Association of vitamin D insufficiency and low physical activity with fatigue, headaches and psychological distress in college students, North-Mediterranean Croatia – a pilot study

Cilj ove studije bio je ispitati vitamin D u serumu kod studenata prijediplomskog zdravstvenog studija i njegovu povezanost s učestalošću konzumacije hrane bogate vitaminom D, izlaganjem suncu, umorom vezanim za studiranje, glavoboljom i psihopatološkim statusom, te posljednja tri s vrstom tjelesne aktivnosti. Razina 25-hidroksivitamina D (25-OHD-a) u krvi, procjena nesposobnosti vezane za migrenu (Migraine Disability Assessment (MIDAS)), kakvoće života vezane za umor (Pediatric Quality of Life Inventory Multidimensional Fatigue Scale), psihopatološkog statusa (Clinical Outcomes in Routine Evaluation – Outcome Measure (COREOM)), načina prehrane i tjelesne aktivnosti ispitani su kod nasumice izabranih studenata. Rezultati studije su pokazali da je 49% studenata imalo nedostatak/manjak 25-OHD-a . Vrijednosti MIDAS-a bile su veće u skupini s nedostatkom/manjkom (p =0.035) i bile su povezane su sa satima tjednih kardio-vježbi (r = -0,48, p =0,031). CORE-OM i ukupni umor korelirali su s 25-OHD-a (r = -0,59, p =0,024; r =0,51, p =0,023). Studenti s dovoljno 25- OHD-a imali su značajno veći unos vitamina D konzumirajući srdele u svojoj mjesečnoj prehrani (p =0,048); 25-OHD je korelirao s količinom mjesečno pojedenih srdela (r =0,59, p =0,006). Naši rezultati pružaju početne dokaze o tome kako je pravilan način života ispunjen pravilnom tjelesnom aktivnošću, posebno kardio-vježbanjem, i prehranom bogatom vitaminom D važan za smanjenje umora, glavobolje i psiholoških tegoba.The aim of the study was to investigate serum vitamin D level in undergraduate students of health studies and its relationship with the frequency of vitamin D rich food consumption, sun exposure, study-related fatigue, headache and psychopathological status, and the relationship of the latter three parameters with the type of physical activity. A blood level of 25-hydroxyvitamin D (25(OH)D), Migraine Disability Assessment (MIDAS), Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), nutrition and physical activity were surveyed in randomly chosen students. Study results showed that 49% of students had 25(OH)D insufficiency/deficiency. The MIDAS values were higher in the insufficient/ deficient group (p=0.035) and were associated with hours of weekly cardio exercises (r=-0.48, p=0.031). CORE-OM and total fatigue correlated with 25(OH)D (r=-0.59, p=0.024; r=0.51, p=0.023). Students with sufficient 25(OH)D had a significantly higher vitamin D intake by consuming sardines in their monthly nutrition (p=0.048). 25(OH)D correlated with the amount of monthly consumed sardines (r=0.59, p=0.006) in general. Our results provide initial evidence that an appropriate lifestyle along with proper physical activity, especially cardio exercise, and vitamin D rich nutrition is important to reduce fatigue, headaches and psychological distress

Efficacy of pain treatment with shock wave therapy in plantar fasciitis, calcific tendinitis of the shoulder and lateral epicondylitis of the elbow

