Accelerometer-measured physical activity and its impact on sleep quality in patients suffering from restless legs syndrome.

BACKGROUND: The primary symptoms of restless legs syndrome (RLS) are sleep onset insomnia and difficulty to maintain sleep. Previous studies have shown that regular physical activity can reduce the risk of developing RLS. However, the relationship between physical activity and sleep quality parameters in individuals suffering from RLS has not yet been investigated by applying accelerometry. Thus, the present study investigates the impact of physical activity (measuring both intensity levels and duration of physical activity) during the day (7-12 h, 12-18 h, 18-23 h) on sleep quality in patients suffering from idiopathic RLS by applying a real-time approach. METHODS: In a sample of 47 participants suffering from idiopathic RLS, physical activity and sleep quality were measured over one week using accelerometers. For data analysis, physical activity levels and step counts during three periods of the day (morning, afternoon, evening) were correlated with sleep quality parameters of the subsequent night. RESULTS: This observational study revealed that in most instances physical activity was not correlated with sleep parameters (two exceptions exist: steps taken in the morning were negatively correlated with periodic leg movements during sleep, and physical activity in the evening was negatively correlated with total sleep time). The physical activity levels of the participants in this study, however, were unexpectedly high compared to population-level data and variance in physical activity was low. The average activity was 13,817 (SD = 4086) steps and 347 (SD = 117) minutes of moderate physical activity per day in females, and 10,636 (SD = 3748) steps and 269 (SD = 69) minutes of moderate physical activity in males, respectively. Participants did not engage in any vigorous physical activity. CONCLUSIONS: Further interventional studies are needed to investigate the daily effects of different intensities of physical activity on RLS symptoms.

Measuring capabilities in health and physical activity promotion: a systematic review.

BACKGROUND: The capability approach by Amartya Sen and Martha Nussbaum has gained increasing attention in the field of public health. As it combines individual, social and structural factors and shifts the focus of attention from the actual behavior towards available options for health behaviors that people can actually choose from, it may help advance our understanding of complex health issues. OBJECTIVES: The aim of this article is to identify and describe tools available to measure capabilities within the context of health, with a specific focus on capabilities for health-enhancing physical activity. METHOD: We conducted a systematic literature review using 11 databases covering scientific journal articles published in English or German between the years 2000 and 2020 with a focus on capabilities for health or physical activity. RESULTS: We found a total of 51 articles meeting our inclusion criteria. Four articles measured capabilities using qualitative methods, one combined qualitative and quantitative methods, while the rest used quantitative methods. We identified a total 11 different capability questionnaires, all showing moderate to good validity/reliability. Only one questionnaire and one interview-based tool specifically dealt with capabilities for health enhancing physical activity. CONCLUSION: Although we were able to identify measurement tools for capabilities in health, this review has shown that there is no generic tool available for the measurement across all population- and age-groups, and tools focusing on physical activity are scarce. However, our results can be used as guide for future projects that aim at measuring capabilities.

[Physician Counseling about Physical and Sports Activity in Neurological Practices in Germany: Results of a Survey Among Members of the German Neurological Society]. / Beratung zu körperlicher und sportlicher Aktivität in neurologischen Praxen in Deutschland. Ergebnisse einer Umfrage unter den Mitgliedern der Deutschen Gesellschaft für Neurologie e.V.

Physical inactivity is a major but modifiable risk factor for morbidity and mortality. Regular physical activity has preventive and therapeutic effects on numerous diseases including neurological disorders. Therefore, it is desirable that physicians motivate their patients to increase their physical and sports activities and that they help them to overcome barriers to exercising. The present study is a survey of neurologists who are members of the German Neurological Society with their own practices; they were asked whether they advised their patients on the benefits of physical activity. Details on physician counseling on physical activity were obtained, such as the frequency of counseling, the neurological disorders considered by the practitioners to be worth the effort of counseling, and the barriers to exercise on the part of patients. More than 80 % of the participants who responded to the survey stated that they frequently provide their patients with advice on the preventive and therapeutic aspects of physical activity. Almost all of them recommended endurance sports; this was followed by Far Eastern types of sport such as tai chi or yoga (70 % of all physicians who advice sports activities). The frequency of counseling about physical activity significantly correlated to the physician's own sports activity. Frequency of counseling was reduced if the physician assessed the patients to be incapable of adopting and maintaining a lifestyle of habitual physical activity. Lack of time as well as an insufficient reimbursement of the counseling, however, did not significantly influence the frequency of counseling. The physician's own sports activity matched that of individuals with similar social status. Thus, a selection bias does not seem to be of importance regarding the results of the survey. However, since only 169 of the 784 invited neurologists (21.6 %) responded to the questionnaire, the representativeness of the survey may be limited. Counseling about physical activity seems to be an essential part of consultations in neurological practices.

