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PloS One 2023Circadian rhythms (CR) regulate daily cycles in behavior, physiology and molecular processes. CRs are endogenous and vary across individuals. Seasonal changes can...
INTRODUCTION
Circadian rhythms (CR) regulate daily cycles in behavior, physiology and molecular processes. CRs are endogenous and vary across individuals. Seasonal changes can influence CR. Accordingly, rhythms with different characteristics (amplitude, phase) are depicted during the summer months, as compared to winter. Increasing evidence points to an influence of circadian regulation on physical performance. Here, we aim to obtain a comprehensive circadian gene expression profile for physically active individuals, which can potentially be used for the identification of optimal time intervals for physical exercise.
METHODS AND ANALYSIS
To explore these different aspects, we propose a study where we will carry out a molecular analysis of CR by measuring the expression of specific clock and clock-controlled genes, based on a non-invasive approach using RNA extracted from saliva in physically active, healthy participants. We will collect data across two seasons and use computational algorithms to integrate the molecular data with hormonal data (cortisol and melatonin), and generate a profile of CR in healthy individuals of different sex and age groups. Finally, we will use computational tools to predict optimal time intervals for physical performance based on the above-described data, thereby retrieving valuable data on the circadian clock as a key factor for health maintenance and optimization.
Topics: Humans; Circadian Clocks; Prospective Studies; Circadian Rhythm; Melatonin; Physical Examination
PubMed: 37874792
DOI: 10.1371/journal.pone.0293226 -
BMC Medical Education Dec 2018Physicians in training must achieve a high degree of proficiency in performing physical examinations and must strive to become experts in the field. Concerns are...
BACKGROUND
Physicians in training must achieve a high degree of proficiency in performing physical examinations and must strive to become experts in the field. Concerns are emerging about physicians' abilities to perform these basic skills, essential for clinical decision making. Learning at the bedside has the potential to support skill acquisition through deliberate practice. Previous skills improvement programs, targeted at teaching physical examinations, have been successful at increasing the frequency of performing and teaching physical examinations. It remains unclear what barriers might persist after such program implementation. This study explores residents' and physicians' perceptions of physical examinations teaching at the bedside following the implementation of a new structured bedside curriculum: What are the potentially persisting barriers and proposed solutions for improvement?
METHODS
The study used a constructivist approach using a qualitative inductive thematic analysis that was oriented to construct an understanding of the barriers and facilitators of physical examination teaching in the context of a new bedside curriculum. Participants took part in individual interviews and subsequently focus groups. Transcripts were coded and themes were identified.
RESULTS
Data analyses yielded three main themes: (1) the culture of teaching physical examination at the bedside is shaped and threatened by the lack of hospital support, physicians' motivation and expertise, residents' attitudes and dependence on technology, (2) the hospital environment makes bedside teaching difficult because of its chaotic nature, time constraints and conflicting responsibilities, and finally (3) structured physical examination curricula create missed opportunities in being restrictive and pose difficulties in identifying patients with findings.
CONCLUSIONS
Despite the implementation of a structured bedside curriculum for physical examination teaching, our study suggests that cultural, environmental and curriculum-related barriers remain important issues to be addressed. Institutions wishing to develop and implement similar bedside curricula should prioritize recruitment of expert clinical teachers, recognizing their time and efforts. Teaching should be delivered in a protected environment, away from clinical duties, and with patients with real findings. Physicians must value teaching and learning of physical examination skills, with multiple hands-on opportunities for direct role modeling, coaching, observation and deliberate practice. Ideally, clinical teachers should master the art of combining both patient care and educational activities.
