Activities Of Daily Living Difficulties Research Articles

Dual-task interference during hand dexterity is a predictor for activities of daily living performance in Parkinson's disease

IntroductionDual-task interference (DTI) leads to impairment of hand dexterity in Parkinson's disease (PD). The performance of activities of daily living (ADL) is negatively affected by dexterity in PD. However, the contribution of DTI to dexterity-related ADL disability remains unclear. This cross-sectional study aimed to investigate the contribution of DTI to ADL performance as well as other factors affecting dexterity. MethodsOne-hundred and eight patients with PD were assessed using the ADL-related dexterity questionnaire-24 to measure dexterity-related ADL performance. Performance in single and dual task conditions was measured with the 9-hole peg test. Disease severity, cardinal symptoms and grip strength were assessed using Hoehn&Yahr, a modified version of the Unified Parkinson Disease Rating Scale, Part-III, and a hand dynamometer. The age and cognitive status were control variables. ResultsMultiple regression analysis revealed that disease severity explained 8.5% of the variance in dexterity-related ADL (p = 0.002). The DTI in the dominant hand was the strongest predictor of ADL performance (R2 change = 0.44, p < 0.001), but DTI in the non-dominant hand did not contribute. When cardinal symptoms were added to the model, bradykinesia contributed to ADL difficulty (R2 change = 0.072, p < 0.001), while tremor and rigidity were not significant in any model. This model accounted for 59.2% of the variance in ADL difficulties in total. ConclusionThe study demonstrated that disease severity, bradykinesia and DTI in the dominant hand contributed to ADL difficulties in patients with PD, and DTI in the dominant hand is the strongest predictor of ADL performance in PD.

SAT-031 DIFFICULTY IN ADL AND FALLS IN HEMODIALYSIS PATIENTS IN COMPARISON WITH NON-RENAL PATIENTS

Patients undergoing hemodialysis have impaired activity of daily living (ADL), but it is not well characterized what activities are particularly difficult for such patients. In addition, hemodialysis patients have a high incidence of falls, although no previous study examined comparison with other population. The aims of this study were 1) to characterize the subjective difficulty in ADL, 2) to examine history of falls, and 3) to explore a possible relationship between ADL difficulty and falls in hemodialysis patients by comparing with those without renal failure. This was a cross-sectional study including two groups of out-patients in a single hospital aged 50 years or older. One was renal failure patients treated with maintenance hemodialysis, and the other was non-renal patients with diabetes mellitus, hypertension, and/or dyslipidemia (control group). ADL difficulty was evaluated by a questionnaire regarding a total of 48 items which were classified into the six categories of ADL namely locomotion, eating, toileting, dressing, bathing, and grooming. These items were rated by each participant as very easy (0), relatively easy (1), relatively difficult (2), or very difficult (3). Falls in the previous year was examined by a questionnaire. The participants were 209 hemodialysis patients (median age of 68, 42% women), 139 patients in the control group (median age of 67, 37% women). The median (interquartile range) of the total score of ADL difficulty was 10 (2 to 39) in the hemodialysis group, which was significantly higher than 2 (0 to 10) of the control group. The higher ADL difficulty in the hemodialysis group was again significant when the score was compared in the six categories. The proportion of those with history of falls in a year was 35% in the hemodialysis group, which was significantly higher than 12% in the control group. We examined factors associated with falls by using multivariate logistic regression analysis. Higher age and female sex were significant factors associated with falls in the control group, but not in the hemodialysis group. Of note, a higher total score of ADL difficulty was an independent factor associated with falls in both groups, and the same was true when the scores of the six ADL categories were individually analyzed. As compared with the control group, patients undergoing hemodialysis had a significantly higher difficulty in various ADLs, which could be attributable to both lower and upper limbs. They had history of falls at a higher proportion. The history of falls was shown to be associated with ADL difficulty commonly in the hemodialysis and control groups.

Subjective health and quality of life among elderly people living with chronic multimorbidity and difficulty in activities of daily living in rural South Africa.

