Background: Symptoms of anxiety and depression in patients with restless legs syndrome (RLS) have been observed. However, it is unclear whether rates of threshold depression and anxiety disorders according to DSM-IV criteria in such patients are also elevated. Methods: 238 RLS patients were assessed with a standardized diagnostic interview (Munich- Composite International Diagnostic Interview for DSM-IV) validated for subjects aged 18–65 years. Rates of anxiety and depressive disorders were compared between 130 RLS patients within this age range and 2265 community respondents from a nationally representative sample with somatic morbidity of other types. Results: RLS patients revealed an increased risk of having 12-month anxiety and depressive disorders with particularly strong associations with panic disorder (OR=4.7; 95% CI=2.1–10.1), generalized anxiety disorder (OR=3.5; 95% CI= 1.7–7.1), and major depression (OR=2.6; 95% CI=1.5–4.4). In addition, lifetime rates of panic disorder and most depressive disorders as well as comorbid depression and anxiety disorders were considerably increased among RLS patients compared with controls. Conclusions: The results suggest that RLS patients are at increased risk of having specific anxiety and depressive disorders. Causal attributions of patients suggest that a considerable proportion of the excess morbidity for depression and panic disorder might be due to RLS symptomatology.

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Thesis. 1977. B.S. cn--Massachusetts Institute of Technology. Dept. of Mechanical Engineering. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / Bibliography: leaves 85-86. / by Kenneth J. Launie. / B.S.cn

Thesis. 1977. B.S.--Massachusetts Institute of Technology. Dept. of Mechanical Engineering. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / Bibliography: leaves 71-72. / by J. Mark Deric. / B.S.

Syftet med denna systematiska litteraturstudie var att beskriva hur restless legs inverkar på individens sömn och livskvalitet. Syftet var även att granska vilka olika former av behandlingar som finns att tillgå vid restless legs. För att finna information om detta ämne har endast vetenskapliga artiklar använts. Datainsamlingen har skett via databaser, internet samt Högskolans bibliotek, och artiklar från år 1995 och framåt har valts ut. Inklusionskriterier för denna studie var att de valda artiklarna skulle vara internationella vetenskapliga artiklar i fulltext. De funna artiklarna granskades med avseende på vetenskaplig kvalitet och poängsattes utifrån för ändamålet avsedda granskningsmallar. Denna bedömning resulterade i 21 artiklar. Resultatet visade att restless legs patienter upplever sömnbristen som det största problemet. För flertalet individer som drabbas av restless legs försämrades livskvaliteten och patienterna drabbades vanligtvis av psykologiska och fysiologiska besvär. Det vanligaste sättet att behandla restless legs var att använda dopaminerga läkemedel samt bensodiazepiner, antiepileptika och opioider. Andra former av behandlingar var järn, homeopatiska läkemedel, hypnos samt fysisk aktivitet. Det förekom även att restless legs patienter på eget initiativ använde hasch eftersom det ansågs lindra symtomen.

It is known that sleep problems affect people’s wellbeing and has great consequences for public health. Restless legs syndrome (RLS) gives uncomfortable sensations in the legs at rest, leading to an irresistible need for activity. It aggravates in evening and at night. Therefore, RLS provides poorer sleep and can affect quality of life through fatigue, family life and social activities, work, and comorbidity. It is demonstrated a dysfunction of the dopaminergic system in the brain with low levels of dopamine and / or less sensitive dopamine receptors. RLS is more common in women and the prevalence increases with age and during pregnancy. Periodic limb movements are characterized by uncontrolled stretching movements of the legs, especially the toes, ankles, knees and hips during sleep. They last between 0.5 and 5 seconds, and can cause brief awakenings leading to daytime sleepiness. The clinical significance of PLM is rather controversial and PLM is sometimes seen in healthy people with no daytime symptoms. RLS is a subjective diagnosis and translated with the help of questionnaires. PLM however, can objectively be evaluated by polysomnography. Depression is common during and after pregnancy. It is not known whether women with RLS during pregnancy have a higher risk of prenatal or postpartum depression. The aims of this thesis was to  to examine the prevalence, associated symptoms and comorbidities, in particular, vasomotor symptoms, menopause, and hormone replacement therapy (HRT) use, among women who suffer from RLS and PLMs. We also evaluated the impact of RLS and PLMs on health related quality of life (HRQoL), and if RLS before and during pregnancy increases the risk of antenatal or postpartum depressive symptoms. Three different poulations were used.  Paper 1-3 were cross-sectional and included 5000 resp. 10000 randomly selected women from the general populations of Dalarna and Uppsala County. Questionnaires, polysomnographic recordings, blodtests etc. were used. Paper 4 was a longitudinal cohort study where 1428 pregnant women in Uppsala County were followed. In summary, data included in this thesis points out that RLS and PLMs are more common in women with estrogendeficiency-related symptoms of menopause. RLS-positive women had an impaired mental HRQoL compared to RLS-negative women and more often suffered from comorbidities. Data also revealed that women with RLS before and during pregnancy are at increased risk for depression during and after pregnancy.

