OBJETIVOS: caracterizar o estado nutricional de indivíduos ativos, portadores de deficiência motora. METODOLOGIA: Foram avaliados 68 indivíduos ativos, do sexo masculino, portadores de lesão medular (LM, n= 28), seqüelas de poliomielite (L, n=32) ou amputados (A, n= 8). Foram avaliados: o consumo alimentar (recordatório de 24h e lista de freqüência de alimentos), antropometria (peso, altura, dobras cutâneas), composição corporal por DEXA e por bioimpedância. Quanto aos parâmetros bioquímicos: glicemia de jejum, lipídeos plasmáticos (colesterol total, LDL, HDL e triacilgliceróis), uréia e creatinina, insulina, cortisol e IGF-1 plasmáticos. Os dados dos grupos foram submetidos à análise univariada (ANOVA) e os contrastes significativos ao teste de Tuckey, além da análise multivariada para detecção das correlações entre os parâmetros de avaliação. RESULTADOS: os grupos apresentaram um consumo energético abaixo das predições normais, o que pode ser explicado pela menor necessidade decorrente da diminuição da massa muscular. A distribuição percentual da ingestão de lipídeos apresentou-se elevada, inversamente ao consumo de carboidratos. O IMC mostrou-se um bom indicador da gordura corporal, o DEXA mostrou alta correlação com os dados obtidos por dobras cutâneas e com as predições convencionais de gordura corporal. A densidade óssea do corpo total apresentou normalidade, porém, nos LMe nos P a região das pernas apontou para osteopenia e/ou osteoporose. Os dados bioquímicos apresentaram-se normais. CONCLUSÕES: a atividade física parece ter sido um fator determinante para a normalidade encontrada na maioria dos parâmetros avaliados, embora não tenha sido suficiente para manter a densidade óssea e muscular nas regiões paralisadas. Ficou evidente a necessidade de trabalhos de Educação Nutricional para esses indivíduos. No que diz respeito a parâmetros de densidade óssea, é importante a análise dos diferentes segmentos do corpo. / OBJECTIVES: to characterize the nutricional status of active, handicapped individuals. METHODOLOGY: 68 individuals active, men, with spinal cord injury (SCI) (LM, n = 28), poliomelite sequels (L, n=32) or amputed ( n = 8). They had been evaluated by: food consumption (24h dietary recall and food frequency), anthropometry (weight, height, skinfolders and cicunferences), body composition from DEXA and bioelectrical impedance. About the biochemical parameters: serum fast glucose, serum lipids (total cholesterol, LDL, HDL and triglycerides), serum urea and creatinine, insulin, cortisol and IGF-1. The data had been submitted to the ANOVA and the significant contrasts to the Tuckey test, beyond the multivaried analysis for correlations values between the parameters. RESULTS: the groups had presented an energy consumption below of the normal predictions, what it can be explained by the muscle mass reduction. The distribution of the lipids ingestion was high, inversely to the carbohydrates consumption. The body mass index (BMI) revealed to be a good index of the body fat, the DEXA showed high correlation with the skinfolders and with the body fat predicictions. The total bone density presented normality, however, in the LM and the P the region of the legs pointed osteopenia and/or osteoporose. The biochemical data had been normal. CONCLUSIONS: the physical activity seems to have been a determinative factor for the normality found in the majority of the evaluated parameters, even so it has not been enough to keep the bone and muscle density in the paralyzed regions. The necessity of Nutricional Education was evident for these individuals. About the parameters of bone density, the analysis of the different regions is important .

Background: Symptomatic knee osteoarthritis (OA) is an incurable condition that affects nearly 50% of adults, and women are twice as likely as men to develop OA. Throughout pregnancy, women experience large changes in morphology and gait mechanics, as well as changes in joint loading. It is possible these adaptations could cause lasting changes postpartum, which may potentially contribute to initiation of OA, thereby increasing the overall risk of OA for women. Purpose: This exploratory study looked to identify differences between lower limb gait mechanics of healthy nulliparous women and healthy parous women. Methods: 28 healthy female participants (14 parous, 14 nulliparous) were recruited for the study. Nulliparous participants had never given birth to a child, and were self-reported not pregnant. Parous participants had given birth to at least one full term infant (37 – 42 weeks) without complications between one to five years before data collection. Kinematic and kinetic data was collected for the lower body, using motion capture and in-ground force plates. Participants completed one quiet standing trial, and walked over-ground through the motion capture space at their preferred, fast, and set walking speeds (1.4 m/s). An ANOVA was performed to test if there were significant differences in between groups. Results: Q angle did not differ between groups. There was a significant main effect of group indicating a larger knee flexion angle at toe off (p = 0.060), smaller knee extension moment at heel strike (p = 0.0006), smaller first peak knee flexion moment (p = 0.040), and smaller peak hip adduction moment for the parous group compared to the nulliparous group (p = 0.003). Conclusions: Our data revealed a decrease in the moments experienced, which could possibly lead to degradation of cartilage due to under loading of the joint. We think this may be an indication that pregnancy could increase risk of OA, and therefore more research into this possibility is warranted.