Does physical activity increase life expectancy? A review of the literature.

Physical activity reduces many major mortality risk factors including arterial hypertension, diabetes mellitus type 2, dyslipidemia, coronary heart disease, stroke, and cancer. All-cause mortality is decreased by about 30% to 35% in physically active as compared to inactive subjects. The purpose of this paper was to synthesize the literature on life expectancy in relation to physical activity. A systematic PubMed search on life expectancy in physically active and inactive individuals was performed. In addition, articles comparing life expectancy of athletes compared to that of nonathletes were reviewed. Results of 13 studies describing eight different cohorts suggest that regular physical activity is associated with an increase of life expectancy by 0.4 to 6.9 years. Eleven studies included confounding risk factors for mortality and revealed an increase in life expectancy by 0.4 to 4.2 years with regular physical activity. Eleven case control studies on life expectancy in former athletes revealed consistently greater life expectancy in aerobic endurance athletes but inconsistent results for other athletes. None of these studies considered confounding risk factors for mortality. In conclusion, while regular physical activity increases life expectancy, it remains unclear if high-intensity sports activities further increase life expectancy.

Inequality in quality? Regional and educational differences in treatment with fluoroquinolone in urinary tract infection of 236,376 Swedish patients.

BACKGROUND: In an international effort to reduce antibiotic resistance, in part suggested to be the effect of inappropriate antibiotic use, several quality indicators for outpatient antibiotic use have been proposed. In this study, geographical and educational differences in fluoroquinolone prescription in the treatment of urinary tract infection in women are presented. METHODS: The age-adjusted ratio of women who were dispensed fluoroquinolones (ciprofloxacin or norfloxacin) among all 236,376 women dispensed any of the following antibiotics used in the treatment of lower urinary tract infection were studied: ciprofloxacin, norfloxacin, pivmecillinam, trimethoprim and nitrofurantoin. Only the first prescription during July 2006 to June 2007 was studied. Prescription data were linked to information on geographical area, marital status, country of birth and educational attainment, which allowed multivariate analysis of the importance of these factors. RESULTS: The rate of fluoroquinolone prescription varied from 29.5% to 17.1% in the 21 regions in Sweden. Middle-aged women with ≥15 years of schooling were more often prescribed fluoroquinolones compared to those with only 9 years (OR 1.28, 95% CI 1.23 to 1.34). CONCLUSION: Quality indicators in healthcare should be developed bearing in mind the overall level of adherence to guidelines and whether there are regional or socioeconomic or other differentials in their distribution in the population because such differentials in healthcare quality might further contribute to inequalities in health.

Area characteristics and determinants of hospitalised childhood burn injury: a study in the city of Cape Town.

OBJECTIVES: To investigate the impact of local living circumstances on the level of childhood burn injuries. STUDY DESIGN/METHOD: This study was an ecological investigation encompassing the 634 residential areas of the city of Cape Town (about 668,900 children aged 12 years and younger). Fifteen socio-physical features of these areas that describe the population, household, dwelling types and services were considered using data from the 2001 census. Data of childhood burn injuries were gathered from the Red Cross Children's Hospital's register over 1999-2000 (n=923). Area features were synthesized into three main dimensions using factor analysis (principal axis method). Each dimension was split into three (exposure) levels, and the effect of each dimension on childhood burn injury was measured, compiling odds ratios with 95% confidence intervals and using the most favourable exposure level as the reference category within each dimension. RESULTS: The main dimensions of contextual exposure were defined as housing conditions (five variables), child dependency (three variables) and socio-economic barriers (three variables). Each aspect had a significant impact on the risk of burn injury, with increased levels of exposure leading to increased risk of burns. For housing conditions (Factor 1) and socio-economic barriers (Factor 3), a graded relationship was observed with noteably increased odds for increased levels of exposure. CONCLUSIONS: The occurrence of child burn injury is highly influenced by various features of the local environment. These features may be essential targets for sustainable childhood burn injury control and prevention programmes.