Background: South Africa has been experiencing a growing proportion of elderly population with rapid increases in the burden of non-communicable diseases (NCDs) characteristic of population aging. Rural areas in South Africa represent a far smaller fraction of the population, however, share a relatively higher burden of NCDs. In the current literature, there is limited evidence on rural studies in the context of chronic diseases and activities of daily living (ADLs) among the elderly population (60 years and above) in South Africa.Purpose: In this regard, we undertook the present study with the objective of examining the demographic, behavioral, and socioeconomic predictors of subjective health, depression, and quality of life among elderly men and women living in the rural areas (n=2,627).Methods: Data for this study were collected from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). Main explanatory variables were self-reported NCDs and difficulties in ADLs. The predictors of subjective health, depression, and quality of life were assessed using multivariable regression methods.Results: We found that the proportion of participants who reported good health, not having depression, and good quality of life was respectively 44.7%, 81.3%, and 63%. Women in the oldest age group (80+ years) were significantly less likely to report good health (OR=0.577, 95% CI=0.420, 0.793) and quality of life (OR=0.709, 95% CI=0.539, 0.933) compared with those in the youngest group. Having more than one chronic condition and ADL difficulties significantly lowered the odds of good health, having no depression, and quality of life among men and women.Conclusion: The present findings suggest the involvement of sociodemographic factors in health and quality of life outcomes among elderly South Africans, and call for enhanced efforts to address these health limiting conditions such as ADLs and chronic multimorbidity.

Years of life with and without limitation in physical function and in activities of daily living by body mass index among older adults.

While older adults with pre-obesity and Class I obesity have similar or lower mortality risk versus those with normal weight, a heavier body mass index (BMI) may not translate into more healthy life years. Utilizing longitudinal data on 3452 older (≥60 years) Singaporeans, we assessed the association between BMI and years of remaining life overall with and without limitation in physical function and in activities of daily living (ADLs). Difficulty in any of nine tasks involving upper or lower extremities was considered as limitation in physical function, and health-related difficulty in any basic ADL or instrumental ADL as limitation in ADLs. We utilized multistate life tables, including BMI as a time-varying covariate. At age 60, life expectancy (LE) was similar for those with normal weight, pre-obesity and obesity. However, those with obesity, versus normal weight, had 6.3 [95% confidence interval: 3.4-9.2] more years with limitation in physical function and 4.9 [3.4-6.5] less years without limitation in physical function. Those with pre-obesity, versus normal weight, also had 3.7 [1.9-5.3] more years with limitation in physical function. The same pattern across BMI categories was observed for years of life with and without limitation in ADLs. In stratified analyses, similar associations of BMI with years of life with and without limitation in physical function and in ADLs were observed across gender, ethnicity, and educational status. The increasing global prevalence of obesity may result in an increase in years of life with limitation in physical function and in ADLs at older ages. Older adults, their families and healthcare systems should be cognizant of this issue.

Symptoms and Functional Measures in Individuals Performing Various Exercise Intensities: A Pilot Study