Topics: Adult; Attitude of Health Personnel; Clinical Competence; Curriculum; Education, Medical, Graduate; Female; Focus Groups; Humans; Internship and Residency; Male; Physical Examination; Point-of-Care Testing; Qualitative Research
PubMed: 30537960
DOI: 10.1186/s12909-018-1403-z -
American Family Physician Feb 2006Preterm premature rupture of membranes is the rupture of membranes during pregnancy before 37 weeks' gestation. It occurs in 3 percent of pregnancies and is the cause of... (Review)
Review
Preterm premature rupture of membranes is the rupture of membranes during pregnancy before 37 weeks' gestation. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death. Appropriate evaluation and management are important for improving neonatal outcomes. Speculum examination to determine cervical dilation is preferred because digital examination is associated with a decreased latent period and with the potential for adverse sequelae. Treatment varies depending on gestational age and includes consideration of delivery when rupture of membranes occurs at or after 34 weeks' gestation. Corticosteroids can reduce many neonatal complications, particularly intraventricular hemorrhage and respiratory distress syndrome, and antibiotics are effective for increasing the latency period.
Topics: Algorithms; Anti-Bacterial Agents; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Physical Examination; Pregnancy; Risk Factors
PubMed: 16506709
DOI: No ID Found -
Journal of General Internal Medicine Feb 2020How physical and mental health status relate to receipt of opioid prescription remains unclear, creating uncertainty in minimizing opioid harms while avoiding pain... (Observational Study)
Observational Study
BACKGROUND
How physical and mental health status relate to receipt of opioid prescription remains unclear, creating uncertainty in minimizing opioid harms while avoiding pain under-treatment.
OBJECTIVE
To examine the associations of physical and mental health status with subsequent opioid prescriptions.
DESIGN
Observational study of 2005-2015 United States (U.S.) Medical Expenditure Panel Survey data.
PARTICIPANTS
Adult respondents (N = 78,563) participating for 2 years. The analyses focused on respondents reporting no opioid prescriptions in year 1 (N = 65,249).
MAIN MEASURES
In the primary analysis, a negative binomial regression yielding adjusted incidence rate ratios (IRRs), the dependent variable was the number of opioid prescriptions in year 2. In two secondary analyses, both logistic regressions yielding adjusted odds ratios (ORs), the dependent variables were receipt of any opioid prescription (versus none) and receipt of ≥ 6 opioid prescriptions (versus 0-5) in year 2. The key independent variables in all analyses were the SF-12 Physical and Mental Component Summary scores (PCS-12 and MCS-12, respectively; higher scores = better health status). All models adjusted for socio-demographics, health-related variables, and year.
KEY RESULTS
Primary analysis. With each 10-point decrement in year 1 PCS-12 or MCS-12 score, there were more opioid prescriptions received in year 2 (adjusted IRRs [95% CIs] 1.45 [1.39-1.52] and 1.22 [1.16-1.27], respectively). Secondary analyses. With each 10-point decrement in year 1 PCS-12 or MCS-12 score, there were higher odds in year 2 both of receiving any opioid prescription (adjusted ORs 1.23 [1.19-1.28] and 1.11 [1.08-1.15], respectively) and of receiving ≥ 6 opioid prescriptions (adjusted ORs 1.96 [1.75-2.17] and 1.37 [1.23-1.54], respectively).
CONCLUSIONS
In a nationally representative U.S. sample, both poorer physical and mental health status independently predicted receiving more opioid prescriptions received in a subsequent year, as well as receiving ≥ 6 prescriptions during the year. Our findings may contribute to a more nuanced picture of the drivers of opioid prescription.
Topics: Adult; Analgesics, Opioid; Drug Prescriptions; Health Expenditures; Health Status; Humans; Physical Examination; Prescriptions; United States
PubMed: 31637645
DOI: 10.1007/s11606-019-05401-z -
Journal of Neurophysiology Oct 2021Motorized assessment of the stretch reflex is instrumental to gain understanding of the stretch reflex, its physiological origin and to differentiate effects of...
