Long-term physical activity on prescription intervention for patients with insufficient physical activity level-a randomized controlled trial.

BACKGROUND: Physical activity (PA) can be used to prevent and treat diseases. In Sweden, licensed healthcare professionals use PA on prescription (PAP) to support patients to increase their PA level. The aim of this randomized controlled trial was to evaluate a 2-year intervention of two different strategies of PAP treatment for patients with insufficient PA level, after a previous 6-month period of ordinary PAP treatment in a primary health care setting. METHODS: We included 190 patients, 27-77 years, physically inactive with metabolic risk factors where the patients were not responding to a previous 6-month PAP treatment with increased PA. The patients were randomized to either enhanced support from a physiotherapist (PT group) or continued ordinary PAP treatment at the health care centre (HCC group). The PAP treatment included an individualized dialogue; an individually dosed PA recommendation, including a written prescription; and a structured follow-up. In addition to PAP, the PT group received aerobic fitness tests and more frequent scheduled follow-ups. The patient PA level, metabolic health, and health-related quality of life (HRQOL) were measured at baseline and at 1- and 2-year follow-ups. RESULTS: At the 2-year follow-up, 62.9% of the PT group and 50.8% of the HCC group had increased their PA level and 31.4% vs. 38.5% achieved ≥ 150 min of moderate-intensity PA/week (difference between groups n.s.). Over 2 years, both groups displayed increased high-density lipoproteins (HDL) (p = 0.004 vs. baseline), increased mental health status (MCS) (p = 0.036), and reduced body mass index (BMI) (p = 0.001), with no difference between groups. CONCLUSION: During long-term PAP interventions, the PA level, metabolic health, and HRQOL increased in patients at metabolic risk without significant differences between groups. The results indicate to be independent of any changes in pharmacological treatment. We demonstrated that the PAP treatment was feasible in ordinary primary care. Both the patients and the healthcare system benefitted from the improvement in metabolic risk factors. Future studies should elucidate effective long-term PAP-treatment strategies. TRIAL REGISTRATION: ClinicalTrials.gov NCT03012516 . Registered on 30 December 2016-retrospectively registered.

Long-range diffusion in xylitol-water mixtures.

Dynamic light scattering (DLS) and small-angle neutron scattering (SANS) were employed to study mixtures of xylitol and water. The results were also related to a previous dielectric relaxation study on the same system. In the temperature range of the DLS measurements the viscosity related structural (α) relaxation is too fast to be observed on the experimental time scale, but a considerably slower exponential and hydrodynamic relaxation process is clearly observable in the polarized light scattering data. A similar ultraslow process has been observed in many other types of binary liquids and commonly assigned to long-range concentration or density fluctuations. In some studies this interpretation has been supported by observations of substantial structural inhomogeneities in static light scattering or SANS experiments. However, in this study we observe such an ultraslow process without any indication of structural inhomogeneities on length-scales above 2 nm. Hence, we suggest that our observed ultraslow process is due to long-range diffusion of single xylitol molecules or small clusters of a few xylitol molecules (and perhaps some associated water molecules) which are randomly dispersed and sufficiently small to not be structurally detected in our SANS study. In the q-range of the DLS measurements this ultraslow relaxation process is around room temperature several orders of magnitude slower than the structural α-relaxation. However, if its 1/q(2)-dependent relaxation time is extrapolated to q-values where relaxation times from dielectric spectroscopy and quasielastic neutron scattering are compatible (about 10 nm(-1)), a relaxation time similar to that of the dielectric α-relaxation is obtained. Thus, the large difference in time scale between the two relaxation processes in the q-range of a DLS study is due to the fact that the α-relaxation is cooperative in nature, rather than caused by long-range single particle diffusion, and thus q-independent at low q-values.

Calorimetric and relaxation properties of xylitol-water mixtures.

