Screening and Treatment of Posttraumatic Stress Disorder in Wildfire Evacuees: A Cost-Utility Analysis.

Background. Global climate change is resulting in dramatic increases in wildfires. Individuals exposed to wildfires experience a high burden of posttraumatic stress disorder (PTSD), and the cost-effectiveness of the treatment options to address PTSD from wildfires has not been studied. The objective of this study was to conduct a cost-utility analysis comparing screening followed by treatment with paroxetine or trauma-focused cognitive behavioral therapy (TF-CBT) versus no screening in Canadian adult wildfire evacuees. Methods. Using a Markov model, quality-adjusted life-years (QALYs) and costs were evaluated over a 5-y time horizon using health care and societal perspectives. All costs and utilities in the model were discounted at 1.5%. Probabilistic and deterministic sensitivity analyses examined the uncertainty in the incremental net monetary benefit (INMB) under a willingness-to-pay threshold of $50,000. Results. From a societal perspective, no screening (NMB = $177,641) was dominated by screening followed by treatment with paroxetine (NMB = $180,733) and TF-CBT (NMB = $181,787), with TF-CBT having the highest likelihood of being cost-effective at a willingness-to-pay threshold of $50,000 per QALY (probability = 0.649). The initial prevalence of PTSD, probability of acceptance of treatment, and costs of productivity had the largest impact on the INMB of both paroxetine or TF-CBT versus no screening. Neither intervention was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective. Interpretation. Screening followed by treatment with paroxetine or TF-CBT compared with no screening was found to be cost-saving while providing additional QALYs in wildfire evacuees. Governments should consider funding screening programs for PTSD followed by treatment with TF-CBT for wildfire evacuees. Highlights: Two prior studies examined the cost-effectiveness of screening followed by treatment for PTSD among individuals exposed to other disaster-type events (i.e., terrorist attack and Hurricane Sandy) and found screening followed by treatment (i.e., cognitive behavioral therapy [CBT]) to be highly cost-effective.Among wildfire evacuees, screening followed by treatment with paroxetine or trauma-focused (TF)-CBT provides additional quality-adjusted life-years (QALYs) and is cost-saving from a societal perspective. TF-CBT was the treatment option found most likely to be cost-effective.Neither treatment option was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective.Screening programs for PTSD should be considered for wildfire evacuees, and individuals diagnosed with PTSD could be prescribed either TF-CBT or paroxetine depending on their preference and resources availability.

Loss of Neural Automaticity Contributes to Slower Walking in COPD Patients.

The physical impairments (e.g., slower walking speed) in patients with chronic obstructive pulmonary disease (COPD) have been attributed to peripheral characteristics (e.g., muscle atrophy). However, cognitive impairment may compromise motor control including walking automaticity. The objective of this study was to investigate PFC neural activity, evaluated using changes in oxygenated hemoglobin (ΔO2Hb), during preferred paced walking (PPW) in COPD patients and age-matched controls. The ΔO2Hb from the left and right dorsolateral PFC was measured using functional near-infrared spectroscopy. Fifteen COPD patients (age: 71 ± 8) and twenty age-matched controls (69 ± 7 years) participated. Two-way mixed ANOVA demonstrated that O2Hb in both groups decreased during PPW from the start (quintile 1; Q1) to the end (quintile 5; Q5) in the left dorsolateral and medial PFC. Q1 was comprised of the data during the first 20% of the task, while Q5 included data collected in the last 20% of the task duration. PPW duration ranged between 30.0 and 61.4 s in the control group and between 28.6 and 73.0 s in COPD patients. COPD patients demonstrated a higher O2Hb in Q5 compared to the negative O2Hb in controls in the right medial and dorsolateral PFC during PPW. PPW velocity was lower in COPD patients compared to controls (1.02 ± 0.22 vs. 1.22 ± 0.14 m/s, p = 0.005). Healthy older controls exhibited automaticity during walking unlike patients with COPD. The lesser decrease in O2Hb in COPD patients may be attributed to increased executive demands or affect-related cues (e.g., pain or dyspnea) during walking.

Decreased automaticity contributes to dual task decrements in older compared to younger adults.

PURPOSE: To contrast older and younger adults' prefrontal cortex (PFC) neural activity (through changes in oxygenated hemoglobin) during single and dual tasks, and to compare decrements in task performance. METHODS: Changes in oxygenated hemoglobin of dorsolateral PFC were monitored using functional near-infrared spectroscopy during single tasks of spelling backwards (cognitive task) and 30 m preferred paced walk; and a dual task combining both. Gait velocity was measured by a pressure sensitive mat. RESULTS: Twenty sex-matched younger (27.6 ± 3.5 years) and 17 older adults (71.2 ± 4.9 years) were recruited. The left PFC oxygenated hemoglobin decreased from start (1st quintile) to the end (5th quintile) of the walking task in younger adults ( - 0.03 ± 0.03 to - 0.72 ± 0.20 µM; p < .05) unlike the non-significant change in older adults (0.03 ± 0.06 to - 0.41 ± 0.32 µM, p > .05). Overall, oxygenation increased bilaterally during dual versus single walk task in older adults (Left PFC: 0.22 ± 0.16 vs. - 0.23 ± 0.21 µM, respectively; Right PFC: 0.17 ± 0.18 vs. - 0.33 ± 0.22 µM, respectively), but only in right PFC in younger adults ( - 0.02 ± 0.15 vs. - 0.47 ± 0.13 µM). Older adults exhibited lower velocity during the dual task compared to younger adults (1.03 ± 0.16 vs. 1.20 ± 0.17 m/s, respectively). Older age was associated with dual task cost on velocity during walking after adjusting for confounding variables. CONCLUSIONS: Age-related cognitive decline in older adults may increase neural activity for cognitive tasks and diminish walking automaticity that may lead to decrements during dual tasking; the greater PFC increases in the oxygenated hemoglobin and lower velocity may be due to increased cognitive load and limited attentional resources.