Animals effectively move and negotiate a variety of environments exemplifying the neuromuscular system's ability to produce complex coordinated movements. Our central thesis is that the nonlinear dynamical properties of muscle play a critical role in power production and stability during such movements. We have developed a closed-loop system that couples an isolated muscle to a physical or computational load, facilitating the study of the interactions between intrinsic muscle properties and external forces. We used this system to determine how elastic elements in the frog semimembranosus can improve power production during a jumping task and how the contractile element automatically manages energy to maintain a stable bouncing gait. Our results reveal that, during ballistic movements (e.g. jumping), series elastic elements stretch and shorten to temporally concentrate energy transfer from the contractile element to the body, amplifying power production. We measured peak instantaneous power greater than twice the maximum power the contractile element could produce alone. Our results show how, during a bouncing gait, the contractile and elastic elements autonomously interact to produce, dissipate, and recycle energy and to maintain dynamic stability without sensory feedback. Our data suggest that muscles can recover over 75% of the kinematic energy from one step and apply it to the next. These results demonstrate the effects and importance of intrinsic muscle properties during movements. Ultimately, this research can guide the development of biomimetic robotic and prosthetic technologies capable of life-like mobility.

Freiburg i. Br., Univ., Diss., 2007.

Universidade Federal do Cearà / ESPI e HemodiÃlise. O estudo compreendeu duas fases, transversal em uma primeira fase e prospectivamente durante os dois anos seguintes (2007-2009) para avaliar as alteraÃÃes do sono, sintomas depressivos e a mortalidade em pacientes em hemodiÃlise (HD). Dos 400 pacientes estudados 59% eram homens, idade=51,6Â15,5, em HD hà 5,9Â5,5 anos. SÃndrome de pernas inquietas (SPI) presente em 21,5% predominou em mulheres (p< 0,005); 55,8% apresentavam SPI moderada/grave (International Restless Legs Syndrome (IRLS)>15),e 44,2% sintomas leves. Pacientes com SPI apresentavam reduÃÃo da hemoglobina (p < 0,005) e tendÃncia a hipoalbuminemia (p=0,06). Mà qualidade do sono (Ãndice de Qualidade do Sono de Pittsburgh, IQSP>5) foi mais comum nos indivÃduos com SPI tinham quando comparados aos que nÃo tinham SPI (69,8% vs 56,8%, p=0,002). O risco de SAOS foi maior nos casos com SPI (todos os casos p = 0,01 e casos com SPI moderada/grave, p=0,007, respectivamente). Os casos com SPI moderada/grave associaram-se com hipertensÃo arterial (p=0,01) que permaneceu apÃs o controle para o risco de SAOS (p=0,02). Os turnos de diÃlise nÃo se relacionaram com transtornos do sono nem com sintomas depressivos e outras variÃveis clÃnicas e laboratoriais. AlteraÃÃes do sono e sintomas depressivos na HD. Foram utilizados os questionÃrios IQSP, a Escala de SonolÃncia de Epworth (ESE), o questionÃrio de Berlin, o IDB-II e o Ãndice de Comorbidades de Charlson (ICC). Os fatores de risco independentes associados com a mà qualidade do sono (56,8%) foram insuficiÃncia cardÃaca (OR=1,99, p=0,006), envelhecimento (OR=1,01, p=0,009). Os fatores de risco independentes para depressÃo (BDI-II>16, 19,3%) foram diabetes (OR=2,96, p=0,001], gÃnero feminino (OR=1,96, p=0,007), e hipoalbuminemia (OR=1,86, p=0,024). Mortalidade. O teste mÃltiplo de regressÃo mostrou que, em ambos os gÃneros, o aumento das comorbidades (p<0,005) e idade avanÃada (p<0,005) associaram-se com a mortalidade. Nas mulheres, o Ãndice de comorbidades determinou a mortalidade (p<0,005). Em homens, hipoalbuminemia (p=0,007), idade mais avanÃada(p<0,005), paratormÃnio reduzido (p=0,001) e sonolÃncia excessiva (p=0,03) diurna constituem fatores de risco para mortalidade. ConclusÃes. A prevalÃncia de depressÃo nos pacientes