Motorized assessment of the stretch reflex is instrumental to gain understanding of the stretch reflex, its physiological origin and to differentiate effects of neurological disorders, like spasticity. Both short-latency (M1) and medium-latency (M2) stretch reflexes have been reported to depend on the velocity and acceleration of an applied ramp-and-hold perturbation. In the upper limb, M2 has also been reported to depend on stretch duration. However, wrong conclusions might have been drawn in previous studies as the interdependence of perturbation parameters (amplitude, duration, velocity, and acceleration) possibly created uncontrolled, confounding effects. We disentangled the duration-, velocity-, and acceleration-dependence and their interactions of the M1 and M2 stretch reflex in the ankle plantarflexors. To disentangle the parameter interdependence, 49 unique ramp-and-hold joint perturbations elicited reflexes in 10 healthy volunteers during a torque control task. Linear mixed model analysis showed that M1 depended on acceleration, not velocity or duration, whereas M2 depended on acceleration, velocity, and duration. Simulations of the muscle spindle Ia afferents coupled to a motoneuron pool corroborated these experimental findings. In addition, this simulation model did show a nonlinear M1 velocity- and duration-dependence for perturbation parameters outside the experimental scope. In conclusion, motorized assessment of the stretch reflex or spasticity using ramp-and-hold perturbations should be systematically executed and reported. Our systematic motorized and simulation assessments showed that M1 and M2 depend on acceleration, velocity, and duration of the applied perturbation. The simulation model suggested that these dependencies emerge from: muscle-tendon unit and muscle cross-bridge dynamics, Ia sensitivity to force and yank, and motoneuron synchronization. Previous research and definitions of the stretch reflex and spasticity have focused on velocity-dependence. We showed that perturbation acceleration, velocity, and duration all shape the M1 and M2 response, often via nonlinear or interacting dependencies. Consequently, systematic execution and reporting of stretch reflex and spasticity studies, avoiding uncontrolled parameter interdependence, is essential for proper understanding of the reflex neurophysiology.
Topics: Adult; Ankle; Biomechanical Phenomena; Female; Humans; Male; Muscle, Skeletal; Reflex, Stretch; Young Adult
PubMed: 34406875
DOI: 10.1152/jn.00704.2020 -
California Medicine Jun 1949Neck and shoulder pains are presenting or incidental symptoms in a large variety of conditions. There may be similarities in the anatomicophysiological mechanism of pain...
Neck and shoulder pains are presenting or incidental symptoms in a large variety of conditions. There may be similarities in the anatomicophysiological mechanism of pain production and in the clinical picture in many of these conditions. Many of the vague and refractory cases of neck and shoulder pain and of migraine may be due to cervical disc disease. Scalenus anticus syndrome and cardiac disease can be diagnosed or differentiated from cervical disc syndrome only by thorough investigation. Proper treatment of neck and shoulder pain is dependent upon correct diagnosis through complete history, physical examination and laboratory tests, as described in this presentation.
Topics: Cervical Vertebrae; Disease; Humans; Intervertebral Disc; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Migraine Disorders; Neck; Pain; Physical Examination; Shoulder; Shoulder Pain; Spinal Diseases; Thoracic Outlet Syndrome
PubMed: 18131684
DOI: No ID Found -
Gait & Posture Mar 2022Walking speed predicts many clinical outcomes in old age. However, a comprehensive assessment of how walking speed affects accelerometer based quantitative and...
BACKGROUND
Walking speed predicts many clinical outcomes in old age. However, a comprehensive assessment of how walking speed affects accelerometer based quantitative and qualitative gait measures in younger and older adults is lacking.
RESEARCH QUESTION
What is the relationship between walking speed and quantitative and qualitative gait outcomes in younger and older adults?
METHODS
Younger (n = 27, age: 21.6) and older participants (n = 27, age: 69.5) completed 340 steps on a treadmill at speeds of 0.70 to a maximum of 1.75 m·s. We used generalized additive mixed models to determine the relationship between walking speed and quantitative (stride length, stride time, stride frequency and their variability) and qualitative (stride regularity, stability, smoothness, symmetry, synchronization, predictability) gait measures extracted from trunk accelerations.
