Impaired Physical Function Research Articles

Psychosocial Problems on Adolescents with Thalassemia Major: A Systematic Scoping Review

Disease and treatment of thalassemia major that are carried out for life can cause physical and psychological problems in sufferers. Adolescents with thalassemia major will experience disturbances at a stage of development that is undergoing dynamic changes. Nurses, as health workers who provide holistic services, need to know what psychosocial problems may arise in adolescents with thalassemia major. This study aims to describe psychosocial problems in adolescents with thalassemia major. This study uses a scoping review design by searching English literature through the CINAHL, PubMed, and Scopus databases. The keywords used are psychosocial problems, thalassemia major, and adolescence. The criteria for the article in this study where the patient was a teenager with thalassemia, open access full text, and the time setting was the last 10 years (2013-2022). We found 9 articles discussing psychosocial problems in adolescents with thalassemia. Psychosocial problems that arise in the form of disturbances in several functions, namely physical, emotional, social, and school functions. Psychosocial disorders that occur in adolescents with thalassemia cause disturbances at the stage of adolescent development. Psychosocial problems that occur in adolescents with thalassemia include impaired physical, emotional, social, and school functions.
 Keywords: adolescence, psychosocial problems, thalassemia major

Adverse Childhood Experiences and Aging-Associated Functional Impairment in a National Sample of Older Community-Dwelling Adults.

Prior research on the health implications of adverse childhood experiences (ACEs) has focused on early or midlife adults, not older adults who bear the greatest burden of health-related functional impairment. To examine associations between ACEs, objectively measured physical mobility and cognitive impairment, and functional disability in older community-dwelling adults. Cross-sectional analysis. Community-dwelling older U.S. adults ages 50years and older. Participants completed structured questionnaires assessing history of ACEs (childhood experience of violence/abuse, witnessing of violence, financial insecurity, parental separation, or serious illness), underwent standardized physical performance testing (tandem balance, 3-m walk, chair stand test) and cognitive testing (survey adaptation of the Montreal Cognitive Assessment), and reported functional disability (difficulty with activities of daily living). Among the 3387 participants (aged 50 to 97years; 54% female), 44% reported a history of one or more types of ACEs. Thirty-five percent met criteria for physical mobility impairment, 24% for cognitive impairment, and 24% for functional disability. After adjusting for age, gender, race, and ethnicity, participants reporting any ACE history were more likely to demonstrate physical mobility impairment (OR 1.30, 95% CI 1.11-1.52) and cognitive impairment (OR 1.26, 95% CI 1.03-1.54) and report functional disability (OR 1.69, 95% CI 1.38-2.07), compared to those with no ACE history. Childhood experience of violence was associated with greater physical mobility impairment (OR 1.38, 95% CI 1.11-1.71) and functional disability (OR 1.86, 95% CI 1.49-2.33). Older adults with a history of ACEs are more likely to experience physical and cognitive functional impairment, suggesting that efforts to mitigate ACEs may have implications for aging-associated functional decline. Findings support the need for trauma-informed approaches to geriatric care that consider the potential role of early life traumatic experiences in shaping or complicating late-life functional challenges.

Socioeconomic Status Disparities in Cognitive and Physical Functional Impairment among Older Adults: Comparison of Asians with other Major Racial/Ethnic Groups.