The neighbourhood socio-demographic context of teenage girls' deliberate self-harm.

This study investigates whether living area characteristics relate to the commission of self-inflicted injuries and to psychiatric consultation among teenage girls. An ecological study was conducted at the parish level. Seven descriptors of the population's sociodemographic composition were selected and psychiatric health care seeking and hospitalization for deliberate self-harm (DSH) among girls aged 12-19 years were considered (years 1999-2003). For each parish characteristic, three levels of concentration were determined and health outcomes were compared between levels using rate ratios (RR). Acute psychiatric consultation was strongly associated with all parish characteristics, particularly with the concentration of female-headed households. For hospitalization for DSH, RR were significantly higher in parishes with higher concentrations of female-headed poor families, social welfare recipients and low-income people. Teenage girls' acute psychiatric consultations more than their rate of DSH injuries are affected by parish compositional characteristics. The contextual, family-related and individual mechanisms lying behind this deserve further investigation. This may have implications for prevention strategies and for the allocation of care.

Hip fractures among older people: do marital status and type of residence matter?

This study analysed the extent to which civil status and type of residence affect the risk of elderly people sustaining a hip fracture. The study population consisted of all residents, aged 65 years or older, living in Stockholm County in Sweden between the years 1993 and 1995 (about 250,000 in total). Cases of hip fractures in the County's outpatient register (1993-1995) were linked to national registers, enabling injured people to be attributed a marital status (during year of injury), and also a size of dwelling and form of residential entitlement (in 1990). Gender-specific injury rates for three age groups were computed, as were age-standardized odds ratios (ORs) by gender for each variable of interest. As expected, hip fractures were found to rise with age among both men and women, and the risk of women sustaining such injuries was higher than that of men for all age groups. The proportion of injured men and women was higher among the unmarried than the married, and the majority of the injured were in rented accommodation (in all three age groups). The age-standardized ORs showed that the risk of hip fracture was substantially affected by civil (marital) status, but form of residential entitlement and size of dwelling did not affect the risk to any remarkable extent. The study demonstrates that being unmarried increases the risk of hip fracture among older men and women. This suggests that elderly unpartnered people may have a different daily-life pattern and may be in poorer health, both of which may be associated with a diminished social network.

Reactive macrophage activation syndrome: a simple screening strategy and its potential in early treatment initiation.

QUESTIONS UNDER STUDY: starting treatment of reactive macrophage activation syndromes as early as possible (rMAS, haemophagocytic lymphohistiocytosis), e.g., with intravenous immunoglobulins (IVIG), seems to be essential for optimal outcome. However, there is no diagnostic gold standard which reliably indicates need for early treatment. We used a simple screening strategy consisting of serum ferritin measurements and/or morphological assessment of haemophagocytosis and compared the studied patient population with published series. METHODS: Retrospective analysis of clinical and laboratory data of 57 patients experiencing 60 episodes of rMAS. RESULTS: Screening by serum ferritin measurements and/or morphological assessment of haemophagocytosis of patients presenting with a systemic inflammatory response syndrome (SIRS) indicates that rMAS might be considerably more frequent than stated in the literature. Serum ferritin exceeded >10,000 microg/L in 91% rMAS episodes. Although the patient population studied was otherwise similar in most aspects to the published rMAS series, the fact that 40% of patients fulfilled the criteria for Still's disease (SD) as the disorder underlying rMAS is remarkable and questions the distinct nature of the two diseases. IVIG responders and non-responders did not differ regarding their initial characteristics with exception to the timepoint of IVIG administration, confirming the importance of early treatment initiation. Malignancy-associated rMAS however, has a poor prognosis and seems to be refractory to manipulation with IVIG in most instances, even when responding initially. CONCLUSIONS: rMAS has to be considered in patients with a SIRS- or SD-like clinical presentation. Hyperferritinaemia >or=10,000 microg/l seems to be a good marker for defining patients with or at risk for developing rMAS and should be completed with a morphological assessment of haemophagocytosis. The perception of acute SD and rMAS as two distinct entities has to be questioned at least in a subgroup of patients.