A comparative study of the sarcopenia screening in older patients with interstitial lung disease.

BACKGROUND: The Asian Working Group for Sarcopenia 2019 (AWGS 2019) is the gold standard diagnostic criteria for sarcopenia in Asian populations. The calf circumference (CalF), the strength, assistance in walking, rising from a chair, climbing stairs, and falls (SARC-F) and the SARC-CalF questionnaires for sarcopenia screening have been used by AWGS 2019. The aim of this study was to assess accuracy of these three sarcopenia screening tools in patients with interstitial lung disease. METHODS: In this cross-sectional study, stable patients with interstitial lung disease were enrolled. The SARC-F, SARC-CalF, and CalF, used in patients with interstitial lung disease, were compared to the diagnostic criteria proposed by AWGS 2019. The accuracy of screening tools was compared using sensitivity and specificity. Moreover, areas under the receiver operating characteristic curves (AUC) were computed. RESULTS: Seventy eight patients were analyzed, and sarcopenia was identified in 25 (32.1%) patients with interstitial lung disease by the AWGS 2019 criteria. The sensitivity of the CalF was highest (96%) of the three screening tools, while the specificity was 60%. The sensitivity of SARC-F and SARC-CalF were 24% and 68%, while the specificity were 92% and 66%, respectively. The AUCs of CalF, SARC-F, and SARC-CalF in all patients were 0.78, 0.58, and 0.67, respectively. CONCLUSIONS: The CalF is most suitable for screening sarcopenia in patients with interstitial lung disease, while SARC-F and SARC-CalF are not.

Changes in Oxyhemoglobin Concentration in the Prefrontal Cortex during Cognitive-Motor Dual Tasks in People with Chronic Obstructive Pulmonary Disease.

Cognitive and motor impairment are well documented in chronic obstructive pulmonary disease (COPD) patients, but their relationship has not been studied. This study evaluated and compared cognitive and motor performance during dual tasks and related dorsolateral prefrontal cortex (PFC) changes in oxygenated hemoglobin (ΔO2Hb), a proxy measure of neural activity, in patients with COPD and age-matched healthy individuals. Participants performed three single tasks: (1) backwards spelling cognitive task; (2) 30 m preferred paced walk; (3) 30 m fast walk, and two dual tasks: (4) preferred paced walk + backwards spelling; (5) fast paced walk + backwards spelling. The ΔO2Hb from left and right dorsolateral PFC were measured using functional near-infrared spectroscopy. Gait velocity was measured using a Zeno walkway. Compared to healthy adults (n = 20), patients with COPD (n = 15) had higher ΔO2Hb during single preferred (-0.344 ± 0.185 vs. 0.325 ± 0.208 µM; p = 0.011) and fast paced walk (-0.249 ± 0.120 vs. 0.486 ± 0.182 µM; p = 0.001) in right PFC. Among healthy adults, ΔO2Hb were higher bilaterally during preferred paced walking dual versus single task (right: 0.096 ± 0.159 vs. -0.344 ± 0.185 µM, p = 0.013; left: 0.114 ± 0.150 vs. -0.257 ± 0.175 µM, p = 0.049) and in right PFC during fast walking dual versus single task (0.102 ± 0.228 vs. -0.249 ± 0.120, p = 0.021). Patients with COPD did not increase O2Hb during dual versus single tasks. Patients with COPD exhibited slower velocity than older adults during all walking tasks. The lack of further increase in O2Hb from single to dual tasks in patients with COPD, may indicate reduced cognitive-motor capacity and contribute to poorer motor performance limiting safe ambulation. Dual tasking rehabilitation may improve neural efficiency to offset these risks.

Aerobic and breathing exercises improve dyspnea, exercise capacity and quality of life in idiopathic pulmonary fibrosis patients: systematic review and meta-analysis.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive disease associated with significant dyspnea and limited exercise capacity. This systematic review aimed to synthesize evidence of exercise interventions during pulmonary rehabilitation that aim to improve exercise capacity, dyspnea, and health-related quality of life (HRQL) in IPF patients. METHODS: Searches were performed in MEDLINE, Embase, CENTRAL, SPORTDiscus, PubMed and PEDro from inception to January 2019 using search terms for: (I) participants: 'IPF or interstitial lung disease'; (II) interventions: 'aerobic training or resistance training or respiratory muscle training'; and (III) outcomes: 'exercise capacity or dyspnea or health-related quality of life'. Two reviewers independently screened titles, abstracts and full texts to identify eligible studies. Methodological quality of studies was assessed using the Downs and Black checklist and meta-analyses were performed. RESULTS: Of 1,677 articles identified, 14 were included (four randomized controlled trials and 10 prospective pre-post design studies) that examined 362 patients receiving training and 95 control subjects. Exercise capacity was measured with the 6-minute walk distance, peak oxygen consumption, peak work rate, or endurance time for constant work rate cycling, which increased after exercise [aerobic exercise; aerobic and breathing exercises; aerobic and inspiratory muscle training (IMT) exercises] compared to the control groups. Dyspnea scores improved after aerobic and breathing exercises. HRQL also improved after aerobic exercise training alone or combined with breathing exercises. Aerobic training alone or combined with IMT or breathing exercises improved exercise capacity. CONCLUSIONS: Breathing exercises appears to complement exercise training towards improved dyspnea and HRQL in patients with IPF.