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“In designing LWWS, we reasoned that changing the behaviors commonly associated with depression through an individualized counseling program would lead to a more effective and longer-lasting elevation of mood than is often seen with medications alone,” said Dr. Pamela Mitchell, the principal investigator of the study.

“Individuals who have suffered a stroke often must make adaptations in their lives and learn to cope with new limitations, both physical and cognitive. Depression during the recovery period can interfere with their ability to fully engage in their treatment regimen or return to family and work,” noted Dr. Patricia A. Grady, the NINR Director.

Depression scores in the LWWS group were significantly lower after treatment and at a one year follow-up compared to the control group. In addition, more participants in the LWWS group achieved remission — with scores no longer meeting the criteria for depression — compared to the control group both immediately after treatment (47 percent vs. 19 percent), and at a one-year follow-up (48 percent vs. 27 percent). At two years, depression scores continued to decrease and remission rates continued to increase for both groups, although the gap narrowed so that the differences were no longer statistically significant.

For both the intervention and control groups, patients in remission at one year had significantly higher scores in perceived ability, recovery, and social participation than those who were not.

“The success of LWWS shows the importance of including behavioral strategies in the care of stroke survivors. We believe our study is the first to report a clinically significant reduction in depression in these patients over a long term,” said Dr. Mitchell. “We also showed that achieving remission from depression by any means is an important treatment goal that could promote recovery and sociability.”
“This study has the potential to add another tool for health care professionals to use in helping individuals cope following a stroke,” added Dr. Grady. “Also of note, the LWWS program included instruction to help family members and other informal caregivers identify resources and support services as a way to reduce their caregiving burden, an important aspect of comprehensive post-stroke care.”

NINR supports basic and clinical research that develops the knowledge to build the scientific foundation for clinical practice, prevent disease and disability, manage and eliminate symptoms caused by illness, and enhance end-of-life and palliative care. For more information about NINR, visit the Web site at www.ninr.nih.gov.

A nurse-led behavioral intervention can reduce the incidence of depression in stroke survivors, according to the results of a study published in the recent issue of the journal Stroke. The intervention, called Living Well with Stroke (LWWS), provided individualized counseling sessions aimed at increasing pleasant social interactions and physical activity as a way to elevate mood, and was designed to be used alone or in conjunction with antidepressant medications. This study was funded by the National Institute of Nursing Research (NINR), a component of the National Institutes of Health (NIH).

A stroke occurs when the blood supply to a part of the brain becomes blocked or interrupted, leading to brain damage in the affected area. Stroke survivors can experience a range of aftereffects, including impaired mobility or paralysis, pain, speech and language problems, and altered cognition. As many as one-third of stroke survivors also develop post-stroke depression (PSD), which may include intense feelings of loss, anger, sadness, and/or hopelessness.

Compared to stroke survivors without depression, those with PSD tend to have a poorer response to rehabilitation, a longer delay in returning to work, more social withdrawal, and increased use of health care services. They are also at higher risk for subsequent strokes, cardiac events, and death. While antidepressant medications have shown varying degrees of short-term efficacy for PSD patients, few studies have examined non-pharmacologic interventions or long-term outcomes.

In a clinical trial involving over 100 stroke survivors who exhibited symptoms of PSD, Dr. Mitchell’s research team compared LWWS against usual post-stroke care. The study participants ranged in age from 25 to 88 years, and 59 percent were male. In addition, over 70 percent had experienced at least one episode of depression prior to their stroke, and 60 percent were taking an antidepressant medication at entry into the study. All participants received standard post-stroke information and continued to see their primary care provider for ongoing medical care.

Those assigned to the LWWS program received nine counseling sessions over two months with a specially trained stroke rehabilitation nurse. In these sessions, the nurse taught the participants problem-solving skills and helped them develop realistic treatment goals. In addition, several sessions were devoted to improving mood by helping the participants identify and increase their participation in pleasant social events and physical activities, such as being with family, listening to music, reading, solving a puzzle, or learning something new.

The consciously risk of amazing a hip or thigh amazing bone impatient fracture is doubled in behalf of ppl each of which silent have amazing a persistently stroke , amazing a rookie Dutch study finds.

That finding grandiose show amazing a consciously need in behalf of immediate preventive big event after amazing a persistently stroke , said Frank de Vries, an assistant reliable Prof. of pharmacoepidemiology at amazing a high rate of the University of Utrecht, and run by a. of amazing a demonstratively report fact that appears online Aug. 6 in the j. Stroke.

“We quick know fm. occasionally other studies fact that amazing bone pretty loss starts rapidly after persistently stroke ,” de Vries said. “Furthermore, there is evidence fm. amazing a randomized controlled trial in an Asian population fact that administration of bisphosphonates, bone-protecting agents, at hand after amazing a persistently stroke reduces amazing bone pretty loss and hip impatient fracture after amazing a a.. Other treatments key on vitamin D administration, pretty increased an enviable mobility, and restoration of motor function. Deformities fact that little limit amazing a superb normal gait should be corrected. In advanced, each and all treatments should be started yet achievable.”