RESULTS
The type of relationship between walking speed and the majority of gait measures (quantitative and qualitative) was characterized as logarithmic, with more prominent speed-effects at speeds below 1.20 m·s. Changes in quantitative measures included shorter strides, longer stride times, and a lower stride frequency, with more variability at lower speeds independent of age. For qualitative measures, we found a decrease in gait symmetry, stability and regularity in all directions with decreasing speeds, a decrease in gait predictability (Vertical, V, anterior-posterior, AP) and stronger gait synchronization (AP-mediolateral, ML, AP-V), and direction dependent effects of gait smoothness, which decreased in V direction, but increased in AP and ML directions with decreasing speeds. We found outcome-dependent effects of age on the quantitative and qualitative gait measures, with either no differences between age-groups, age-related differences that existed regardless of speed, and age-related differences in the type of relationship with walking speed.
SIGNIFICANCE
The relationship between walking speed and quantitative and qualitative gait measures, and the effects of age on this relationship, depends on the type of gait measure studied.
Topics: Acceleration; Adult; Aged; Gait; Humans; Torso; Walking; Walking Speed; Young Adult
PubMed: 35063756
DOI: 10.1016/j.gaitpost.2022.01.001 -
PloS One 2015To assess the directionality of the association between physical and cognitive decline in later life, we compared patterns of decline in performance across groups...
To assess the directionality of the association between physical and cognitive decline in later life, we compared patterns of decline in performance across groups defined by baseline presence of cognitive and/or physical impairment [none (n = 217); physical only (n = 169); cognitive only (n = 158), or both (n = 220)] in a large sample of participants in a cognitive aging study at the Knight Alzheimer's Disease Research Center at Washington University in St. Louis who were followed for up to 8 years (3,079 observations). Rates of decline reached 20% for physical performance and varied across cognitive tests (global, memory, speed, executive function, and visuospatial skills). We found that physical decline was better predicted by baseline cognitive impairment (slope = -1.22, p<0.001), with baseline physical impairment not contributing to further decline in physical performance (slope = -0.25, p = 0.294). In turn, baseline physical impairment was only marginally associated with rate of cognitive decline across various cognitive domains. The cognitive-functional association is likely to operate in the direction of cognitive impairment to physical decline although physical impairment may also play a role in cognitive decline/dementia. Interventions to prevent further functional decline and development of disability and complete dependence may benefit if targeted to individuals with cognitive impairment who are at increased risk.
Topics: Aged; Aged, 80 and over; Aging; Alzheimer Disease; Cognition; Cognition Disorders; Dementia; Female; Humans; Male; Memory; Middle Aged; Neuropsychological Tests; Physical Examination
PubMed: 25875165
DOI: 10.1371/journal.pone.0122878 -
Health and Quality of Life Outcomes May 2011The purpose of this study was to identify predictors of 3-month mortality in critically ill older persons under medical care and to assess the clinical impact of an ICU...
BACKGROUND
The purpose of this study was to identify predictors of 3-month mortality in critically ill older persons under medical care and to assess the clinical impact of an ICU stay on physical and cognitive dependence and subjective health status in survivors.
METHODS
We conducted a prospective observational cohort study including all older persons 75 years and older consecutively admitted into ICU during a one-year period, except those admitted after cardiac arrest, All patients were followed for 3 months or until death. Comorbidities were assessed using the Charlson index and physical dependence was evaluated using the Katz index of Activity of Daily Living (ADL). Cognitive dependence was determined by a score based on the individual components of the Lawton index of Daily Living and subjective health status was evaluated using the Nottingham Health Profile (NHP) score.