Uvod: Terapija udarnim valom (TUV) (od engl. shockwave therapy) je neinvazivna metoda temeljena na mehaničkim pulsovima koji se u obliku vala šire kroz ljudsko tijelo te izazivaju mikroskopske intersticijalne i ekstracelularne biološke učinke među kojima je i regeneracija tkiva. Cilj: Cilj ovog retrospektivnog istraživanja bio je ispitati učinkovitost i razlike u liječenju bola TUV-om u pacijenata s dijagnozama plantarni fascitis, kalcificirajući tendinitis ramena i lateralni epikondilitis lakta nakon upotrebe tri i pet uzastopnih tretmana. Ispitanici i metode: U radu su korišteni podatci pacijenata iz baze podataka Zavoda za fizikalnu i rehabilitacijsku medicinu Kliničkog bolničkog centra u Rijeci, a pri tome su u skladu s Helsinškom deklaracijom ostali anonimni: dob, spol, mjerenja intenziteta bola dobivena uz pomoć vizualno analogne skale (od engl. Visual Analogue Scale, VAS). Ispitanici su podijeljeni u dvije grupe za svaku dijagnozu (TUV3 i TUV5). Ispitivanje je sadržavalo ukupno 148 pacijenata: plantarni fascitis N = 50, kalcificirajući tendinitis ramena N = 50 i lateralni epikondilitis lakta N = 48. Rezultati: Primjena terapije udarnim valom kod pacijenata s dijagnozama plantarni fascitis, kalcificirajući tendinitis ramena i lateralni epikondilits lakta, s ciljem smanjenja intenziteta bola, pokazala se uspješnom. Dobivenim rezultatima utvrđeno je da primjena pet TUV tretmana dovodi do boljih rezultata smanjenja bola u sve tri dijagnoze negoli samo tri primijenjena tretmana (p < 0,001; p < 0,001; p < 0,001). Nadalje je utvrđeno da se nakon tri primijenjena tretmana postigao bolji učinak smanjenja bola kod plantarnog fascitisa negoli kod kalcificirajućeg tendinitisa ramena i lateralnog epikondilitisa lakta, dok nakon pet primijenjena tretmana nije bilo razlike u smanjenju bola među dijagnozama. Zaključak: Ova studija preporučuje primjenu pet tretmana kod sve tri dijagnoze kako bi pacijenti imali bolji učinak smanjenja bola.Introduction: Shock wave therapy (SWT) is a non-invasive method based on mechanical pulses widening through the human body and causing microscopic interstitial and extracellular biological effects, including tissue regeneration. Aim: The aim of this retrospective study was to analyze efficacy and differences in pain treatment with SWT in patients with plantar fasciitis, calcific tendinitis of the shoulder and lateral epicondylitis of the elbow after three and five consecutive treatments. Participants and methods: The patients data were taken from the database at the Departmentof Physical and Rehabilitation Medicine of the Clinical Hospital Center in Rijeka and used only in purpose of this work, and according to the Helsinki Declaration, stayed anonymous: age, sex, pain intensity measurements obtained using the Visual Analogue Scale. The participants were devided into two groups (TUV3 and TUV5). The data were taken from 148 patients: plantar fasciitis N = 50, calcific tendinitis of the shoulder N = 50 and lateral epicondylitis of the elbow N = 48. Results: The therapy with SWT proved to be successful in patients with diagnosis of plantar fasciitis, calcific tendinitis of the shoulder and lateral epicondylitis of the elbow. The analyzed results showed that three or five treatments both resulted in pain reduction in all three diagnosis, with five treatments being more efficient than just three applied treatments (p < 0,001; p < 0,001; p < 0,001). It has also been established that after three applied treatments a better effect of pain reduction is achieved in plantar fascitis than in calcific tendinitis of the shoulder and lateral epicondylitis of the elbow, and after five applied treatments there was no difference in pain reduction between diagnoses. Conclusion: Therefore, this study recommends the application of five treatments in all three diagnoses in order for patients to have better pain relief