Zafirlukast has no beneficial effects in the treatment of chronic urticaria.

BACKGROUND: Leukotriene receptor antagonists have shown some efficacy in t he treatment of asthma. Injection of LTC4, LTD4 and LTE4 into the skin leads to a weal-and-flare reaction, suggesting an involvement of leukotrienes in the pathogenesis of urticaria. Indeed, various reports have indicated a beneficial effect for leukotriene receptor antagonists in patients with chronic urticaria. OBJECTIVE: To determine the therapeutic effect of the leukotriene receptor antagonist zafirlukast in patients with chronic urticaria. METHODS: The study was a double-blind, placebo-controlled, cross-over study lasting for 12 weeks. Fifty-two patients with chronic urticaria were investigated at a university hospital. The patients were randomized to receive 20 mg zafirlukast b.i.d. or placebo and cross-over was scheduled after 6 weeks. The efficacy of the treatment was evaluated by a daily symptom score, six physical examinations, the requirement of rescue antihistamines (acrivastine) and an overall assessment by the patient andthe investigating physician. RESULTS: Forty-six patients completed the study: zafirlukast was well tolerated without alteration of the investigated laboratory parameters. In comparison with placebo, treatment with zafirlukast resulted in no significant positive effect for any of the efficacy measures. Moreover, we were unable to identify any subgroup of patients with chronic urticaria responding with a therapeutic benefit. CONCLUSIONS: The leukotriene receptor antagonist zafirlukast does not provide a significant therapeutic benefit at a dose of 20 mg b.i.d. in patients with chronic urticaria.

Hyperferritinemia as indicator for intravenous immunoglobulin treatment in reactive macrophage activation syndromes.

The underlying mechanisms of reactive macrophage activation syndromes (rMAS) are not understood in detail, and there is no specific treatment. This observational study was prompted by intravenous immunoglobulin (IVIG), dramatically halting two distinct rMAS episodes in the same patient. We evaluated the potential benefits of IVIG administration in treating fulminant rMAS and the usefulness of monitoring serum ferritin levels as an indication for emergency treatment with IVIG. Ten females and 10 males experiencing 22 episodes of rMAS were recruited on the basis of serum ferritin levels >or=10,000 microg/l and/or direct evidence of haemophagocytosis in 11 intensive care units in secondary and tertiary care hospitals in Switzerland between October 1993 and May 2000. In individual patients, serially measured ferritin was closely related to disease activity. Abrupt increases of up to >100,000 microg/l could be observed within hours. Rapid and profound beneficial effects of emergency IVIG treatment were seen in 12 episodes of rMAS accompanied by a prompt decrease of serum ferritin. IVIG produced partial or delayed improvements in 5 patients. No apparent effects were seen in 5 patients. IVIG was only successful if started early during the ferritin run-up to peak values. In conclusion, IVIG is effective in at least a subgroup of adult rMAS when started at the beginning of the macrophage activation process. The monitoring of serum ferritin levels might be helpful in detecting macrophage activation in order to commence IVIG treatment early enough.

[Treatment of anaphylactic shock]. / Behandlung des anaphylaktischen Schocks.

Anaphylaxis is a life-threatening allergological emergency: it has to be recognized and treated immediately by the physician. Most often anaphylaxis is caused by drugs, foods and insect stings. Emergency treatment consists in intramuscular application of adrenaline and volume substitution. Only afterwards antihistamines and corticosteroids should be administered. All patients have to be hospitalized immediately and treated on an intensive care unit. After anaphylaxis the following preventive measures are most important: consultation with an allergist, including instruction for allergen avoidance and emergency medications. In anaphylaxis induced by insect stings specific immunotherapy should be started.

Reduction of side-effects from ultrarush immunotherapy with honeybee venom by pretreatment with fexofenadine: a double-blind, placebo-controlled trial.

