Cold Water Immersion Directly and Mediated by Alleviated Pain to Promote Quality of Life in Indonesian with Gout Arthritis: A Community-based Randomized Controlled Trial

Background: Gout arthritis is an autoinflammatory arthritis that generates chronic long-term pain. Pain impacts physical activities, joint mobility, stress, anxiety, depression, and quality of life. Cold-water immersion therapy reduces inflammation and pain associated with gout arthritis. However, cold-water immersion therapy has not been conducted among people worldwide with gout arthritis. Objective: To investigate the cold-water immersion intervention on pain, joint mobility, physical activity, stress, anxiety, depression, and quality of life among acute gout patients. Methods: A community-based randomized control trial design with two parallel-intervention groups: a cold-water immersion group (20–30°C 20 minutes/day for 4 weeks) and a control group. In total, 76 eligible participants in Tomohon City, Indonesia, were recruited using a multi-stage sampling method and were randomly assigned using block randomization. A generalized estimating equation model was used to analyze the results (coef. β) and produce 95% confidence intervals (CIs). A path analysis was used to analyze mediating effects. Results: Significant pain alleviation ( β = −2.06; −2.42), improved joint mobility ( β = 1.20, 1.44), physical activity ( β = 2.05, .59), stress ( β = −1.25; −1.35), anxiety ( β = −.62; −1.37), and quality of life ( β = 5.34; 9.93) were detected after cold-water immersion at the second-week, and were maintained to the fourth-week time point, compared to pre-intervention and the control group. Depression ( β = −1.80) had decreased by the fourth week compared to the pre-test and control group. Cold-water immersion directly mediated alleviation of pain ( β = −.46, p ≤ .001) and to promote the quality of life ( β = .16, p = .01). Conclusions: Cold-water immersion decreased pain, stress, anxiety, and depression, and increased joint mobility, physical activity, and quality of life. It mediated alleviation of pain to increase the quality of life.

Dietary Sodium, Potassium, and Sodium to Potassium Ratio in Patients With Systemic Lupus Erythematosus

Purpose: The aim of this study was to investigate the association between dietary sodium, potassium, and sodium:potassium ratio and clinical disease activity parameters, damage accrual, and cardiovascular disease risk factors in a population of patients with systemic lupus erythematous (SLE). Research design and study sample: A cross-sectional study including a total of 280 patients was conducted (90.4% females; mean age 46.9 ± 12.85 years). Data collection: The SLE Disease Activity Index (SLEDAI-2K) and the SDI Damage Index were used to assess disease activity and disease-related damage, respectively. A 24-hour diet recall was used to estimate dietary intake of sodium and potassium. Results: Dietary sodium intake was significantly associated with anti-dsDNA ( β = −.005; 95% CI [.002 .008]; p = .001) and complement C4 level ( β = −.002; 95% CI [−.003, .000]; p = .039). Dietary potassium intake was also significantly associated with complement C3 level ( β = −.004; 95% CI [−.007, −.001]; p = .021). Multiple logistic regression models revealed a positive association between dietary sodium intake and the risk of having hsCRP > 3 ( p = .005) and an inverse association between dietary potassium intake and the risk of having hsCRP > 3 ( p = .004). Conclusions: SLE patients with higher dietary sodium and lower dietary potassium intakes had an increased risk of higher hsCRP. Dietary sodium intake was significantly associated with anti-dsDNA and complement C4 level, while dietary potassium intake was associated with complement C3 level, supporting that dietary sodium and potassium intakes might play a key role in markers related to disease activity in SLE patients.

The Brain-Derived Neurotrophic Factor Functional Polymorphism and Hand Grip Strength Impact the Association between Brain-Derived Neurotrophic Factor Levels and Cognition in Older Adults in the United States

Introduction Aging is associated with subtle cognitive decline in attention, memory, executive function, processing speed, and reasoning. Although lower brain-derived neurotrophic factor (BDNF) has been linked to cognitive decline among older adults, it is not known if the association differs among individuals with various BDNF Val66Met (rs6265) genotypes. In addition, it is not clear whether these associations vary by hand grip strength or physical activity (PA). Methods A total of 2904 older adults were included in this study using data from the Health and Retirement Study. Associations between serum BDNF and measures of cognitive function were evaluated using multivariable linear regression models stratified by Met allele status. PA and hand grip strength were added to the model to evaluate whether including these variables altered associations between serum BDNF and cognition. Results Mean age was 71.4 years old, and mean body mass index was 28.3 kg/m2. Serum BDNF levels were positively associated with higher total cognitive score (beta = 0.34, p = .07), mental status (beta = 0.16, p = .07), and word recall (beta = 0.22, p =.04) among Met carriers, while serum BDNF levels were negatively associated with mental status (beta = −0.09, p = .07) among non-Met carriers. Furthermore, associations changed when hand grip strength was added to the model but not when PA was added to the model. Conclusions The BDNF Val66Met variant may moderate the association between serum BDNF levels and cognitive function in older adults. Furthermore, such associations differ according to hand grip strength but not PA.