Najčešća odstupanja u razvoju motorike šake od rođenja do prve godine života

The early child development, from birth until the age of one year is, amongst other changes, characterized by intense motor learning. During that period, the voluntary learning patterns evolve from reflexive patterns to coordinated voluntary patterns. All of the child’s voluntary movements present active forms in which the child communicates with the environment. In this communication, the hand plays an important role. Its brain representation covers one-third of the entire motor region, situated in the close proximity to the speech region. For this reason, some authors refer to hand as a “speech organ”. According to numerous studies, each separate finger also has a relatively large representation in the cerebral cortex, which points to the importance of the fine motor skills development, or precise, highly differentiated movements of hand muscles following the principles of differentiation and hierarchical integration. Development of the fine motor skills in the hand is important for the overall child development, and it also serves as a predictor pointing to immaturity of the central nervous system. The aim of this paper is to present the development of hand motoricity from birth until the age of one year, as well as the most frequent deviations observed in children hospitalized at Children’s Department of Rehabilitation, Clinical Department of Rheumatology, Physical Medicine and Rehabilitation, Sestre milosrdnice University Hospital Center.Rani razvoj djeteta, od rođenja do prve godine života, obilježen je između ostalog i intenzivnim motoričkim učenjem kojim se obrasci voljnih pokreta od refleksnih obrazaca razvijaju u koordinirane voljne pokrete. Svi voljni pokreti djeteta njegovi su aktivni oblici komunikacije s okolinom. U toj komunikaciji veliku važnost ima ruka. Njezina reprezentacija u mozgu zauzima trećinu cjelokupnog prostora motorne regije koja se nalazi u neposrednoj blizini regije za govor. Stoga neki autori ruku nazivaju “organom govora”. Kako su pokazale različite studije, svaki prst zasebno također ima relativno veliku zastupljenost u moždanoj kori, što upućuje na važnost razvoja fine motorike, odnosno preciznih visokodiferenciranih pokreta muskulature šake po načelima diferencijacije i hijerarhijske integracije. Razvoj fine motrike šake važan je za cjelokupni razvoj djeteta, a također je i prediktor koji ukazuje na nezrelost središnjega živčanog sustava. Cilj ovoga rada je prikazati razvoj motorike šake od rođenja do prve godine života, kao i najčešća odstupanja koja su zapažena kod djece koja su boravila na Odsjeku za rehabilitaciju djece Klinike za reumatologiju, fizikalnu medicinu i rehabilitaciju Kliničkog bolničkog centra „Sestre milosrdnice“

Rehabilitation of lower limb amputees

Rehabilitation of amputees represents a complex process during the course of which an amputee receives professional aid and support, so as to adapt to the use of prosthesis, i.e. an artificial supplement for the lost body part. The process aims at achieving an independent performance of the amputee in all areas of everyday life and as high quality of life as possible. The rehabilitation encompasses not only the pre-amputation, postoperative, pre-prosthetic and prosthetic stage, within which an amputee is provided with a prosthetic aiding device, but also the subsequent long-term monitoring and follow-up. The implementation of the rehabilitation process runs in line with the biopsychosocial model and requires a multidisciplinary and an interdisciplinary approach, so as to achieve a successful reintegration of an amputee and allow for a lifestyle resembling the pre-amputation one as much as possible. The article brings the causes and types of amputation, the principles underpinning contemporary amputation surgery, prosthetics and rehabilitation during preoperative, postoperative, pre-prosthetic and prosthetic stages, as well as the stage goals and MOs of their attainment. Principles of evaluation of prosthetic rehabilitation outcomes in limb amputees, which make use of appraisal questionnaires, have been discussed as well

