The effect of pelvic floor muscle training on sexual function in men with lower urinary tract symptoms after stroke.

BACKGROUND: Erectile dysfunction and lower urinary tract symptoms (LUTS) are common sequelae in men after stroke. OBJECTIVE: The objective of this study was to evaluate the effect of pelvic floor muscle training (PFMT) on measured erectile function as an indicator of sexuality in men with LUTS after stroke. METHOD: A sample of 516 men with stroke was invited to participate in this single-blinded, randomized controlled trial according to in- and exclusion criteria. This resulted in 31 participants who were randomized to either a Treatment Group (n = 16) or a Control Group (n = 15). The intervention included 12♣weeks of PFMT. The effect was measured on the International Index of Erectile Function (IIEF-5) questionnaire. RESULTS: Thirty participants (median age: 68 years; interquartile range: 60-74 years) completed the study, 15 in each group. The results of the IIEF-5 sum score showed a significant improvement (P < 0.04) from pre-test to post-test in the Treatment Group, but not in the Control Group. Within pre-test and 6-month follow-up, the median sum score decreased in both groups, worsened in the Control Group [Treatment Group, 3 (17%) versus Control Group, 5 (31%)]. There were differences between the groups at post-test and at follow-up, but they were not statistically significant. CONCLUSION: The results showed that, as measured by erectile function in men with LUTS after stroke, PFMT may have short-term and long-term effect, although no statistically significant effect was demonstrated between the groups.

Dietary folate and related micronutrients, folate-metabolising genes, and ovarian cancer survival.

OBJECTIVE: Folate is essential for DNA synthesis and methylation and is implicated in tumour progression. Few studies have examined its role in ovarian cancer survival. Our objective was to determine relationships between intake of folate, related one-carbon nutrients, single nucleotide polymorphisms (SNPs) in folate-metabolising genes and survival following ovarian cancer diagnosis. METHODS: This analysis included 1270 women with invasive epithelial ovarian cancer diagnosed in 2002-2006. Pre-diagnostic and some post-diagnostic lifestyle, dietary, and sociodemographic information was collected via self-administered questionnaires. DNA samples were genotyped for SNPs in methylenetetrahydrofolate reductase (MTHFR), methionine synthase (MTR) and methionine synthase reductase (MTRR) genes. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression. RESULTS: Multivariate analyses did not identify associations between higher pre-diagnostic intake of folate, folic acid, vitamins B2, B6, and B12, methionine, betaine or choline and survival overall. In stratified analyses, higher folic acid and folate intake was associated with significantly worse survival among women with mucinous tumours (HRs per 100 µg 1.30 and 1.43, respectively) and smokers (HRs per 100 µg 1.23 and 1.16 respectively). There was also a suggestion that higher supplemental folic acid use post-diagnosis was associated with worse survival (HR per 100 µg 1.03, 95%CI 1.00-1.05). MTHFR SNP rs2066470 was significantly associated with survival (per allele HR 0.81, 95%CI 0.67-0.98). CONCLUSIONS: Our data provide little evidence that folate intake affects ovarian cancer survival. However, combined effects with smoking, and findings within the mucinous subtype and for post-diagnosis folic acid, warrant further investigation.

Initial experience of TAS-102 chemotherapy in Australian patients with Chemo-refractory metastatic colorectal cancer.

For patients with refractory metastatic colorectal cancer (mCRC) treatment with Trifluridine/Tipiracil, also known as TAS-102, improves overall survival. This study aims to investigate the efficacy and safety of TAS-102 in a real-world population from Victoria, Australia. A retrospective analysis of prospectively collected data from the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry was undertaken. The characteristics and outcomes of patients receiving TAS-102 were assessed and compared to those enrolled in the registration study (RECOURSE). Across 13 sites, 107 patients were treated with TAS-102. The median age was 60 years (range: 31-83), compared to 63 for RECOURSE. Comparing registry TAS-102-treated and RECOURSE patients, 75% vs 100% were ECOG performance status 0-1, 74% vs 79% had initiated treatment more than 18 months from diagnosis of metastatic disease and 36% vs 49% were RAS wild-type. Median time on treatment was 10.4 weeks (range: 1.7-32). Median progression-free survival (PFS) was 3.3 months compared to 2 months in RECOURSE, while median overall survival was the same at 7.1 months. Two patients (2.3%) had febrile neutropenia and there were no treatment-related deaths, where TAS-102 dose at treatment initiation was at clinician discretion.TRACC registry patients treated with TAS-102 were younger than those from the RECOURSE trial, with similar overall survival observed. Less strict application of RECIST criteria and less frequent imaging may have contributed to an apparently longer PFS.