Sarcopenia is a disease of muscle wasting primarily seen in older adults. Although this term was first coined over three decades ago, there is a lack of consensus on a definition, screening criteria, and treatment protocol for sarcopenia. The primary purpose of this study is to determine whether registered dietitian nutritionists (RDNs) in the United States (U.S.) screen for sarcopenia. Study participants were recruited through a randomized email list and included RDNs throughout the U.S. Respondents completed a survey questioning knowledge of sarcopenia, screening tools and company protocols in place, and the need and desire for sarcopenia education. Data revealed a lack of pre-existing protocols in place, a dissonance of validated and unvalidated screening tools used in practice, and substantial need for sarcopenia education.

Hintergrund: Ein signifikanter Anteil der Patienten mit einer chronischen körperlichen Erkrankung weist eine komorbide psychische Störung auf. Ob und in welchem Ausmaß sich die Prävalenzraten psychischer Störungen bei Patienten mit einer chronischen Erkrankung von denen der Allgemeinbevölkerung unterscheiden, ist bislang noch kaum untersucht. Fragestellung: Die vorliegende epidemiologische Studie untersucht geschlechts- und altersadjustierte 4-Wochen, 12-Monats- und Lebenszeitprävalenzen psychischer Störungen bei Rehabilitationspatienten mit muskuloskelettalen und kardiovaskulären Erkrankungen im Vergleich zu Prävalenzraten der Allgemeinbevölkerung. Methode: Die Daten der drei Stichproben (N = 4192) basieren jeweils auf einem zweistufigen, epidemiologischen Untersuchungsansatz mit einer schriftlichen Befragung der Patienten bzw. Probanden zu ihrem psychischen Befinden (GHQ-12; M-CIDI-S) und einem anschließenden Interview (M-CIDI) bei einem randomisiert ausgewählten Teil der Gesamtstichprobe. Ergebnisse: Mit adjustierten Lebenszeitprävalenzen von 59.3 % (OR: 1.6) und 56.2 % (OR: 1.4) weisen die Patienten mit einer muskuloskelettalen und kardiovaskulären Erkrankung im Vergleich zur Allgemeinbevölkerung (47.9 %) eine deutlich erhöhte Prävalenz psychischer Störungen auf. Am häufigsten sind affektive Störungen (22.5 % bis 34.9%) und Angststörungen (18.4 % bis 33.8 %). Schlussfolgerung: Der im Vergleich zur Allgemeinbevölkerung deutliche Zusammenhang zwischen chronischen körperlichen Erkrankungen und psychischen Störungen verdeutlicht die Bedeutsamkeit einer verstärkten Diagnostik und Behandlung komorbider psychischer Störungen bei chronisch erkrankten Patienten. / Background: A significant part of patients with chronic diseases have comorbid mental disorders. However, by now it is nearly unexplored if and to what extend the prevalence rates of mental disorders in patients with chronic diseases differ from the rates of the general population. Objective: The present epidemiologic study investigates sex- and age-adjusted 4-week, 12-months, and lifetime prevalence rates of mental disorders in inpatients with musculoskeletal and cardiovascular diseases compared to prevalence rates of the general population. Methods: In each sample (N = 4192), the data based on a two-stage epidemiologic design. The first stage entailed the use of a screening questionnaire for mental disorders (GHQ-12; M-CIDI-S). The second stage consisted of an interview (M-CIDI) of a randomised part of the sample. Results: The adjusted lifetime prevalence in both clinical samples (musculoskeletal: 59.3 %, OR 1.6; cardiovaskular: 56.2 %, OR 1.4) is high compared to the rate of the general population (47.9 %). Affective disorders (22.5 % to 34.9 %) and anxiety disorders (18.4% to 33.8 %) are the most common disorders. Conclusions: Compared to the general population there is a clear correlation between chronic diseases and mental disorders, that shows the importance of an improved diagnostic and treatment of patients suffering from comorbid mental disorders.

