Integrating Function‐Directed Treatments into Palliative Care

The growing acceptance of palliative care has created opportunities to increase the use of rehabilitation services among populations with advanced disease, particularly those with cancer. Broader delivery has been impeded by the lack of a shared definition for palliative rehabilitation and a mismatch between patient needs and established rehabilitation service delivery models. We propose the definition that, in the advanced cancer population, palliative rehabilitation is function‐directed care delivered in partnership with other clinical disciplines and aligned with the values of patients who have serious and often incurable illnesses in contexts marked by intense and dynamic symptoms, psychological stress, and medical morbidity to realize potentially time‐limited goals. Although palliative rehabilitation is most often delivered by inpatient physical medicine and rehabilitation consultation/liaison services and by physical therapists in skilled nursing facilities, outcomes in these settings have received little scrutiny. In contrast, outpatient cancer rehabilitation programs have gained robust evidentiary support attesting to their benefits across diverse settings. Advancing palliative rehabilitation will require attention to historical barriers to the uptake of cancer rehabilitation services, which include the following: patient and referring physicians’ expectation that effective cancer treatment will reverse disablement; breakdown of linear models of disablement due to presence of concurrent symptoms and psychological distress; tension between reflexive palliation and impairment‐directed treatment; palliative clinicians’ limited familiarity with manual interventions and rehabilitation services; and challenges in identifying receptive patients with the capacity to benefit from rehabilitation services. The effort to address these admittedly complex issues is warranted, as consideration of function in efforts to control symptoms and mood is vital to optimize patients’ autonomy and quality of life. In addition, manual rehabilitation modalities are effective and drug sparing in the alleviation of adverse symptoms but are markedly underused. Realizing the potential synergism of integrating rehabilitation services in palliative care will require intensification of interdisciplinary dialogue.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146938/1/pmr2s335.pd

Land quality, sustainable development and environmental degradation in agricultural districts: A computational approach based on entropy indexes

Land Degradation (LD) in socio-environmental systems negatively impacts sustainable development paths. This study proposes a framework to LD evaluation based on indicators of diversification in the spatial distribution of sensitive land. We hypothesize that conditions for spatial heterogeneity in a composite index of land sensitivity are more frequently associated to areas prone to LD than spatial homogeneity. Spatial heterogeneity is supposed to be associated with degraded areas that may act as hotspots for future degradation processes. A diachronic analysis (1960-2010) was carried out at the agricultural district scale in Italy to identify environmental factors associated to spatial heterogeneity in the level of land sensitivity to degradation based on the Environmentally Sensitive Area Index (ESAI). In 1960, diversification in the level of land sensitivity measured through two common indexes of entropy (Shannon's diversity and Pielou's evenness) increased significantly with the ESAI, indicating a high level of land sensitivity to degradation. In 2010, surface area classified as 'critical' to LD was the highest in districts with evident diversification in the spatial distribution of ESAI values, confirming the hypothesis formulated above. Entropy indexes, based on observed alignment with the concept of LD, constitute a valuable base to inform mitigation strategies against desertification

Assessing the impact of Motivational-Interviewing via Co-active Life Coaching on engagement in physical activity

The purpose of this 12-week pre-post design study was to assess the impact of Motivational Interviewing via Co-Active Life Coaching (MI-via-CALC) on engagement in physical activity for 25 women between the ages of 30 and 55 years. Data on task self-efficacy, barrier-specific self-efficacy, self-esteem, physical activity (PA), body mass index (BMI), and waist-to-tip ratio and circumference were collected. Results indicated some positive, but not significant differences in barrier-specific self-efficacy, which were detected between pre- and post- intervention, and statistically significant differences in self-esteem between pre- and post-intervention were found. No statistically significant differences were found in participants’ task self-efficacy scores and PA scores. Statistically significant decreases were detected for BMI, and waist-to-hip ratios and circumference. MI-via-CALC is an encouraging approach for women who are seeking a more physically active lifestyle, and additional research with a larger sample size is recommended

Uncovering the Role of Biophysical Factors and Socioeconomic Forces Shaping Soil Sensitivity to Degradation: Insights from Italy

[EN] Following an operational framework derived from earlier research, our study research estimates the specific contribution of biophysical and socioeconomic factors to soil sensitivity to degradation at two-time points (Early-1990s and Early-2010s) in Italy, a Mediterranean hotspot for desertification risk. A total of 34 variables associated (directly or, at least, indirectly) with different processes of soil degradation (erosion, salinization, sealing, contamination, and compaction) and climate change were considered here, delineating the predominant (underlying) cause (i.e., biophysical or socioeconomic). This set of variables represented the largest (quantitative) information available from national and international data sources including official statistics at both national and European scale. Contribution of biophysical and socioeconomic dimensions to soil sensitivity to degradation was heterogeneous in Italy, with the level of soil sensitivity to biophysical factors being the highest in less accessible, natural areas mostly located in hilly and mountainous districts. The highest level of soil sensitivity to socioeconomic drivers was instead observed in more accessible locations around large cities and flat rural districts with crop intensification and low (but increasing) population density. All these factors delineated an enlarged divide in environmental quality between (i) flat and upland districts, and between (ii) Northern and Southern Italian regions. These findings suggest the appropriateness of policy strategies protecting soils with a strong place-specific knowledge, i.e., based on permanent monitoring of local (biophysical and socioeconomic) conditions.Gambella, F.; Colantoni, A.; Egidi, G.; Morrow, N.; Prokopova, M.; Salvati, L.; Giménez Morera, A.... (2021). Uncovering the Role of Biophysical Factors and Socioeconomic Forces Shaping Soil Sensitivity to Degradation: Insights from Italy. Soil Systems. 5(1):1-15. https://doi.org/10.3390/soilsystems5010011S1155

