BACKGROUND:When performing two tasks at once, a dual task, performance on one or both tasks typically suffers. People with Parkinson's disease (PD) usually experience larger dual task decrements on motor tasks than healthy older adults (HOA). Our objective was to investigate the decrements in cycling caused by performing cognitive tasks with a range of difficulty in people with PD and HOAs.

METHODS:Twenty-eight participants with Parkinson's disease and 20 healthy older adults completed a baseline cycling task with no secondary tasks and then completed dual task cycling while performing 12 tasks from six cognitive domains representing a wide range of difficulty.

RESULTS:Cycling was faster during dual task conditions than at baseline, and was significantly faster for six tasks (all p<.02) across both groups. Cycling speed improved the most during the easiest cognitive tasks, and cognitive performance was largely unaffected. Cycling improvement was predicted by task difficulty (p<.001). People with Parkinson's disease cycled slower (p<.03) and showed reduced dual task benefits (p<.01) than healthy older adults.

CONCLUSIONS:Unexpectedly, participants' motor performance improved during cognitive dual tasks, which cannot be explained in current models of dual task performance. To account for these findings, we propose a model integrating dual task and acute exercise approaches which posits that cognitive arousal during dual tasks increases resources to facilitate motor and cognitive performance, which is subsequently modulated by motor and cognitive task difficulty. This model can explain both the improvement observed on dual tasks in the current study and more typical dual task findings in other studies.

During trials of aluminium adsorbed diphtheria-tetanus/acellular pertussis vaccines from a single producer, persistent itching nodules at the vaccination site were observed in an unexpectedly high frequency. The afflicted children were followed in a longitudinal observational study, and the presence of aluminium sensitization was investigated in the children with itching nodules and their symptomless siblings by patch tests. Itching nodules were found in 645 children out of about 76,000 vaccinees (0.8%) after both subcutaneous (s.c.) and intramuscular (i.m.) injection. The itching was intense and long-lasting. So far, 75% still have symptoms after a median duration of 4 years. Contact hypersensitivity to aluminium was demonstrated in 77% of the children with itching nodules and in 8% of the symptomless siblings who had received the same vaccines (P<0.001). Children with persistent itching nodules and/or aluminium sensitization should be warned about aluminium containing products (e.g. vaccines and antiperspirants). The reason for the high incidence of itching nodules after SSI vaccines is unknown and should be further investigated.

BRCA1 mutation carriers face a high lifetime risk of developing breast cancer. Physical activity induces broad transcriptional changes and multiple studies have documented its beneficial effects across cancers. Since haploinsufficiency predisposes to breast cancer in these women, factors that increase BRCA1 levels may mitigate the effect of the mutation. Whether physical activity modulates BRCA1 expression, and whether lifestyle factors could benefit women with a mutation remains unclear. The objective of this study was to systematically evaluate whether physical activity or sedentary behavior affect BRCA1 mRNA expression. Activity levels were assessed in 50 female participants (14 BRCA1 mutation carriers and 36 non-carriers) using the GT3X Actigraph accelerometer, and BRCA1 mRNA expression was quantified from peripheral blood lymphocytes using the Nanostring nCounter Analysis System. There was a significant negative correlation between the longest sedentary bout and BRCA1 mRNA expression (ρ = ─ 0.32; P = 0.02). Women below the median for the longest sedentary bout had significantly higher BRCA1 mRNA levels compared to women above the median (161 vs. 132 counts; P = 0.04; one-sided Mann-Whitney U test). There was no significant relationship between mean Metabolic Equivalents of Task (MET) rate or mean sedentary time and BRCA1 mRNA expression (Spearman correlation P ≥ 0.75; P ≥ 0.14; Mann-Whitney U test). These findings suggest that prolonged periods of sedentary behavior are associated with significantly lower BRCA1 mRNA expression. Whether this translates into a potentially more harmful effect in BRCA1 mutation carriers warrants further investigation.