Frailty and In-Hospital Mortality Risk Using EHR Nursing Data

Purpose The purpose of this study was to evaluate four definitions of a Frailty Risk Score (FRS) derived from EHR data that includes combinations of biopsychosocial risk factors using nursing flowsheet data or International Classification of Disease, 10th revision (ICD-10) codes and blood biomarkers and its predictive properties for in-hospital mortality in adults ≥50 years admitted to medical-surgical units. Methods In this retrospective observational study and secondary analysis of an EHR dataset, survival analysis and Cox regression models were performed with sociodemographic and clinical covariates. Integrated area under the ROC curve (iAUC) across follow-up time based on Cox modeling was estimated. Results The 46,645 patients averaged 1.5 hospitalizations (SD = 1.1) over the study period and 63.3% were emergent admissions. The average age was 70.4 years (SD = 11.4), 55.3% were female, 73.0% were non-Hispanic White (73.0%), mean comorbidity score was 3.9 (SD = 2.9), 80.5% were taking 1.5 high risk medications, and 42% recorded polypharmacy. The best performing FRS-NF-26-LABS included nursing flowsheet data and blood biomarkers (Adj. HR = 1.30, 95% CI [1.28, 1.33]), with good accuracy (iAUC = .794); the reduced model with age, sex, and FRS only demonstrated similar accuracy. The poorest performance was the ICD-10 code-based FRS. Conclusion The FRS captures information about the patient that increases risk for in-hospital mortality not accounted for by other factors. Identification of frailty enables providers to enhance various aspects of care, including increased monitoring, applying more intensive, individualized resources, and initiating more informed discussions about treatments and discharge planning.

Effect of Patient-Centered Self-Management Program on Blood Pressure, Renal Function Control, and the Quality of Life of Patients With Hypertensive Nephropathy: A Longitudinal Randomized Controlled Trial

This longitudinal study with a randomized controlled trial evaluated the long-term effectiveness of the patient-centered self-management intervention program on the control of blood pressure and renal function, as well as the quality of life of patients with hypertensive nephropathy. The control group ( n = 38) received usual care while the experimental group ( n = 38) participated in a patient-centered self-management program. After the pre-test, the intervention was performed with the experimental group once a week for a total of 4 weeks. Then, the post-test was performed 1, 3, and 6 months later. A questionnaire was used to collect the demographic data and disease characteristics, laboratory data, and quality of life scale. This study tracked three time points (i.e., 1, 3, and 6 months) after the intervention and found that the experimental group achieved significant results in controlling systolic blood pressure ( p < 0.001), diastolic blood pressure ( p = 0.007), and eGFR ( p = 0.013). Significant results were achieved in the overall quality of life ( p < 0.001) and the quality of life in the physical (PHC; p < 0.001) and mental health components (MHC; p < 0.001). Furthermore, the effects in the experimental group lasted for as long as 6 months and were better than those in the control group. Moreover, this program can provide nursing staff with a reference different from traditional health education methods.

Clinical Features of COVID-19 Patients in the First Year of Pandemic: A Systematic Review and Meta-Analysis

Background The new coronavirus disease (COVID-19) carries a high risk of infection and has spread rapidly around the world. However, there are limited data about the clinical symptoms globally. The purpose of this systematic review and meta-analysis is to identify the prevalence of the clinical symptoms of patient with COVID-19. Methods A systematic review and meta-analysis were carried out. The following databases were searched: PubMed, CINAHL, MEDLINE, EMBASE, PsycINFO, medRxiv, and Google Scholar, from December 1st, 2019 to January 1st, 2021. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. Results A total of 215 studies, involving 132,647 COVID-19 patients, met the inclusion criteria. The pooled prevalence of the four most common symptoms were fever 76.2% ( n = 214; 95% CI 73.9–78.5); coughing 60.4% ( n = 215; 95% CI 58.6–62.1); fatigue 33.6% ( n = 175; 95% CI 31.2–36.1); and dyspnea 26.2% ( n = 195; 95% CI 24.1–28.5). Other symptoms from highest to lowest in terms of prevalence include expectorant (22.2%), anorexia (21.6%), myalgias (17.5%), chills (15%), sore throat (14.1%), headache (11.7%), nausea or vomiting (8.7%), rhinorrhea (8.2%), and hemoptysis (3.3%). In subgroup analyses by continent, it was found that four symptoms have a slight prevalence variation—fever, coughing, fatigue, and diarrhea. Conclusion This meta-analysis found the most prevalent symptoms of COVID-19 patients were fever, coughing, fatigue, and dyspnea. This knowledge might be beneficial for the effective treatment and control of the COVID-19 outbreak. Additional studies are required to distinguish between symptoms during and after, in patients with COVID-19.

