Bjerrumbutcher3503

Purpose Impaired swallowing is a serious symptom of amyotrophic lateral sclerosis (ALS) impacting on health and wellbeing. Little is known about how cognitive impairment in amyotrophic lateral sclerosis impacts on oropharyngeal swallowing. A scoping review was undertaken to explore how cognitive impairment impacts on a person living with ALS's (plwALS) ability to understand and manage oropharyngeal swallowing function.Method Subject headings and keywords were searched across MEDLINE, SCOPUS, CINAHL, PsychINFO, Emcare and Google Scholar in May 2019. Articles containing information on amyotrophic lateral sclerosis and cognition and swallowing were reviewed. A secondary search was conducted in July 2020 with broadened search terms.Result The primary search identified 1055 articles, and 47 were included for full-text review. Of these, no articles directly met the inclusion criteria of both cognitive impairment and swallowing. The secondary search with broadened terms identified an additional 762 studies, and 9 were included for full-text review, but none met the inclusion criteria. Consequently, thematic analysis was completed on articles from the full-text review to identify themes that related to both cognition and swallowing. The themes identified were (i) early specialised multidisciplinary management of ALS achieves better outcomes; (ii) cognitive impairment impacts on management; and (iii) impaired swallowing occurs in nearly all people living with ALS and is a serious symptom of the disease.Conclusion The interaction between cognitive impairment and oropharyngeal swallowing function in ALS has not been investigated. This is important, as cognitive impairment impacts insight and decision-making and may have implications for oropharyngeal swallowing management.This study investigated the effects of a 16-week Tai Chi (TC) intervention on cutaneous sensitivity and proprioception among older adults with and without sensory loss. Thirty-six older adults were divided into sensory loss and control groups, and they underwent a 16-week TC intervention. Significant interactions were detected in heel cutaneous sensitivity (p = 0.046, F = 4.419) and knee flexion (p = 0.043, F = 4.580), extension (p = 0.027, F = 5.529) and ankle plantar-flexion proprioception (p = 0.037, F = 4.860). The post hoc test indicated that in the sensory loss group, heel cutaneous sensitivity threshold (p = 0.034) and knee flexion (p = 0.004), extension (p = 0.002) and ankle plantar-flexion (p = 0.023) proprioception threshold decreased at week 17, whereas in the control group, knee flexion (p = 0.029) proprioception threshold decreased at week 17. TC intervention improved cutaneous sensitivity at more sites and proprioception in more joints among the older adults with sensory loss. TC intervention is a good option for older adults to exercise, and it is more effective among older adults with sensory loss.Study objectives Clinical guidelines recommend cognitive-behavioral therapy for insomnia (CBT-I) as first-line treatment. KU-57788 cell line However, provision of CBT-I is limited due to insufficient time and expertise. Internet-delivered CBT-I might bridge this gap. This study aimed to estimate the cost-effectiveness of guided, internet-delivered CBT-I (i-Sleep) compared to care-as-usual for insomnia patients in general practice over 26 weeks from a societal perspective.Methods Primary outcomes were the Insomnia Severity Index (ISI, continuous score and clinically relevant response), and Quality-Adjusted Life Years (QALYs). Societal costs were assessed at baseline, and at 8 and 26 weeks. Missing data were imputed using multiple imputation. Statistical uncertainty around cost and effect differences was estimated using bootstrapping, and presented in cost-effectiveness planes and acceptability curves.Results The difference in societal costs between i-Sleep and care-as-usual was not statistically significant (-€318; 95% CI -1282 to 645). Cost-effectiveness analyses revealed a 95% probability of i-Sleep being cost-effective compared to care-as-usual at ceiling ratios of €450/extra point of improvement in ISI score and €7,000/additional response to treatment, respectively. Cost-utility analysis showed a 67% probability of cost-effectiveness for i-Sleep compared to care-as-usual at a ceiling ratio of 20,000 €/QALY gained.Conclusions The internet-delivered intervention may be considered cost-effective for insomnia severity in comparison with care-as-usual from the societal perspective. However, the improvement in insomnia severity symptoms did not result in similar improvements in QALYs.The aims of the study were to assess the contribution of resilience, coping style, and COVID-19 stress on the quality of life (QOL) in frontline health care workers (HCWs). The study was a cross-sectional surveyperformed among 309 HCWs in a tertiaryhospital during the outbreak of COVID-19 in China. Data were collected through an anonymous, self-rated questionnaire, including demographic data, a 10-item COVID-19 stress questionnaire, Generic QOL Inventory-74, Connor-Davidson Resilience Scale, and the Simplified Coping Style Questionnaire. Hierarchical regression was used to analyse the relationship between the study variables and the QOL. Among the 309 participants, resilience and active coping were positively correlated with the QOL (P less then 0.001), whereas, working in confirmed case wards, COVID-19 stress, and passive coping were negatively correlated with the QOL (P less then 0.001). Resilience and the active coping were negatively correlated with COVID-19 stress (P less then 0.001). Resilience, coping style,and COVID-19 stressaccounted for 32%, 13%, and 8% of the variance in predicting the Global QOL, respectively. In conclusion, working in confirmed COVID-19 case wards and COVID-19 stress impaired the QOL in HCWs. Psychological intervention to improve the resilience and coping style, and reduce COVID-19 stress are important in improving the QOL and mental health of HCWs.Slowed gait is one of the strongest predictors of fall risk in older adults. The present study investigated whether gait speed mediated the relationship between depression and fall history in 147 older adults presenting to a memory clinic for cognitive complaints. Depression, cognitive status, gait speed, and number of falls within the last year were the primary measures. Results revealed fallers, relative to non-fallers, had slower gait speed and higher depression scores. As hypothesized, analyses using the PROCESS macro found that gait mediated the relationship between depression and fall history. Additionally, the combination of depression and mild cognitive impairments (MCI) associated with a significantly greater likelihood of falling. Our findings indicate that combined depression and MCI have additive effects on fall risk, likely through the destabilizing effect of slowed gait on balance. Better understanding the underlying pathophysiology involved in MCI and depression-related gait disturbances may lead to improved intervention targets for fall risk prevention.