This study investigated to what extent socioeconomic status (SES) disparity associates with cognitive and physical impairment within older Asian Americans in comparison with other races/ethnicities. Data were from the National Health and Nutrition Examination Survey 2011-2018 that included 3,297 White, 1,755 Black, 1,708 Hispanic, and 730 Asian Americans aged ≥ 60. Physical functioning was measured by activities of daily living (ADL) or instrumental activities of daily living (IADL). Memory and language fluency were evaluated using the Alzheimer's Disease Word List Memory Task and Animal Fluency Tests, respectively. Multivariate logistic regressions were conducted to investigate the association between SES and physical and cognitive impairment within racial/ethnic groups, and seemingly unrelated regressions compared coefficients across subgroups. Asians with ≤ high school education had the highest prevalence of age- and sex-adjusted memory impairment among all races/ethnicities, while no difference was observed for those with > high school education. ADL/IADL disability odds did not differ between Asians and Whites, but Asians were more likely to exhibit impaired verbal fluency. Education disparity for ADL disability (OR, 3.40; 95% CI, 2.20-5.25) and memory impairment (OR, 11.57; 95% CI, 6.59-20.31) were largest among Asians compared to Whites, Blacks, and Hispanics. Income disparity for function impairment showed no significant difference across racial/ethnic groups (all P > 0.05). Asians experienced the highest burden of physical functioning and memory impairment due to education disparity. Efforts should focus on strengthening research infrastructure and creating targeted programs and services to improve cognitive and physical health for racially/ethnically underrepresented older adults with lower education attainment.

Patient-Reported Outcomes After Ferric Carboxymaltose Treatment for Iron Deficiency Anemia: A Prospective Observational Study.

Iron deficiency anemia (IDA) is a common cause of fatigue and impaired quality of life. The present study aimed to evaluate the impact of intravenous iron supplementation with ferric carboxymaltose (FCM) on fatigue, physical function, and general health among patients with IDA attending routine clinical care. This was a prospective, single arm, observational study of adult patients prescribed with intravenous FCM for the treatment of IDA during routine clinical care. We used Patient-Reported Outcomes Measurement Information System (PROMIS) instruments to evaluate fatigue (PROMIS Short Form v1.0 13a [FACIT-Fatigue]), general health status (PROMIS Scale v1.2), and physical function (PROMIS Short Form v2.0 4a) before and at 3 and 6 months after FCM treatment. A total of 152 patients were enrolled. Mean age was 47.4 ± 16.0 years and 82.2% were female. Mean serum hemoglobin was 10.2 ± 1.4 g/dL at baseline. All patients were treated with at least one FCM dose at baseline, with 77.6% receiving a two-dose treatment course. The mean baseline FACIT-Fatigue score was 61.0 ± 9.0, improving significantly to 50.2 ± 9.5 at 3 months after FCM treatment. A minimum 5-point improvement, pre-defined as clinically meaningful, was seen in the FACIT-Fatigue, PROMIS Global Physical Health, Global Mental Health and PROMIS Physical Function scores for 72.7%, 52.8%, 41.7% and 39.8% of patients at 3 months (p < 0.0001 for each change from baseline), with statistically significant improvement continuing at 6 months. Mean serum hemoglobin was significantly increased at both 3 and 6 months (12.8 g/dL [N = 44] and 12.4 g/dL [N = 54], respectively). IDA patients attending routine clinical practice reported substantial levels of fatigue and impairments in physical function and global health prior to intravenous iron treatment. Patients experienced significant improvements in fatigue symptoms, physical function, and global health at 3 months after treatment with FCM, which were sustained at 6 months.

Fear of Falling as a Behavioral Symptom in Neurocognitive Impaired Patients: Evidence from an Underrepresented Population.

Fear of falling (FoF) is a condition associated with falls, multi-morbidity, and functional impairment. To date it remains unknow which clinical, somatic, socio-demographic, behavioral, and emotional factors are associated with FoF and how these factors interact in people with Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD). Identify the association of FoF with clinical, socio-demographic, and neuropsychiatric factors in patients with AD and bvFTD. We evaluated 98 participants, 58 with AD and 40 with bvFTD at mild or moderate stages and assess FoF using the Falls Efficacy Scale-International. Additionally, we analyzed cognitive, physical performance variables, functional impairment, and affective and behavioral symptoms associated with FoF using standardized scales and a regression model analysis. The prevalence of FoF in AD and bvFTD was 51% and 40%, respectively. In the AD group, physical performance [F (3, 53) = 4.318, p = 0.009], the behavioral symptoms model [F (19, 38) = 3.314, p = 0.001], and the anxiety model [F (1, 56) = 13.4, p≤0.01] showed statistically significant values. In addition, the presence of hallucinations assessed with the Neuropsychiatric Inventory and social behavior assessed with the Mild Behavioral Impairment Checklist were significant. In contrast, in the bvFTD group, a homologous group of models was evaluated but we did not find any significant results. FoF in people with AD was related to physical performance, neuropsychiatric symptoms such as apathy and hallucinations, and affective symptoms such as anxiety. However, this pattern was not seen in the bvFTD group, and therefore further studies are required.

