Efficacy and hypnotic effects of melatonin in shift-work nurses: double-blind, placebo-controlled crossover trial

<p>Abstract</p> <p>Background</p> <p>Night work is associated with disturbed sleep and wakefulness, particularly in relation to the night shift. Circadian rhythm sleep disorders are characterized by complaints of insomnia and excessive daytime sleepiness that are primarily due to alterations in the internal circadian timing system or a misalignment between the timing of sleep and the 24-h social and physical environment.</p> <p>Methods</p> <p>We evaluated the effect of oral intake of 5 mg melatonin taken 30 minutes before night time sleep on insomnia parameters as well as subjective sleep onset latency, number of awakenings, and duration of sleep. A double-blind, randomized, placebo-controlled crossover study with periods of 1 night and washouts of 4 days comparing melatonin with placebo tablets was conducted. We tried to improve night-time sleep during recovery from night work. Participants were 86 shift-worker nurses aged 24 to 46 years. Each participant completed a questionnaire immediately after awakening.</p> <p>Results</p> <p>Sleep onset latency was significantly reduced while subjects were taking melatonin as compared with both placebo and baseline. There was no evidence that melatonin altered total sleep time (as compared with baseline total sleep time). No adverse effects of melatonin were noted during the treatment period.</p> <p>Conclusion</p> <p>Melatonin may be an effective treatment for shift workers with difficulty falling asleep.</p

The effects on functional balance in hemiplegic stroke individuals wearing an ankle foot orthosis with rocker bottom shoes

Background: One of the disorders in stroke patients is asymmetrical posture, which leads to decreased movement and balance control. An ankle-foot orthosis (AFO) is the most common orthopedic device used in patients with post-stroke hemiplegia, and are often utilized with shoes. The purpose of this study was to investigate the effect, in stroke patients, of rocker bottom shoes on an AFO in the clinical assessments of balance compared to standard shoes on an AFO.    Methods: This quasi-experimental study involved 10 chronic stroke patients. The evaluated individuals were under four conditions using rocker bottom shoes and standard shoes coupled with a rigid AFO immediately, and after a 3-week adaptation. The walking speed was assessed using a 10-m walk test (10 MWT), and the clinical assessments of balance were evaluated using the Timed-Up and Go test (TUG) and the Functional Reach Test (FRT).   Results: The findings revealed that wearing rocker bottom shoes on the AFO significantly increased walking speed, the distance on the FRT, and reduced the TUG compared to wearing standard shoes on the AFO (p < 0.05). Conclusion: The study indicated that stroke patients showed an improvement in walking speed and functional balance when utilizing the AFOs with rocker bottom shoes. This outcome could be a possibility in application by doctors to prescribe this type of footwear for individuals who have had a stroke

Temperature measurement and control system for transtibial prostheses: single subject clinical evaluation.

The snug fit of a prosthetic socket over the residual limb can disturb thermal balance and put skin integrity in jeopardy by providing an unpleasant and infectious environment. The prototype of a temperature measurement and control (TM&C) system was previously introduced to resolve thermal problems related to prostheses. This study evaluates its clinical application in a setting with reversal, single subject design. The TM&C system was installed on a fabricated prosthetic socket of a man with unilateral transtibial amputation. Skin temperature of the residual limb without prosthesis at baseline and with prosthesis during rest and walking was evaluated. The thermal sense and thermal comfort of the participant were also evaluated. The results showed different skin temperature around the residual limb with a temperature decrease tendency from proximal to distal. The TM&C system decreased skin temperature rise after prosthesis wearing. The same situation occurred during walking, but the thermal power of the TM&C system was insufficient to overcome heat build-up in some regions of the residual limb. The participant reported no significant change of thermal sense and thermal comfort. Further investigations are warranted to examine thermography pattern of the residual limb, thermal sense, and thermal comfort in people with amputation.N/

Temperature measurement and control system for transtibial prostheses: functional evaluation.

The accumulation of heat inside the prosthetic socket increases skin temperature and fosters perspiration, which consequently leads to high tissue stress, friction blister, discomfort, unpleasant odor, and decreased prosthesis suspension and use. In the present study, the prototype of a temperature measurement and control (TM&C) system was designed, fabricated, and functionally evaluated in a phantom model of the transtibial prosthetic socket. The TM&C system was comprised of 12 thermistors divided equally into two groups that arranged internal and external to a prosthetic silicone liner. Its control system was programmed to select the required heating or cooling function of a thermal pump to provide thermal equilibrium based on the amount of temperature difference from a defined set temperature, or the amount of difference between the mean temperature recorded by inside and outside thermistors. A thin layer of aluminum was used for thermal conduction between the thermal pump and different sites around the silicone liner. The results showed functionality of the TM&C system for thermoregulation inside the prosthetic socket. However, enhancing the structure of this TM&C system, increasing its thermal power, and decreasing its weight and cost are main priorities before further development.The Hong Kong Polytechnic University supported all expenses of functional evaluation. Moreover, The ST&G Corporation, South Korea, has donated silicone liners for functional evaluation. The authors received no more support for conduction of this stud

Design and preliminary evaluation of a new ankle foot orthosis on kinetics and kinematics parameters for multiple sclerosis patients