Bandwidth tuning triggers interplay of charge order and superconductivity in two-dimensional organic materials.

We observe charge-order fluctuations in the quasi-two-dimensional organic superconductor ß''-(BEDT-TTF)2SF5CH2CF2SO3, both by means of vibrational spectroscopy, locally probing the fluctuating charge order, and by investigating the in-plane dynamical response by infrared reflectance spectroscopy. The decrease of the effective electronic interaction in an isostructural metal suppresses both charge-order fluctuations and superconductivity, pointing to their interplay. We compare the results of our experiments with calculations on the extended Hubbard model.

Consensus on core phenomena and statements describing Basic Body Awareness Therapy within the movement awareness domain in physiotherapy.

Physiotherapists are facing complex health challenges in the treatment of persons suffering from long-lasting musculoskeletal disorders and mental health problems. Basic Body Awareness Therapy (BBAT) is a physiotherapy approach within the movement awareness domain developed to bridge physical, mental, and relational health challenges. The purpose of this study was to reach a consensus on core phenomena and statements describing BBAT. A consensus-building process was conducted using the nominal group technique (NGT). Twenty-one BBAT experts from 10 European countries participated in a concentrated weekend workshop of 20 hours. All participants signed informed consent. Participants reached a consensus on 138 core phenomena, clustered in three overarching categories: clinical core, historical roots, and research and evaluation phenomena. Of the 106 clinical core phenomena, the participants agreed on three categories of phenomena: movement quality, movement awareness practice, and movement awareness therapy and pedagogy. Furthermore, the participants reached 100 percent consensus on 16 of 30 statements describing BBAT. This study provides a consensus on core phenomena and statements describing BBAT. The data reveal phenomena implemented when promoting movement quality through movement awareness. Data provide clarity in some aspects of the vocabulary as fundamental theory. Further reearch will be developed.

Has aerobic exercise effect on pain perception in persons with migraine and coexisting tension-type headache and neck pain? A randomized, controlled, clinical trial.

BACKGROUND: A large subset of persons with migraine suffers from coexisting tension-type headache and neck pain which may adversely affect the prognosis of migraine. Aerobic exercise has been shown to decrease migraine burden in these persons. Therefore, the aim of this study was to investigate whether the effect of aerobic exercise in persons with migraine and coexisting tension-type headache and neck pain can be explained by changes in pain perception. METHOD: Seventy consecutively recruited persons with migraine and coexisting tension-type headache and neck pain were randomized into exercise group or control group. Aerobic exercise consisted of bike/cross-trainer/brisk walking for 45 min, three times/week for 3 months. Controls continued their usual daily activities. Pericranial tenderness, pain thresholds, supra-thresholds and temporal summation were assessed at baseline, after treatment and at follow-up (6 months from baseline). RESULTS: Fifty-two persons with migraine and coexisting tension-type headache and neck pain completed the study. Aerobic exercise did not induce consistent changes in nociceptive pathways measured by pericranial tenderness, pressure pain thresholds and sensitivity to electrical stimulation. CONCLUSION: The effect of aerobic exercise cannot be explained by measurable effects on the pain modulation system. Thus, the positive effect on migraine burden may rather be explained by positive alteration of avoidance behaviour. Aerobic exercise can be recommended as a safe and inexpensive migraine treatment strategy. SIGNIFICANCE: This study adds further knowledge about the positive effect of aerobic exercise for persons with migraine and coexisting tension-type headache and neck pain. This effect cannot be measured by changes in pain modulation, but may rather be explained by positive alteration of avoidance behaviour.

The Lighthouse Alarm and Locator trial - a pilot study.

An important factor for health is the possibility to be active and mobile. To make this possible various kinds of support are needed. Integrating geographical information systems technology and user experiences is important in the development of more user-friendly positioning devices. The Lighthouse Alarm and Locator trial aimed to test a new mobile alarm system with additional functionality such as positioning and monitoring of vital signs which can be used regardless of location (in hospital, at home). The system was tested by elderly persons from a pensioner organisation and home care personnel answered up on the alarms. After the tests qualitative interviews were performed with the two groups. The results showed that their experiences of the new mobile alarm system could be described in three main categories: to be supervised, to feel safe and to be mobile. These categories formed a theme: Positioning - an ethical dilemma. The clients' mobility was perceived to increase. The personnel did not think that positioning was ethical but the clients (elderly) did.

Effects of a self-guided, web-based activity programme for patients with persistent musculoskeletal pain in primary healthcare: A randomized controlled trial.