Study protocol for the ‘preventing functional decline in acutely hospitalised older patients (PREV_FUNC)’ study: effects of two multicomponent exercise programmes on physical function – a three-armed randomised controlled trial

IntroductionAcutely hospitalised older patients often live with frailty and have an increased risk of impaired physical function. Previous studies suggest that exercise might mitigate the risk of physical impairment; however,...

Impact of Vutrisiran on Quality of Life and Physical Function in Patients with Hereditary Transthyretin-Mediated Amyloidosis with Polyneuropathy.

Hereditary transthyretin (ATTRv; v for variant) amyloidosis, also known as hATTR amyloidosis, is a progressive and fatal disease associated with rapid deterioration of physical function and patients' quality of life (QOL). Vutrisiran, a subcutaneously administered RNA interference (RNAi) therapeutic that reduces hepatic production of transthyretin, was assessed in patients with ATTRv amyloidosis with polyneuropathy in the pivotal HELIOS-A study. The phase 3 open-label HELIOS-A study investigated the efficacy and safety of vutrisiran in patients with ATTRv amyloidosis with polyneuropathy, compared with an external placebo group from the APOLLO study of the RNAi therapeutic patisiran. Measures of QOL and physical function were assessed. At month 18, vutrisiran improved Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QOL-DN) total score (least squares mean difference [LSMD] in change from baseline [CFB]: -21.0; p=1.84×10-10) and Norfolk QOL-DN domain scores, compared with external placebo. This benefit relative to external placebo was evident across all baseline polyneuropathy disability (PND) scores and most pronounced in patients with baseline PND scores I-II. Compared with external placebo, vutrisiran also demonstrated benefit in EuroQoL-Visual Analog Scale (EQ-VAS) score (LSMD in CFB: 13.7; nominal p=2.21×10-7), 10-m walk test (LSMD in CFB: 0.239m/s; p=1.21×10-7), Rasch-built Overall Disability Score (LSMD in CFB: 8.4; p=3.54×10-15), and modified body mass index (mBMI) (LSMD in CFB: 140.7; p=4.16×10-15) at month 18. Overall, Norfolk QOL-DN, EQ-VAS, and mBMI improved from pretreatment baseline with vutrisiran, whereas all measures worsened from baseline in the external placebo group. At month 18, Karnofsky Performance Status was stable/improved from baseline in 58.2/13.1% with vutrisiran versus 34.7/8.1% with external placebo. Vutrisiran treatment provided significant clinical benefits in multiple measures of QOL and physical function in patients with ATTRv amyloidosis with polyneuropathy. Benefits were most pronounced in patients with earlier-stage disease, highlighting the importance of early diagnosis and treatment. ClinicalTrials.gov: NCT03759379.

Prospective study to evaluate quality of life in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative rare disease characterized by symptoms and signs in the upper and lower motor neurons, leading to progressive neuro-degeneration and muscle atrophy. Our objective was to analyse the quality of life (QoL) in patients with ALS and compare with general population and with patients with cancer. Prospective study from consecutive ALS patients in one center. In order to assess quality of life, during the first visit three questionnaires were administered: Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R), Short Form-36 (SF-36) and EuroQoL 5D (EQ-5D). We compared SF-36 of ALS patients with a reference population (n = 9151), and we compared the EQ-5D index score of ALS patients versus patients with cancer in the same area and in the same period (2015–2018). Between June 2015 and September 2017, 23 were included. The mean age was 65.1 ± 12.6 years and 56.5% were women. Compared with the general population, patients with ALS showed lowest QoL (p < 0.05) in all the dimensions, with a very important impairment in physical function (median: 0; p25-75: 0–10) and physical role (median: 0; p25-75: 0–6.25). In EQ-5D questionnaire, patients with ALS presented an EQ-5D index score of 0.21 ± 0.39 (mean ± standard deviation) with a visual analog scale (VAS) score of 0.32 ± 0.24. Compared with an oncological population, patients with ALS had a worse EQ-5D index score both clinically and statistically (0.21 ± 0.39 vs. 0.77 ± 0.27; p < 0.05). We demonstrate a poorer quality of life in patients with ALS is poor, and clinically and statistically worse than in patients with cancer or general population. New studies need to evaluate the impact of strategies in this population to improve the quality of life.

