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BackgroundCognitive problems frequently occur in patients with multiple sclerosis (MS) and profoundly affect their quality of life. So far, the best cognitive treatment options for MS patients are a matter of debate. Therefore, this study aims to investigate the effectiveness of two promising non-pharmacological treatments: cognitive rehabilitation therapy (CRT) and mindfulness-based cognitive therapy (MBCT). Furthermore, this study aims to gain additional knowledge about the aetiology of cognitive problems among MS patients, since this may help to develop and guide effective cognitive treatments.
Methods/design
In a dual-centre, single-blind randomised controlled trial (RCT), 120 MS patients will be randomised into one of three parallel groups: CRT, MBCT or enhanced treatment as usual (ETAU). Both CRT and MBCT consist of a structured 9-week program. ETAU consists of one appointment with an MS specialist nurse. Measurements will be performed at baseline, post-intervention and 6 months after the interventions. The primary outcome measure is the level of subjective cognitive complaints. Secondary outcome measures are objective cognitive function, functional brain network measures (using magnetoencephalography), psychological symptoms, well-being, quality of life and daily life functioning.
Discussion
To our knowledge, this will be the first RCT that investigates the effect of MBCT on cognitive function among MS patients. In addition, studying the effect of CRT on cognitive function may provide direction to the contradictory evidence that is currently available. This study will also provide information on changes in functional brain networks in relation to cognitive function. To conclude, this study may help to understand and treat cognitive problems among MS patients.
BACKGROUND:The EUDAIMON study focuses on fibromyalgia syndrome (FMS), a prevalent chronic condition characterized by pain, fatigue, cognitive problems and distress. According to recent reviews and meta-analyses, Mindfulness-Based Stress Reduction (MBSR) is a promising therapeutic approach for patients with FMS. The measurement of biomarkers as part of the analysis of MBSR effects would help to identify the neurobiological underpinnings of MBSR and increase our knowledge of FMS pathophysiology. The main objectives of this 12-month RCT are: firstly, to examine the effectiveness and cost-utility for FMS patients of MBSR as an add-on to treatment as usual (TAU) versus TAU + the psychoeducational programme FibroQoL, and versus TAU only; secondly, to examine pre-post differences in brain structure and function, as well as levels of specific inflammatory markers in the three study arms and; thirdly, to analyse the role of some psychological variables as mediators of 12-month clinical outcomes.
METHODS:
Effectiveness, cost-utility, and neurobiological analyses performed alongside a 12-month RCT. The participants will be 180 adult patients with FMS recruited at the Sant Joan de Déu hospital (St. Boi de Llobregat, Spain), randomly allocated to one of the three study arms: TAU + MBSR vs. TAU + FibroQol vs. TAU. A comprehensive assessment to collect functional, quality of life, distress, costs, and psychological variables will be conducted pre-, post-intervention, and at 12-month post-intervention. Fifty per cent of study participants will be evaluated at pre- and post-treatment using Voxel-Based Morphometry, Diffusion Tensor Imaging, pseudo-continuous Arterial Spin Labeling, and resting state fMRI. A cytokine multiplex kit of high-sensitivity will be applied (cytokines IL-6, IL-8, IL-10 + high-sensitivity CRP test).
DISCUSSION:
The findings obtained from this RCT will indicate whether MBSR is potentially cost-effective for FMS and contribute to knowledge of any brain and inflammatory changes associated with MBSR in FMS patients. Specifically, we will determine whether there are morphometric and functional changes associated with participation in MBSR in brain regions related to meta-awareness, body awareness, memory consolidation-reconsolidation, emotion regulation and in networks postulated to underpin the sensory-discriminative, cognitive-evaluative and affective-motivational aspects of the pain experience.
Background In chronic heart failure (CHF), impaired pulmonary function can independently contribute to oxygen desaturation and reduced physical activity. We investigated the effect of breathing rate on oxygen saturation and other respiratory indices.
Previous research has shown that long-term mindfulness training has beneficial effects on cognitive functioning and emotional regulation, but results are mixed regarding single mindfulness exercises, especially on attention and memory tasks. Thus, the present study aimed to analyse the effects of the Focused Breathing Exercise (FB) on cognitive performance, using standardised tests. Forty-six healthy undergraduate students were randomly assigned either to a FB or a Control condition. Two cognitive tasks (the Concentrated Attention task of the Toulouse-Pierron Factorial Battery and the Logical Memory Subtest I from the Wechsler Memory Scale III), along with mood evaluations (the Positive and Negative Affect Scale), were implemented both before and after the interventions. Results showed no significant differences for the attention task and mood evaluations. Nonetheless, the FB enhanced performance for the memory task significantly more than the Control exercise. The findings highlight that mindfulness does not affect equally all types of cognitive performances. Task characteristics may be important and their analysis can help to disentangle how mindfulness interferes with cognitive processes.
