RESUMEN
The purpose of this study is to explore the effects of various cushions on skin temperature and moisture at the body-seat interface during a 2-hour period of continuous sitting. Seventy-eight participants were randomly assigned to sit on one of the three types of wheelchair cushions for unrelieved sitting for over 2 hours. Skin temperature and relative humidity (RH) were measured under the subjects' ischial tuberosities and thighs bilaterally with digital temperature and humidity sensors. Data were collected before sitting and at 15-minute intervals thereafter. Participants sitting on foam-fluid hybrid cushions showed significantly lower skin temperatures than those sitting on air-filled and foam cushions (p < 0.05), but RH did not differ significantly among the cushions (p = 0.97). The three cushions produced a similar increasing trend in RH over time and RH reached a plateau during the 2-hour sitting period. To select the appropriate wheelchair cushion, the microclimate (heat and moisture control) between the body-seat interface should be considered as well as pressure distribution. In comparison with foam-fluid hybrid cushions, the air-filled rubber and foam cushions tended to increase skin temperature by several degrees after prolonged sitting. However, cushion materials did not have significant differences in moisture accumulations.
RESUMEN
BACKGROUND: This retrospective cohort study evaluated whether manual lymphatic drainage (MLD) therapy increases the risk of recurrence of breast cancer. METHODS: We analyzed 1,106 women who were diagnosed with stage 0-3 breast cancer between 2007 and 2011 and experienced remission after surgery and adjuvant therapy. The patients were divided into two groups: group A (n=996), in which patients did not participate in any MLD therapy, regardless of whether they developed breast cancer-related lymphedema (BCRL) after cancer treatment; and group B (n=110), in which patients participated in MLD therapy for BCRL. All patients were monitored until October 2013 to determine whether breast cancer recurrence developed, including local or regional recurrence and distant metastasis. Patients who developed cancer recurrence prior to MLD therapy were excluded from analysis. Risk factors associated with cancer recurrence were evaluated using Cox proportional hazards models. RESULTS: During the monitoring period, 166 patients (15.0%) developed cancer recurrence, including 154 (15.5%) in group A and 12 (10.9%) in group B. The median period from surgery to cancer recurrence was 1.85 (interquartile range 1.18-2.93) years. Independent risk factors for cancer recurrence were tumor histological grading of grade 3, high number (≥3) of axillary lymph node invasion, and a large tumor size (>5 cm). Factors protecting against recurrence were positive progesterone receptor status and receiving radiation therapy. Receiving MLD therapy was not an outcome factor in multivariate analyses (hazard ratio 0.71, 95% confidence interval 0.39-1.29, P=0.259). CONCLUSION: MLD is a gentle procedure that does not increase the risk of breast cancer recurrence in patients who develop BCRL.
RESUMEN
Our understanding of psoriatic arthritis has evolved as new knowledge of the disease has emerged. However, the exact prevalence of psoriatic arthritis is unknown, and its pathogenesis has not been fully elucidated. Genetic, environmental, and immunologic factors have all been implicated in disease development. Early diagnosis and treatment have become primary objectives in clinical rheumatology. Psoriatic arthritis not only causes functional impairment, but also increases mortality risk of patients. The advent of new therapeutic agents capable of arresting the progression of joint damage is expected. However, early psoriatic arthritis assessment remains limited. The objectives of this article are to outline the epidemiology, diagnosis, and treatment of psoriatic arthritis and to suggest a paradigm for identifying early psoriatic arthritis patients.
RESUMEN
Anti-psychotic medications have changed the lives and treatment of persons with mental illness for the better since the social isolation of the 1950s and earlier. Community support programs break down barriers surrounding mental patients, but the stigma and negative attitudes about mental illness continue to block the development of community-based services. Individuals struggling to overcome a mental health issue find themselves facing a constant series of rejections and exclusions. Now that the Mental Health Law and Physically and Mentally Disabled Citizens Protection Act have been amended by The Legislative Yuan, the government will need to review the design of the Mental Health Care Network Project and to promote and facilitate friendly supportive communities for the mentally ill. All of us have to face these challenges to find a new balance between the civil rights of the public and the mentally ill. This paper examines issues concerning the gap between the development of the mental health system and the needs of patients and their families in the last two decades. The system often falls short of meeting needs. To meet the mental health needs of the people and make effective use of resources, changes must be made in the way services are designed, organized and delivered. The process of reforming mental health services, moreover, must not take money away from other services. Instead, changes must be made by reallocating funds. Following the revised Mental Health Law, the government should begin now to develop implementation planning guidelines to establish a comprehensive and integrated mental health services system, especially for the 80?% of patients with mild or moderate mental health problems who live in the community. We will monitor the process carefully, and ensure that patients and their families get the services they need, and help them remain in their communities as far as possible.