Spontaneous physical functional recovery after hospitalization for COVID-19: insights from a 1 month follow-up and a model to predict poor trajectory.

Long COVID syndrome has emerged as a new global healthcare challenge, with impaired physical performance being a prominent debilitating factor. Cardiopulmonary rehabilitation is a mainstay of management of symptomatic post-COVID patients, and optimization of candidate selection might allow for more effective use of available resources. In order to study the natural dynamics and to identify predictors of physical functional recovery following hospitalization for COVID-19, 6 min walk test was performed pre-discharge in 176 patients (40% hypertensive, 53% female, mean age 53.2 ± 13.5 years) with re-evaluation at 1 month. Six min walk distance and the reached percent of predicted distance (6MWD%) were suboptimal at both visits-396 ± 71 m (68.7 ± 12.4%) pre-discharge and 466 ± 65 m (81.8 ± 13.6%) at 1 month. Associated changes included significant oxygen desaturation (2.9 ± 2.5 and 2.3 ± 2.2%, respectively) and insufficient increment of heart rate during the test (24.9 ± 17.5 and 28.2 ± 12.0 bpm) that resulted in low reached percent of individual maximum heart rate (61.1 ± 8.1 and 64.3 ± 8.2%). Automatic clusterization of the study cohort by the 6MWD% changes has allowed to identify the subgroup of patients with poor "low base-low increment" trajectory of spontaneous post-discharge recovery that were characterized by younger age (38.2 ± 11.0 vs. 54.9 ± 12.1, p < 0.001) but more extensive pulmonary involvement by CT (43.7 ± 8.8 vs. 29.6 ± 19.4%, p = 0.029) and higher peak ESR values (36.5 ± 9.7 vs. 25.6 ± 12.8, p < 0.001). Predictors of poor recovery in multivariate logistic regression analysis included age, peak ESR, eGFR, percentage of pulmonary involvement by CT, need for in-hospital oxygen supplementation, SpO2 and mMRC dyspnea score pre-discharge, and history of hypertension. COVID-19 survivors were characterized by decreased physical performance pre-discharge as assessed by the 6 min walk test and did not completely restore their functional status after 1 month of spontaneous recovery, with signs of altered blood oxygenation and dysautonomia contributing to the observed changes. Patients with poor "low base-low increment" trajectory of post-discharge recovery were characterized by younger age but more extensive pulmonary involvement and higher peak ESR values. Poor post-discharge recovery in the study cohort was predictable by the means of machine learning-based classification model that used age, history of hypertension, need for oxygen supplementation, and ESR as inputs.

A randomized controlled trial on the effects and acceptability of individual mindfulness techniques – meditation and yoga – on anxiety and depression in people with Parkinson’s disease: a study protocol