Recent evidence suggested a protective role of dietary monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) intakes against several chronic diseases and, therefore, an increased human longevity. After a median follow-up of 8.5 years, we investigated the possible role of MUFA, PUFA, and other selected food groups in protecting against all-causes mortality in a population-based, prospective study, conducted in one of the eight centers of the Italian Longitudinal Study on Aging (ILSA), Casamassima, Bari, Italy. Out of 704 elderly subjects (65-84 years), 278 nondemented persons agreed to participate at the first survey (1992-1993). During the follow-up, there were 91 deaths. A semi-quantitative food frequency questionnaire evaluating macronutrient daily intakes were performed at the first survey. Higher MUFA intake was associated with an increase of survival (hazard ratio 0.81, 95% CI 0.66-0.99), a higher unsaturated fatty acids (UFA) to SFA ratio (hazard ratio 1.20, 95% CI 0.99-1.45) increased total mortality only marginally, while no effect about other selected food groups were found. In conclusion, in this prospective study on older nondemented subjects with a typical Mediterranean diet, a higher MUFA intake increased survival, while a higher UFA/SFA ratio increased total mortality, but only marginally.

OBJECTIVE:This study presents the outcomes of patients with idiopathic degenerative and posttraumatic atlantoaxial osteoarthritis who were treated with upper cervical manipulation in combination with mobilization device therapy.

CLINICAL FEATURES:A retrospective case review of 10 patients who were diagnosed with either degenerative or posttraumatic atlantoaxial arthritis based on histories, clinical symptoms, physical examination, and radiographic presentations was conducted at a multidisciplinary integrated clinic that used both chiropractic and orthopedic services. All 10 patients selected for this series were treated with a combination of upper cervical manipulation and mechanical mobilization device therapy. Outcome measures were collected at baseline and at the end of the treatment period. Assessments were measured using patients' self-report of pain using a numeric pain scale (NPS), physical examination, and radiologic changes. Average premanipulative NPS was 8.6 (range, 7-10), which was improved to a mean NPS of 2.6 (range, 0-7) at posttreatment follow-up. Mean rotation of C1-C2 at the end of treatment was improved from 28° (±3.1) to 52° (±4.5). Restoration of joint space was observed in 6 patients. Overall clinical improvement was described as "good" or "excellent" in about 80% of patients. Clinical improvements in pain and range of motion were seen in 80% and 90% of patients, respectively.

CONCLUSION:Chiropractic management of atlantoaxial osteoarthritis yielded favorable outcomes for these 10 patients.

Ten healthy subjects who swim regularly in ice-cold water during the winter (winter swimming), were evaluated before and after this short-term whole body exposure. A drastic decrease in plasma uric acid concentration was observed during and following the exposure to the cold stimulus. We hypothesize that the uric acid decrease can be caused by its consumption after formation of oxygen radicals. In addition, the erythrocytic level of oxidized glutathione and the ratio of oxidized glutathione/total glutathione also increased following cold exposure, which supports this hypothesis. Furthermore, the baseline concentration of reduced glutathione was increased and the concentration of oxidized glutathione was decreased in the erythrocytes of winter swimmers as compared to those of nonwinter swimmers. This can be viewed as an adaptation to repeated oxidative stress, and is postulated as mechanism for body hardening. Hardening is the exposure to a natural, e.g., thermal stimulus, resulting in an increased tolerance to stress, e.g., diseases. Exposure to repeated intensive short-term cold stimuli is often applied in hydrotherapy, which is used in physical medicine for hardening.