Efficacy of Tai Chi on Patients With Chronic Kidney Disease

Previous systematic reviews elucidate the efficacy of Tai Chi on the rehabilitation and treatment for various chronic diseases. Yet, no consensus has been reached on its efficacy and safety from those with chronic kidney disease (CKD). Therefore, we conducted a systematic review to critically summarize what is already known about the prevailing benefits of Tai Chi for CKD patients. There was no evidence that Tai Chi had adverse effects on CKD patients. Long-term Tai Chi exercises could improve quality of life, cardiorespiratory fitness, and physical motor function for the end-stage renal disease (ERSD) patients undergoing dialysis. Regular Tai Chi exercises might exert modest influences in delaying CKD progression for mild–moderate CKD patients. However, there is insufficient evidence to demonstrate positive effects of Tai Chi exercises on bone health of the ESRD patients. Accordingly, rigorously designed, longer-term studies of Tai Chi are warranted to identify its efficacy on CKD patients across different stages, especially targeting potential mechanisms in terms of Tai Chi altering biological gene profile expressions.

Self-Managed Music-Guided Exercise Intervention Improved Upper and Lower Extremity Muscle Strength for ICU Survivors—A Pilot Randomized Controlled Study

Objective The objective of this study was to evaluate effects of a self-managed music-guided exercise intervention on muscle strength among intensive care unit (ICU) survivors. Methods We used a two-arm randomized-controlled trial. Following ICU discharge, eligible participants were assigned to one of two groups: music group ( n = 13) or active control group ( n = 13). The music group was taught to self-manage upper and lower extremity exercise movements by listening to an individualized music-guided playlist twice daily for 5 days. The active control group was provided an exercise brochure and advised to perform the same exercises at the same intervals. Dynamometers were used to measure muscle strength. T-tests and Weighted GEE models were used for testing the intervention effect between groups. Results Twenty-six subjects were enrolled. The mean age was 62.8 ( SD = 13.8), 53.8% were male, 65.4% were Caucasian, and the mean APACHE severity of illness score was 59 ( SD = 23.4). Reasons for ICU admission were mainly cardiac and medical. The music group showed significant improvements in handgrip, plantar flexion, leg extension, elbow flexion, and shoulder adduction strengths on left and right sides. Additionally, left and right leg extensor and left plantar flexor strengths showed significant post-differences, and small to moderately large effect sizes, between the music group and control group. Conclusion These findings suggest that a music-guided exercise intervention has the potential to improve muscle strength in ICU survivors and prevent further post-ICU deterioration in ICU survivors. Future trials should build upon these preliminary findings.

Effect of Exercise Training on Spexin Level, Appetite, Lipid Accumulation Product, Visceral Adiposity Index, and Body Composition in Adults With Type 2 Diabetes

Objective To compare the effects of resistance and aerobic training (RT and AT) on spexin (SPX), appetite, lipid accumulation product (LAP), visceral adiposity index (VAI), and body composition in type 2 diabetes mellitus (T2DM) patients. Materials and Methods: Thirty-six T2DM men were randomized to receive RT ( n = 12), AT ( n = 12), or to act as a non-exercise control (CON, n = 12) 3 days a week for 12 weeks. Results: SPX was increased after both RT and AT (66.2% and 46.5%, respectively). VAI, LAP, and homeostasis model assessment-insulin resistance (HOMA-IR) were reduced in both groups, while quantitative insulin sensitivity check index (Quicki) and McAuley’s indexes were increased following both interventions. However, the increases of both hunger and PFC in the RT group were greater than those of the AT. Moreover, the improvement of upper-body strength (41% vs. 10.3%) and lower-body strength (42.2% vs. 20.5%) in the RT group was greater than those of the AT. Conclusion: Our investigation shows that regardless of the modes of the regimen, a 12-week exercise intervention with RT and AT can effectively induce a significant improvement in SPX levels, appetite, LAP, VAI, and body composition in adults with T2DM.