Psychosocial Effects of the Pandemic on MS Patients at a University Hospital Following Patients with Telemedicine, Cross-sectional Study.

Introduction: The psychosocial effect of the pandemic on people with a disease such as multiple sclerosis (MS) that can cause disability and which medications that affect the immune system are used in treatment should be evaluated by physicians. We aimed to determine the psychosocial effects of the pandemic on MS patients and to evaluate the working and treatment continuation status, compliance with pandemic rules, and their perceptions regarding coronavirus disease 2019 (COVID-19). Methods: This study was designed as a cross-sectional and descriptive survey study. A total of 315 MS patients' demographic data, comorbidities, and degrees of disability, Beck Depression Inventory (BDI), Coronavirus Anxiety Scale (CAS), and compliance scores with pandemic restrictions were evaluated. Results: In the first period of the pandemic, approximately one-third of the patients were found to have major depression, and approximately 10% to have COVID anxiety. Both COVID anxiety and BDI scores were significantly higher in patients with symptoms suggestive of an attack during the pandemic process (p:0.0001 and p:0.002). CAS was higher in those who had a COVID-19 contact (p:0.045). BDI scores were significantly higher (respectively p:0.034, p:0.006, p:0.0001) in married/cohabiting patients, in patients who went on unpaid leave or lost their job, and in patients who described worsening of their previous MS-related complaints. Conclusion: Although the pandemic negatively affects the psychosocial status of MS patients, this effect can be reduced by identifying the groups that may be affected via telemedicine and taking necessary interventions.

The Effect of Flipped Learning Physical Education on Students' Knowledge, Skills and Motivation / El efecto de la educación física Flipped Learning en el conocimiento, las habilidades y la motivación de los estudiantes

It seems inevitable that the developing technology will be integrated into the field of education. The application of Flipped Learning (FL), which includes a technology component, in physical education will enable us to better understand the reflections of the approach on the lesson. The purpose of this study was to examine the effectiveness of the FL on students’ knowledge, motivation and skill development in physical education. A pretest-posttest matched control group design was used. The participants, whose mean age is 14.5±1.0, consists of 62 high school students who have just started their school, including 32 experimental (11 boys, 21 girls), 30 control (10 boys, 20 girls ). The FL, which was used in physical education, increased students' knowledge (Z= -4.18, p= .00) and motivation (Wilks' λ= .16, F(1, 60)= 55.60, p= .00, η2= .83), according to the findings. It only had an impact on the passing technical skill of the volleyball, which was utilized to assess skill development (M= 3.00, Sd= 1.07; p< .05) . As a result, this study offers some evidence that the FL is an important factor affecting students' volleyball content knowledge in physical education and can help to motivate them to participate the lesson. Further studies are needed to test the effect of the FL on skill development in physical education. (AU)

Parece inevitable que la tecnología en desarrollo se integre en el campo de la educación. La aplicación de Flipped Learning (FL) , que incluye un componente tecnológico, a la educación física nos permitirá comprender mejor los reflejos del enfoque en el curso. El objetivo de este estudio es examinar el efecto de FL en el conocimiento, la motivación y el desarrollo de habilidades de los estudiantes en educación física. Se utilizó un diseño de grupo de control apareado pretest-postest. Los participantes, cuya media de edad es 14,5±1,0, son 62 estudiantes de secundaria que acaban de comenzar su escuela, incluidos 32 experimentales (11 niños, 21 niñas), 30 de control (10 niños, 20 niñas). De acuerdo con los hallazgos, la FL utilizada en educación física incrementó el conocimiento (Z= -4.18, p= .00) y la motivación de los estudiantes (λ de Wilks= .16, F(1, 60)= 55.60, p= .00, η2 = .83). Por otro lado, el desarrollo de la habilidad en voleibol tuvo un efecto solo en la habilidad técnica de pase (M= 3.00, Sd= 1.07; p< .05). En conclusión, este estudio proporciona alguna evidencia de que FL es un factor importante que influye en el conocimiento del contenido de voleibol de los estudiantes en educación física y puede ayudar a motivarlos a participar en clase. Se necesitan más estudios para probar el efecto de FL en el desarrollo de habilidades en educación física. (AU)

The comparison of fatigue, sleep quality, physical activity, quality of life, and psychological status in multiple sclerosis patients with or without COVID-19.

