In systemic sclerosis, anxiety and depression assessed by hospital anxiety depression scale are independently associated with disability and psychological factors.

Background. Anxious and depressive symptoms are frequent in Systemic Sclerosis (SSc). Our objective is to assess their prevalence and association with district and global disability and psychological variables. Methods. 119 SSc patients were assessed by Hospital Anxiety Depression Scale (HADS). Clinical depression and anxiety were defined for HADS score cutoff ≥8. Patients were assessed for psychological symptoms (RSES, COPE-NIV), hand (HAMIS, CHFDS, fist closure, and hand opening) and face disability (MHISS, mouth opening), global disability, and fatigue (HAQ, FACIT). Results. Both depression and anxiety in SSc are 36%. Depressive patients with comorbid anxiety have higher HADS-D score than patients with depression only (). HADS-A and -D are positively correlated with global disability, hands and mouth disability, fatigue, self-esteem and avoidance coping strategy, and, only HADS-A, also with social support (). By multiple regression, HADS-D is independently associated with FACIT-F (), RSES (), and MHISS total score (), together explaining 50% of variance. HADS-A is independently associated with RSES (), COPE-NIV SA (), COPE-NIV SS (), FACIT-F (), and MHISS mouth opening (), explaining 41% of variance. Conclusions. In SSc depression and anxiety correlate to local and global disabilities and psychological characteristics. Depressive patients with comorbid anxiety have higher level of depressive symptoms

Impact of Manual Therapy on Instrumentalist Musicians With Playing-Related Musculoskeletal Disorders: A Systematic Review

Objective: To investigate the effects of manual therapy on playing-related musculoskeletal disorders (PRMDs) in instrumentalist musicians. Data Sources: PubMed, MEDLINE, CINAHL, Scopus, Web of Science, and EMBASE were searched from inception until December 17, 2024. Study Selection: Randomized controlled trials (RCTs), noncontrolled trials, case reports evaluating the effects of any manual therapy on PRMDs of instrumentalists were selected. Data Extraction: Two independent authors extracted data and assessed quality using different risk of bias assessment tools, depending on study design. Data Synthesis: Of the 529 retrieved titles, 9 were included: 3 articles on 2 RCTs (one with 69 string/wind/percussion players and the other with 30 wind players, aged 18-30y), 1 case series (689 instrumentalists), 1 pre-post trial (32 string/wind/keyboard/percussion/other instrumentalists, aged 18-30y), and 4 case reports (4 string/wind/keyboard players, aged 25-64y). The first RCT showed significantly reduced pain and disability after soft tissue and mobilization techniques along with postural exercises versus postural exercises alone in temporomandibular dysfunction of wind instrument students. The other RCT reported immediate and medium-term significant pain reduction after Tuina versus sham Tuina in PRMDs in professional musicians. The case series, pre-post study, and 1 case report were of low-very low quality, while 3 case reports were of good quality. However, it should be noted that support for treatment was very limited; both RCTs were underpowered and had a high risk of bias, whereas the evidence from the other studies was limited by low quality and/or design. Heterogeneity did not allow for meta-analysis. Conclusions: The evidence supporting manual therapy for PMRDs in instrumentalists is scarce and of low quality. High-quality RCTs are needed to investigate the risks and benefits of these interventions

Multiple imputation integrated to machine learning: predicting post-stroke recovery of ambulation after intensive inpatient rehabilitation

Abstract Good data quality is vital for personalising plans in rehabilitation. Machine learning (ML) improves prognostics but integrating it with Multiple Imputation (MImp) for dealing missingness is an unexplored field. This work aims to provide post-stroke ambulation prognosis, integrating MImp with ML, and identify the prognostic influential factors. Stroke survivors in intensive rehabilitation were enrolled. Data on demographics, events, clinical, physiotherapy, and psycho-social assessment were collected. An independent ambulation at discharge, using the Functional Ambulation Category scale, was the outcome. After handling missingness using MImp, ML models were optimised, cross-validated, and tested. Interpretability techniques analysed predictor contributions. Pre-MImp, the dataset included 54.1% women, 79.2% ischaemic patients, median age 80.0 (interquartile range: 15.0). Post-MImp, 368 non-ambulatory patients on 10 imputed datasets were used for training, 80 for testing. The random forest (the validation best-performing algorithm) obtained 75.5% aggregated balanced accuracy on the test set. The main predictors included modified Barthel index, Fugl-Meyer assessment/motricity index, short physical performance battery, age, Charlson comorbidity index/cumulative illness rating scale, and trunk control test. This is among the first studies applying ML, together with MImp, to predict ambulation recovery in post-stroke rehabilitation. This pipeline reliably exploits the potential of incomplete datasets for healthcare prognosis, identifying relevant predictors