BACKGROUND: Web-based interventions for pain management are increasingly used with possible benefits, but never used in addition to multimodal rehabilitation (MMR). MMR is recommended treatment for persistent pain in Sweden. The aim was to evaluate the effects of a self-guided, web-based programme added to MMR for work ability, pain, disability and health-related quality of life. METHODS: We included 99 participants with persistent musculoskeletal pain in a randomized study with two intervention arms: (1) MMR and web-based intervention, and (2) MMR. Data was collected at baseline, 4 and 12 months. Outcome measures were work ability, working percentage, average pain intensity, pain-related disability, and health-related quality of life. RESULTS: There were no significant effects of adding the web-based intervention to MMR regarding any of the outcome variables. CONCLUSIONS: This trial provides no support for adding a self-guided, web-based activity programme to MMR for patients with persistent musculoskeletal pain. SIGNIFICANCE: The comprehensive self-guided, web-based programme for activity, Web-BCPA, added to multimodal treatment in primary health care had no effect on work ability, pain, disability or health-related quality of life. Future web-based interventions should be tailored to patients' individual needs and expectations.

Development and reliability of the Motivation for Change Questionnaire.

PURPOSE: The purpose of this study was to describe the development of the Motivation for Change Questionnaire (MCQ) and to test its intra-patient reliability on musculoskeletal pain patients in interdisciplinary rehabilitation as a basis for use in rehabilitation planning. METHOD: The MCQ questionnaire was developed from a literature search in the Medline, Cinahl and Psychlit databases concerning motivating factors for change in the life and work situation. Questions covering these factors were developed (item generation). Factor analysis of the questions implied a reduction of the number of questions (item reduction). Inter-item correlation was assessed on the baseline administration of the questionnaire by calculating Cronbach's alpha. When testing the structure of the scales, it was shown that the MCQ questionnaire could be described in two scales, one scale relating to motivation for change in the life situation and the other focusing on motivation for change in the work situation and in total 49 questions. RESULTS: The test -- retest reliability was calculated using the intra-class correlation coefficient (ICC) and 95% confidence intervals were calculated. One question was excluded due to the threshold limit of > 0.5. Seven scales relating to the life situation were accepted by the analysis: social support, mastery in life, challenges in life, control in life, values, self-efficacy and self-confidence. Six scales relating to the work situation were also accepted: co-worker support, supervisory support, challenges in work, job control, interaction and job-satisfaction. CONCLUSIONS: The MCQ questionnaire with 48 questions is reliable for use on musculoskeletal pain patients in interdisciplinary rehabilitation. It can be used to identify each individual's motivating factors for change in life and work situation as a basis for motivational work within rehabilitation and/or to measure within-subject changes in motivation over time. The validity and the responsiveness of the MCQ, need to be studied.

Personal factors in systemic sclerosis and their coverage by patient-reported outcome measures. A multicentre European qualitative study and literature review.

BACKGROUND: Systemic sclerosis (SSc) is an autoimmune disease where thickening of the skin can lead to reduced body function and limitations in activities. Severe forms can also affect and seriously damage inner organs. Patient-centred rehabilitation emphasises considerations of patients' background, experience and behavior which highlights the need to know if patient-reported outcome measures (PROMs) include such personal factors. AIM: To identify and describe personal factors in the experiences of functioning and health of persons with SSc and to examine if and to what extent PROMs in SSc research cover these factors. DESIGN: Data from a qualitative study with focus group interviews were analysed. PROMs in SSc research were identified in a literature review between 2008-2013. SETTING: Participants were recruited from outpatient clinics at rheumatology department. POPULATION: Sixty-three patients with SSc from four European countries participated. METHODS: Data from interviews were analysed using a structure of personal factors developed by Geyh et al. Identified PROMs were analysed and linked to main concepts, related to the personal factors, found in the interview data. RESULTS: Nineteen main concepts were related to the area "patterns of experience and behaviour" in the personal factor structure, 16 to "thoughts and beliefs", nine to "feelings", one to "motives" and one to "personal history and biography", respectively. Among the 35 PROMs identified, 15 did not cover any of the identified concepts. Concepts within the area "feelings" were mostly covered by the PROMs. Five of the PROMs covered "patterns of experience and behaviour", while "motives" and "personal history and biography" were not covered at all. Four of the identified PROMs covered concepts within the areas "feelings", "thoughts and beliefs" and "patterns of experience and behaviour" in the same instrument. The Illness Cognition Questionnaire and Illness Behaviour Questionnaire were such PROMs. CONCLUSION: Patterns of experience and behaviour had the highest number of concepts related to personal factors, but few of the PROMs in SSc research covered these factors. Only a few PROMs covered several personal factors areas in the same instrument. CLINICAL REHABILITATION IMPACT: The results would be of value when developing core sets for outcome measurements in SSc.

