Why don't they accept Non-Invasive Ventilation? : Insight into the interpersonal perspectives of patients with MND.

"Objectives. Although non-invasive ventilation (NIV) can benefit survival and quality of life, it is rejected by a substantial proportion of people with motor neurone disease (MND). The aim of this study was to understand why some MND patients decline or withdraw from NIV. Method. Nine patients withMND(male = 7, mean age = 67 years) participated in this study. These patients, from a cohort of 35 patients who were offered NIV treatment to support respiratory muscle weakness, did not participate in NIV treatment when it was clinically appropriate. Semi-structured interviews and interpretative phenomenological analysis (IPA) were employed to explore these patient’s experience of MND and their thoughts and understanding of NIV treatment. Results. Using IPA, four themes were identified: preservation of the self, negative perceptions of NIV, negative experience with health care services, and not needing NIV. Further analysis identified the fundamental issue to be the maintenance of perceived self, which was interpreted to consist of the sense of autonomy, dignity, and quality of life. Conclusions. The findings indicate psychological reasons for disengagement with NIV. The threat to the self, the sense of loss of control, and negative views of NIV resulting from anxiety were more important to these patients than prolonging life in its current form. These findings suggest the importance of understanding the psychological dimension involved in decision-making regarding uptake of NIV and a need for sensitive holistic evaluation if NIV is declined.

Rasch analysis of the hospital anxiety and depression scale (hads) for use in motor neurone disease

<p>Abstract</p> <p>Background</p> <p>The Hospital Anxiety and Depression Scale (HADS) is commonly used to assess symptoms of anxiety and depression in motor neurone disease (MND). The measure has never been specifically validated for use within this population, despite questions raised about the scale's validity. This study seeks to analyse the construct validity of the HADS in MND by fitting its data to the Rasch model.</p> <p>Methods</p> <p>The scale was administered to 298 patients with MND. Scale assessment included model fit, differential item functioning (DIF), unidimensionality, local dependency and category threshold analysis.</p> <p>Results</p> <p>Rasch analyses were carried out on the HADS total score as well as depression and anxiety subscales (HADS-T, D and A respectively). After removing one item from both of the seven item scales, it was possible to produce modified HADS-A and HADS-D scales which fit the Rasch model. An 11-item higher-order HADS-T total scale was found to fit the Rasch model following the removal of one further item.</p> <p>Conclusion</p> <p>Our results suggest that a modified HADS-A and HADS-D are unidimensional, free of DIF and have good fit to the Rasch model in this population. As such they are suitable for use in MND clinics or research. The use of the modified HADS-T as a higher-order measure of psychological distress was supported by our data. Revised cut-off points are given for the modified HADS-A and HADS-D subscales.</p

An analysis of the relationship between hostility and training in the martial arts

Contrasting views and data are available on the issue of whether combative sports facilitate or reduce aggression. In the present study levels of hostility were assessed in two groups of martial arts students using the Buss-Durkee Inventory. Levels of hostility on a variety of the sub-scales were compared with scores from similar samples of participants in a body contact, aggressive but non-combative sport (rugby football) and a competitive sport with no body contact or direct aggression (badminton). When the effects of age and length of training were controlled by use of partial correlation there was no evidence to support group differences in either the combined score from the varied sub-scales of the inventory or the more specific assaultive sub-scale. However, there was evidence to suggest a significant effect of length of training on hostility levels in martial artists. Beginners attracted to the martial arts were more hostile but the hostility declined with the duration of training. No difference was apparent in this respect for students participating in either jui jitsu or karate. It is suggested that such differential effects with respect to length of training may lead to the overall absence of the between-sport differences. The results provide tentative support for the notion that the discipline of the martial arts may reduce assaultive hostility rather than serve as a model for such behaviour, yet support the need for prospective longitudinal studies on intra-individual hostility

Health benefits of Tai Chi exercise: Improved balance and blood pressure in middle-aged women

This article is not available through ChesterRep.Tai Chi has been widely practiced as a Chinese martial art that focuses on slow sequential movements, providing a smooth, continuous and low intensity activity. It has been promoted to improve balance and strength and to reduce falls in the elderly, especially those 'at risk'. The potential benefits in healthy younger age cohorts and for wider aspects of health have received less attention. The present study documented prospective changes in balance and vascular responses for a community sample of middle-aged women. Seventeen relatively sedentary but healthy normotensive women aged 33-55 years were recruited into a three times per week, 12-week Tai Chi exercise programme. A further 17 sedentary subjects matched for age and body size were recruited as a control group. Dynamic balance measured by the Functional Reach Test was significantly improved following Tai Chi, with significant decreases in both mean systolic (9.71 mmHg) and diastolic (7.53 mmHg) blood pressure. The data confirm that Tai Chi exercise can be a good choice of exercise for middle-aged adults, with potential benefits for ageing as well as the aged

Why don't they accept Non-Invasive Ventilation? : Insight into the interpersonal perspectives of patients with MND.

"Objectives. Although non-invasive ventilation (NIV) can benefit survival and quality of life, it is rejected by a substantial proportion of people with motor neurone disease (MND). The aim of this study was to understand why some MND patients decline or withdraw from NIV.\ud Method. Nine patients withMND(male = 7, mean age = 67 years) participated in this study. These patients, from a cohort of 35 patients who were offered NIV treatment to support respiratory muscle weakness, did not participate in NIV treatment when it was clinically appropriate. Semi-structured interviews and interpretative phenomenological analysis (IPA) were employed to explore these patient’s experience of MND and their thoughts and understanding of NIV treatment. \ud Results. Using IPA, four themes were identified: preservation of the self, negative perceptions of NIV, negative experience with health care services, and not needing NIV. Further analysis identified the fundamental issue to be the maintenance of perceived self, which was interpreted to consist of the sense of autonomy, dignity, and quality of life.\ud Conclusions. The findings indicate psychological reasons for disengagement with NIV. The threat to the self, the sense of loss of control, and negative views of NIV resulting from anxiety were more important to these patients than prolonging life in its current form.\ud These findings suggest the importance of understanding the psychological dimension involved in decision-making regarding uptake of NIV and a need for sensitive holistic evaluation if NIV is declined.

Role of the gut microbiota in host appetite control: bacterial growth to animal feeding behaviour

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