Few population studies have measured urinary levels of pesticides in individuals with vegan, vegetarian, or organic diets. The objectives of this study were to evaluate whether a vegan/vegetarian diet was associated with increased exposure to organophosphate and carbamate pesticides, and to evaluate the impact of organic consumption on pesticide exposure in vegans and vegetarians. In the current pilot study conducted in 2013-2014, we collected spot urine samples and detailed 24h recall dietary data in 42 adult residents of Amirim, a vegetarian community in Northern Israel. We measured urinary levels of non-specific organophosphate pesticide metabolites (dialkylphosphates, (DAPs)) and specific metabolites of the current-use pesticides chlorpyrifos (3,5,6-trichloro-2-pyridinol (TCPy)), propoxur (-isopropoxyphenol (IPPX)), and carbaryl (1-naphthol). Six DAP metabolites were detected in between 67 and 100% of urine samples, with highest geometric mean concentrations for dimethylphosphate (19.2μg/g). Creatinine-adjusted median concentrations of total DAPs and of TCPy were significantly higher in Amirim residents compared to the general Jewish population in Israel (0.29μmol/g compared to 0.16, p<0.05 for DAPs and 4.32μg/g compared to 2.34μg/g, p<0.05 for TCPy). Within Amirim residents, we observed a positive association between vegetable intake and urinary TCPy levels (rho=0.47, p<0.05) and lower median total dimethyl phosphate levels in individuals reporting that>25% of the produce they consume is organic (0.065μmol/L compared to 0.22, p<0.05). Results from this pilot study indicate relatively high levels of urinary organophosphate pesticide metabolite concentrations in residents of a vegetarian community, a positive association between vegetable intake and urinary levels of a chlorpyrifos specific metabolite, and lower levels of total dimethyl phosphate in individuals reporting higher intake of organic produce. Results suggest that consumption of organic produce may offer some protection from increased exposure to organophosphate pesticide residues in vegetarians.

OBJECTIVES:The purpose of this research was to investigate the effect of Urtica dioica in comparison with placebo, acupuncture and combined therapy on hot flashes and quality of life in postmenopausal women.

METHODS:In a double-blinded randomized controlled trial, patients were treated for 7 weeks then followed up 4 weeks. Seventy-two postmenopausal women who reported at least 20 hot flashes attacks per week were randomly allocated into one of the 4 groups of Urtica dioica 450 mg/day and acupuncture 11 sessions (A), acupuncture and placebo (B), sham acupuncture and Urtica dioica (C), and sham acupuncture and placebo (D). The primary outcomes were the change in hot flashes score from baseline to the end of treatment and follow up; and the change in the quality of life (MENQOL) from baseline to the end of treatment. Secondary outcomes included changes in FSH, LH, and ESTRADIOL levels from baseline to the end of treatment. The trial was conducted from October 2017 to July 2018 in Acupuncture clinic of a teaching hospital in Iran.

RESULTS:A total of 72 women 45-60 years old were enrolled, and 68 were included in the analyses. The median (IQR) hot flashes score decreased in the A group by 20.2 (31.7) and 21.1 (25.1), B group by 19 (18) and 17.3 (27), C group by 14.6 (25.4) and 20.8 (13), and D group by 1.6 (11.6) and 1 (13.3) at the end of treatment and follow up (P < 0.0001, P < 0.0001); no significant difference between A, B and C groups. The mean (SD) of MENQOL score decreased in the A group by 42.6 (21.1), B group by 40.7 (29.8), C group by 37.8 (26.8) and D group by 9.8 (14.3) at the end of treatment (P = 0.001); no significant difference between A, B and C groups.

CONCLUSIONS:Urtica dioica can decrease menopausal hot flashes and increase the quality of life of postmenopausal women better than placebo-sham control but same as acupuncture. The combination of Urtica dioica and acupuncture did not add to the effects of those therapies.

OBJECTIVES:To evaluate the rates, pattern, satisfaction with, and presence of predictors of complementary and alternative medicine (CAM) use in a clinical population of patients with cluster headache (CH).

DESIGN AND SETTING:One hundred CH patients attending one of three headache clinics were asked to undergo a physician-administered structured interview designed to gather information on CAM use.

RESULTS:Past use of CAM therapies was reported by 29% of the patients surveyed, with 10% having used CAM in the previous year. Only 8% of the therapies used were perceived as effective, while a partial effectiveness was reported in 28% of CAM treatments. The most common source of recommendation of CAM was a friend or relative (54%). Approximately 62% of CAM users had not informed their medical doctors of their CAM use. The most common reason for deciding to try a CAM therapy was that it offered a "potential improvement of headache" (44.8%). Univariate analysis showed that CAM users had a higher income, had a higher lifetime number of conventional medical doctor visits, had consulted more headache specialists, had a higher number of CH attacks per year, and had a significantly higher proportion of chronic CH versus episodic CH. A binary logistic regression analysis was performed and two variables remained as significant predictors of CAM use: income level (OR=5.7, CI=1.6-9.1, p=0.01), and number of attacks per year (OR=3.08, CI=1.64-6.7, p<0.0001).

