Parkinson’s disease (PD) is the second-most common age-related neurodegenerative disorder. Despite recommendations for a palliative approach, little is known about what palliative needs are unmet by standard care. This study aims to (a) identify palliative needs of PD patients, (b) determine the relationship between palliative needs and health-related quality of life (HRQoL), and (c) probe into factors affecting HRQoL. PD patients and neurologists were recruited for a survey on palliative need; a subset of patients was interviewed. Significant differences between physicians and patients were found in Physical, Psychological, Social, Financial, and Spiritual domains. Physical and Psychological needs predicted HRQoL. Primary themes across interviews included (a) lack of healthcare education and (b) need for care coordination. Secondary themes included (a) the importance of support groups, (b) the role of spirituality/religion, and (c) the narrow perceived role of the neurologist. Findings highlight the importance of coordinated individualized care.
Introduction: Excess sitting is a risk factor for early mortality. This may be due, at least in part, to the displacement of physical activity (PA) with sedentary behaviors. The purpose of this observational study was to examine the mortality risk reductions associated with replacing 30 min•day −1 sitting for an equivalent duration of light (LPA) or moderate-vigorous intensity PA (MVPA).Methods: Participants included 37,924 men and 54,617 women in the Cancer Prevention Study-II Nutrition Cohort, among whom 14,415 men and 13,358 women died during follow-up (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014). An isotemporal substitution approach to the Cox proportional hazards regression model was used to estimate adjusted hazard ratios and 95% confidence intervals (HR, 95% CI) for mortality associated with the substitution of 30 min•day −1 self-reported sitting for LPA or MVPA. Analyses were conducted in 2018.Results: Among the least active participants (MVPA ≤17 min/day), the replacement of 30 min•day −1 sitting with LPA was associated with a 14% mortality risk reduction (HR=0.86, 0.81-0.89) and replacement with MVPA was associated with a 45% mortality risk reduction (HR=0.55, 0.47-0.62). Similar associations were seen among moderately active participants (HR=0.94, 0.91-0.97 LPA replacement, HR=0.83, 0.76-0.88 MVPA replacement). However, for the most active (MVPA >38 min/day), substitution of sitting time with LPA or MVPA was
Background:Children in residential children’s homes (RCH) may be at increased risk for physical inactivity due to decreased access to opportunities for activity. Little is known about environmental determinants of physical activity for children in RCH.Methods:Thirty-minute blocks of MVPA and Total METs were measured using the 3-Day Physical Activity Recall (3DPAR). A staff interview, based on the Structural Ecologic Model of Health Behavior, assessed physical activity opportunities, structures, characteristics, policies, and social environment. Wilcoxon 2-sample tests were used to examine differences in environment by location and presence of a recreation director. Mixed model ANOVAs assessed the differences in child level activity by environmental variables.Results:There were significant correlations between opportunities and characteristics of physical activity, facilities, and equipment with total METS for children. Children in homes with a recreation director and homes in rural locations reported more physical activity. Only rural location had a significant effect on physical activity. Presence of a recreation director was significant in several models.Conclusions:Rural location may be conducive for increased physical activity in children at RCH. Employing a recreation director or other trained personnel may be an important policy determinant of physical activity for children.
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