PURPOSE: The study was purposed to investigate the effect of COVID-19 disease on fatigue, sleep quality, physical activity, quality of life, and psychological status in people with MS. METHODS: A total of 104 people with MS, including 46 of them with COVID-19 disease history, were enrolled in the study. All patients were evaluated with the Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire Short Form (IPAQ-SF), the EuroQoL Instrument (EQ-5D-3L), the Fear of COVID-19 Scale (FCV-19S) and the Coronavirus Anxiety Scale (CAS). RESULTS: People with MS in the COVID-19 positive group had a significantly lower IPAQ-Total score (p = 0.014). Besides, the FCV-19S scores of COVID-19 positive patients were significantly higher (p = 0.006). EQ-5D-3L Index and EQ-5D-3L VAS scores were higher in the group with COVID-19 (p1 = 0.021, p2 = 0.014, respectively). FCV-19S had a moderate correlation with EDSS (r = -0.362). IPAQ-Total was moderately associated with MS duration, EDSS and FSS (r1 = -0.471, r2 = -0.389, r3 = -0.388, respectively). The EQ-5D-3L Index was moderately correlated with FSS (r1 = -0.404). There was a weakly significant relationship between EQ-5D-3L Index and BMI, MS duration, PSQI and CAS (r1 = -0.471, r2 =-0.389, r3 = -0.388, r4 = -0.326, respectively). On the other hand, EQ-5D-3L was moderately associated with VAS and EDSS and PSQI (r1 = -0.393, r2 = -0.357, respectively). CONCLUSION: COVID-19 negatively affected the people with MS's physical activity and coronavirus related fear parameters. However, the causality of this influence should be investigated in detail.

Association of leukoaraiosis with stroke recurrence within 5 years after initial stroke.

BACKGROUND: Leukoaraiosis (LA) is closely associated with stroke. Despite the fact that LA has consistently been shown to predict development of recurrent stroke, prior studies on the association of LA and stroke subtypes have been unsatisfactory. In this study, we sought to identify whether LA contributes to the recurrence of certain subtypes of stroke at long term. METHODS: Data from the Ege Stroke Registry were examined, and 5 years follow-up data for LA and stroke recurrence were analyzed. We performed survival curves using the Kaplan-Meier method (unadjusted) and log-rank tests in patients with stroke to determine the relationship between LA and recurrent stroke by stroke subtypes within a time period of 5 years. Multivariate survival analyses were undertaken using Cox proportional hazards models to determine the prognostic value of LA, stroke subtypes, and other vascular risk factors before recurrent stroke. RESULTS: Of 9522 patients with stroke, 1280 (26%) with LA and 901 (19%) without LA experienced a stroke recurrence within 5 years of follow-up (odds ratio, 1.53; 95% confidence interval, 1.39-1.69). After stratification by stroke subtypes, multivariable analysis revealed a significant association between LA and large artery disease (LAD; odds ratio [OR], 1.39; 95% confidence interval [CI], 1.18-1.64), small artery disease (SAD; OR, 1.57; 95% CI, 1.27-1.94), and intracerebral hemorrhage (ICH; OR, 1.88; 95% CI, 1.32-2.66), except cardioembolic stroke and "other" stroke subtypes at 5 years after stroke onset. The survival analysis showed that stroke recurrence was significantly higher in patients with severe LA compared with those with mild/moderate LA (log-rank test [Mantel-Cox], P < .001). CONCLUSIONS: Our results showed that LA is related to the recurrent strokes in patients with stroke within 5 years after stroke, specifically to the LAD, SAD and ICH.

