Marguerite Foidart-Dessalle

A Double-Blind, Placebo Controlled, Randomized Trial to Assess the Impact of a Monthly Administration of 50,000 IU of Vitamin D3 for 6 Months on Serum Levels of 25-Hydroxyvitamin D in Healthy Young Adults.

In this double blind, unicentre, randomized, placebo controlled study, we evaluated the changes in 25-hydroxyvitamin D (25(OH)D) serum levels in 150 young Belgian adults (18–30 years), monthly supplemented with 50,000u2009IU of vitamin D (VTD) or placebo for 6 months, from November 2010 to May 2011. At T0, 30% of the population presented 25(OH)D serum levels below 20u2009ng/mL. In the VTD-treated group, mean serum levels increased from 21.2 ± 8.2 to 30.6 ± 8.8u2009ng/mL (P < 0.001) at T3mo and to 36.0 ± 9.2u2009ng/mL (P < 0.001) at T6mo. Despite documented VTD intake, no changes in serum levels were, however, observed in 10% of the treated group. In the placebo group, mean 25(OH)D serum levels decreased from 22.8 ± 8.5 to 14.0 ± 6.9u2009ng/mL at T3mo (P < 0.001) but returned to values not significantly different from those observed at T0 (23.5 ± 8.6u2009ng/mL) at T6mo. No difference between serum calcium levels was observed between the groups throughout the study. In conclusion, monthly supplementation with 50,000u2009UI of VTD in winter can warrant serum 25(OH)D levels above 20u2009ng/mL in 96.2% of those healthy young adults without inducing unacceptably high 25(OH)D concentration. This supplementation is safe and may be proposed without 25(OH)D testing.

Multidisciplinary rehabilitation program after breast cancer: benefits on physical function, anthropometry and quality of life.

BACKGROUNDnDifferent clinical trials show beneficial effects of physical training offered during and/or after breast cancer treatment. However, given the variety of side effects that may be encountered, physical training could be combined with psychological, relational and social guidance. This kind of multidisciplinary program has been little studied so far.nnnAIMnThe aim of this study was to determine the benefits of a three-month multidisciplinary rehabilitation program among women after breast cancer treatment.nnnDESIGNnControlled no-randomized trial.nnnSETTINGnUniversity for outcomes, University Hospital Center for interventions.nnnPOPULATIONnTwo hundred and nine outpatients who have been treated for a primary breast carcinoma.nnnMETHODSnPatients were divided into a control group (N.=106) and an experimental group (N.=103) which has benefited from a rehabilitation program of three months including physical training and psycho-educational sessions. The assessments, performed before and after the program, included functional assessments (Sit and Reach Test, maximal incremental exercise test and Six-Minute Walk Test), body composition measurements (Body Mass Index [BMI] and body fat percentage) and a questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30).nnnRESULTSnAfter three months, flexibility, walking distance and all parameters measured during the maximal incremental exercise, except maximal heart rate, were significantly improved in the experimental group. The body fat percentage was significantly decreased and a significant improvement was observed for perceived health status (quality of life), functional role, emotional state, physical, cognitive and social functions and for most symptoms. In the control group, most of these improvements didnt appear and a significant increase in BMI and body fat percentage was observed.nnnCONCLUSIONSnThis trial identifies the benefits of a well detailed multidisciplinary rehabilitation program, including physical re-conditioning and psycho-educational sessions, with important improvements in functional capacity, body composition and the majority of functions and symptoms among women after breast cancer treatment.nnnCLINICAL REHABILITATION IMPACTnThrough its results, this study could contribute to the development of hospital quality standards for oncologic rehabilitation. Physiotherapists can efficiently propose this kind of multidisciplinary rehabilitation program.

How Does Spasticity Affect Patients with Disorders of Consciousness

Spasticity is a frequent issue encountered by brain-damaged patients, arising from an anarchic reorganization of the central nervous system that may significantly alter motor function. While it is well described in patients with a lesion of the descending corticospinal system, little is known about the occurrence and physiopathology of this disorder in patients with more complex brain lesions and disorders of consciousness (coma, unresponsive wakefulness syndrome, and minimally conscious state). Most of the time, these patients are bedridden and lack voluntary motor command which favors spasticity to occur and may lead to complications including pain, loss in range of motion, or bed sores. Given the inability for many of these patients to express their pain or discomfort and knowing that spastic syndromes may restrain them to express signs of consciousness, the multimodal treatment of this spasticity is crucial for their management. In the present chapter, we describe the physiopathology and the current available treatments of spasticity in this specific population of severe brain-injured patients with disorders of consciousness.