We present the first broadband dielectric spectroscopy (BDS) and differential scanning calorimetry study of supercooled xylitol-water mixtures in the whole concentration range and in wide frequency (10(-2)-10(6) Hz) and temperature (120-365 K) ranges. The calorimetric glass transition, T(g), decreases from 247 K for pure xylitol to about 181 K at a water concentration of approximately 37 wt. %. At water concentrations in the range 29-35 wt. % a plentiful calorimetric behaviour is observed. In addition to the glass transition, almost simultaneous crystallization and melting events occurring around 230-240 K. At higher water concentrations ice is formed during cooling and the glass transition temperature increases to a steady value of about 200 K for all higher water concentrations. This T(g) corresponds to an unfrozen xylitol-water solution containing 20 wt. % water. In addition to the true glass transition we also observed a glass transition-like feature at 220 K for all the ice containing samples. However, this feature is more likely due to ice dissolution [A. Inaba and O. Andersson, Thermochim. Acta, 461, 44 (2007)]. In the case of the BDS measurements the presence of water clearly has an effect on both the cooperative α-relaxation and the secondary ß-relaxation. The α-relaxation shows a non-Arrhenius temperature dependence and becomes faster with increasing concentration of water. The fragility of the solutions, determined by the temperature dependence of the α-relaxation close to the dynamic glass transition, decreases with increasing water content up to about 26 wt. % water, where ice starts to form. This decrease in fragility with increasing water content is most likely caused by the increasing density of hydrogen bonds, forming a network-like structure in the deeply supercooled regime. The intensity of the secondary ß-relaxation of xylitol decreases noticeably already at a water content of 2 wt. %, and at a water content above 5 wt. % it has been replaced by a considerably stronger water (w) relaxation at about the same frequency. However, the similarities in time scale and activation energy between the w-relaxation and the ß-relaxation of xylitol at water contents below 13 wt. % suggest that the w-relaxation is governed, in some way, by the ß-relaxation of xylitol, since clusters of water molecules are rare at these water concentrations. At higher water concentrations the intensity and relaxation rate of the w-relaxation increase rapidly with increasing water content (up to the concentration where ice starts to form), most likely due to a rapid increase of small water clusters where an increasing number of water molecules interacting with other water molecules.

Hydrogen bond induced nonmonotonic composition behavior of the glass transition in aqueous binary mixtures.

The glass transition temperature, T(g), of a binary mixture commonly varies monotonically between the T(g)s of its two components. However, mixtures of strongly associating liquids can instead exhibit a nonmonotonic T(g) variation. The origins of such nonideal mixing behavior have often been correlated with composition dependent structural variations. For binary mixtures between a hydrogen- (H-) bonded liquid and water, however, such behavior is generally not well understood. The ubiquity and importance of aqueous mixtures both in nature and in man-made applications stresses the needed for a better understanding. We here demonstrate nonmonotonic T(g) variations in binary mixtures of n-propylene glycol monomethyl ethers (nPGMEs) and water, where the composition dependent T(g) show maxima within an intermediate composition range. We show that these T(g) maxima correspond to crossovers in the composition dependence of the step amplitude in the isobaric heat capacity at T(g). We further demonstrate that the observed effects are caused by H-bond interactions involving the nPGME hydroxyl group. We can account for our obervations using a simple model based on two effects due to the added water: (i) an H-bond induced formation of effective relaxing entities and (ii) a plasticizing effect at high water contents.

Effects of water contamination on the supercooled dynamics of a hydrogen-bonded model glass former.

Broad-band dielectric spectroscopy is a commonly used tool in the study of glass-forming liquids. The high sensitivity of the technique together with the wide range of probed time scales makes it a powerful method for investigating the relaxation spectra of liquids. One particularly important class of glass-forming liquids that is often studied using this technique consists of liquids dominated by hydrogen (H) bond interactions. When investigating such liquids, particular caution has to be taken during sample preparation due to their often highly hygroscopic nature. Water can easily be absorbed from the atmosphere, and dielectric spectroscopy is a very sensitive probe of such contamination due to the large dipole moment of water. Our knowledge concerning the effects of small quantities of water on the dielectric properties of these commonly investigated liquids is limited. We here demonstrate the effects due to the presence of small amounts of water on the dielectric response of a typical H-bonded model glass former, tripropylene glycol. We show how the relaxation processes present in the pure liquid are affected by addition of water, and we find that a characteristic water induced relaxation response is observed for water contents as low as 0.15 wt%. We stress the importance of careful purification of hygroscopic liquids before experiments and quantify what the effects are if such procedures are not undertaken.

Reduced mobility of di-propylene glycol methylether in its aqueous mixtures by quasielastic neutron scattering.