CONCLUSION:Our findings suggest that CH patients, in their need of and quest for care, seek and explore both conventional and CAM approaches, even though only a very small minority finds them very satisfactory.

The aim of the present study was to assess the use of complementary and alternative medicine (CAM) treatments in outpatients with cardiovascular disease and their interest in future use. The increasing popularity of CAM therapies highlights the need to explore their use among patients with cardiovascular disease. Data were collected with a prospective, point-of-care, anonymous, 17-question survey about basic medical information and previous use and interest in the future use of dietary supplements and other CAM interventions among patients undergoing outpatient cardiology evaluation at a Midwestern tertiary care center. The survey was completed by 1,055 patients (655 men, 351 women; mean age 63.5 years) of whom 98.1% were white. Of these, 36.8% had cardiac symptoms for>10 years, 48.2% had coronary artery disease, and 82.5% reported use of CAM therapies. Of these patients, 75.4% reported using dietary supplements, 31.5% chiropractic therapy, 23.9% mind-body therapies, and 19.2% massage. Only 14.4% had discussed the use of CAM treatments with their physicians. The top 4 treatments used for cardiac symptoms were relaxation techniques, stress management, meditation, and guided imagery. Also, 48.6% were interested in participating in a future clinical trial of an alternative treatment. The great majority of patients seen in current practice use CAM therapies, and a large proportion expressed an interest in participating in research with CAM therapies. In conclusion, research directed with an integrative approach to cardiovascular care might prove beneficial when designing future studies.

PURPOSE:GLUT-1 deficiency syndrome (GLUT1DS) is a neurologic disorder manifesting as epilepsy, abnormal movements, and cognitive delay. The currently accepted treatment of choice is the classic 4:1 ratio ketogenic diet.

METHODS:A 2-page survey was distributed to all attendees of a family-centered conference for GLUT1DS in July 2015. The surveys were completed by parents, collected anonymously, and information analyzed in a database.

RESULTS:Surveys were received from 92 families, of which 90 (98%) had been treated with dietary therapies. Diets used were extremely varied: 59 were treated with the classic ketogenic diet (KD), 29 with the Modified Atkins Diet (MAD), 4 with the Medium-chain Triglyceride (MCT) Diet and 2 with the low glycemic index treatment. The mean diet duration was 5.5 years (range: 1 month-20 years). Of those with seizures, 95% of the children had>50% seizure reduction and 80% had>90% seizure reduction. Children who were seizure-free were currently younger on average (8.2 vs. 11.6 years, p=0.01) and slightly younger at GLUT1DS diagnosis (3.8 vs. 5.3 years, p=0.05). There was an equal percentage of children seizure-free receiving the KD/MCT Diets compared to the MAD/Low Glycemic Index Treatment (74% vs. 63%, p=0.30). The majority (64%) were not receiving anticonvulsants.

CONCLUSION:This represents the largest series of KD experience in children with GLUT1DS. Nearly all patients surveyed were on dietary therapies for long durations with reported excellent seizure control, often without anticonvulsant drugs. Several different ketogenic diets were utilized with similar efficacy. Early diagnosis and treatment were correlated with success.

In 2001 it was discovered that exposing the eyes to light in the blue end of the visible spectrum suppresses the production of the sleep hormone, melatonin. New mothers need to get up during the night to care for their babies. This is the time when melatonin is normally flowing. Exposing their eyes to light can cut off the flow. It may also reset their circadian (internal) clock. On subsequent nights the melatonin may not begin flowing at the normal time making it difficult to fall asleep. Over time, disruption of the circadian rhythm plus sleep deprivation may result in depression. Women suffering postpartum depression were enrolled in a small clinical trial. Some were provided with glasses and light bulbs that block blue light. Others were equipped with glasses and light bulbs that looked colored but did not block the rays causing melatonin suppression. Those with the"real glasses"recovered somewhat more quickly than those with the placebo glasses and light bulbs. The hypothesis that should be tested in large scale clinical trials is that the risk of postpartum depression can be reduced when a new mother avoids exposing her eyes to blue light when she gets up at night to care for her baby. In the meantime, all new mothers may benefit from using glasses and light bulbs that block blue light when getting up at night to care for their babies.

