Physical activity and risk of comorbidities in patients with chronic obstructive pulmonary disease: a cohort study

Multi-morbidity is common in patients with chronic obstructive pulmonary disease and low levels of physical activity are hypothesized to be an important risk factor. The current study aimed to assess the longitudinal association between physical activity and risk of seven categories of comorbidity in chronic obstructive pulmonary disease patients. The study included 409 patients from primary care practice in the Netherlands and Switzerland. We assessed physical activity using the Longitudinal Ageing Study Amsterdam Physical Activity Questionnaire at baseline and followed patients for up to 5 years. During follow-up, patients reported their comorbidities (cardiovascular, neurological, endocrine, musculoskeletal, malignant, and infectious diseases) and completed the Hospital Anxiety and Depression Scale questionnaire for mental health assessment. We implemented multinomial logistic regression (an approximation to discrete time survival model using death as a competing risk) for our analysis. Study results did not suggest a statistically significant association of baseline physical activity with the development of seven categories of comorbidity. However, when we focused on depression and anxiety symptoms, we found that higher levels of physical activity at baseline were associated with a lower risk for depression (adjusted hazard ratio, 0.85; 0.75-0.95; p = 0.005) and anxiety (adjusted hazard ratio, 0.89; 0.79-1.00; p = 0.045). In chronic obstructive pulmonary disease patients, those with high physical activity are less likely to develop depression or anxiety symptoms over time. Increasing physical activity in chronic obstructive pulmonary disease patients may be an approach for testing to lower the burden from incident depression and anxiet

Natural course of post COVID-19 condition and implications for trial design and outcome selection: A population-based longitudinal cohort study

Background Evidence from population-based studies on the longer-term natural course of post COVID-19 condition is limited, but crucial for informing patients and healthcare providers and for effectively designing clinical trials. Objectives To evaluate longer-term symptoms and health outcomes within a cohort of SARS-CoV-2 infected individuals. Design Population-based, longitudinal cohort. Setting General population, Canton of Zurich, Switzerland. Patients 1543 adults with confirmed SARS-CoV-2 infection and 628 adults without infection. Measurements Changes in self-reported health status over time, factors associated with persistence of non-recovery, and prevalence and excess risk of symptoms at 6 and 12 months post-infection compared to non-infected individuals. Results 25% of SARS-CoV-2 infected individuals did not recover by 6 months. Of those, 67% and 58% also did not recover at 12 and 18 months after infection, respectively. Hospitalization for acute COVID-19, pre-existing fatigue and pain or discomfort, and presence of specific systemic, cardiovascular, or musculoskeletal symptoms at 6 months were associated with persistent non-recovery. Symptom prevalence was higher among infected individuals compared to non-infected individuals at 6 months (adjusted risk difference (aRD)=17%) and 12 months (aRD=20%). aRDs for individual symptoms ranged from 2% to 12%, with the highest excess risks observed for altered taste or smell, post-exertional malaise, fatigue, and reduced concentration and memory. Limitations We relied on self-reported assessments and did not assess the effects of vaccination or infection with emerging variants of concern. Conclusion These findings emphasize the need for effective interventions to reduce the burden of post COVID-19 condition. They further demonstrate the importance of using multiple outcome measures and of considering the expected rates of natural recovery and heterogenous patient trajectories in the design and interpretation of clinical trials

Diffuse swelling of the buccal mucosa and palate as first and only manifestation of an extranodal non-Hodgkin ‘double-hit' lymphoma: report of a case

Background: Most of the lymphomas arising in the oral cavity are of B-cell origin. Among these, diffuse large B-cell lymphomas are the most common. Diffuse large B-cell lymphomas may exhibit more than one chromosomal rearrangement and are then referred to as ‘double-hit' or ‘triple-hit' lymphomas. Case report: We present a case of an intraoral ‘double-hit' lymphoma in a 76-year-old male who had been referred by an oral surgeon in private practice. Intraoral examination exhibited a firm, exophytic lesion in the region of the right hard palate and buccal mucosa with extension to the soft palate. Radiographic examination exhibited a massive thickening of the right sinus membrane, and arrosion of the lateral and basal cortical sinus walls in the right maxilla. After diagnosis of the lesion, the patient was treated with six cycles of chemotherapy. Discussion: Lymphomas arising within the oral cavity account for less than 5% of all oral malignancies and typically affect the palatine tonsils and the palate. ‘Double-hit' lymphomas are associated with older age, usually present with an advanced stage of disease, and show an aggressive clinical behaviour. They normally have a poor prognosis, even when treated with intensive chemotherapy regimens. Nevertheless, in the case presented, the patient was free of symptoms 1year after initial diagnosi