Background: Although it is well established that chronic somatic diseases are significantly associated with a wide range of psychopathology, it remains unclear to what extent subjects with chronic somatic diseases are at increased risk of experiencing mental disorders. The present epidemiological study investigates age- and sex-adjusted 12-month prevalence rates of mental disorders in patients with cancer, and musculoskeletal, cardiovascular and respiratory tract diseases, based on comprehensive physicians’ diagnoses and compared with physically healthy probands. Methods: Prevalence rates were calculated from two large epidemiological surveys. These studies investigated inpatients and patients from the general population with cancer (n = 174) and musculoskeletal (n = 1,416), cardiovascular (n = 915) and respiratory tract diseases (n = 453) as well as healthy controls (n = 1,083). The prevalence rates were based on the Munich Composite International Diagnostic Interview, a standardized interview for the assessment of mental disorders. Results: Prevalence rates were very similar for inpatients (43.7%) and patients from the general population (42.2%). The adjusted odds ratios (OR) of patients with chronic somatic diseases were significantly elevated for mental disorders in comparison with healthy probands (OR: 2.2). Mood, anxiety and somatoform disorders were most frequent. The prevalence rates did not differ significantly between the somatic index diseases. The number of somatic diseases per patient had a higher association with mental disorders. Conclusions: There is a strong relationship between chronic somatic diseases and mental disorders. A future task is to improve the care of mental disorders in patients with chronic physical illness, specifically with multimorbid conditions.

Remarkable progress has been made in the development of effective treatments for patients with rheumatoid arthritis (RA). To ensure that a patient is optimally responding to treatment, consistent monitoring of disease activity is recommended. Established composite and individual disease activity measures often cannot be computed due to missing laboratory values. Simplified measures that can be calculated without a lab value have been developed and previous studies have validated these new measures, yet differences in their performance compared with established measures remain. Therefore, the goal of my doctoral research was to examine and evaluate disease activity and composite measures to facilitate monitoring of response in clinical care settings and inclusion of patients with missing laboratory values in epidemiological research. In the first study, the validity of two composite measures, the Clinical Disease Activity Index (CDAI) and the Disease Activity Score with 28 joint count (DAS28) was examined and both were significantly associated with a rheumatologist’s decision to change therapy (CDAI OR=1.58; 95% CI: 1.42, 1.76) (DAS28 OR=1.34; 95% CI 1.27,1.56). However, further evaluation using receiver operating characteristic (ROC) analysis found that they were not strong predictors of physician decisions to change therapy (AUC=0.75, 0.76, respectively). Thus, they should not be used to guide treatment decisions in the clinic. Two measures of disease activity, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are often not measured and impede the computation of composite measures of disease activity. In the second study, significant factors which may predict the measurement of the ESR and CRP were identified and included physician and clinical variables but no quantitative disease activity measures. Thus the suitability of the ESR and CRP as measures of disease activity is suspect. In the final study, I created a new composite measure, the modified disease activity score with 28 joint count (mDAS28), by replacing the laboratory value in the DAS28. The mDAS28 was then validated by comparing its performance with the DAS28. The measures were strongly correlated (r=0.87), and strong agreement was found between the two measures when categorizing patients to levels of disease activity (ĸ=0.77) and treatment response (ĸ=0.73). Therefore, the mDAS28 could be used in place of the DAS28 when laboratory values needed to compute the DAS28 are missing. In summary, I found that the CDAI and DAS28 were not strong predictors of the rheumatologist’s decision to change therapy. I also found that the variability in the measurement of ESR and CRP was not associated with disease activity. I was able to modify the DAS28 by replacing the laboratory measure and create a new simplified measure, the mDAS28. I also validated the mDAS28 for use in the clinic and in epidemiological research when the DAS28 is unavailable.