Arboviruses recovered from sentinel cattle using several virus isolation methods.

A group of 20 sentinel steers was bled weekly for 5 months in 1986 and the blood samples were examined for arboviruses by inoculation firstly into embryonated chicken eggs (ECE), baby mice, Aedes albopictus cells and BHK21 monolayers. A second group of cattle was similarly examined for virus in 1987, except that baby mice were not used. Viruses were recovered from 26% of the 878 weekly bleeds. The viruses identified consisted of 14 types belonging to the bluetongue, epizootic haemorrhagic disease (EHD), Palyam and Simbu groups with a single isolation of bovine ephemeral fever virus. The ECE system was found to be the best for isolating bluetongue and Simbu viruses, though the eggs were not usually killed by the inoculum. The ECE and A. albopictus systems were equally sensitive for recovering EHD viruses, while Palyam group viruses were most efficiently isolated in BHK21 monolayers.

Investigations of bluetongue and other arboviruses in the blood and semen of naturally infected bulls.

Small groups of bulls were exposed to natural infection with arboviruses. The bulls were bled and ejaculated regularly and the blood and semen were processed for virus isolation. Over a 5-year observation period, virus isolation and serology indicated that the 29 exposed bulls had experienced 79 viraemic episodes with the viruses of the bluetongue, epizootic haemorrhagic disease, Palyam and Simbu serogroups and an incompletely characterised rhabdovirus. In no instance was there unequivocal evidence of bluetongue virus contamination of semen, despite 18 infections in the study period.

Arboviruses recovered from sentinel livestock in northern Australia.

Over 700 arboviruses were recovered between 1981 and 1987 from the blood of sentinel livestock near Darwin. Twenty-three isolates were made from sheep, goats, swamp buffalo (Bubalus bubalis) and horses, and the remainder were from cattle. The isolates have been typed as 27 separate viruses belonging to the bluetongue, epizootic haemorrhagic disease, Palyam, Simbu, bovine ephemeral fever, Tibrogargan and alphavirus groups. Ten of these viruses have not been isolated elsewhere in Australia and four have been isolated only in Darwin. Considerable annual variations in virus activity and in the durations of detectable viraemia were observed.

A monoclonal antibody blocking ELISA detects antibodies specific for epizootic haemorrhagic disease virus.

The isolation of a monoclonal antibody (1G9/C9) with specificity for the epizootic haemorrhagic disease (EHD) serogroup has enabled the development of a highly sensitive and specific blocking ELISA (B-ELISA) for the detection of serum antibodies to EHD viruses. The assay was sensitive to blocking antibodies present in hyperimmune reference antisera to all six EHD serotypes tested but was unaffected by reference antisera to 19 South African and eight Australian serotypes of the related orbivirus bluetongue virus (BTV). The sensitivity of the EHD B-ELISA exceeded that of an indirect ELISA (I-ELISA) for EHD-specific antibody detection. Serum antibody titres to BTV and EHD in experimental and field sera, including a sentinel herd from which virus isolations were made, were examined in both the BTV and EHD B-ELISA tests. These results showed the B-ELISA was only sensitive to antibodies specific for the homologous serogroup in each case, even where sequential and mixed infections with each virus type occurred.

First reported case of endometrial carcinoma in association with HIV infection.

Endometrial adenocarcinoma is the most common gynecologic cancer in developed countries, although it has never before been documented in a female infected with human immunodeficiency virus (HIV). By contrast, cervical carcinoma is well described in association with HIV infection and in 1993 was added to the AIDS case definition. We present the unique case of a 38-year-old HIV-infected female with endometrial carcinoma, who became rapidly disseminated following her initial surgery. Although HIV is unlikely to have an etiologic role in endometrial carcinoma, it is conceivable that immunosuppression contributed to an accelerated course of her malignancy.

Test of swedish anti-skid devices on five different slippery surfaces.