PurposeTo assess the functional limitations in activities of daily living (ADL) and level of delayed onset of muscle soreness (DOMS) in individuals after completing various intensities of exercises with and without prior yoga stretching poses.MethodsTwelve research participants (untrained active healthy men and women) aged between 18 and 30 years were recruited from students of University of New England and randomly assigned into 2 groups (six participants each). Four muscle groups (elbow flexors, elbow extensors, knee flexors and knee extensors) were selected (one muscle group per limb) from each participant and maximal voluntary isometric contraction (MVIC) in all four selected muscles were calculated using a hand‐held Dynamometer.Participants performed eccentric exercises protocol (5 × 10 repetitions with rest time) with full active range of motion using (Ultimately Fit Adjustable Ankle Weights) their 15% of MVIC on day 1 of first week, 25% of MVIC on day 1 of third week, and 35% of MVIC on day 1 of fifth week in all four limbs (right and left upper elbows and right and left knees). Participants did not perform any exercise protocol during the week 2 and 4. In weeks 1, 3, and 5, after the eccentric exercise protocol (day 1), from day 2 to 6 the subjective (health activities of daily living (ADL) difficulty scale, visual analogue scale (VAS)) and objective assessments (pain pressure threshold (PPT), arm and thigh circumference, and active range of motion (AROM)) were carried out. Group 1 (6 participants) performed only exercise protocol whereas group 2 (6 participants) performed prior yoga stretching poses for upper and lower limbs along with above mentioned exercise protocol.ResultsGroup 2 participants has minimal pain and health activities of daily living (ADL) difficulty when compared to group 1 participants. Group 1 participants performed exercise protocol at week 5 with 35% MVIC had moderate pain (pain scale ranged 3–6 out of 10) in the elbow extensors and ADL difficulty (difficulty level scale ranged 3–6 out of 10) in pull a heavy object, carry an object with my arm above shoulder, washing opposite armpit and back, reach high shelf, ascending stairs, bend to pick up form the floor when compared to group 2 participants. There was no significant difference in the AROM and, arm and thigh circumference between both groups during entire exercise protocol.ConclusionUpper limb (extensors) muscles are more prone for DOMS when compared to lower limb muscles. Yoga stretching poses prior to eccentric exercise protocol may have effect in reducing DOMS.Support or Funding InformationFunded by Biology Department, College of Arts and Sciences, University of New England, METhis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Validation of the global activity limitation indicator in Taiwan

BackgroundThe Global Activity Limitation Indicator (GALI) is a single-item measure of functional decline, it is widely used in Europe but it has never been validated in an Asian population. The aim of this study was to validate the GALI in a sample of older Taiwanese people and to explore whether it captured not only physical but also psychological limitations.MethodsData for 4961 individuals (mean age, 62.4 ± 9.4 years; 47.2% men) were obtained from a national representative refresh cohort of the 8th wave of the Taiwan Longitudinal Survey on Aging. Logistic regression analysis was used to examine associations among the GALI, activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and to explore whether depressive symptoms (measured by the Center for Epidemiologic Studies Depression Scale, CES-D) could be an indicator of reporting limitations on the GALI.ResultsResponding to the GALI, 21.7% of the sample described themselves as ‘limited.’ In logistic regression, the GALI response was significantly associated with those who reported one or more ADL difficulties (odds ratio [OR] = 35.89, 95% confidence interval [CI] 21.10, 61.03) and IADL difficulties (OR = 13.37, 95%CI 10.09, 17.71), respectively. Furthermore, those with more depressive symptoms were more likely to report they were ‘limited’ on the GALI.ConclusionsThese findings provided evidence that the GALI is a valid tool to assess general limitations in an Asian population. Furthermore, it captured psychological limitations to some extent. There were variations between Taiwan and European countries (as has been previously reported between European countries). The reporting level in the GALI by the Taiwan population was comparatively lower than that in European countries, highlighting the need to embrace cultural differences and to use caution when comparing GALI results across countries.

Disability-Specific Associations with Child Health and Functioning.

This study examined the health profile of children with different types of disabilities and explored the disability-specific associations with various types of health and functioning using a large nonclinical sample of children. A cross-sectional school survey was conducted during 2016 and 2017. A total of 4114 children (aged 6–18 years) receiving primary or secondary education, or their proxy, in Hong Kong participated in the study. Disabilities were categorized as (a) physical disabilities; (b) learning and developmental disabilities; (c) intellectual disabilities; (d) internalizing disorders or mental illness; and (e) autism spectrum disorder. Health-related quality of life (QoL), sleep-related QoL, activities of daily living (ADL), emotional functioning, and social functioning were assessed and compared between children with disabilities and those without. The results showed that children with disabilities showed poorer physical functioning, health-related QoL, and emotional and social functioning than their counterparts without disabilities. Disability-specific associations with health were found: (a) physical disabilities and intellectual disabilities were associated with greater difficulties in ADL; (b) language impairment and Attention deficit/ hyperactivity disorder (ADHD) were negatively associated with sleep-related QoL; (c) all types of disabilities but hearing impairment were negatively associated with health-related QoL (HRQoL); and (d) language impairment, ADHD, internalizing disorder, as well as autism spectrum disorder were associated with greater abnormal behavioral difficulties. The findings warrant the development of tailor-made intervention programs and give insights to effective resource allocation for the children in need.