Genetic Risk Score Predicts Late-Life Cognitive Impairment

Introduction. A family history of Alzheimer's disease is a significant risk factor for its onset, but the genetic risk associated with possessing multiple risk alleles is still poorly understood. Methods. In a sample of 95 older adults (Mean age = 75.1, 64.2% female), we constructed a genetic risk score based on the accumulation of risk alleles in BDNF, COMT, and APOE. A neuropsychological evaluation and consensus determined cognitive status (44 nonimpaired, 51 impaired). Logistic regression was performed to determine whether the genetic risk score predicted cognitive impairment above and beyond that associated with each gene. Results. An increased genetic risk score was associated with a nearly 4-fold increased risk of cognitive impairment (OR = 3.824, P = .013) when including the individual gene polymorphisms as covariates in the model. Discussion. A risk score combining multiple genetic influences may be more useful in predicting late-life cognitive impairment than individual polymorphisms

Failure of Acute Ethanol Administration to Alter Cerebrocortical and Hippocampal Allopregnanolone Levels in C57BL/6J and DBA/2J Mice

Ethanol (EtOH) administration increases brain allopregnanolone levels in rats, and this increase contributes to sensitivity to EtOH's behavioral effects. However, EtOH's effects on allopregnanolone may differ across species. We investigated the effects of acute EtOH administration on allopregnanolone, progesterone, and corticosterone levels in cerebral cortex and hippocampus of C57BL/6J and DBA/2J mice, 2 inbred strains with different alcohol sensitivity

Measure of indigenous perennial staple crop, Ensete ventricosum, associated with positive food security outcomes in southern Ethiopian highlands

Enset-based food systems are unique to southern Ethiopia where they serve as a staple food for millions of households. Enset, a banana relative of which the entire pseudostem and corm are edible, possesses a highly unusual combination of crop traits including perenniality, highly flexible planting and harvest times, and tolerance of a very wide range of environmental conditions, which together earn it the local name of “the tree against hunger.” Previous studies have identified the strategic food security value of mature enset stands for household food security, but a multisector panel data set makes identifying wider enset food security associations tractable for the first time. We assess whether household data on area of mature enset is associated with four indicators of food security together with demographic, asset, and consumption covariates. We find that area of mature enset significantly improves estimates for three of four food security indicators, thus improving our understanding of the role of understudied indigenous crops. Consistent and reliable food security indicators are needed to improve monitoring, particularly with regard to stability. Variance components of multilevel longitudinal models indicate that exposure to both idiosyncratic and covariate disturbance affects food security stability in a way that is consistent with reports of enset acting as both a food security buffer and an active adaptation strategy in the face of shocks or change. Here we show that living assets comprising culturally relevant indigenous crops such as enset can improve accuracy of food insecurity assessments, which may encourage wider investigation of other agrifood system-specific asset-like natural stores of value associated with food security and resilience

Efficacy of Oral Metronidazole with Vaginal Clindamycin or Vaginal Probiotic for Bacterial Vaginosis: Randomised Placebo-Controlled Double-Blind Trial

BACKGROUND: To determine if oral metronidazole (MTZ-400 mg bid) with 2% vaginal clindamycin-cream (Clind) or a Lactobacillus acidophilus vaginal-probiotic containing oestriol (Prob) reduces 6-month bacterial vaginosis (BV) recurrence. METHODS: Double-blind placebo-controlled parallel-group single-site study with balanced randomization (1:1:1) conducted at Melbourne Sexual Health Centre, Australia. Participants with symptomatic BV [Nugent Score (NS) = 7-10 or ≥3 Amsel's criteria and NS = 4-10], were randomly allocated to MTZ-Clind, MTZ-Prob or MTZ-Placebo and assessed at 1,2,3 and 6 months. MTZ and Clind were administered for 7 days and Prob and Placebo for 12 days. Primary outcome was BV recurrence (NS of 7-10) on self-collected vaginal-swabs over 6-months. Cumulative BV recurrence rates were compared between groups by Chi-squared statistics. Kaplan-Meier, log rank and Cox regression analyses were used to compare time until and risk of BV recurrence between groups. RESULTS: 450 18-50 year old females were randomized and 408 (91%), equally distributed between groups, provided ≥1 NS post-randomization and were included in analyses; 42 (9%) participants with no post-randomization data were excluded. Six-month retention rates were 78% (n = 351). One-month BV recurrence (NS 7-10) rates were 3.6% (5/140), 6.8% (9/133) and 9.6% (13/135) in the MTZ-Clind, MTZ-Prob and MTZ-Placebo groups respectively, p = 0.13. Hazard ratios (HR) for BV recurrence at one-month, adjusted for adherence to vaginal therapy, were 0.43 (95%CI 0.15-1.22) and 0.75 (95% CI 0.32-1.76) in the MTZ-Clind and MTZ-Prob groups compared to MTZ-Plac respectively. Cumulative 6-month BV recurrence was 28.2%; (95%CI 24.0-32.7%) with no difference between groups, p = 0.82; HRs for 6-month BV recurrence for MTZ-Clind and MTZ-Prob compared to MTZ-Plac, adjusted for adherence to vaginal therapy were 1.09(95% CI = 0.70-1.70) and 1.03(95% CI = 0.65-1.63), respectively. No serious adverse events occurred. CONCLUSION: Combining the recommended first line therapies of oral metronidazole and vaginal clindamycin, or oral metronidazole with an extended-course of a commercially available vaginal-L.acidophilus probiotic, does not reduce BV recurrence. TRIAL REGISTRATION: ANZCTR.org.au ACTRN12607000350426