The impact of the COVID-19 pandemic on an international rehabilitation study in MS: the CogEx experience

Pandemic restrictions have led to changes in therapy plans and disrupted rehabilitation services for people with multiple sclerosis. CogEx is an international, multicentre MS dual-intervention (cognitive rehabilitation, aerobic exercise) randomized, controlled rehabilitation trial confined to people with progressive disease. The primary outcome is cognition (processing speed).There are 11 treatment sites in six countries with participants required to make 27 site visits over 12 weeks. Collectively, the large, in-person demands of the trial, and the varying international policies for the containment of COVID-19, might disproportionately impact the administration of CogEx. During the first lockdown, all centres closed on average for 82.9 (SD = 24.3) days. One site was required to lockdown on two further occasions. One site remained closed for 16 months. Ten staff (19.2%) were required to quarantine and eight staff (15.4%) tested positive for COVID. 10 of 264 (3.8%) participants acquired COVID-19. All survived. The mean duration of enrollment delay has been [236.7 (SD = 214.5) days]. Restarting participants whose interventions were interrupted by the pandemic meant recalculating the intervention prescriptions for these individuals. While the impact of the pandemic on CogEx has been considerable, all study sites are again open. Participants and staff have shown considerable flexibility and resilience in keeping a complex, international endeavour running. The future in general remains uncertain in the midst of a pandemic, but there is cautious optimism the study will be completed with sufficient sample size to robustly evaluate our hypothesis and provide meaningful results to the MS community on the impact of these interventions on people with progressive MS. Trial registration: The trial was registered on September 20th 2018 at www.clinicaltrials.gov having identifier NCT03679468. Registration was performed before recruitment was initiated

A scoping review mapping the effects of menopause on symptomatology, disease course, and lived experience in women with MS

Growing research has explored how menopause may affect clinical and health-related outcomes in women with multiple sclerosis (MS), such as MS symptoms and disease progression. However, not much is known about how the menopausal transition is subjectively experienced in women with MS. This gap in understanding hinders comprehensive, patient-centered care and highlights the need to synthesize evidence from both quantitative and qualitative perspectives. This scoping review aims to map the breadth of literature examining how menopause, whether natural or induced, and the menopausal transition affects the symptoms and disease course of MS in women with MS undergoing these transitions. Our questions include the following: 1. How does menopause, including natural or induced transitions, affect symptoms, disease course, and physiological mechanisms in women with MS? a. Subtopics include clinical characteristics (e.g., EDSS, MS subtype), symptom burden (e.g., fatigue, cognition, mood), quality of life, and biomarkers (e.g., cytokines, MRI scans). 2. What qualitative or mixed-methods studies are there that describe the lived experiences of women with MS during this transition, and what themes emerge? a. Subtopics Include experiences with symptom changes (physiological, psychosocial), healthcare decision-making (e.g, provider interaction), and menopause-related treatments (e.g., hormone therapy)

A scoping review mapping the effects of menopause on symptomatology, disease course, and lived experience in women with MS

Growing research has explored how menopause may affect clinical and health-related outcomes in women with multiple sclerosis (MS), such as MS symptoms and disease progression. However, not much is known about how the menopausal transition is subjectively experienced in women with MS. This gap in understanding hinders comprehensive, patient-centered care and highlights the need to synthesize evidence from both quantitative and qualitative perspectives. This scoping review aims to map the breadth of literature examining how menopause, whether natural or induced, and the menopausal transition affects the symptoms and disease course of MS in women with MS undergoing these transitions. Our questions include the following: 1. How does menopause, including natural or induced transitions, affect symptoms, disease course, and physiological mechanisms in women with MS? a. Subtopics include clinical characteristics (e.g., EDSS, MS subtype), symptom burden (e.g., fatigue, cognition, mood), quality of life, and biomarkers (e.g., cytokines, MRI scans). 2. What qualitative or mixed-methods studies are there that describe the lived experiences of women with MS during this transition, and what themes emerge? a. Subtopics Include experiences with symptom changes (physiological, psychosocial), healthcare decision-making (e.g, provider interaction), and menopause-related treatments (e.g., hormone therapy)