The hydrogen (H-) bonding interplay between water and other organic molecules is important both in nature and in a wide range of technological applications. Structural relaxation and, thus, diffusion in aqueous mixtures are generally dependent on both the strength and the structure of the H-bonds. To investigate diffusion in H-bonding mixtures, we present a quasielastic neutron scattering study of di-propylene glycol methylether (2PGME) mixed with H(2)O (or D(2)O) over the concentration range 0-90 wt.% water. We observe a nonmonotonic behavior of the dynamics with a maximum in average relaxation time for the mixture with 30 wt.% water, which is more than a factor 2 larger compared to that of either of the pure constituents. This is a result in qualitative agreement with previous calorimetric studies and the behavior of aqueous mixtures of simple mono-alcohols. More surprisingly, we notice that the dynamics of the 2PGME molecules in the mixture is slowed down by more than a factor 3 at 30 wt.% water but that the water dynamics indicates an almost monotonous behavior. Furthermore, in the low momentum transfer (Q) range of the 2PGME, where the intermediate scattering function I(Q,t) is considerably stretched in time (i.e., the stretching parameter ß â‰ª 1), it is evident for the 2PGME-D(2)O samples that the Q-dependence of the inverse average relaxation time, <τ>(-1), is greater than 2. This implies that the relaxation dynamics is partly homogenously stretched, i.e., the relaxation of each relaxing unit is somewhat intrinsically stretched in time.

Dielectric secondary relaxation of water in aqueous binary glass-formers.

Glassy aqueous binary mixtures generally exhibit a water induced dielectric relaxation. The characteristic time-scale of this relaxation follows an Arrhenius temperature dependence with a nearly universal activation energy. We here demonstrate for a series of model aqueous mixtures that the relaxation time also follows a remarkably general exponential dependence on the weight fraction of water. By comparison to literature data we show that this behaviour is shared by a wide range of molecular systems. Neither the detailed nature of the water molecules' glassy environment nor the details of the route of formation of the glassy state has a significant effect on the observed behaviour.

Investigating hydration dependence of dynamics of confined water: monolayer, hydration water and Maxwell-Wagner processes.

The dynamics of water confined in silica matrices MCM-41 C10 and C18, with pore diameter of 21 and 36 A, respectively, is examined by broadband dielectric spectroscopy (10(-2)-10(9) Hz) and differential scanning calorimetry for a wide temperature interval (110-340 K). The dynamics from capillary condensed hydration water and surface monolayer of water are separated in the analysis. Contrary to previous reports, the rotational dynamics are shown to be virtually independent on the hydration level and pore size. Moreover, a third process, also reported for other systems, and exhibiting a saddlelike temperature dependence is investigated. We argue that this process is due to a Maxwell-Wagner process and not to strongly bound surface water as previously suggested in the literature. The dynamics of this process is strongly dependent on the amount of hydration water in the pores. The anomalous temperature dependence can then easily be explained by a loss of hydration water at high temperatures in contradiction to previous explanations.

Perceptual matching for assessment of itch; reliability and responsiveness analyzed by a rank-invariant statistical method.

The aim of this study was to evaluate the reliability and responsiveness of a new device-perceptual matching by Matcher (Cefar Medical AB, Lund, Sweden)-in the assessment of the progress of experimentally induced itch as well as determine the reliability of the method in patients with skin disease and itch. The perceptual matching unit electrically stimulates the skin of the fingers in the left hand. When the amplitude of the sensation corresponded to that of the experienced itch, the subject was instructed to halt the stimulation and a value was automatically saved in the electronic device. A total of 36 healthy subjects and nine patients participated in the study. The healthy subjects were asked to rate the level of itch every 30 s during the first 5 min and thereafter every minute. The reliability was determined in a test-retest procedure of the time points 5, 10, and 15 min after induction of itching. To test the stability of the method, the first sensation of pain in healthy subjects without itch was determined every 10th minute during 60 min. In patients, the test-retest procedure was repeated within 5 min. Perceptual matching was found to be a reliable method of itch assessment, with no evidence for random individual disagreement between the assessments. The augmented rank order coefficient ra was excellent: 1.00 at 5 min; 0.99 at 10 min; and 1.00 at 15 min. There was a clear indication of responsiveness for detecting changes in itch over time, p