Rehabilitation of lower limb amputees – Guidelines for clinical work in Croatia

Rehabilitacija osoba s amputacijom donjih udova kompleksan je proces u kojem se osobi koja je doživjela gubitak uda pomaže da se, uz stručnu podršku, adaptira na protezu kao artificijelni nadomjestak izgubljenog dijela te da uz primjenu proteze postigne maksimalno moguću neovisnost u svim područjima života, sa što boljom kvalitetom življenja. Rehabilitacija obuhvaća razdoblje od amputacije, koja može biti posljedica ozljede ili bolesti, kroz postoperacijsku i predprotetičku fazu do protetičke faze rehabilitacije u kojoj se provodi protetička opskrba, ali i kasniju fazu dugotrajnog praćenja. Medicinsku rehabilitaciju nužno mora pratiti adekvatna psihološka i socijalna rehabilitacija, po biopsihosocijalnom modelu, kako bi se ostvario konačni cilj rehabilitacije, a to je uspješna reintegracija osobe u život sa stilom koji je što sličniji onom koji je prethodio amputaciji. U radu su prezentirani uzroci i vrste amputacije, načela suvremene protetike i rehabilitacije osoba s amputacijom donjih udova tijekom predoperacijske, postoperacijske, predprotetičke i protetičke faze s ciljevima rehabilitacije u pojedinim fazama, načinima njihova ostvarivanja, kao i načelima psihosocijalne rehabilitacije. Također su prezentirani evaluacijski upitnici i načela Međunarodne klasifikacije funkcioniranja, onesposobljenosti i zdravlja (MKF) za procjenu rezultata rehabilitacije osoba s amputacijom donjih udova.The rehabilitation of the person with limb loss is a complex process and a period of training to learn how to function using the prosthesis, with the aim of being independent in all the activities of daily living, vocational and non-vocational activities. The final aim is to live one’s life the way the person used to live before the amputation. The article brings the causes and types of amputation, the principles underpinning contemporary amputation surgery, goals and principles of prosthetic restoration and rehabilitation for lower extremity during preoperative amd postoperative management, pre-prosthetic and prosthetic rehabilitation stages, clinical monitoring and follow up of prosthetically rehabilitated amputees as well the stage goals and manner of their attainment. Principles of evaluation of prosthetic rehabilitation outcomes in limb amputees which make use of appraisal questionnaires have been discussed as well

Combined upper limb and breathing exercise programme for pain management in ambulatory and non-ambulatory multiple sclerosis individuals: part II analyses from feasibility study

Abstract Purpose The present small semi-controlled feasibility study investigated a possible efficacy of a combined upper limb and breathing exercise programme in managing pain in ambulatory and non-ambulatory patients with EDSS from 0.0–8.0. Method People with MS (N = 19) were enrolled in this single-blind randomized controlled study and divided into 2 groups: exercise group (5 ambulatory, 5 non-ambulatory ; Expanded Disability Status Scale (EDSS), 1.0–8.0) and related control group that performed no exercise (4 ambulatory, 5 non-ambulatory ; EDSS, 1.0–7.5). The exercise group performed combined upper limb and breathing exercises in a group led by a physiotherapist (2 days/week, 60 min/session) accompanied by independent home exercises (3 days/week, ≥ 20 min/session). Participants underwent measures of pain level (visual analogue scale) for physical pain, functional independence of daily activities (Barthel index) and handgrip strength (HGS) for dominant (D) and non-dominant (ND) hand evaluated by a dynamometer before and after the 4-week period by the blinded assessor. Results The VAS for pain showed statistically significant group-by-time interaction only in non-ambulatory (p = .049) individuals, but with large intervention effects on both subgroups (ambulatory, p = .159 ; non-ambulatory, d = 0.97). Functional independence in daily activities (Barthel index) showed statistically non-significant group-by-time interaction in ambulatory (p = .195, d = 0.89) and non-ambulatory (p = .102, d = 1.64) individuals, but despite the absence of statistical significance, there were large intervention effects. Handgrip strength was significantly improved for both hands in ambulatory (D, p = .012 ; d = 2.07 ; ND, p = .025, d = 1.77) and only non-dominant hand in non-ambulatory individuals (D, p = .288, d = 0.83 ; ND, p = .012, d = 2.21). Conclusion This small pilot study provides preliminary proof-of-concept data supporting low-intensity upper limb and breathing exercise programme for potential reduction of pain and improvement of functional independence in both ambulatory and nonambulatory individuals with MS in a larger sample and that strengthening the upper limbs might be an additional pain relief mechanism. Trial registration NTC0322259