A scoping review mapping the effects of menopause on symptomatology, disease course, and lived experience in women with MS

Growing research has explored how menopause may affect clinical and health-related outcomes in women with multiple sclerosis (MS), such as MS symptoms and disease progression. However, not much is known about how the menopausal transition is subjectively experienced in women with MS. This gap in understanding hinders comprehensive, patient-centered care and highlights the need to synthesize evidence from both quantitative and qualitative perspectives. This scoping review aims to map the breadth of literature examining how menopause, whether natural or induced, and the menopausal transition affects the symptoms and disease course of MS in women with MS undergoing these transitions. Our questions include the following: 1. How does menopause, including natural or induced transitions, affect symptoms, disease course, and physiological mechanisms in women with MS? a. Subtopics include clinical characteristics (e.g., EDSS, MS subtype), symptom burden (e.g., fatigue, cognition, mood), quality of life, and biomarkers (e.g., cytokines, MRI scans). 2. What qualitative or mixed-methods studies are there that describe the lived experiences of women with MS during this transition, and what themes emerge? a. Subtopics Include experiences with symptom changes (physiological, psychosocial), healthcare decision-making (e.g, provider interaction), and menopause-related treatments (e.g., hormone therapy)

A research agenda to examine the efficacy and relevance of the Transtheoretical Model for physical activity behavior

Regular physical activity (PA) decreases the risk of several chronic diseases including some cancers, type II diabetes, obesity, and cardiovascular disease; however, the majority of US adults are not meeting the recommended levels to experience these benefits. To address this public health concern, the underlying mechanisms for behavior change need to be understood, translated and disseminated into appropriately tailored interventions. The Transtheoretical Model (TTM) provides a framework for both the conceptualization and measurement of behavior change, as well as facilitating promotion strategies that are individualized and easily adapted. The purpose of this manuscript is to present the constructs of the TTM as they relate to PA behavior change. We begin with a brief synopsis of recent examinations of the TTM constructs and their application. Subsequent to its introduction, we specifically present the TTM within the PA context and discuss its application and usefulness to researchers and practitioners. Criticisms of the TTM are also noted and presented as opportunities for future research to enhance the valid application of the TTM. We offer general study design recommendations to appropriately test the hypothesized relationships within the model. With further examinations using appropriate study design and statistical analyses, we believe the TTM has the potential to advance the public health impact of future PA promotion interventions

Food Outlet Accessibility and Fruit and Vegetable Consumption

Purpose: To examine if spatial access to healthy and unhealthy outlets comprising the local food environment was associated with fruit and vegetable consumption. Design: Cross-sectional. Setting: Population-based sample residing in Hawaii. Subjects . Three hundred and eighty-four adults (36% Asian-American, 33% non-Hispanic white, 31% other/mixed race). Measures: A spatial model of the local food environment was constructed using radial buffers extending from participants' place of residence. Fruit and vegetable intake was estimated using the National Cancer Institute Fruit and Vegetable All-Day Screener. Analysis: Mean intakes of fruits and vegetables were compared for spatial access to total, healthy, and unhealthy food outlets at distances of .5 to 3.5 km. Multiple linear regression was used to estimate differences in fruit and vegetable intake for residing further from a food outlet or for residing in an area with a greater number of food outlets. Results: Residing in an area with a greater density of total or healthy food outlets was associated with a higher mean intake of fruits and vegetables (p < .05) at .5 km. No differences in mean intakes were detected for distances beyond .5 km or for regression models. Conclusion: Findings suggest that greater spatial accessibility to food outlets comprising the local food environment in Hawaii may not be meaningfully associated with fruit and vegetable consumption; however, associations were detected for the smallest spatial scale examined, warranting further investigation