BackgroundBetween 40 and 50% of patients with Parkinson’s disease (PD) experience anxiety and depression, associated with impaired physical function, high care dependency and mortality. Recently, the United States National Institutes of Health has urged the implementation of mindfulness practices in chronic illness care. Most research to date has examined the effects on chronically ill patients of complex interventions using a combination of mindfulness techniques. In PD patients, however, such complex modalities appear to hinder the technique mastery. Hence, the aim of this trial is to investigate the effects and underlying mechanism of individual mindfulness techniques among PD patients, as well as exploring participants’ experience in using individual mindfulness techniques as a lifestyle intervention for stress and symptom management.MethodsWe will conduct an assessor-blind three-arm randomized waitlist-controlled trial with a descriptive qualitative evaluation. Up to 168 PD patients will be recruited from community settings and out-patient clinics, and randomized to meditation, yoga, or usual care group. Meditation and yoga sessions of 90-minute are held weekly for 8 weeks. Primary outcomes include anxiety and depression. Secondary outcomes include PD-related motor and non-motor symptoms and quality-of-life; and level of mindfulness and biomarkers of stress and inflammatory responses will be measured as mediating variables. All outcome evaluations will be assessed at baseline, 8 weeks, and 24 weeks. Following the intention-to-treat principle, generalized estimating equation models and path analysis will be used to identify the treatment effects and the mediating mechanisms. A subsample of 30 participants from each intervention group will be invited for qualitative interviews.DiscussionThe study would also generate important insights to enhance the patients’ adaptation to debilitating disease. More specifically, symptom management and stress adaptation are highly prioritized healthcare agenda in managing PD. The research evidence will further inform the development of community-based, nurse-led compassionate care models for neurodegenerative conditions, which is complementary to existing health services.Trial registrationWHO Primary Registry – Chinese Clinical Trials Registry number: ChiCTR2100045939; registered on 2021/04/29 (https://www.chictr.org.cn/showproj.html?proj=125878).

Resistance, Ambivalence and Change: People with Drug and Alcohol Addiction

When people with drug and alcohol addiction drop out of treatment, they may experience impaired psychological, physical, and mental functioning, emotional distress, and return to intense drug use. Some of the reasons for dropping out of treatment are related to the personal characteristics of the clients, their family background, and the therapeutic intervention that may not be well suited to the client's needs.

Association of the use of psychotropic drugs with hospitalization, cardiovascular events, and mortality in patients with type 2 diabetes: a propensity score-matched cohort study.

Use of psychotropic drugs (PD) may be associated with impairment of physical function. However, few studies have assessed the impact of PD on health outcomes in patients with type 2 diabetes. This study aimed to examine the associations between psychotropic drug use and handgrip strength (HGS) and between the use of PD and hospitalization in patients with type 2 diabetes. From April 2013 to December 2015, we conducted a retrospective cohort study in patients with type 2 diabetes at the National Center for Global Health and Medicine Kohnodai Hospital. Patients aged 20 years and over who can measure HGS were included. All participants received nutritional guidance regarding diet therapy for type 2 diabetes at baseline. Nonpsychotropic drug users were matched one-to-one with the PD users using propensity score matching method with respect to their baseline covariates. The differences in HGS and the number of patients who had hospitalizations during the study period were examined. By Cox proportional hazard regression analysis, the association between the use of PD and repeated hospitalizations was estimated. A total of 1,282 patients were enrolled and followed up for 2.36 ± 0.73 years. In the propensity score matching cohort, HGS was significantly lower (p = 0.006) in PD users than non-PD users. PD users had more hospitalizations than non-PD users. Cox proportional hazard regression analysis confirmed the association of repeated hospitalizations with the use of PD (hazard ratio = 2.138; 95% confidence interval, 1.144-3.995, p = 0.017)). In addition, HGS was significantly and inversely correlated with the number of hospitalizations (r = -0.143, p = 0.013). The use of PD could increase the risk of repeated hospitalizations. Skeletal muscle may play a role in reducing the risk of hospitalization in patients who are treated with PD.

Cardiopulmonary exercise testing before and after intravenous iron in preoperative patients: a prospective clinical study