Background: The damage of the central nervous system due to Multiple Sclerosis (MS) leads to many walking disorders in this population. However, current ankle-foot orthoses prescribed for improving walking disorders for these patients are not clinically cost-efficient. Objective: This study aimed to design and fabricate a dynamic ankle foot orthosis and a new spring-damper joint mechanism that could adapt the walking problems of MS patients and evaluate the immediate effect of the new orthosis on the speed, range of motion, moment, total work and ground reaction force during walking. Material and Methods: In this case-series study, after the design and fabrication of a new orthosis, the kinetics and kinematics of walking of four patients with MS were assessed in a case series study. Results: Walking speed improved with the new orthosis in two participants. The sagittal range of motion (ROM) increased for most of the participants. The sagittal moments increased for hip, knee and ankle joints in most of the measurements. The total joint work showed noticeable difference in the ankle joint. The increased values of vertical component of the ground reaction force (VGRF) were negligible and the increase in the impulse of VGRF was noticeable for only one participant. Conclusion: The new orthosis had positive effects kinetic and kinematic parameters of walking such as the increased velocity by two subjects and also a more normal sagittal ROM, moment and work, suggesting the potential usefulness of the new orthotic device for MS population. © 2020, Shriaz University of Medical Sciences. All rights reserved

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

The Effect of Ankle Angle and Foot-plate Length of Ankle-Foot Orthoses on Spatiotemporal Parameters and Knee Joint Angle in Post-Stroke Hemiplegic Gait

Background and Objectives:  Equinovarus deformity and knee hyperextension are the most common problems in stroke patients. Ankle foot orthosis (AFO) is commonly prescribed to improve these disorders in these patients, as well as gait parameters that are approved. The aim of this study is to investigate the effect of ankle alignment and rigid AFO footplate length on spatiotemporal parameters and knee joint angle in hemiplegic post-stroke patients. Materials and Methods: This quasi-experimental study was performed on 6 hemiplegic post-stroke patients using three rigid AFO modes, including neutral ankle angle with full-length foot-plate -conventionally aligned AFO (CAFO), neutral ankle angle with ¾ length foot plate (¾AFO), and 50dorsi-flexion ankle angle with full-length foot-plate (50DF AFO) to investigate the effect of the alignment and foot plate length on spatiotemporal parameters and knee joint angle. The 3D motion analysis system with a Vicon Camera was used to collect the spatiotemporal parameters data. Results: The mean walking speed of patients after using 50DF AFO was significantly higher compared to CAFO (P=0.036). The mean stride length, cadence and maximum knee extension angle in the stance phase during single limb support was not significantly different in the three different test modes of ¾AFO, CAFO, 50DF AFO (P > 0.05). Conclusion: The DF AFO with 50ankle angle increases the walking speed and also controls knee hypertension in the terminal stance phase, which can be due to the progression of tibia in the mid to late stance phase and the alteration of ground reaction force vector

Effect of Milwaukee Brace on Quality of Life in Adolescents with Idiopathic Scoliosis

Introduction: Scoliosis is defined as a lateral deviation of the normal vertical line of the spine measured on radiography, with the curve greater than 10 degrees. One of the braces commonly used for scoliosis is Milwaukee. The purpose of this study was to evaluate the effect of Milwaukee brace on quality of life (QoL) in adolescents with adolescent idiopathic scoliosis (AIS) using the QLPSD questionnaire. Material and Method: Eighty-four patients (10- 20 years old) with AIS were recruited. Patients divided into two groups: intervention group (with Milwaukee brace) and control group (without any interventions), The "Quality of Life Profile for Spine Deformities" (QLPSD) questionnaire was used to assess the individuals' QoL. The highest score indicates the lowest QoL and the lowest score indicates the highest QoL. The independent t-test was used to evaluate the difference between two groups. Result: There were a significant increase between two groups in total QLPSD score (P=0.015). Regarding the QLPSD dimensions, mental function (P=0.003), sleep disorders (P=0.001), self-image (P=0.016), and flexibility of spine (P=0.018) were increased in Milwaukee brace group compared with no intervention group. Pain differences in two groups was not significant (P=0.061). Conclusion: Using the Milwaukee brace reduced individuals' QoL with AIS. Due to the effective role of QoL on the treatment process, the Milwaukee braces should be prescribed cautiously.Key words: Idiopathic Scoliosis, Milwaukee Brace, Quality of Life, QLPSD Questionnair

Internal Consistency of Reliability Assessment of the Persian version of the ‘Home Falls and Accident Screening Tool’

Objectives: Falling is a common problem among the elderly. Falling indoors and outdoors is highly prevalent among the Iranian elderly. Therefore, identification of the contributing factors at home and their modification can reduce falls and subsequent injuries inthe elderly. The goal of this study was to identify the elderly at risk of fall, using the &lsquo;Home Falls and Accident Screening Tool&rsquo; (HOME FAST), and to determine the reliability of this tool. Methods: Sixty old people were selected from five geographical regions of Tehran through the Local Town Councils. Participants were aged 60 to 65 years, and HOME FAST was used to assess inter rater and test- retest reliability. Results: Test-retest reliability in the study showed that agreement between the items of the Persian version of HOME FAST was over 0.8, which is a very good reliability. The agreement between the domains was 0.65-1.00, indicative of moderate to high reliability. Moreover, the Inter rater reliability of the items was over 0.8, which is also very good. The correlation of each item between the domains was 0.01-1.00, which shows poor to high reliability. Discussion: This study showed that the reliability of the Persian version of HOME FAST is high. This tool can therefore be used as an appropriate screening tool by professionals to take necessary preventive measures for the Iranian elderly population