CONTEXT: Qigong is a traditional Chinese health practice believed to have special healing and recovery power. Little scientific documentation was found on qigong and its effectiveness, and no literature was found on qigong as a treatment of substance addiction.

OBJECTIVE: To explore the effectiveness of qigong therapy on detoxification of heroin addicts compared to medical and nonmedical treatment.

DESIGN: Participants were randomly assigned to 1 of 3 groups: qigong treatment group (n = 34), medication group (n = 26), and no-treatment control group (n = 26).

PARTICIPANTS: Eighty-six male heroin addicts, aged 18 to 52 years, who met the substance-dependence criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised, with a history of heroin use from .5 to 11 years. All were residents at a mandatory drug-treatment center in the People's Republic of China.

INTERVENTION: The qigong group practiced Pan Gu qigong and received qi adjustments from a qigong master daily. The medication group received the detoxification drug lofexidine-HCl by a 10-day gradual reduction method. The control group received only basic care and medications to treat severe withdrawal symptoms.

MEASURES: Urine morphine test, electrocardiogram, Hamilton Anxiety Scale, and a withdrawal-symptom evaluation scale were applied before and during the 10-day intervention.

RESULTS: Reduction of withdrawal symptoms in the qigong group occurred more rapidly than in the other groups. From day 1, the qigong group had significantly lower mean symptom scores than did the other groups (P<.01). Both the qigong and medication groups had much lower anxiety scores than did the control group (P<.01), and the qigong group had significantly lower anxiety scores than did the medication group (P<.01). All subjects had a positive response to the urine morphine test before treatment. Fifty percent of the qigong group had negative urine tests on day 3, compared to 23% in the control group and 8% in the medication group (P<.01). By day 5 of treatment, all subjects in the qigong group had negative urine tests, compared to day 9 for the medication group and day 11 for the control group.

CONCLUSIONS: Results suggest that qigong may be an effective alternative for heroin detoxification without side effects, though we cannot completely eliminate the possibility of the placebo effect from the current study.

PROBLEM: Therapeutic holding is a commonly used tool for the containment of aggressive behavior in children. Although often effective, the intervention has inherent physical and emotional safety risks. Can a body-based therapy be used to limit these risks?

METHODS: Research was conducted incorporating dance/movement therapy techniques (D/MT) before and after therapeutic holding to investigate this question. Volunteer residential treatment center staff participated in a 4-hour D/MT-based training workshop integrating the techniques with the intervention. Children participated via self-report.

FINDINGS: D/MT training increased adult awareness, sensitivity, perspective shifting ability, and confidence in the intervention while decreasing the necessity for physicality.

CONCLUSION: Integrating D/MT therapy training with therapeutic holding decreased the threat of trauma to adult participants. Further research into the integration of D/MT techniques with safe holding procedures may prove helpful in the challenge of making restraints safer for both children and adults.

Patients who presented with purpura and blood platelets<30x10(9)/l within 1 month after vaccination were collected from a population based material of 506 consecutive pediatric patients with newly diagnosed ITP. Of the 35 such patients, 24 had thrombocytopenia after MMR vaccination giving an estimated ITP risk of approximately 1 in 30,000 MMR inoculations. Symptoms of the 35 patients were nearly always acute. Thrombocytopenia disappeared within a month in 74% of the study patients and lasted longer than 6 months in only 10%. Bleeding episodes were uncommon during the follow-up period. We conclude that the incidence of symptomatic thrombocytopenia after vaccinations is much lower than that after respective natural infections and that the outcome in most cases is excellent.

