have built upon previous evidence demonstrating mild detrimental neurocognitive effects from prenatal methylmercury exposure from maternal fish consumption during pregnancy. New studies examining the effects of prenatal fish consumption as well as methylmercury suggest there are benefits from prenatal fish consumption, but also that consumption of fish high in mercury should be avoided. Future studies incorporating information on both the methylmercury and the docosahexaenoic acid contained within fish will help to refine recommendations to optimize outcomes for mothers and children. Additional recent studies have supported the safety of vaccines containing thimerosal and of dental amalgam for repair of dental caries in children. SUMMARY: Exposure to mercury may harm child development. Interventions intended to reduce exposure to low levels of mercury in early life must, however, be carefully evaluated in consideration of the potential attendant harm from resultant behavior changes, such as reduced docosahexaenoic acid exposure from lower seafood intake, reduced uptake of childhood vaccinations and suboptimal dental care.