Everyday Language Difficulties in Parkinson's Disease: Caregiver Description and Relationship With Cognition, Activities of Daily Living, and Motor Disability.

Purpose Parkinson's disease (PD) impacts language in multiple ways, though important questions remain. The current article explores 2 main issues: what type of everyday language difficulties (ELDs) are noted by care partners and how do ELDs relate to cognition, daily activities, and motor disability in PD. Method Care partner reports of ELD were collected in 42 community-dwelling individuals with PD. Descriptive information of ELD was tallied, and the relationship of cognitive decline, activities of daily living (ADLs), and motor disability with ELD was evaluated. Results Forty-two percent of patients were described by care partners as having at least 1 consistent ELD, and the frequency of ELD increased in the presence of dementia, χ2(2) = 14.37, p = .0008. The most commonly described ELDs by caregivers were related to comprehension of instructions and deriving the point of conversations. ELD was correlated with worse cognition ( r s = -.524, p < .001), increased difficulty with daily activities ( r s = .634, p < .001), and increased motor dysfunction ( r s = .554, p < .001). Mild ADL decline (Functional Assessment Questionnaire score of 4); an area under the curve of .81 ( SE = .07) was highly specific to the presence of ELD (95.4%). Conclusions Care partners note a variety of ELDs in patients with PD, most commonly comprehension difficulties. These difficulties increase with overall cognitive decline but are described in 30%-40% of those without significant cognitive deficits. ADL difficulties correlate with functional, motoric, and cognitive status, with even mild functional declines predictive of the presence of ELD. Implications for research and practice in this population are discussed.

Association between fear of falling and activities of daily living among community-dwelling Japanese older adults

Objectives This study aimed to explore the association of difficulties in activities of daily living (ADL) (activities related to bending, spine extension, standing endurance, and walking) with fear of falling among community-dwelling older adults.Methods We recruited 642 older adults (men, n=267; women, n=375) aged 65 years and over. The mean age was 72.2±5.1 years. Fear of falling, falls in the previous year, pain (low back pain or knee pain), comorbidity, and cataracts were assessed using a self-administered questionnaire. ADL difficulties were assessed individually, such as activities related to bending (getting in or out the car, picking up a lightweight object, putting on socks or stockings, and lifting a 5 kg object from the floor), spine extension (reaching an object above your head), standing endurance (standing on your feet for 2 h), and walking (walking 100 m on a level surface, climbing 10 steps without stopping, and walking down 10 steps). The independent association between fear of falling and each ADL difficulties was assessed using logistic regression analysis.Results Participants with fear of falling, compared with those without fear of falling, had an older age (74.8 and 71.6 in men, 73.3 and 71.0 in women, respectively; P<0.01), more falls in the previous year (21% and 9% in men, 28% and 11% in women, respectively; P<0.05), pain (80% and 61% in men, 82% and 64% in women, respectively; P<0.01), and comorbidity (23% and 15% in women, respectively; P<0.05). Multivariate logistic regression analysis identified each ADL difficulties except walking 100 m on a level surface as being independently associated with fear of falling after adjusting for age, body mass index, sex, falls in the previous year, pain, and comorbidity.Conclusion ADL difficulties, such as activities related to bending, spine extension, standing endurance, and walking, except for walking 100 m on a level surface, were associated with fear of falling.

Understanding parents' difficulties in executing activities of daily living of children with autism spectrum disorder: A qualitative descriptive study

