Cancer-related fatigue:Predictors and effects of rehabilitation

Background. The aims of the study were to examine the effects of a multidimensional rehabilitation program on cancer-related fatigue, to examine concurrent predictors of fatigue, and to investigate whether change in fatigue over time was associated with change in predictors. Methods. Sample: 72 cancer survivors with different diagnoses. Setting: rehabilitation center. Intervention: 15-week rehabilitation program. Measures: Fatigue (Multidimensional Fatigue Inventory), demographic and disease/treatment-related variables, body composition (bioelectrical impedance), exercise capacity (symptom-limited bicycle ergometry), muscle force (handheld dynamometry), physical and psychological symptom distress (Rotterdam Symptom Check List), experienced physical and psychological functioning (RAND-36), and self-efficacy (General-Self-Efficacy Scale, Dutch version). Measurements were performed before (T0) and after rehabilitation (T1). Results. At T1 (n = 56), significant improvements in fatigue were found, with effect sizes varying from -0.35 to -0.78. At TO, the different dimensions of fatigue were predicted by different physical and psychological variables. Explained variance of change in fatigue varied from 42%-58% and was associated with pre-existing fatigue and with change in physical functioning, role functioning due to physical problems, psychological functioning, and physical symptoms distress. Conclusions. Within this selected group of patients we found that (a) rehabilitation is effective in reducing fatigue, (b) both physical and psychological parameters predicted different dimensions of fatigue at baseline, and (c) change in fatigue was mainly associated with change in physical parameters

Cancer-Related Fatigue and Rehabilitation: A Randomized Controlled Multicenter Trial Comparing Physical Training Combined With Cognitive-Behavioral Therapy With Physical Training Only and With No Intervention

Background. Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer. To date, it is unclear what type of rehabilitation is most beneficial. Objective. This randomized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention. Design. In this multicenter randomized controlled trial, 147 survivors of cancer were randomly assigned to a group that received physical training combined with cognitive-behavioral therapy (PT + CBT group, n = 76) or to a group that received physical training alone (PT group, n = 71). In addition, a nonintervention control group (WLC group) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included. Setting. The study was conducted at 4 rehabilitation centers in the Netherlands. Patients. All patients were survivors of cancer. Intervention. Physical training consisting of 2 hours of individual training and group sports took place twice weekly, and cognitive-behavioral therapy took place once weekly for 2 hours. Measurements. Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention (12 weeks after enrollment). The WLC group completed questionnaires at the same time points. Results. Baseline fatigue did not differ significantly among the 3 groups. Over time, levels of fatigue significantly decreased in all domains in all groups, except in mental fatigue in the WLC group. Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue, on physical and mental fatigue, and on reduced activation but not on reduced motivation. Compared with the WLC group, the PT group reported significantly greater decline in 4 domains of fatigue, whereas the PT + CBT group reported significantly greater decline in physical fatigue only. No significant differences in decline in fatigue were found between the PT + CBT and PT groups. Conclusions. Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention. Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue, suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training

Fifty-third annual report of the American Museum of Natural History, 1921.

Objective: To conduct a randomized controlled trial and compare the effects on cancer survivors' quality of life in a 12-week group-based multidisciplinary self-management rehabilitation program, combining physical training (twice weekly) and cognitivebehavioral training (once weekly) with those of a 12-week group-based physical training (twice weekly). In addition, both interventions were compared with no intervention. Methods: Participants (all cancer types, medical treatment completed ≥3 months ago) were randomly assigned to multidisciplinary rehabilitation (n = 76) or physical training (n = 71). The nonintervention comparison group consisted of 62 patients on a waiting list. Quality of life was measured using the RAND-36. The rehabilitation groups were measured at baseline, after rehabilitation, and 3-month follow-up, and the nonintervention group was measured at baseline and 12 weeks later. Results: The effects of multidisciplinary rehabilitation did not outperform those of physical training in role limitations due to emotional problem (primary outcome) or any other domains of quality of life (all p < .05). Compared with no intervention, participants in both rehabilitation groups showed significant and clinically relevant improvements in role limitations due to physical problem (primary outcome; effect size (ES) = 0.66), and in physical functioning (ES = 0.48), vitality (ES = 0.54), and health change (ES = 0.76) (all p <.01). Conclusions: Adding a cognitive-behavioral training to group-based self-management physical training did not have additional beneficial effects on cancer survivors' quality of life. Compared with the nonintervention group, the group-based self-management rehabilitation improved cancer survivors' quality of life. Copyrigh