BackgroundAnemia is associated with impaired physical performance and adverse perioperative outcomes. Iron-deficiency anemia is increasingly treated with intravenous iron before elective surgery. We explored the relationship between exercise capacity, anemia, and total hemoglobin mass (tHb-mass) and the response to intravenous iron in anemic patients prior to surgery.MethodsA prospective clinical study was undertaken in patients having routine cardiopulmonary exercise testing (CPET) with a hemoglobin concentration ([Hb]) < 130 g.l−1 and iron deficiency/depletion. Patients underwent CPET and tHb-mass measurements before and a minimum of 14 days after receiving intravenous (i.v.) Ferric derisomaltose (Monofer®) at the baseline visit. Comparative analysis of hematological and CPET variables was performed pre and post-iron treatment.ResultsTwenty-six subjects were recruited, of whom 6 withdrew prior to study completion. The remaining 20 (9 [45%] male; mean ± SD age 68 ± 10 years) were assessed 25 ± 7 days between baseline and the final visit. Following i.v. iron, increases were seen in [Hb] (mean ± SD) from 109 ± 14 to 116 ± 12 g l−1 (mean rise 6.4% or 7.3 g l−1, p = < 0.0001, 95% CI 4.5–10.1); tHb-mass from 497 ± 134 to 546 ± 139 g (mean rise 9.3% or 49 g, p = < 0.0001, 95% CI 29.4–69.2). Oxygen consumption at anerobic threshold (dot{text{V}} O2 AT) did not change (9.1 ± 1.7 to 9.8 ± 2.5 ml kg−1 min−1, p = 0.09, 95% CI − 0.13 − 1.3). Peak oxygen consumption (dot{text{V}} O2 peak) increased from 15.2 ± 4.1 to 16 ± 4.4 ml.kg.−1 min−1, p = 0.02, 95% CI 0.2–1.8) and peak work rate increased from 93 [67–112] watts to 96 [68–122] watts (p = 0.02, 95% CI 1.3–10.8).ConclusionPreoperative administration of intravenous iron to iron-deficient/deplete anemic patients is associated with increases in [Hb], tHb-mass, peak oxygen consumption, and peak work rate. Further appropriately powered prospective studies are required to ascertain whether improvements in tHb-mass and performance in turn lead to reductions in perioperative morbidity.Trial registrationClinicalTrials.gov identifier: NCT 033 46213.

Successful Management of a Polytrauma with Open Complex Pelvic Fracture

Abstract Pelvic fractures frequently result from powerful external forces and carry a high risk of concurrent injuries. In these patients, fatalities are often caused by associated injuries. Pelvic fractures cause substantial morbidity and can lead to long-term impairment in physical functioning, as well as difficulties with daily activities and negative psychological health. Surgical intervention is necessary for treating unstable pelvic fractures, which may involve isolated posterior or combined posterior and anterior fixation utilizing screws and plates to restore anatomical alignment and promote natural healing. A 19-year-old female road traffic accident victim in hemorrhagic shock was hemodynamically stabilized and investigated for associated injuries. She was diagnosed with bilateral sacroiliac joint dislocations, bilateral superior and inferior pubic rami fractures and crescent fracture of the right iliac wing, Grade III liver injury, Grade III splenic infarction and hemoperitoneum, lung contusion, and bilateral hemothorax with multiple rib fractures, fracture of the transverse process of L4 and L5 vertebrae. A secondary survey revealed a right sciatic nerve injury, admitted to intensive care and managed by a multidisciplinary approach. Abdomen and thorax injuries were managed conservatively, and meanwhile, the pelvic fracture was stabilized by a damage control protocol, and definitive surgical intervention includes iliac crest wound debridement and pelvic ring open reduction and internal fixation by the Modified Stoppa approach. Abdomen and chest injuries were managed conservatively. Monthly regular follow-up was the first 6 months, was able to walk and sit comfortably at the end of 4 months, and was able to resume her normal routine work and job at 6 months without any pain and limitation of movements. It is essential to promptly identify and assess the injuries and implement appropriate perioperative management by a multidisciplinary team. Temporary stabilization of fracture followed by the management of associated injuries and delayed definite fixation yields the best result in polytrauma patients with pelvic fracture.