A new rating scale for adult ADHD based on the Symptom Checklist 90 (SCL-90-R)

Attention deficit hyperactivity disorder (ADHD) in adults is increasingly recognized as a clinically important syndrome. The aim of this study was to evaluate the psychometric performance of a new scale for adult ADHD based on the widely used Symptom Checklist 90 Revised (SCL-90-R). Scale performance was assessed in a clinical study including 100 ADHD patients and 65 opiate-dependent patient controls, and in the Zurich study, an epidemiological age cohort followed over 30years of adult life. Assessments included a ROC analysis of sensitivity and specificity, internal consistency, test-retest reliability, external validity and measurement invariance over nine testing occasions. The new scale showed a sensitivity and specificity of 75 and 54%, respectively, internal consistency over 0.8 (McDonald's omega, Cronbach's alpha), one-year test-retest reliabilities over 0.7, statistically significant and substantial correlations with two other validated self-rating scales of adult ADHD (R=0.5 and 0.66, respectively), and an acceptable degree of longitudinal stability (i.e., measurement invariance). The proposed scale must be further evaluated, but these preliminary results indicate it could be a useful rating instrument for adult ADHD in situations where SCL-90-R data, but no specific ADHD assessment, are available, such as in retrospective data analysis or in prospective studies with limited methodical resource

Patient-reported physical activity questionnaires: A systematic review of content and format

Many patients with chronic illness are limited in their physical activities. This systematic review evaluates the content and format of patient-reported outcome (PRO) questionnaires that measure physical activity in elderly and chronically ill populations.status: publishe

Association between serologically confirmed COVID-19 infection and cognitive functioning in community dwelling older adults

INTRODUCTION COVID-19 infection can impact the central nervous system, and is often associated with cognitive decline. However, there are no studies linking serologically confirmed COVID-19 infection with objectively assessed cognitive functioning. We explored whether presence of SARS-CoV-2 antibodies account for variability in participants' scores on a neuropsychological assessment. METHODS In this cross-sectional study participants were 657 (mean age = 72.97; SD = 6.07 years; women = 47.7%) individuals randomly selected from the general population of the canton of Zurich and included in the Corona Immunitas study. We conducted serological tests between October 2020 and May 2021 to detect and quantify SARS-CoV-2 antibodies in peripheral venous blood samples. We assessed cognitive function, vaccination status (vaccinated; not vaccinated), number of health conditions, and demographic variables between January and August 2021. We studied the association between seropositivity and global cognitive function and five cognitive domains (language expression, language comprehension, temporal orientation, spatial orientation, and memory) with linear regression models. Based on SARS-CoV-2 antibodies and vaccination status, we stratified participants into three groups: No SARS-CoV-2 antibodies (N = 402); SARS-CoV-2 antibodies due to vaccination (N = 218); history of SARS-CoV-2 infection and no vaccination (N = 37). RESULTS In the regression model adjusted for age, sex, educational level, and number of health conditions, compared to those without SARS-CoV-2 antibodies, those with SARS-CoV-2 antibodies due to vaccination had better global cognitive functioning (Standardized beta = 0.10; 95% CI = 0.02; 0.17), and those with SARS-CoV-2 antibodies due to infection had poorer cognitive functioning (Standardized beta = -0.10; 95% CI = -0.18; -0.03). Regarding cognitive domains, compared to those without SARS-CoV-2 antibodies, those with SARS-CoV-2 antibodies due to infection scored more poorly on language comprehension and temporal orientation, and those with SARS-CoV-2 antibodies due to vaccination scored better on memory. DISCUSSION By linking serologically confirmed presence of SARS-CoV-2 antibodies to poorer global cognitive functioning in community dwelling older adults we strengthen existing evidence in support of cognitive decline related to COVID-19. Given the large number of infected older adults, and the endurance of the pandemic, our results highlight the need to address COVID-19 related cognitive decline in the clinical and public health areas of prevention, diagnosis, and treatment

Updating national physical activity guidelines based on the global WHO guidelines: experiences and challenges from Switzerland