Influence of a multidisciplinary post-breast cancer rehabilitation program on lifestyle and behavior faced with physical activities

B the gaps in cancer care is a daunting task that requires self-awareness, education, and advocacy founded in the Code of Ethics for Nurses and aligned with our Nursing’s Social Policy Statement (ANA, 2010). Though ethical underpinnings of both the code and social contract with individuals, families, and communities remain constant, healthcare is constantly evolving. One of the most important roles of nurses as leaders in healthcare is to give voice to the under-served and ensure fairness and equity to all people regardless of race, creed, gender, or economic status (ANA, 2010). Now, with growing visibility of marginalized US populations, the healthcare industry and its providers are challenged to meet the needs of the LGBTQ populations in an equitable and just way. For several decades, grassroots efforts, championed by the Fenway Institute (Boston, MA) and many of our national medical and nursing organizations (IOM, ANA,), have called for an adjustments to the binary healthcare structure that has yet to address the new norms of an expanding diversity of culture. Inherent in the lack of readiness to support the LGBTQ community are deficits in provider information, ineffective communication, confusion surrounding gender and sexuality differences and conscious and unconscious biases that interfere with the ability to recognize and to deliver appropriate healthcare. Despite this trending need, pre-professional education has dedicated limited amount of time in preparing nurses, nurse practitioners and medical staff in the standards of care for LGBTQ people. For the purpose of this presentation, cancer risk assessment, screenings, healthcare practices, and health promotion for LGBTQ people, from the very young to the elderly, will be explored. Strategies to provide a compassionate, and welcoming environments to gender, non-conforming individuals will be discussed. Recommendations for nursing education and preparedness using evidence-based applications in clinical practice will be offered.Exercise stage b 3.152 Contemplation .281 1.208 0.054 1.325 (0.124-14.143) Preparation .851 1.282 0.441 2.342 (0.190-28.866) Action 1.291 1.298 0.989 3.636 (0.285-46.305) Maintenance 1.944 1.368 2.020 6.990 (0.478-102.125) Table1 the predictive factor analysis of glycemic control Introduction It is important for patients with diabetes mellitus to understand the importance of drug compliance and healthy lifestyle. However, the actual condition of this management is not ideal. The behavior of personality traits is an important factor of compliance. There is a close relationship between personality traits, self-discipline, and selfcare. It is critical to understand the personality traits of subjects for glycemic control. Methods This study was conducted in the Division of Metabolism in a teaching hospital in Taiwan. There were 219 patients with Type 2 diabetes under survey with questionnaires. The effective sample size is 214. Results a) The older the patients have the lower the risk of poor glycemic control. b) Increase of every 10 years of age, the risk of poor glycemic control decreases by 9.2%. c) Increased fasting blood glucose of 10mg/dl increases 59% risk of poor glycemic control. d) Increased every 10 g/dl TG makes the increase of risk for poor glycemic control by 39%. e) Patients with prudent personality or agreeable personality have a lower risk of poor glycemic control but without significant difference. f) Neuroticism personality is an important predictor for poor glycemic control g) Neuroticism personalities have a 7.52 times higher risk of poor glycemic control.

ECCENTRIC TRAINING FOR ELBOW HYPERMOBILITY

Background Patients with hypermobility suffer from joints problems and chronic pain is the most frequently reported symptom. Objective Eccentric muscle strengthening could be very important to protect hypermobile joints. Design Case report. Setting Amateur tennis player. Patient A girl (16 y.o.) affected by an Ehler-Danlos syndrome presented pain in the right elbow and the right wrist after a season of tennis. Interventions Her training consisted of wrist prono-supination and flexion-extension muscle group reinforcement and proprioceptive training. To protect the wrist against excessive load, the eccentric strengthening exercises of prono-supinator and flexor-extensor muscles of elbow and wrist were undertaken gradually, at increasing speeds within a limited range of motion in flexion and extension, on an isokinetic device after an evaluation. She was also given an orthesis restricting the joint range of motion of the wrist. Main outcome measurements The evaluation was made by isokinetic evaluation, visual analog scale and MOS-SF36 questionnaire before and after training. Results The patient rapidly noted a decrease in pain and an increase in the stability of her right arm even when playing tennis. Isokinetic evaluation objectified a significant improvement in maximal torque in flexion-extension muscles of the right elbow. She was also given individualized home exercises. Conclusions The goal of this eccentric training is to avoid hypermobility by using the muscles as a protective brake in the control of joint positioning. Muscles can be reinforced in eccentric mode with starting position at the maximum length of these muscles when unstreched. The exercises can be carried out safely on an isokinetic device, at slow speed and limited range of joint motion to avoid risk of luxation. Thus, in this case report, the eccentric exercises using an isokinetic device were effective to safely reinforce the muscles as a protective brake for joint hypermobility and prevent pain during practicing tennis.