Pelvic floor muscles training to reduce symptoms and signs of vulvovaginal atrophy : a case study

Objective: Vulvovaginal atrophy (VVA), caused by decreased levels of estrogen, is a common problem in aging women. Main symptoms of VVA are vaginal dryness and dyspareunia. First-line treatment consists of the application of local estrogen therapy (ET) or vaginal moisturizer. In some cases however, symptoms and signs persist despite those interventions. This case study describes a 77-year-old woman with severe VVA symptoms despite use of local ET and the addition of pelvic floor muscle (PFM) training to her treatment. Methods: A patient with stress urinary incontinence and VVA was referred to a randomized clinical trial on PFM training. On pretreatment evaluation while on local ET, she showed VVA symptoms on the ICIQ Vaginal Symptoms questionnaire and the ICIQ-Female Sexual Matters associated with lower urinary tract Symptoms questionnaire, and also showed VVA signs during the physical and dynamometric evaluation of the PFM. She was treated with a 12-week PFM training program. Results: The patient reported a reduction in vaginal dryness and dyspareunia symptoms, as well as a better quality of sexual life after 12 weeks of PFM training. On posttreatment physical evaluation, the PFMs' tone and elasticity were improved, although some other VVA signs remained unchanged. Conclusions: Pelvic floor muscle training may improve some VVA symptoms and signs in women taking local ET. Further study is needed to investigate and confirm the present case findings and to explore mechanisms of action of this intervention for VVA

Eicosapentaenoic acid decreases postprandial beta-hydroxybutyrate and free fatty acid responses in healthy young and elderly

Objectives: We investigated whether a dietary supplement rich in eicosapentaenoic acid (EPA) increases fasting plasma ketones or postprandial ketone responses in healthy young and elderly subjects. Methods: Ten young (22 ± 1 y old) and 10 elderly (75 ± 1 y old) subjects were recruited and participated in two identical study days, one before and one 6 wk after providing an EPA-enriched supplement (1.4 g/d of EPA and 0.2 g/d of docosahexaenoic acid). On the study days, blood samples were collected at fasting and every hour for 6 h after giving a breakfast. Fasting and postprandial plasma β-hydroxybutyrate (β-OHB), free fatty acid (FFA), triacylglycerol, glucose, and insulin responses were measured. Fatty acid profiles were assessed in fasting plasma samples before and after the EPA supplement. Results: After the EPA supplement, postprandial plasma β-OHB responses decreased by 44% in the young and by 24% in the elderly subjects, in addition to 20% and 34% lower FFA responses in the young and elderly adults, respectively. β-OHB and FFAs were positively and significantly correlated in young but not in elderly subjects before and after the EPA supplement. In both groups, postprandial plasma triacylglycerols, glucose, and insulin were not significantly different after the intake of the EPA supplement. Before and after the EPA supplement, fasting plasma EPA was 50% higher in the elderly but increased by about five times in both groups after intake of the EPA supplement. Conclusion: Contrary to our expectations, EPA supplementation lowered postprandial β-OHB response and, in the elderly subjects, the concentration of postprandial β-OHB was not lowered after intake of the EPA supplement

Test-retest reliability of clitoral blood flow measurements using color Doppler ultrasonography at rest and after a pelvic floor contraction task in healthy adult women

Aims: Test-retest reliability assessment of the dorsal clitoral artery's blood flow at rest and after muscle activation has never been documented. If this outcome measure is to be used in conditions impeding vascularity, it requires a psychometric evaluation. The aim of this study was to assess the inter-session test-retest reliability of clitoral blood flow in healthy women using color Doppler ultrasonography at rest and after a pelvic floor muscle (PFM) contraction task. Methods: Two assessment sessions were conducted using a clinical ultrasound system. Clitoral blood flow measurements were repeated at rest and after a PFM contraction task. Measurements of the peak systolic velocity (PSV), time-averaged maximum velocity (TAMX), end-diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI) were taken. The test-retest reliability was assessed using paired t-test, intraclass correlation coefficient (ICC), and Bland-Altman plots. Results: For reliability at rest, ICC values were 0.95 for PSV, 0.87 for TAMX, and 0.67 for both PI and RI. The variability between measurements, as per Bland-Altman plots, was small for PSV, TAMX, and RI and acceptable for PI. For reliability after the PFM contractions task, ICC values were 0.85 for PSV, 0.77 for TAMX, 0.79 for PI, and 0.81 for RI. The variability between measurements was small for PSV and RI and acceptable for TAMX and PI. EDV parameter did not perform as well in both conditions. Conclusions: Assessment of the clitoral blood flow with color Doppler ultrasound is reliable at rest and after a PFM contraction task