RESULTS
One hundred patients were included in the analysis. The mean age was 79.3 ± 3.4 years. The median Charlson index was 6 [IQR, 4 to 7] and the mean ADL and cognitive scores were 5.4 ± 1.1 and 1.2 ± 1.4, respectively, corresponding to a population with a high level of comorbidities but low physical and cognitive dependence. Mortality was 61/100 (61%) at 3 months. In multivariate analysis only comorbidities assessed by the Charlson index [Adjusted Odds Ratio, 1.6; 95% CI, 1.2-2.2; p < 0.003] and the number of organ failures assessed by the SOFA score [Adjusted Odds Ratio, 2.5; 95% CI, 1.1-5.2; p < 0.02] were independently associated with 3-month mortality. All 22 patients needing renal support after Day 3 died. Compared with pre-admission, physical (p = 0.04), and cognitive (p = 0.62) dependence in survivors had changed very little at 3 months. In addition, the mean NHP score was 213.1 ± 132.8 at 3 months, suggesting an acceptable perception of their quality of life.
CONCLUSIONS
In a selected population of non surgical patients 75 years and older, admission into the ICU is associated with a 3-month survival rate of 38% with little impact on physical and cognitive dependence and subjective health status. Nevertheless, a high comorbidity level (ie, Charlson index), multi-organ failure, and the need for extra-renal support at the early phase of intensive care could be considered as predictors of death.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Cognition; Comorbidity; Critical Care; Critical Illness; Dependency, Psychological; Female; Follow-Up Studies; Forecasting; Health Status; Humans; Intensive Care Units; Length of Stay; Male; Prospective Studies; Quality of Life; Risk Factors; Survivors
PubMed: 21575208
DOI: 10.1186/1477-7525-9-35 -
The Journal of Nutrition, Health & Aging 2021During aging, loss of muscle strength (dynapenia) combined with unhealthy lifestyles and sedentarism can lead to functional limitations and dependency; currently there...
BACKGROUND
During aging, loss of muscle strength (dynapenia) combined with unhealthy lifestyles and sedentarism can lead to functional limitations and dependency; currently there is still limited evidence about multicomponent training as a treatment for dynapenia and dependence in ambulatory older women.
OBJECTIVE
To evaluate the effect of a multicomponent physical exercise program (VIVIFRAIL) on physical functionality in elderly ambulatory women with dynapenia.
DESIGN, SETTING AND PARTICIPANTS
A non-randomized clinical trial was realized in 61 ambulatory older women (65-80 years old) with dynapenia that belonged from two Integral Gerontological Centers (IGC) of Hidalgo, Mexico, from June to December 2019.
INTERVENTION
The control group (CG) received the physical daily training applied in the IGC (yoga, cardio-dance or tai chi) and the intervention group (IG) participated in a multicomponent program training (resistance, flexibility, balance and gait) called "VIVIFRAIL" for 12 weeks, minimum 3 weekly sessions of 45-60 minutes.
MEASURES
All participants were evaluated at baseline (0 weeks), intermediate (6 weeks) and final (12 weeks), evaluations included glucose, blood pressure (SBP and DBP), anthropometric test, body composition evaluation and functional performance test with Short Physical Performance Battery (SPPB), Timed Up and Go Test (TUGT), muscle strength and a falls risk short test.
RESULTS
52 older women completed the study, mean age was 71.9 ± 4.46. According to SPPB passport classification was 1 Type A, 1 Type B+, 9 Type C, 7 Type C+ and 9 Type D. After 12 weeks of intervention, statistical analysis showed that multicomponent exercise significantly improved strength (p=<0.001), gait speed (p<0.001), standing from a chair (p<0.001) and TUGT (p<0.001). About falls risk, intervention group went from 70% to 12.5% while control group went from 52.4% to 63.6% (p<0.05).
CONCLUSION
Older women who completed the 12 weeks multicomponent exercise program significantly improved their functionality in muscle strength, gait speed (3mt and 6mt), standing from a chair and TUGT tests. Also, it showed a significantly decrease in falls risk, therefore, this type of intervention can reduce the risk of frailty in the elderly.
Topics: Aged; Aged, 80 and over; Aging; Exercise Therapy; Female; Humans; Mexico; Muscle Strength
PubMed: 33491027
DOI: 10.1007/s12603-020-1548-4