MYCOBACTERIUM TUBERCULOSIS HIP INFECTION MANAGEMENT: CASE REPORT AND LITERATURE REVIEW

Infection of the hip by Mycobacterium tuberculosis is a rare yet serious condition that can result in significant pain and impaired physical function. This case report outlines the clinical manifestation and treatment of a 50-year-old patient experiencing hip discomfort and functional impotence. The patient's left lower extremity exhibited adduction and flexion of the thigh relative to the pelvis, resulting in severe pain and immobility. The hip infection has been attributed to M. tuberculosis following an extensive clinical evaluation and research. The medical recommendation was to undergo a twostage hip arthroplasty procedure. During the initial stage of treatment, the contaminated prosthesis was extracted, and the infectious outbreak was thoroughly sanitized. Subsequently, a cement spacer was introduced to maintain the space between the surfaces of the hip joint and prevent additional infection. Despite its challenging and invasive nature, the twostage hip arthroplasty procedure is an effective treatment choice for hip infections caused by Mycobacterium tuberculosis. The case report highlights the importance of promptly identifying and treating hip infections in patients caused by uncommon bacteria, such as Mycobacterium tuberculosis. Infection of the hip caused by M. tuberculosis is infrequent but perilous, necessitating prompt treatment. Two-stage hip arthroplasty is a beneficial therapeutic choice that should be considered for patients with suspected hip infections.

Prevalence of Cognitive Impairment Amongst Older Adults and the Associated Risk Factors

Cognitive impairment in older adults refers to a decline in mental abilities such as memory, attention, and problem-solving, often associated with aging. This study aimed to show the prevalence of cognitive impairment among older people and examine the risk factors in acquiring the disease. This cross-sectional, community-based study was implemented between August 2022 and August 2023. The study population involved older adults (n= 400) living in urban regions aged ≥60 years. A questionnaire used to collect sociodemographic data. Further, mini mental state examination tool to assess cognitive function, activities of daily living tool to assess physical functional capacity, patient health questionnaire-9 tool to identify depressive symptoms, Snellen chart to examine visual acuity and whispered voice test to examine hearing acuity were used. Chi-square test used to investigate the association between risk factors and cognitive impairment. The prevalence of cognitive impairment was 31.25% in examined community. The risk of the disease was higher in the following participants: age group 90-100 (71.4%), female (45.9%), unemployed (47.1%), having insufficient socioeconomic level (51.2%), being illiterate (49.3%), having low hearing acuity (77.4%), having sever functional impairment (78.6%), being widowed (56.8%), living with others rather than a spouse (54.4%), having low visual acuity (33.3%), and having depressive symptoms (65.1%). The severity of cognitive impairment is statistically significantly related to age group of 90-100 years old (80%), smokers (n = 21) is mostly mild [n=9/21 (42.85%)], the decrease in hearing acuity is more frequent among those with sever cognitive impairment [n= 9/24 (37.5%)], and most of the features were of mild severity [n= 45/69 (65.2%)]. Cognitive impairment is a prevalent disease, and the risk factors are being females, unemployed, have a low socioeconomic level, illiterate, and widowed. Moreover, the disease is substantially related with increasing age, low hearing and visual acuity, depressive symptoms, and physical functional impairment.

Тривога та порушення сну: можливості комбінованої фітотерапії

According to the WHO, the number of people suffering from anxiety disorders, sleep disorders, and depression is increasing every year, especially in low-income countries, where life expectancy is increasing dramatically, and with it the incidence of mental disorders [1, 2]. Anxiety disorders are the most common group of mental illnesses together with sleep disorders and astheno-neurotic syndrome [3]. Anxiety accompanies the course of many mental and somatic diseases [4]. It usually appears early in life, causes cumulative damage, and can contribute to depression, substance abuse, and other adverse outcomes [5]. Sleep disturbances and anxiety are frequent competing or synergistic symptoms. The onset and development of these conditions are often interrelated. In addition, these conditions often correlate with the appearance and course of other disorders - such as depression, dementia, and obsessive-compulsive disorder. Long-term, uncorrected disturbances of circadian rhythms lead to clinically significant distress and cause mental, physical, social, professional, educational, or other functional impairments [6].