Plasma n-3 fatty acids in the elderly

The elderly reportedly have a significantly higher % of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids in plasma and red cell lipids. However, these observations are from a few small studies and the health status of the elderly in these studies is for the most part unclear. Since the elderly are susceptible to cardiovascular and neurological illnesses that seem to be related in part to lower intake of n-3 fatty acids it seems paradoxical that their blood levels of EPA and DHA would be higher than in young adults. We report here plasma fatty acid profiles and their response to supplementation with two types of fish oils from several of our recent studies in the moderately healthy elderly. We define the moderately healthy elderly as those who were in good physical condition, had no cognitive decline and, if present, in whom hypothyroidism, hyperlipidemia and/or hypertension were well-controlled. As shown previously, we confirm the higher % EPA and % total n-3 fatty acids (but not DHA) in fasting plasma and extend these findings to include higher plasma concentrations (mg/L) of n-3 fatty acids as well. The EPA-predominant supplement raised DHA only in the young, whereas the DHA-predominant supplement raised EPA more in the young than in the elderly. The moderately healthy elderly clearly have higher plasma n-3 fatty acids but whether this reflects differences in intake versus aging-related changes in n-3 fatty acid metabolism remains to be elucidated

Molecular remodeling of adipose tissue is associated with metabolic recovery after weight loss surgery

Background Bariatric surgery is an effective therapy for individuals with severe obesity to achieve sustainable weight loss and to reduce comorbidities. Examining the molecular signature of subcutaneous adipose tissue (SAT) following different types of bariatric surgery may help in gaining further insight into their distinct metabolic impact. Results Subjects undergoing biliopancreatic diversion with duodenal switch (BPD-DS) showed a significantly higher percentage of total weight loss than those undergoing gastric bypass or sleeve gastrectomy (RYGB + SG) (41.7 ± 4.6 vs 28.2 ± 6.8%; p = 0.00005). Individuals losing more weight were also significantly more prone to achieve both type 2 diabetes and dyslipidemia remission (OR = 0.75; 95%CI = 0.51–0.91; p = 0.03). Whole transcriptome and methylome profiling showed that bariatric surgery induced a profound molecular remodeling of SAT at 12 months postoperative, mainly through gene down-regulation and hypermethylation. The extent of changes observed was greater following BPD-DS, with 61.1% and 49.8% of up- and down-regulated genes, as well as 85.7% and 70.4% of hyper- and hypomethylated genes being exclusive to this procedure, and mostly associated with a marked decrease of immune and inflammatory responses. Weight loss was strongly associated with genes being simultaneously differentially expressed and methylated in BPD-DS, with the strongest association being observed for GPD1L (r²=0.83; p=1.4x10⁻⁶). Conclusions Present findings point to the greater SAT molecular remodeling following BPD-DS as potentially linked with higher metabolic remission rates. These results will contribute to a better understanding of the metabolic pathways involved in the response to bariatric surgery and will eventually lead to the development of gene targets for the treatment of obesity

Linking low docosahexaenoic acid intake to Alzheimer's disease : caution recommended

Prospective cohort studies and animal models support the concept that low docosahexaenoic acid intake is implicated in the etiology or progression of Alzheimer’s disease. However, other studies crucial to this relationship are less encouraging. To date, the few trials using docosahexaenoic acid to treat declining cognition in the elderly have either been very small or, in the largest trial, the beneficial effect was mild and limited to a sub-group of patients. The supplements used in each of these clinical trials contained at least one polyunsaturated fatty acid other than docosahexaenoic acid, so the active ingredient remains unclear. One widely cited study reported markedly lower brain docosahexaenoic acid in Alzheimer’s disease but at least five other much less commonly cited reports have not corroborated this effect. There are numerous inconsistencies or confounders in the data and several challenges to overcome before definitively attributing a specific role to docosahexaenoic acid in the protection of cognitive function in the elderl