BACKGROUND: Immunotherapy with Hymenoptera venoms is highly effective but causes allergic side-effects frequently, especially when honeybee venom is used. Therefore, our objective was to investigate the effect of pretreatment with the antihistamine fexofenadine on the incidence of allergic side-effects during ultrarush immunotherapy with bee venom. METHODS: In a double-blind, placebo-controlled trial, 57 patients with a history of systemic allergic reactions to honeybee stings and positive diagnostic tests (skin tests, serum specific IgE to honeybee venom) were investigated. Bee venom immunotherapy was started with an ultrarush protocol and patients were randomized to pretreatment with either fexofenadine 180 mg or placebo on days 1, 8, 22, and 50 of the protocol. Local and systemic allergic side-effects were registered. RESULTS: Fifty-four patients completed the study, 28 on fexofenadine and 26 on placebo pretreatment. On day 1, large local reactions were significantly reduced in both extension and duration by fexofenadine pretreatment (P<0.025). Systemic allergic side-effects on the whole were not reduced. However, the symptoms pruritus, urticaria, and angioedema occurred less frequently with fexofenadine (P<0.05). CONCLUSIONS: Pretreatment with fexofenadine during venom immunotherapy reduces local allergic reactions and generalized symptoms of the urticaria and angioedema type.

Elevation of soluble Fas and soluble Fas ligand in reactive macrophage activation syndromes.

Derailed T-cell activation can give rise to life-threatening macrophage activation, the final common pathway of the different forms of reactive macrophage activation syndromes (rMAS). Besides inappropriate activation of the immune system, impaired termination of immune responses might be another mechanism leading to rMAS. The Fas (CD95)/Fas ligand (CD95 ligand) system functions in turning off immune responses by executing activation-induced cell death (AICD). Soluble Fas (sFas) and Fas ligand (sFasL) can interfere with their corresponding membrane-bound counterparts, qualifying them as potential parameters of impaired immune termination. Hence, sFas and sFasL were analyzed in sera of rMAS patients. We show that soluble Fas/CD95 (sFas) is elevated >2 SD over the mean of controls in all 8 rMAS episodes studied (mean 12.08 +/- 6.12 ng/mL, range 3.7-20.2; controls 2.46 +/- 0.49, range 1.5-2.9). sFasL was detected during five rMAS episodes (0.70 +/- 0.49 ng/mL, range 0.16-1.28; controls all below the limit of detection of 0.1). In addition, both parameters decrease during convalescence, reflecting clinical evolution. In conclusion, sFas seems to be consistently elevated during acute rMAS. sFasL is detected only in a subgroup of our adult rMAS patients extending the recent finding of sFasL elevation in a majority of children with macrophage activation syndromes (Hasegawa et al. Blood 1998;91(8):2793-2799). By interfering with AICD, sFas and sFasL might contribute to the pathogenesis of at least a subset of rMAS.

Are anaphylactic reactions to snake bites immunoglobulin E-mediated?

BACKGROUND: Bites by poisonous European snakes of the genus Vipera lead to local tissue damage and systemic symptoms such as generalized oedema, hypotension, gastrointestinal symptoms, haemolysis and renal dysfunction. Not rarely anaphylactic symptoms like urticaria, localized angioedema and asthma are observed. OBJECTIVE: To look for snake venom-specific immunoglobulin (Ig) E antibodies in patients with a history of bites by European vipers and for cross-reactions with Hymenoptera venoms, that have a similar composition. METHOD: Ten patients with a history of bites by Vipera aspis or Vipera berus were investigated. Three patients had been bitten only once, and two of these had developed only local reactions. Four reported previous allergic reactions to Hymenoptera stings. All patients, 10 Hymenoptera venom-allergic and five nonallergic individuals who served as controls underwent i.c. skin test endpoint titration with snake (V. aspis, V. berus) and Hymenoptera venoms (honey bee, Vespula spp.) and were investigated for specific serum IgE antibodies to the same venoms. RESULTS: Seven of the eight patients with systemic snake bite reactions had both positive skin tests and serum IgE antibodies to snake venoms, while these tests were negative in the two patients with only local reactions to snake bites and all controls. Seven of the eight patients with systemic snake bite reaction also had positive skin tests and specific IgE with one or both Hymenoptera venoms. By RAST-inhibition with sera of four patients with high IgE to both Vipera and Hymenoptera venoms, partial cross-reactivity could be demonstrated in one. CONCLUSIONS: Anaphylactic reactions following snake bites may be IgE-mediated, especially in patients with repeated bites.