Skaraborg Logistic Center - historien bakom och framtida utvecklingsmöjligheter

Transporter som utnyttjar en kombination av olika transportslag, så kallade intermodala transporter, spås bli allt viktigare i framtiden och motiveras med både miljömässiga som ekonomiska incitament. Kombiterminaler spelar en central roll för denna utveckling och tillväxten av antalet kombiterminaler i Sverige har de senaste åren varit stark. Syftet med den här rapporten är att kartlägga betydande aspekter vid utvecklingen och etableringen av ett samarbetsprojekt inom logistik på regional nivå samt ta reda på hur ett sådant projekt påverkas av tidigare försök och erfarenheter. För att besvara forskningsfrågorna har vi valt att studera Skaraborg Logistic Center (SLC) i Falköping. Genom flertalet intervjuer med personer, som på endera sättet varit involverad i utvecklingsarbetet av SLC, har vi redogjort för hur utvecklings- och implementeringsprocessen sett ut. Då Falköping för drygt 30 år sedan gjort en satsning som är slående lik dagens har vi för att besvara den andra forskningsfrågan kartlagt det projektet, som kallades Scand Point, för att återkoppla till dagens satsning. I början av 1980-talet beslöt Falköpings kommun sig för att med en storartad satsning på en terminalverksamhet vid namn Scand Point, försöka bryta den negativa trenden som Falköping då befann sig i. Satsningen blev snabbt mycket större än vad som först var tanken och kom senare att bli ett misslyckat och för skattebetalarna dyrbart projekt. Endast fem år senare, efter en rad märkliga turer, sålde kommunen verksamheten. Ett decennium efter försäljningen av Scand Point, 1995, beslöt sig Leif Bigsten på Falköpings kommun för att återigen få upp frågan på bordet. Efter att en utredning konstaterat att det fanns goda förutsättningar för Falköping lades en vision om Falköping som en godsknutpunkt för järnväg fram. Till skillnad från Scand Point var nu startsträckan lång och det dröjde ända till 2003 då kommunen gick med i ett EU-projekt och arbetet intensifierades. Trafikverket meddelade att de endast var intresserade av att delfinansiera en kombiterminal i regionen Skaraborg och intresse uppstod då från flera kommuner. Det utmynnade i en dragkamp mellan Falköping och Skövde där de slutligen kom överens om att en lokaliseringsstudie av Handelshögskolan vid Göteborgs Universitet och Chalmers Tekniska Högskola skulle bli styrande för vart etableringen skulle ske. Resultatet visade fördel Falköping gentemot Skövde. Efterföljande tid präglades av stiltje och politiska utspel som försenade utvecklingen. Efter många turer fram och tillbaka meddelades i december 2006 att kombiterminalen skulle byggas i Falköping. Utvecklingsprocessen har varit lång och krokig, men är idag inne i en positiv trend med en ny virkesterminal som ska byggas under 2012 samt att de nominerades till årets transportlösning på Transport & Logistikmässan i Göteborg i maj 2012. Vi har kommit fram till att de aspekter som varit betydande för utvecklings- och etableringsarbetet av ett regionalt samarbetsprojekt, i vår fallstudie av SLC, överensstämmer till stora delar med de aspekter som den befintliga forskningen, som vi tagit del av, lyfter fram. Politiken, komplexiteten i och finansieringen av infrastrukturen, det personliga engagemanget, sårbarheten för en försämrad konjunktur, vikten av en stor transportköpare i ett initial skede samt EU-projekten som verkat som en katalysator i utvecklingsarbetet. Den aspekt som den befintliga forskningen inte framhäver, men som i vår fallstudie visat sig vara av stor vikt är de tidigare erfarenheter som kommunen har av liknande projekt. Det har påverkat kommunens förhållningssätt och hur de har arbetat

Improved physical fitness of cancer survivors:A randomised controlled trial comparing physical training with physical and cognitive-behavioural training

We compared the effect of a group-based 12-week supervised exercise programme, i.e. aerobic and resistance exercise, and group sports, with that of the same programme combined with cognitive-behavioural training on physical fitness and activity of cancer survivors. One hundred and forty seven cancer survivors (all cancer types, medical treatment 3 months ago) were randomly assigned to physical training (PT, n=71) or PT plus cognitive-behavioural training (PT+CBT, n=76). Maximal aerobic capacity, muscle strength and physical activity were assessed at baseline and post-intervention. Analyses using multilevel linear mixed-effects models showed that cancer survivors' physical fitness increased significantly in PT and PT+CBT from baseline to post-intervention. Changes did not differ between PT and PT+CBT. Physical fitness of cancer survivors was improved following an intensive physical training programme. Adding a structured cognitive-behavioural intervention did not enhance the effect

Fusion of a family 1 carbohydrate binding module of Aspergillus niger to the Pycnoporus cinnabarinus laccase for efficient softwood kraft pulp biobleaching

International audiencePycnoporus cinnabarinus laccase was fused to the C-terminal linker and carbohydrate binding module (CBM) of Aspergillus niger cellobiohydrolase B (CBHB). The chimeric enzyme of molecular mass 100 kDa was successfully produced in A. niger. Laccase-CBM was further purified to determine its main biochemical properties. The Michaelis-Menten constant and pH activity profile were not modified, but the chimeric enzyme was less thermostable than either the P. cinnabarinus laccase or the recombinant laccase produced in the same strain. Laccase-CBM was able to bind to a cellulosic substrate and, to a greater extent, to softwood kraft pulp. Binding to the pulp was shown to be mainly time and temperature-dependent. Laccase-CBM was further investigated for its softwood kraft pulp biobleaching potential and compared with the P. cinnabarinus laccase. Addition of a CBM was shown to greatly improve the delignification capabilities of the laccase in the presence of 1-hydroxybenzotriazole (HBT). In addition, ClO2 reduction using 5 U of chimeric enzyme per gram of pulp was almost double than that observed using 20 U of P. cinnabarinus laccase per gram of pulp. We demonstrated that conferring a carbohydrate binding capability to the laccase could significantly enhance its biobleaching propertie