Regard sur la pratique ergothérapique en déficience intellectuelle au Québec : une enquête exploratoire

Introduction : Au Québec, le développement de la pratique de l’ergothérapie en déficience intellectuelle est en pleine émergence au regard du nombre d’ergothérapeutes engagés dans l’offre de services destinée à cette clientèle. Néanmoins, les écrits et les outils liés à l’ergothérapie au Québec dans ce domaine restent limités pour soutenir les ergothérapeutes dans l’accomplissement de leur plein potentiel professionnel. Objectif : Cette étude vise à brosser le portrait de la pratique de l’ergothérapie auprès des personnes ayant une déficience intellectuelle au Québec. Méthode : L’enquête utilisant un questionnaire en ligne, diffusé aux ergothérapeutes par le biais de leur association professionnelle, comprenait des questions liées aux motifs de référence en ergothérapie, aux stratégies d’évaluation et aux méthodes d’intervention utilisées, ainsi qu’aux défis rencontrés dans la pratique. Résultats : Un total de 53 ergothérapeutes a rempli le questionnaire. Les participants travaillent dans divers contextes de pratique et répondent à une variété de demandes de consultation, principalement en lien avec le soutien à l’autonomie. Les ergothérapeutes utilisent plusieurs outils d’évaluation, mais notent un défi concernant la standardisation et l’utilisation des valeurs normatives. Les ergothérapeutes agissent majoritairement à titre de consultants et constatent un accès limité à des formations pour soutenir leur développement professionnel. Conclusion : Bien que les rôles de l’ergothérapeute soient multiples, il semble qu’une faible implication de ces professionnels soit observée dans plusieurs sphères de vie des personnes ayant une déficience intellectuelle. Divers champs d’exercices de l’ergothérapie resteraient à développer au Québec, notamment dans le soutien aux transitions de vie, auprès des personnes présentant des incapacités significatives, et dans l’inclusion socioprofessionnelle. ----- Introduction: In Quebec, the occupational therapy practice in intellectual disability is in full development with regard to the number of occupational therapists involved in services intended for people with an intellectual disability. Nevertheless, scientific literature and professional tools related to occupational therapy specific to this context remains limited to support occupational therapist in achieving their full potential. Aim: This study aims to explore the occupational therapy practice amongst people with an intellectual disability in Quebec. Method: This survey using an online questionnaire, distributed to occupational therapists through their professional association, included closed and open-ended questions related to reasons for referral in occupational therapy services, currently used assessment strategies and intervention methods, as well as challenges encountered by occupational therapists. Results: A total of 53 occupational therapists completed the survey. Participants work in many practice settings and respond to a variety of consultation requests, primarily related to support of autonomy in daily activities. Occupational therapists use several assessment tools, but identify a challenge regarding the standardization and the use of normative values. Occupational therapists mostly act as consultants and report limited access to training supporting their professional development. Conclusion: Although the roles of occupational therapist are multiple, a limited involvement of these professionals is noted in several life domains of people with an intellectual disability. Various fields of expertise still need to be developed in Quebec, notably in the support during life transitions, in interventions with people with significant disabilities, and in socioprofessional inclusion

Plasma response to fish oil in the elderly

Little information is available concerning whether incorporation of dietary omega-3 fatty acids into plasma lipids changes during healthy aging. Elderly (74 ± 4 years old) and young (24 ± 2 years old) adults were given a fish oil supplement for 3 weeks that provided 680 mg/day of docosahexaenoic acid and 320 mg/day of eicosapentaenoic acid, followed by a 2 week wash-out period. Compliance was monitored by spiking the capsules with carbon-13 glucose, the excretion of which was measured in breath CO2. In response to the supplement, plasma docosahexaenoic acid rose 42% more in the elderly but eicosapentaenoic responded similarly in both groups. Despite raising docosahexaenoic acid intake by five to tenfold, the supplement did not raise plasma free docosahexaenoic acid (% or mg/dL) in either group. We conclude that healthy aging is accompanied by subtle but significant changes in DHA incorporation into plasma lipids

Supporting decision making and early prediction of survival for oncology drug development using a pharmacometrics-machine learning based model

International audienc