Depression is a common comorbidity in rheumatoid arthritis (RA), yet it may not be adequately recognized during routine clinical care. RA symptoms may confer a risk for depression, and vice versa; depression may affect RA disease activity and response to treatment. The study aims were to compare patient- and physician-reported depression measures, evaluate the temporal bi-directional association between RA disease activity and depressive symptomology, and assess depression as a moderator of RA treatment. Patients were identified using a national RA registry sample (Consortium of Rheumatology Researchers of North America; CORRONA). Depression prevalence and incidence rates were estimated, and concordance and disagreement using measures reported separately by patients and physicians, as well as baseline cross-sectional associations between RA disease and a history of depression. A survival analysis was conducted to temporally predict the incident onset of self-reported depressive symptoms using the different metrics of RA disease activity. Also, mixed effects models were used to assess prospective changes in RA disease activity by prevalent and incident depressive symptom status. Lastly, logistic regression models compared the likelihood of clinical response to RA treatment during follow-up in those with and without depression when starting biologic disease modifying anti-rheumatic drug (DMARD) therapy. Patient-reported depression rates were much higher and significantly different from physician based comorbidity estimates. Patient and physician RA disease activity measures were associated with an increased risk for depression onset, but not laboratory-reported serum biomarkers. Similarly, depression was temporally associated with significantly slower rates of decline regarding every patient-reported disease activity measure, some physician-reported metrics, but not acute phase reactants. Moreover, there was a significantly lower probability of achieving clinical remission among those with depression on a biologic DMARD after 6 months and an analogous effect at 12-months that was slightly lower in magnitude, which did not reach statistical significance. Rheumatologists under-reported the occurrence of prevalent and incident depressive symptoms, and thus are likely unaware of its presence in their RA patients. Further, the results suggest the bi-directional effects between these conditions are related to the cognitive and behavioral aspects of depression and their interactions with disease activity, rather than shared immunological mechanisms in the context of cell-mediated immunity. When also considering the impact on clinical response to biologic DMARDS, the findings collectively imply that rheumatologists must address any challenges due to depression to provide the best care to their patients.

This survey research explores neonatal intensive care unit speech-language pathologists’ perceptions of infants with neonatal abstinence syndrome; specifically, how NAS affects infants’ feeding skills, along with structural and oral-motor characteristics. The findings of this research will contribute to this population’s information base. The results are expected to inform the field and current evidence-based practice care for infants with NAS.Learner Outcome(s): Explain Neonatal Abstinence Syndrome (NAS) Describe infants with NAS and how NAS affects the infants’ feeding skills from the perspective of Neonatal Intensive Care Unit (NICU) Speech-Language Pathologists (SLPs) Identify how SLPs in the NICU participate in intervention for infants with NAS and their families

Långvarig muskuloskeletal smärta är ett globalt hälsoproblem och är den vanligaste orsaken till funktionnedsättningar hos individer. Individer med långvarig muskuloskeletal smärta har en ökad risk att drabbas av psykisk ohälsa som kan påverka individens välbefinnande och livskvalitet negativt. Individer använder olika strategier (icke farmakologiska och farmakologiska behandlingar) för att hantera smärta. Distriktssköterskan har en avgörande roll vid identifiering av individens smärtproblematik och psykisk ohälsa / Chronic musculoskeletal pain is a global health problem and is the most common cause of disability in individuals. Individuals with long-term musculoskeletal pain have an increased risk of suffering from mental illness, which can negatively affect the individual's well-being and quality of life. Individuals use different strategies (non-pharmacological and pharmacological treatments) to manage pain. The district nurse has a decisive role in identifying the individual's pain problem and mental illness.

<p>Dedicated to the memory of Dr. Colin E. Webber</p> / <p>This comparative study of peripheral (p) QCT, high-resolution pQCT (hr-pQCT) and 1.0 Tesla pMRI technologies quantified short-term test-retest reproducibility, validity, one-year detection limit and clinical sensitivity of each modality’s derived bone measures. Select bone outcomes were evaluated from scans performed on Hamiltonian women above 50 years old and externally validated in a population-based cohort. In the local cohort (age: 74 ± 9 years and BMI 27.65 ± 5.74 kg/m²), Tb.Sp measured on pMRI, Ct.Th and vBMD from pQCT showed significant correlations (r²=0.52-0.85) with hr-pQCT, yielding slopes near unity. Bland-Altman analyses revealed significant relationships between pQCT and pMRI bone outcome values (Tb.Th(-), Tb.N(+), BV/TV(-)) and agreement with hr-pQCT. Short-term reproducibility was < 5% for pQCT but only BV/TV was < 5% for pMRI. Co-registration and excluding individuals with fractures mildly reduced precision error and one-year change. In the local cohort, only Ct.Th and cortical vBMD associated with fractures (OR: 1.09-3.28) using hr-pQCT, which was externally validated in the national cohort. Certain trabecular measures on pMRI and pQCT erred towards increased odds for fractures locally. For pQCT, these became significant in the national cohort (OR:1.04-3.81). This Canadian reference dataset for hr-pQCT showed larger Tb.Sp and smaller Tb.N compared to Americans but age-related decline in Ct.Th and BV/TV was faster in Europeans. This study demonstrated validity of pMRI and pQCT-derived volumetric bone outcomes and reasonable short- and long-term precision error for pQCT but not 1.0T pMRI. A single CT slice from pQCT was comparable to 110 slices from hr-pQCT in associations with fractures.</p> / Doctor of Philosophy (Medical Science)