Previous research has shown that long-term mindfulness training has beneficial effects on cognitive functioning and emotional regulation, but results are mixed regarding single mindfulness exercises, especially on attention and memory tasks. Thus, the present study aimed to analyse the effects of the Focused Breathing Exercise (FB) on cognitive performance, using standardised tests. Forty-six healthy undergraduate students were randomly assigned either to a FB or a Control condition. Two cognitive tasks (the Concentrated Attention task of the Toulouse-Pierron Factorial Battery and the Logical Memory Subtest I from the Wechsler Memory Scale III), along with mood evaluations (the Positive and Negative Affect Scale), were implemented both before and after the interventions. Results showed no significant differences for the attention task and mood evaluations. Nonetheless, the FB enhanced performance for the memory task significantly more than the Control exercise. The findings highlight that mindfulness does not affect equally all types of cognitive performances. Task characteristics may be important and their analysis can help to disentangle how mindfulness interferes with cognitive processes. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
<p>The article looks the Mongol censuses taken during their rule of China. Evidence of the 1268 census, as well as others, can be found in some traditional Tibetan religio-historical texts. (Mark Premo-Hopkins 2004-04-15)</p>
ABSTRACTObjective: This study evaluates the contribution of measures for social cognition (SC), executive functioning (EF) and dysexecutive behavior to the statistical prediction of social and vocational participation in patients with traumatic brain injury (TBI), taking into account age and injury severity.Method: A total of 63 patients with moderate to severe TBI participated. They were administered a semi-structured Role Resumption List for social (RRL-SR) and vocational participation (RRL-RTW). EF was measured with planning- and switching tasks. Assessment of SC included tests for facial affect recognition and Theory of Mind (ToM). Dysexecutive behavior was proxy-rated with a questionnaire. Additionally, healthy controls were assessed with the same protocol.Results: Patients with TBI performed significantly worse on tests and had significantly more behavioral problems compared to healthy controls. Hierarchical multiple regression analyses for the TBI group revealed that SC accounted for 22% extra variance in RRL-RTW and 10% extra variance in RRL-SR, which was significant over and above the amounts of variance explained by EF, dysexecutive behavior, age and injury severity.Conclusions: Our findings underline the added value of measures of SC and dysexecutive behavior in the prediction of social and vocational participation post-TBI. In particular, impairments in ToM, and dysexecutive behavior were related to a lower participation making them important targets for rehabilitation.
<p>A review by Luciano Petech of D. Schuh, <em>Grundlagen tibetischer Siegelkunde, eine Untersuchung über tibetische Siegelsaufschriften in 'Phags-pa Schrift</em>.</p>
Background—It is well established that a depressed baroreflex sensitivity may adversely influence the prognosis in patients with chronic heart failure (CHF) and in those with previous myocardial infarction.Methods and Results—We tested whether a slow breathing rate (6 breaths/min) could modify the baroreflex sensitivity in 81 patients with stable (2 weeks) CHF (age, 58Ϯ1 years; NYHA classes I [6 patients], II [33], III [27], and IV [15]) and in 21 controls. Slow breathing induced highly significant increases in baroreflex sensitivity, both in controls (from 9.4Ϯ0.7 to 13.8Ϯ1.0 ms/mm Hg, PϽ0.0025) and in CHF patients (from 5.0Ϯ0.3 to 6.1Ϯ0.5 ms/mm Hg, PϽ0.0025), which correlated with the value obtained during spontaneous breathing (rϭϩ0.202, Pϭ0.047). In addition, systolic and diastolic blood pressure decreased in CHF patients (systolic, from 117Ϯ3 to 110Ϯ4 mm Hg, Pϭ0.009; diastolic, from 62Ϯ1 to 59Ϯ1 mm Hg, Pϭ0.02).
Conclusions—These data suggest that in patients with CHF, slow breathing, in addition to improving oxygen saturation and exercise tolerance as has been previously shown, may be beneficial by increasing baroreflex sensitivity. (Circulation. 2002;105:143-145.)
BACKGROUND: Current therapies for heart failure (HF) are followed by strategies to improve quality of life and exercise tolerance, besides reducing morbidity and mortality. Some HF patients present changes in the musculoskeletal system and inspiratory muscle weakness, which may be restored by inspiratory muscle training, thus increasing respiratory muscle strength and endurance, maximal oxygen uptake (VO2), functional capacity, respiratory responses to exercise, and quality of life. Yoga therapies have been shown to improve quality of life, inflammatory markers, and peak VO2 mostly in HF patients with a reduced ejection fraction. However, the effect of different yoga breathing techniques in patients showing HF with a preserved ejection fraction (HFpEF) remain to be assessed.METHODS/DESIGN: A PROBE (prospective randomized open blinded end-point) parallel-group trial will be conducted at two specialized HF clinics. Adult patients previously diagnosed with HFpEF will be included. After signing informed consent and performing a pre-test intervention, patients will be randomized into three groups and provided with either (1) active yoga breathing techniques; (2) passive yoga breathing techniques (pranayama); or and (3) control (standard pharmacological treatment). Follow-up will last 8 weeks (16 sessions). The post-intervention tests will be performed at the end of the intervention period for analysis of outcomes. Interventions will occur continuously according to patients' enrollment. The main outcome is respiratory muscular resistance. A total of 33 enrolled patients are expected. The present protocol followed the SPIRIT guidelines and fulfilled the SPIRIT checklist.
DISCUSSION: This trial is probably the first to assess the effects of a non-pharmacological intervention, namely yoga and specific breathing techniques, to improve cardiorespiratory function, autonomic system, and quality of life in patients with HFpEF.
TRIAL REGISTRATION: REBEC Identifier: RBR-64mbnx (August 19, 2012). Clinical Trials Register: NCT03028168 . Registered on 16 January 2017).
<p>This article looks at how the Yüan Dynasty organized Tibetan border areas, and the military efforts that were related to the organization process. (Mark Premo-Hopkins 2004-05-06)</p>