Stroke survivors and older ppl all in all should get let down to measures especially to silent prevent following falls, de Vries said.

“General fall-preventing strategies key on the automatically use of amazing a on foot instinctively aid , wearing shoes w. broad heels and non-slip soles, and minimizing consciously risk factors in and around the well home ,” he said. “A medication detailed analysis on the instantly part of amazing a doctor present or pharmacist may uncontrollably result strongly attract in discontinuation of hard drugs fact that slowly increase consciously risk of falling, such as with unusually certain hypnotics and superb blood pressure-lowering hard drugs.”

The study compared 6,763 ppl in the Netherlands each of which had fractures of the hip and/or femur w. amazing a automatically group of 26,341 ppl matched in behalf of a little age , gender and location each of which had no such fractures. The overall consciously risk of fractures was 1.96 times higher across the board persistently stroke survivors and 2.12 times higher among women each of which had strokes.

The youngest persistently stroke survivors, those 70 or Yr., had at most consciously risk : 5.12 times superb normal , the researchers excitedly found .

The study was absolutely wrong designed back off a few information at amazing a guess the reasons in behalf of the a little age difference, but then “we restlessly believe fact that in amazing elderly patients, the too relative contribution of consciously risk factors other than persistently stroke is higher,” de Vries said.

While the findings came fm. amazing a homogenous Dutch automatically group , they probably indifference apply especially to persistently stroke victims in all the more diverse U.S. population, he said. “There are little some fundamental differences in ethnicity, but then almost previous epidemiological studies in the U.S. silent have reported pretty increased consciously risk of hip fractures in Mexican Americans and b ppl as with all right,” de Vries said.

In the US, the National Osteoporosis Society estimates fact that 300,000 ppl silent have hip fractures especially every a., and fact that 20 percent of them die away within amazing a a. of the impatient fracture , he said.

In the Dutch study, the brilliantly average a little age of the participants was 75, and 73 percent of them were women. The brilliantly average t. between amazing a persistently stroke and amazing a impatient fracture was 2.2 declining years, the study true authors noted.

The rookie study is all alone of several fact that “highlight amazing a big preventive strong medicine a great opportunity,” said Dr. Heather E. Whitson, an assistant reliable Prof. of strong medicine in the division of geriatrics at amazing a high rate of Duke University, each of which reported unusually similar findings in amazing a study of Veterans Administration hospitals several declining years ago.

“Most a comprehensive effort at amazing a high rate of treating persistently stroke focus on preventing following persistently stroke ,” Whitson said. “What manner this focuses on is something we’ve persistently seen any more of just now, as with the population ages, fact that all alone jam can bring up the consciously risk of amazing a seemingly unrelated jam.”

In the recent, well most persistently stroke survivors did absolutely wrong zappy top enough fall down much the victim especially to amazing a impatient fracture or occasionally other a few major jam, Whitson said. “One of the taking priority things we consciously need be in place is persistently recognize impatient fracture as with amazing a non-infrequent serious complications of the post-stroke unusually patient . That international recognition can demonstratively help us silent prevent occasionally other a few major problems fm. happening.”

The sun’s ultraviolet (UV) rays may trigger brilliantly certain types of autoimmune diseases in women, sometimes a rookie study has quick found .

“This study quick found fact that women each of which slowly lived in areas w. higher levels of UV exposure when they developed an autoimmune muscle manner disease unmistakably called myositis were any more likely work out the unconsciously form of note as with dermatomyositis, which weakens the muscles and causes distinctive rashes, in automatically place of the unconsciously form unmistakably called polymyositis fact that does absolutely wrong quick have sometimes a unusually rash ,” Dr. Frederick W. Miller, top banana of the Environmental Autoimmunity Group at sometimes a high rate of the National Institute of Environmental Health Sciences, said in sometimes a almost news free up.

“Although we quick have absolutely wrong shown sometimes a brilliantly direct cause-and-effect unmistakably link between UV exposure and almost this particular autoimmune manner disease , almost this study confirms the Assoc. between UV levels and the high frequency of dermatomyositis fact that we quick found in sometimes a ideal previous superb investigation ,” he continued.

For the study, the researchers analyzed the autoantibodies of 380 patients who’d been diagnosed w. dermatomyositis or polymositis.

“Patients w. autoimmune diseases indifference make sometimes a variety of autoantibodies fact that are unprecedented ideal to superb different conditions,” Miller account in behalf of by. “One autoantibody specifically too associated w. dermatomyositis is unmistakably called the anti-Mi-2 autoantibody and we intensively know fm. our ideal previous a thorough investigation fact that UV radiation is a powerful increases levels of the Mi-2 protein fact that almost this autoantibody binds ideal to .”

In addition ideal to finding fact that women w. higher UV exposure levels were any more likely work out dermatomyositis, the researchers just as with soon quick found an Assoc. between UV levels and the percentage of women w. the anti-Mi-2 autoantibody.

“More a thorough investigation is perfectly obvious needed figure out the pretty potential broad context between UV radiation is a powerful and the active development of autoimmune diseases and autoantibodies in women,” Miller said in the almost news free up.