em HD à maior que na populaÃÃo geral. GÃnero feminino, diabetes, insuficiÃncia cardÃaca, hipoalbuminemia e idade sÃo condiÃÃes importantes associadas com depressÃo nos pacientes de HD e constituem caracterÃsticas Ãteis para identificar com prioridade os pacientes que podem se beneficiar com o tratamento da depressÃo apÃs o seu rastreamento. As mulheres e indivÃduos com anemia tÃm risco maior de SPI e SPI revelou-se importante nesse estudo pela sua associaÃÃo nas formas moderada/grave com hipertensÃo arterial, alÃm de depressÃo e mà qualidade do sono. BenefÃcios do tratamento adequado com possÃvel impacto nesses parÃmetros devem ser avaliados. SonolÃncia excessiva diurna associada com doenÃa cerebrovascular e anemia instiga a possibilidade de que a correÃÃo da anemia pode melhorar a sonolÃncia um conhecido fator de risco para DCV e mortalidade. A influÃncia de fatores distintos na mortalidade de homens e mulheres nesses pacientes merece ser explorada. . / SPI and Hemodialysis. The study comprised two phases, first phase in a cross-sectional and prospectively over the next two years (2007-2009) to evaluate sleep disturbances, depressive symptoms and mortality in patients on hemodialysis (HD). Of the 400 patients studied 59% were men, mean age = 51.6  15.5 in HD for 5.9  5.5 years. Restless Leg Syndrome (RLS) present in 21.5% predominated in women (p <0.005), 55.8% had RLS impairment (International Restless Legs Syndrome (IRLS)> 15) and 44.2% mild symptoms. RLS patients had a reduction in hemoglobin (p <0.005) and tendency to hypoalbuminemia (p = 0.06). Poor quality of sleep (Sleep Quality Index in Pittsburgh, PSQI> 5) was more common in individuals with RLS were compared to those without RLS (69.8% vs 56.8%, p = 0.002). The risk of OSA was higher in patients with RLS (all cases p = 0.01 and RLS cases with moderate / severe, p = 0.007, respectively). Cases with SPI moderate / severe were associated with hypertension (p = 0.01) that remained after controlling for risk of OSA (p = 0.02). The shifts of dialysis were not related to sleep disorders or depression symptoms and other clinical and laboratory findings. Sleep disturbances and depressive symptoms in HD. We used the PSQI questionnaire, the Epworth Sleepiness Scale (ESS), the Berlin questionnaire, the BDI-II and Charlson Comorbidity Index (CCI). The independent risk factors associated with poor sleep quality (56.8%) were heart failure (OR = 1.99, p = 0.006), age (OR = 1.01, p = 0.009). The independent risk factors for depression (BDI-II> 16, 19.3%) were diabetes (OR = 2.96, p = 0.001), female gender (OR = 1.96, p = 0.007), and hypoalbuminemia (OR = 1.86, p = 0.024). Mortality. The multiple regression test showed that in both genders, increasing age and comorbidities were associated with mortality. In women, the comorbidity rates determined mortality (p<005). In men, hypoalbuminemia ((p=0.007), older age (p<005), parathyroid hormone (p=0.001) and reduced excessive daytime sleepiness (p=0.03) were associated with mortality. Conclusion. The prevalence of depression in HD patients is higher than the general population. Female gender, diabetes, heart failure, hypoalbuminemia and age are important conditions associated with depression in HD patients and are useful features to identify priority patients who may benefit from the treatment of depression after his screening. Women and individuals with anemia are at greater risk of SPI and SPI has proved important in this study by its association forms moderate / severe arterial hypertension, and depression and poor sleep quality. Benefits of treatment and a possible impact on these parameters must be evaluated. Somnolence excessive daytime sleepiness associated with cerebrovascular disease and anemia instigates the possibility that correction of anemia may improve sleepiness a known risk factor for CVD and mortality. The influence of different factors on mortality in men and women in these patients deserves to be explored.