Efficacy of Anticonvulsant Administration as Seizure Prophylactic Therapy in Traumatic Brain Injury Patients

Traumatic brain injury (TBI) is a non-degenerative, non-congenital disorder of the brain that occurs due to external mechanics that can cause permanent or temporary impairment of cognitive, physical and psychosocial functions. Based on the 2018 Basic Health Research (Riskesdas) data, the prevalence of head injuries in Indonesia is 11.9%. Seizures after head injury result in secondary brain damage and seizure prophylaxis is only recommended in patients with TBI during the first seven days. This study was designed to assess the efficacy of anticonvulsants as prophylactic therapy in patients with TBI in Indonesia. The research method used was a literature review that was searched using Google Scholar, Pubmed, Medline, Ebsco, Hindawi, ScienceDirect, and Cochrane, published in the last ten years. After obtaining the appropriate literature, the manuscript is written. The results showed that prophylactic anticonvulsants such as Phenytoin could reduce the incidence of early posttraumatic seizures (PTS) in patients with TBI compared to placebo. Another study also stated that giving anticonvulsants (Carbamazepine, Phenobarbital, Phenytoin, Levetiracetam and Valproate) in preventing early PTS showed effective results in TBI when compared to placebo. So, it can be concluded, based on the literature search conducted, anticonvulsants are proven to be able to prevent PTS, with the recommendation of drug choice being Phenytoin.

Physical Functioning in Patients with a Recent Fracture: The “Can Do, Do Do” Framework Applied to Explore Physical Capacity, Physical Activity and Fall Risk Factors

Physical capacity (PC) and physical activity (PA) are associated physical performance measures, and combined, PC and PA are used to categorize physical performance in the “can do, do do” framework. We aimed to explore physical performance of patients attending the fracture liaison service (FLS). In this cross-sectional study, PC was measured by 6-min-walking-test (can’t do/can do) and PA by accelerometer (don’t do/do do). Following quadrants were defined based on predefined cut-off scores for poor performance: (1) “can’t do, don’t do”; (2) “can do, don’t do”; (3) “can’t do, do do”; (4) “can do, do do”. Odds ratios (OR) were calculated and fall and fracture risk factors were assessed between quadrants. Physical performance of 400 fracture patients was assessed (mean age 64; female 70.8%). Patients performed as follows: 8.3% “can’t do, don’t do”; 3.0% “can do, don’t do”; 19.3% “can’t do, do do”; 69.5% “can do, do do”. For the “can’t do” group the OR for low PA was 9.76 (95% CI: 4.82–19.80). Both the “can’t do, don’t do” and “can’t do, do do” group differed significantly compared to the “can do, do do” group on several fall and fracture risk factors and had lower physical performance. The “can do, do do” framework is able to identify fracture patients with an impaired physical performance. Of all FLS patients 20% “can’t do, but “do do” while having a high prevalence of fall risk factors compared to persons that “can do, do do”, which may indicate this group is prone to fall.

Sex-differences in the longitudinal recovery of neuromuscular function in COVID-19 associated acute respiratory distress syndrome survivors.

Patients admitted to the intensive care unit (ICU) following severe acute respiratory syndrome 2 (SARS-CoV-2) infection may have muscle weakness up to 1 year or more following ICU discharge. However, females show greater muscle weakness than males, indicating greater neuromuscular impairment. The objective of this work was to assess sex differences in longitudinal physical functioning following ICU discharge for SARS-CoV-2 infection. We performed longitudinal assessment of physical functioning in two groups: 14 participants (7 males, 7 females) in the 3-to-6 month and 28 participants (14 males, 14 females) in the 6-to-12 month group following ICU discharge and assessed differences between the sexes. We examined self-reported fatigue, physical functioning, compound muscle action potential (CMAP) amplitude, maximal strength, and the neural drive to the tibialis anterior muscle. We found no sex differences in the assessed parameters in the 3-to-6-month follow-up, indicating significant weakness in both sexes.Sex differences emerged in the 6-to-12-month follow-up. Specifically, females exhibited greater impairments in physical functioning, including lower strength, walking lower distances, and high neural input even 1 year following ICU-discharge. Females infected by SARS-CoV-2 display significant impairments in functional recovery up to 1 year following ICU discharge. The effects of sex should be considered in post-COVID neurorehabilitation.