Association of baseline dyslipidemia with stroke recurrence within five-years after ischemic stroke.

BACKGROUND AND PURPOSE: The association between dyslipidemia (DL) and stroke recurrence is unclear, but may be influenced by different subtypes of stroke. This study aims to explore whether DL contributes to the recurrence of certain subtypes of ischemic stroke. METHODS: Data from the Ege Stroke Registry was examined, and five-years follow-up data for stroke recurrence was analyzed. Trial of Org 10172 in Acute Stroke Treatment criteria was used to classify the subtypes of all stroke. Recurrent stroke was defined as a new neurological deficit compatible to ischemic stroke or intracerebral hemorrhage. The association between DL and stroke recurrence in patients with different sroke subtypes was analyzed using univariable and multivariable logistic regression models. Survival curves were estimated with Kaplan-Meier methods, and survival analyses were undertaken using Cox proportional hazards models. RESULTS: Of the 9940 patients with ischemic stroke, 5838 (58·7%) had DL and 2202 (22·2%) experienced a stroke recurrence within five-years. The frequency of stroke recurrence of patients with DL was unsignificantly higher than those without at five-years of follow-up (18·0% vs. 17·0%; P = 0·21). After stratification by Trial of Org 10172 in Acute Stroke Treatment subtypes, multivariable analysis revealed a significant association between DL and stroke recurrence in all ischemic stroke at five-years (odds ratio, 1·2; 95% confidence interval, 1·02-1·42), and in the large-artery disease subtype (odds ratio, 1·46; 95% confidence interval, 1·12-1·91), but not in the other stroke subtypes (cardioembolic: odds ratio, 1·18; 95% confidence interval, 0·84-1·65; small-artery disease: odds ratio, 1·24; 95% confidence interval, 0·87-1·76; other subtype: odds ratio, 0·79; 95% confidence interval, 0·48-1·31). The probability of stroke recurrence increased in patients with large-artery disease and DL, compared with other subtypes of stroke [log rank test (Mantel-Cox) P < 0·013]. CONCLUSIONS: Our results showed that DL is related to the recurrent strokes in patients with ischemic stroke within five-years after ischemic stroke, specifically to the large-artery disease subtype.

CT Angiography and Presentation NIH stroke Scale in Predicting TIA in Patients Presenting with Acute Stroke Symptoms.

Patient candidacy for acute stroke intervention, is currently assessed using brain computed tomography angiography (CTA) evidence of significant stenosis/occlusion (SSO) with a high National Institutes of Health Stroke Scale (NIHSS) (>6). This study examined the association between CTA without significant stenosis/occlusion (NSSO) and lower NIHSS (≤ 6) with transient ischemic attack (TIA) and other good clinical outcomes at discharge. Patients presenting <8 hours from stroke symptom onset, had an NIHSS assessment and brain CTA performed at presentation. Good clinical outcomes were defined as: discharge diagnosis of TIA, modified Rankin Score [mRS] ≤ 1, and home as the discharge disposition. Eighty-five patients received both an NIHSS at presentation and a CTA at 4.2 ± 2.2 hours from stroke symptom onset. Patients with NSSO on CTA as well as those with NIHSS≤6 had better outcomes at discharge (p<0.001). NIHSS ≤ 6 were more likely than NSSO (p=0.01) to have a discharge diagnosis of TIA (p<0.001). NSSO on CTA and NIHSS ≤ 6 also correlated with fewer deaths (p<0.001). Multivariable analyses showed NSSO on CTA (Adjusted OR: 5.8 95% CI: 1.2-27.0, p=0.03) independently predicted the discharge diagnosis of TIA. Addition of NIHSS ≤ 6 to NSSO on CTA proved to be a stronger independent predictor of TIA (Adjusted OR 18.7 95% CI: 3.5-98.9, p=0.001).