The interest for effective preventive strategies for slips and falls is growing. Much remains to be done, however, to prevent slips and falls in the traffic environment. Some pedestrians are injured because of slippery pavements and roadways. Using an appropriate anti-skid device may reduce the risk of slips and falls on different surfaces outdoors during winter. The aim of this study was to evaluate new anti-skid devices on the Swedish market representing three different designs of anti-skid devices; heel device, fore-foot device and whole-foot device on different slippery surfaces, gravel, sand, salt, snow and ice. The evaluations were done according to subject's perceived walking safety and balance, videorecordings of walking postures and movements, time to take on and off each anti-skid device, advantages/disadvantages with each anti-skid device and a list of priority for own use according to three criteria; safety, balance and appearance. Practical tests were carried out on different slippery surfaces, gravel, sand, salt, snow and ice. The subject's were randomly selected from the registered population over 55 years in a city in northern Sweden. The results showed that eight or more of the ten subjects perceived all four anti-skid devices as fairly good or good regarding walking safety and balance when walking on gravel, sand, and salt. Anti-skid device 3, a whole-foot device was perceived as having none or bad walking safety and balance on snow by seven subjects and anti-skid device 4, a heel device, as having none or bad walking balance on ice by all ten subjects. Eight subjects walked with a normal muscle function in the hip and knee with all anti-skid devices on all surfaces. Small deviations in walking posture and movements were noted in one to two subjects when walking on different surfaces, but no systematic difference between the devices. Anti-skid device 1 'Rewa', a fixed heel device, was perceived as the most rapid one to take on. All four devices were perceived as easy to use and as giving good foothold. Anti-skid device 1 'Rewa' and 4 'Thulin-spike', both heel devices, had the highest priority according to walking safety. 'Rewa' also had the highest priority according to walking balance as well as own use. When combining the criterias 'Rewa' had the highest priority according to walking safety and balance, priority for own use, time to take on and easiness to use.

Pedestrians on slippery surfaces during winter--methods to describe the problems and practical tests of anti-skid devices.

Every year there are thousands of pedestrians in Sweden who are injured because of slippery pavements and roadways. Using an appropriate anti-skid device may reduce the risk of slips and falls on ice and snow. Methods to describe functional problems in walking on different slippery surfaces during winter have been developed as rating scales for evaluating walking safety and walking balance and an observation method to observe posture and movements during walking. Practical tests of all 25 anti-skid devices on the market in Sweden were carried out on different slippery surfaces; gravel, sand, salt, snow and ice. The anti-skid devices were described according to the subjects' perception of walking safety, walking balance and priority for own use. The postures and movements during walking were analysed by an expert physical therapist. The wholefoot device 'studs' was perceived as the best according to walking safety and walking balance and had the highest priority for own use.

The expected economic impact of selected exotic diseases on the pig industry of Australia.

The authors assess the expected economic impact of three exotic diseases on the pig industry of Australia. An integrated epidemiological/economic approach was used to assess the effects of classical swine fever, Nipah virus and porcine reproductive and respiratory syndrome. Scenarios involving either an epidemic event, in which the outbreaks were confined to selected regions and were eradicated, or an endemic situation, in which the diseases became established in Australia, were studied. Based only on loss of sales and disposal costs, epidemics resulted in regional losses in income of the order of AUS$10 million-AUS$30 million (16%-37%) depending on disease and region. If any of these diseases became established, opportunity losses in gross national pig income of 5%-11% per year would occur, with classical swine fever the most serious of the three diseases. Establishment of any of the diseases would lead to rapid structural change in the pig industry, with concomitant social and economic dislocation in regional Australia.

Coping after trans-femoral amputation due to trauma or tumour--a phenomenological approach.

PURPOSE: To describe, by use of a phenomenological approach, how relatively young trans-femoral amputees experienced their amputation and their coping strategies in the acute phase and over time. METHOD: Eleven trans-femoral amputees, median age 33.5 years, were interviewed. The amputation was caused by tumour, motorcycle accidents or work-related traumas. Amputation was made in median 7.5 years before the interview. The informants were community dwelling and managed well indoors. One had a half disablement pension and all the others were working or studying full time. The interviews were tape-recorded and transcribed verbatim. RESULTS: Two themes emerged. In the first theme 'Experiences of the amputation' denial and avoidance were the coping strategies mainly used. In the second theme 'Coping strategies to relate to a new norm' the informants used downward comparison, positive comparison and repression. Only one informant indicated a full acceptance of his situation. CONCLUSION: Relatively young, trans-femoral amputees within this sample, have not reached the acceptance level, though a long time has passed since the amputation. They might have benefited from professional support and guidance during the rehabilitation process in order to improve coping strategies to relate to a new norm.

Clinical variations of border disease in sheep according to the source of the inoculum.

Non-cytopathogenic pestivirus obtained from lambs with border disease, with or without nervous signs, was inoculated into pregnant ewes at 57 to 65 days of gestation. Live lambs born to inoculated ewes were clinically identical to the lambs from which virus was obtained, ie, either a hairy birth coat with central nervous system disturbance or a hairy birth coat without central nervous system disturbance.