Background: Activities of daily living (ADLs) refer to the ongoing behaviors that occur on a daily basis. Such behaviors include eating, cooking, bathing, social interactions (such as leisure activities, attending school or work, or assisting with chores), and other activities that one might routinely expect an individual to perform or participate in. Some of the major ADL tasks include personal hygiene, toileting, dressing, and eating. Researchers have documented delayed self-care performance in children with autism spectrum disorder (ASD). Parents report their child to have difficulties with feeding and toileting in particular. Objective: This qualitative pilot study endeavored to understand the difficulties faced by the parents of children with ASD in conducting their children's ADL. Study Design: Qualitative descriptive study was chosen for the research. Methods: The qualitative descriptive study included participants (n = 20) whose children were primarily diagnosed as ASD. Convenient sampling method was used for study sample calculation. The study included parents of children of age group between 5 and 9 years (mean ± standard deviation [SD]: 6.9 ± 1.57 months) with intelligence quotient of ≥80%. The study was conducted in a tertiary care hospital. The parents (fathers = 9 and mothers = 11) were given a semistructured questionnaire to understand difficulties faced by the parents of children with ASD (mean ± SD: 5.56 ± 33.6 months). Results: According to the study, it was observed that most of the parents have reported that their child had maximum difficulties in eating, followed by brushing and grooming and least for toileting. This study also found the priority list of difficulties in ADL. It was noted that early and proper training of the child gives good results in managing a child with ASD. Many parents reported that early training is beneficial. Conclusion: The outcome of this study shows the hierarchy of difficulties in ADL reported by the parents of children with ASD. This study also found that early ADL training gives good results in managing child with ASD.

Developmental Coordination Disorder (DCD): An overview of the condition and research evidence

Abstract Developmental Coordination Disorder (DCD) is a neurodevelopmental condition marked by impairments in the development of motor coordination. The uncoordinated movements of children with DCD lead to performance difficulties in daily life activities and academic settings. Despite the high prevalence of this condition (2-7%) and severe consequences associated with it, DCD is not well recognized in clinical and educational practices, particularly in Brazil. This review provides an overview of DCD and the research evidence - we present definitions and characteristics associated with the condition, the diagnostic criteria, associated difficulties, frequent co-morbidities and a summary of the possible causes. Finally, we review management strategies and intervention approaches for DCD. We also discuss some of the common challenges of the field - while DCD has been largely studied in the last decade, there are still many gaps between research and practice that need to be filled. Awareness and dissemination of relevant, scientific information is necessary. In conclusion, DCD is a significant condition with a clear diagnostic criteria, and requires intervention to improve motor and functional skills, which can improve the associated difficulties as well as the physical and mental health consequences of the condition.

Association Between Executive Dysfunction and Instrumental Activities of Daily Living: Racial and Ethnic Differences Among Community-Dwelling Older Adults in the Southeastern US.

ObjectiveExamining cultural differences in assessment of cognitive/functional disability among older Americans is needed. This analysis examined associations between day-to-day function, measured by activities of daily living (ADL), and cognition, measured by CLOX scores, among older African American (AA) and non-Hispanic White (nHW) community-dwelling women and men. Methods: Design- Cross-sectional. SettingHomes of community-dwelling older adults. Participants- 893 Medicare beneficiaries >65 living in west-central Alabama, without diagnoses of dementia, who were participants in the University of Alabama at Birmingham (UAB) Study of Aging, and who had complete data. Measurements- Physical function was assessed by self-reported ADL difficulty; cognitive function by CLOX, a clock drawing-task. Multivariable, linear regression models were used to examine associations within race/sex specific groups. ResultsAfter controlling for socio-demographic factors and comorbidities, CLOX1 scores were inversely and significantly correlated with ADL for AA men (β = −0.205, P = 0.003). CLOX2 scores were similarly associated with ADL and IADL for the total group (β = −0.118, P = 0.001, and β = −0.180, P < 0.001, respectively); for ADL, significant associations were seen for AA men and nHW women (β = −0.203, P = 0.004, and β = −0.139, P = 0.02, respectively) and, for IADL, in AA women and men (β = −0.156, P = 0.03, and β = −0.24, P < 0.001, respectively). ConclusionWhile African American women reported the highest difficulty with ADLs and IADLs among all race/sex groups, CLOX1 scores were correlated with ADL for AA men only. CLOX1 may have limitations to identify functional disability for older AA women. [Word Count = 234].