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Varicella-zoster virus vaccine has diminished the consequences of chicken pox in terms of health and economical burden. The increasing number of doses administered worldwide has revealed rare but important adverse effects that had not occurred during clinical trials. We report here the case of an immunocompetent 3(1/2)-year-old girl who developed encephalitis and herpes zoster opthalmicus 20 months after her immunization with varicella-zoster virus vaccine. Molecular analysis confirmed the vaccine strain as the causative agent. After an intravenous course with acyclovir, the child made a full recovery with no neurologic sequelae.

IMPORTANCE:Because vaccinations are common, even a small increased risk of multiple sclerosis (MS) or other acquired central nervous system demyelinating syndromes (CNS ADS) could have a significant effect on public health.

OBJECTIVE:To determine whether vaccines, particularly those for hepatitis B (HepB) and human papillomavirus (HPV), increase the risk of MS or other CNS ADS.

DESIGN, SETTING, AND PARTICIPANTS:A nested case-control study was conducted using data obtained from the complete electronic health records of Kaiser Permanente Southern California (KPSC) members. Cases were identified through the KPSC CNS ADS cohort between 2008 and 2011, which included extensive review of medical records by an MS specialist. Five controls per case were matched on age, sex, and zip code.

EXPOSURES:Vaccination of any type (particularly HepB and HPV) identified through the electronic vaccination records system.

MAIN OUTCOMES AND MEASURES:All forms of CNS ADS were analyzed using conditional logistic regression adjusted for race/ethnicity, health care utilization, comorbid diseases, and infectious illnesses before symptom onset.

RESULTS:We identified 780 incident cases of CNS ADS and 3885 controls; 92 cases and 459 controls were females aged 9 to 26 years, which is the indicated age range for HPV vaccination. There were no associations between HepB vaccination (odds ratio [OR], 1.12; 95% CI, 0.72-1.73), HPV vaccination (OR, 1.05; 95% CI, 0.62-1.78), or any vaccination (OR, 1.03; 95% CI, 0.86-1.22) and the risk of CNS ADS up to 3 years later. Vaccination of any type was associated with an increased risk of CNS ADS onset within the first 30 days after vaccination only in younger (<50 years) individuals (OR, 2.32; 95% CI, 1.18-4.57).

CONCLUSIONS AND RELEVANCE:We found no longer-term association of vaccines with MS or any other CNS ADS, which argues against a causal association. The short-term increase in risk suggests that vaccines may accelerate the transition from subclinical to overt autoimmunity in patients with existing disease. Our findings support clinical anecdotes of CNS ADS symptom onset shortly after vaccination but do not suggest a need for a change in vaccine policy.

With continuing occurrence of varicella despite increasing vaccine coverage for the past 20 years, a case-based study, a case-control study, and an immunogenicity and safety study were conducted to address the impact of varicella vaccination in South Korea. Varicella patients under the age of 16 years were enrolled for the case-based study. For the case-control study, varicella patients between 12 months and 15 years of age were enrolled with one control matched for each patient. For the immunogenicity and safety study, otherwise healthy children from 12 to 24 months old were immunized with Suduvax (Green Cross, South Korea). Fluorescent antibody to membrane antigen (FAMA) varicella-zoster virus (VZV) antibody was measured before and 6 weeks after immunization. In the case-based study, the median age of the patients was 4 years. Among 152 patients between 1 and 15 years of age, 139 children received varicella vaccine and all had breakthrough infections. Clinical courses were not ameliorated in vaccinated patients, but more vaccinated patients received outpatient rather than inpatient care. In the case-control study, the adjusted overall effectiveness of varicella vaccination was 54%. In the immunogenicity and safety study, the seroconversion rate and geometric mean titer for FAMA antibody were 76.67% and 5.31. Even with increasing varicella vaccine uptake, we illustrate no upward age shift in the peak incidence, a high proportion of breakthrough disease, almost no amelioration in disease presentation by vaccination, and insufficient immunogenicity of domestic varicella vaccine. There is need to improve the varicella vaccine used in South Korea.