Influence of Tumor Subtype, Radiological Sign and Prognostic Factors on Tumor Size Discrepancies Between Digital Breast Tomosynthesis and Final Histology

open8BackgroundInfluence of tumor subtype, radiological sign and prognostic factors on tumor size discrepancies between DBT and final histology has not been completely investigated so far.PurposeTo study the influence of tumor subtype, radiological sign and prognostic factors on tumor size discrepancies between digital breast tomosynthesis and final histology.Material and methodsThis is a retrospective study conducted between January 2015 and December 2016. After IRB approval, 130 consecutive patients with breast cancer diagnosed with digital breast tomosynthesis (DBT) were evaluated. A discrepancy between DBT and final histology was considered present if the difference was above the cut-off of 5 mm. Tumor subtype, radiological sign and prognostic factors were evaluated in patients with discrepancies. Descriptive statistic and non-parametric tests were used.ResultsA total of 105 cases of cancer, in 96 patients, all female, were included. Mean age was 61 years (range: 35-82 yrs). In 19 (18.1%) cases, discrepancies were found: 13 (68.4%) were underestimated by DBT. For tumor subtype, 10 (52.6%) were infiltrating lobular carcinomas (ILC) (p < 0.01). Fourteen (73.7%) discordant cases were architectural distortions (p < 0.01). Prognostic factors did not affect tumor size discrepancies.ConclusionILC or an architectural distortion represents the majority of cases of tumor size discrepancies between DBT and final histology.openGarlaschi, Alessandro; Calabrese, Massimo; Zaottini, Federico; Tosto, Simona; Gipponi, Marco; Baccini, Paola; Gallo, Maurizio; Tagliafico, AlbertoGarlaschi, Alessandro; Calabrese, Massimo; Zaottini, Federico; Tosto, Simona; Gipponi, Marco; Baccini, Paola; Gallo, Maurizio; Tagliafico, Albert

How to communicate with older adults about climate change: a systematic review

IntroductionAlthough older adults are particularly vulnerable to the effects of climate change, they seem to be overall less concerned about it, and less inclined to support climate policies. The study aims to identify the communication strategies that have been evaluated in promoting awareness and/or climate friendly behaviors in older adults.MethodsWe searched multiple electronic databases for studies that evaluated the effects of any interventions aimed at communicating climate change to older persons (over 65 years) and assessed the results as awareness and /or behavioral changes. We selected quantitative, qualitative and mixed methods studies, and we also included systematic reviews for cross-referencing. Risk of bias of included studies was evaluated using different tools according to the study design.ResultsFrom a total of 5,486 articles, only 3 studies were included. One mixed-method study engaged older adults to assess the community vulnerability to climate change and to develop adaptation recommendations based on their perspectives; one qualitative study conducted focus groups to identify the more effective language, values and themes based on participants’ responses to narratives; one quantitative study utilized a 360-degree audio-visual platform allowing users to engage with immersive visualizations of sea-level rise scenarios.DiscussionDespite the paucity of literature, this review demonstrates the potential for different strategies to increase the awareness of older persons about climate change. The involvement of older adults in the communication process, the identification of their priorities, and the integration of technology in their daily lives are promising approaches but more research, including both quantitative and qualitative studies is recommended on this topic.Systematic review registerationFor further details about the protocol, this systematic review has been registered on PROSPERO on July 1, 2023 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023438256)

Rehabilitation of the face and temporomandibular joint in systemic sclerosis

BACKGROUND: Systemic sclerosis (SSc) alterations of the face and of the mouth cause aesthetic modifications and disability, impairing self-esteem and quality of life (QoL). The aim of this study was to verify the effects of two rehabilitation protocols on facial mimic and mouth opening. METHODS: A total of 47 SSc patients (40 females and 7 males, mean age ± SD 59.08 ± 10.31 years), were consecutively selected: 22 were randomly assigned to protocol 1 [home exercises for temporomandibular joint (TMJ), mimic, masticatory and cervical spine muscles] and 25 to protocol 2 (home exercises and combined physiotherapeutic procedures performed by a physiotherapist). Each treatment had a duration of 12 weeks with a follow up of 8 weeks. TMJ dysfunction, orofacial involvement, disability, QoL, and safety were assessed at enrollment (T0), at the end of the treatment (T1), and at follow up (T2). RESULTS: Both Protocol 1 and Protocol 2 induced significant improvements of some clinical and clinimetric parameters, but better results were obtained with Protocol 2. In the comparison between the effects of Protocol 1 and Protocol 2 at T1 and T2, a significant difference was observed only for Mouth Handicap in SSc [MHISS; Total (p = 0.00178] and for MHISS Mouth opening (p = 0.0098) at T1. No significant difference of indices of short-form 36 was observed. CONCLUSION: The present data suggest that TMJ involvement in SSc may be managed by rehabilitation treatments. The action of a physiotherapist prescribing and personalizing exercises may induce better therapeutic effects

Overview and future challenges of nearly zero energy buildings (nZEB) design in Southern Europe

In times of great transition of the European construction sector to energy efficient and nearly zero energy buildings (nZEB), a market observation containing qualitative and quantitative indications should help to fill out some of the current gaps concerning the EU 2020 carbon targets. Next to the economic challenges, there are equally important factors that hinder renovating the existing residential building stock and adding newly constructed high performance buildings. Under these circumstances this paper summarises the findings of a cross-comparative study of the societal and technical barriers of nZEB implementation in 7 Southern European countries. The study analyses the present situation and provides an overview on future prospects for nZEB in Southern Europe. The result presents an overview of challenges and provides recommendations based on available empirical evidence to further lower those barriers in the European construction sector. The paper finds that the most Southern European countries are poorly prepared for nZEB implementation and especially to the challenge opportunity of retrofitting existing buildings. Creating a common approach to further develop nZEB targets, concepts and definitions in synergy with the climatic, societal and technical state of progress in Southern Europe is essential. The paper provides recommendations for actions to shift the identified gaps into opportunities for future development of climate adaptive high performance buildings. (C) 2017 Elsevier B.V. All rights reserved.info:eu-repo/semantics/publishedVersio