Depression and associated variables in people over 50 years in Spain

IntroductionDepression is a common and disabling psychiatric disorder in adulthood and is associated with higher mortality and functional disability. ObjectivesTo determine the association between clinical and sociodemographic variables with depression in a sample of people over 50 years old living in Spain, and compare the prevalence of depression with the other Survey of Health, Ageing and Retirement (SHARE) countries. Material and methodsThere were 5830 participants in the Spanish sample of the Wave 5, 2013, of SHARE. Tools used: EURO-D (Depression) and CASP-12 (Quality of Life). Statistical analysis: bivariate, and binary logistic. ResultsThe variables associated with depression in the binary logistic regression (EURO-D≥4) were poor self-perceived physical health (OR=13.34; 95% CI: 9.74–18.27), having more than 2 difficulties in Activities of Daily Living (ADL) (OR=4.46; 95% CI: 3.13–6.34) and female gender (OR=2.16; 95% CI: 1.83–2.56). Depression was more common among participants with Alzheimer (76.4%), emotional disorders (73.9%), Parkinson (57.4%), hip fracture (55.4%), and rheumatism (50.9%). Compared with other European countries, Spain had a percentage of people with depression (29.3%) that was higher than the European average (27.9%). ConclusionsThe most important variables associated with depression were poor perceived physical health, presence of difficulties in ADL, and female gender.

Obstetric brachial plexus palsy - A prospective, population-based study of incidence, recovery and long-term residual impairment at 10 to 12 years of age.

To assess the long-term outcome and evaluate prognostic factors in obstetric brachial plexus palsy (OBPP). Of all 114 children with OBPP born in western Sweden in 1999-2001, 98 (61 males, 37 females) were invited to participate. A questionnaire on the symptoms of the OBPP was sent out and those with persisting symptoms were examined in terms of muscle strength, range of motion (ROM), activities of daily living (ADL), pain and sensibility at the age of 10-12years. Contact was made by 87 children. The incidence of persisting OBPP at 10-12 years of age was calculated as 19 per 38,749 live births or 0.49 per 1000. Symptoms were reduced muscle strength and ROM in the arm. Eight children reported pain, four had impaired sensibility and ten children described some difficulties in ADL. Muscle strength in forearm supination, shoulder external rotation and elbow flexion at three months of age can be used to predict outcome. Most children with an OBPP recover completely, but one in five has symptoms of the injury at 10-12 years of age. Muscle strength in the arm at three months of age can be used to predict outcome.

Persistent Pain Quality as a Novel Approach to Assessing Risk for Disability in Community-Dwelling Elders With Chronic Pain.

This study aims to test whether persistent pain quality is associated with incident or worsening disability in four domains: mobility, activity of daily living (ADL) and instrumental activity of daily living (IADL) difficulty, and physical performance. From the MOBILIZE Boston Study, a population-based cohort of adults aged ≥70 years, we studied participants with chronic pain who endorsed at least one pain quality descriptor (N = 398) and completed baseline and 18-month assessments. Pain quality was assessed using an adapted short-form McGill Pain Questionnaire with 20 pain quality descriptors in three categories: sensory, cognitive/affective, neuropathic. Persistence was defined as endorsing the same category at baseline and 18 months. Self-reported outcomes included mobility, ADL, and IADL difficulty. Physical performance was assessed using the short physical performance battery. After adjusting for baseline pain severity and other covariates, individuals with three persistent categories had a greater risk of developing new or worsening IADL difficulty relative to those with one persistent category (relative risk [RR] 2.69, 95% confidence interval [CI] 1.34, 7.79). Similar results were observed for ADL difficulty (RR 5.83, 95% CI 1.32, 25.85), but no differences were noted in risk for mobility difficulty. There was no significant linear trend in physical performance over 18 months according to number of persistent categories (p =.68). Elders with persistent pain quality experienced a higher risk of developing new or worsening IADL and ADL disability with each additional category but not mobility difficulty or poorer physical performance. Longitudinal assessment of pain quality could be useful in determining risk for global disability among elders with chronic pain.

Occupational Therapy Interventions to Improve Activities of Daily Living for Community-Dwelling Older Adults: A Systematic Review.