Drug-induced linear IgA bullous dermatosis associated with ceftriaxone- and metronidazole-specific T cells.

BACKGROUND: Previous reports indicate that various drugs may induce linear IgA bullous dermatosis (LABD). The role of T cells and T-cell-derived cytokines in the pathomechanism of such skin lesions, however, has remained unclear. OBJECTIVE: To describe a case of LABD induced by ceftriaxone and metronidazole in an 80-year-old female suffering from cholelithiasis with concomitant cholecystitis and provide evidence that drug-specific T cells and their cytokines may contribute to the development of LABD lesions. METHODS: We performed flow cytometry analysis of peripheral blood T cells during LABD, epicutaneous testing (scratch-patch) and lymphocyte proliferation analysis (LTT) with the suspected drugs, routine histological and immunohistochemical examination of the acute skin lesions during LABD as well as of the positive epicutaneous test reactions and measurement of cytokines (IL-4, IL-5, IL-10, TNF-alpha, IFN-gamma) in the supernatant of the LTT cultures. RESULTS: An increased number mainly of activated CD8+ cells was detected in the peripheral blood during LABD. T cell sensitization to ceftriaxone and metronidazole was confirmed by epicutaneous testing and LTT, indicating that these methods may be useful in identifying the causative drugs. Enhanced cytokine levels, particularly of IL-5, were found in the supernatant of the LTT stimulated with ceftriaxone and metronidazole. Furthermore, in situ expression of IL-5 was confirmed in the patient's skin lesions by immunohistochemistry. CONCLUSION: Our findings suggest that in addition to IgA antibodies drug-specific T cells and their subsequent release of cytokines may play an important role in the pathogenesis of drug-induced LABD.

[A 17-year-old female patient with recurring fever, chills, exanthema, myalgia and polyserositis]. / 17jährige Patientin mit Fieberschüben, Schttelfrost, Exanthem, Myalgien und Polyserositis.

The 17-year-old was admitted for investigation of a fever persisting for three weeks in spite of antibiotic treatment. Based on the clinical picture presenting with fugitive exanthema during febrile episodes, myalgia, polyserositis, leucocytosis with toxic granulations and-- after an antibiotic window--negative cultures of all investigated fluids (blood, pleural and peritoneal fluid), adult-type Still's disease was diagnosed. Treatment with steroids and indomethacine was only temporarily successful. Therapeutic stabilization first occurred under administration of phenylbutazone. The course was complicated by three surgical abdominal interventions because of an unclear acute abdomen, a strangulation ileus and a small-bowel perforation.

Changes in renal microcirculation induced by infusion of (Fe3+)-and (Fe2+)-myoglobin during hemorrhagic hypotension in the anesthetized rat: influence of L-NAME and 8-Br-cyclic GMP.

The effects of myoglobin on renal microcirculation were studied in anesthetized rats subjected to hemorrhagic hypotension. Capillary flow distribution was determined by allowing two dyes to circulate for 3 and 1 min, respectively, freezing the left kidney and quantifying the dye distribution in histological sections by analyzing the distances of regularly spaced test points to the next dye-labeled capillary. Control experiments showed 88% of distances to be < 12 microns in the cortex [medullary outer stripe (OS): 77%, inner stripe (IS): 93%] and no distance to be > 60 microns. Myoglobin induced disturbances in intrarenal perfusion with a significantly higher potency of (Fe2+)- as compared to (Fe3+)-myoglobin. With the reduced species, the fraction of distances > 60 microns increased to 54% in the cortex (OS: 69%; IS: 67%). L-NAME, an inhibitor of nitric oxide synthesis, induced similar defects of perfusion. The cGMP analogue 8-Br-cGMP was able to nearly completely prevent these effects. The results support the view that myoglobin when released during hemorrhagic hypotension impairs renal microcirculation supposedly by scavenging the endogenous relaxing factor nitric oxide.