Physical activity guidelines are recognized as an important element of a national approach to promote physical activity. This publication summarizes the approach and process taken to update the Swiss Guidelines, presents a summary of the updated guidelines and discusses experiences and identifies challenges. The multistage project involved: 1) to summarize the scientific evidence underpinning the 2020-edition of the WHO guidelines; 2) to systematically analyze the existing Swiss guidelines for different target groups and to develop proposals for updates 3) a participatory process to gain consensus with the main interested groups 4) to finalize the guidelines. Updated guidelines were adopted for infants, pre-school children, children and young people, adults, older adults and pregnant and postpartum women, in most cases following the WHO guidelines. Children, young people and adults living with disability and adults and older adults with chronic conditions are specifically addressed in each of the general guidelines for healthy populations, rather than developing separate guidelines for each of these groups as done by the WHO. The systematic approach in identifying aspects to update, the participatory approach and a scientific consortium and project coordination group with different thematic backgrounds were key strengths in the process. Challenges included the large amount of feedback and finding scientifically sound compromises. The updated versions of the Swiss national guidelines provide an excellent basis to further promote physical activity in Switzerland. A remaining key task is to develop a range of communication tools and materials for different target groups beyond the circle of experts and interested groups, considering available evidence on optimal messaging and best outlet tools and channels. To track population prevalence, inform policy and evaluate physical activity promotion at national and sub-national level in a timely fashion, strengthening existing physical activity monitoring will be important

Hochschuldidaktische Werkstatt: Partizipation und Kooperation im Grundschullehramt

Der Beitrag fokussiert das Projekt „Mentoring: Erfolgreich L1 studieren“ (MERLIN), welches initiiert wurde, um den Übergang für Studienanfänger:innen an die Hochschule zu begleiten. MERLIN gliedert sich in ein „Mentoring-Programm“ und die „Hochschuldidaktische Werkstatt“ (HDW). Die HDW - die im Vordergrund des Beitrages steht - hat das Ziel, neben der Stärkung der Kooperation und Kollaboration von Dozent:innen, die im Grundschullehramt lehren, auch zur Förderung der Partizipation der Studierenden an der Studiengangsentwicklung beizutragen. Zunächst wird die HDW in ihrer Umsetzung und Funktion im Grundschullehramt der Justus-Liebig-Universität Gießen erläutert. Danach findet eine Analyse der HDW anhand von Qualitätsmerkmalen für Lernwerkstätten statt. Hiernach geht der Beitrag näher auf das zugrunde liegende Verständnis von Kooperation und Kollaboration sowie intendierter partizipativer Prozesse in der HDW ein. Der Beitrag schließt mit einer Diskussion, inwiefern das Konzept der HDW ein wirksames Werkzeug zur Förderung von Partizipation, Kooperation und Kollaboration darstellt und somit letztendlich auch zur Studiengangsentwicklung beiträgt. (DIPF/Orig.

The Chronic CARe for diAbeTes study (CARAT): a cluster randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Diabetes is a major challenge for the health care system and especially for the primary care provider. The Chronic Care Model represents an evidence-based framework for the care for chronically ill. An increasing number of studies showed that implementing elements of the Chronic Care Model improves patient relevant outcomes and process parameters. However, most of these findings have been performed in settings different from the Swiss health care system which is dominated by single handed practices.</p> <p>Methods/Design</p> <p>CARAT is a cluster randomized controlled trial with general practitioners as the unit of randomization (trial registration: ISRCTN05947538). The study challenges the hypothesis that implementing several elements of the Chronic Care Model via a specially trained practice nurse improves the HbA1c level of diabetes type II patients significantly after one year (primary outcome). Furthermore, we assume that the intervention increases the proportion of patients who achieve the recommended targets regarding blood pressure (<130/80), HbA1c (=<6.5%) and low-density lipoprotein-cholesterol (<2.6 mmol/l), increases patients' quality of life (SF-36) and several evidence-based quality indicators for diabetes care. These improvements in care will be experienced by the patients (PACIC-5A) as well as by the practice team (ACIC). According to the power calculation, 28 general practitioners will be randomized either to the intervention group or to the control group. Each general practitioner will include 12 patients suffering from diabetes type II. In the intervention group the general practitioner as well as the practice nurse will be trained to perform care for diabetes patients according to the Chronic Care Model in teamwork. In the control group no intervention will be applied at all and patients will be treated as usual. Measurements (pre-data-collection) will take place in months II-IV, starting in February 2010. Follow-up data will be collected after 1 year.</p> <p>Discussion</p> <p>This study challenges the hypothesis that the Chronic Care Model can be easily implemented by a practice nurse focused approach. If our results will confirm this hypothesis the suggestion arises whether this approach should be implemented in other chronic diseases and multimorbid patients and how to redesign care in Switzerland.</p