This systematic review aimed to synthesize the effects of interventions within the scope of occupational therapy to improve performance of activities of daily living (ADLs) in community-dwelling older adults. Searches were conducted in CINAHL, the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, and OTseeker. Empirical studies published between 1995 and 2015 were individually screened and appraised by two reviewers. Forty-three studies met the review inclusion and exclusion criteria. Physical exercise was the most common intervention approach. Physical exercise interventions for frail older adults showed a moderate benefit, but no benefits were found for older adults without noticeable difficulty in ADLs. For older adults with difficulty in ADLs, there was a high benefit of using home-based intervention. The findings of this systematic review highlight the importance of addressing older adults' living environment in intervention to promote independence in ADLs.

Low back pain and disability in military police: an epidemiological study

Abstract Introduction: The low back pain is a major public health problem in industrialized societies, commonly affecting the adult population. The occupation is considered as a risk factor, especially those functions that require physical effort, we have as example the job of the military police, who are exposed to several risk factors, both those who perform administrative activities, and those who perform the ostensive policing. Objective: The aim of this study was to evaluate the prevalence of low back pain among military police, as well the presence of disability and associated factors. Methods: This is an analytical cross-sectional study. Was evaluated the level of disability, pain before and after the work shift, flexibility, postural alterations and anthropometric measures. It was used the regression analysis, considering 95% CI and p &lt; 0.05. Were interviewed 97 military police with mean age of 39.30 (± 5.33), all males. Results: The complaint of low back pain was significantly larger after the work shift, and 82.5% reported difficulties in daily life activities due to low back pain. Conclusion: There is a high prevalence of low back pain and impairment in daily life activities because of military police. The data presented reinforce the need to consider low back pain as a public health problem that affects the whole population, especially the military police.

Abstract P044: Plasma Phospholipid Very Long Chain Saturated Fatty Acids and Healthy Aging in Older Adults: The Cardiovascular Health Study

Introduction: Circulating very long-chain saturated fatty acids (VLSFA) are biomarkers of diet and metabolism which impart different biological activities to sphingolipids and may influence physiological pathways relevant to aging. Higher levels of circulating VLSFAs have been associated with lower risk of all-cause mortality, cardiovascular outcomes, and diabetes. Apart from these associations, it is unknown whether these biomarkers are related to the maintenance of healthy aging. Hypothesis: Higher levels of circulating VLSFA are associated with lower risk of unhealthy aging. Methods: Phospholipid fatty acids were measured in serial plasma samples collected among participants of the Cardiovascular Health Study (CHS) in 1992-93, 1998-99, and 2005-06. Incident unhealthy aging was defined as the onset of cardiovascular disease (CVD), cancer, lung disease, severe chronic kidney disease, ≥1 difficulties with activities of daily living (ADL), or reduced cognitive function (Mini-Mental State Examination&lt;80). We assessed the associations of arachidic acid (20:0), behenic acid (22:0) and lignoceric acid (24:0), with risk of incident unhealthy aging using Cox regression with time-updated fatty acid levels and covariates. Results: Among 2,183 CHS participants with one or more fatty acid measure and healthy aging up to the time of their first VLSFA measurement, mean age at baseline was 75 years, 62% were female, and 12% were black. During median follow-up of 8 years, all but 198 participants failed to age successfully. The most common conditions marking the first occurrence of unhealthy aging were ADL difficulties and CVD (27% each). In analyses adjusted for major risk factors, higher levels of 22:0 and 24:0 were associated with lower risk of unhealthy aging (Table). Conclusions: Higher levels of two circulating VLSFA, 22:0 and 24:0, are associated with lower risk of unhealthy aging. These findings open a new avenue of research into these saturated fatty acids and their possible beneficial role in promoting better aging.

Determinants of difficulty in activities of daily living in ambulatory patients undergoing hemodialysis

BackgroundPatients undergoing hemodialysis (HD) have difficulty performing activities of daily living (ADL) compared to healthy people. ADL difficulty is an early predictor of loss of independence and mortality in older community-living people. However, determinants of ADL difficulty in HD patients have not been clarified. This study aimed to identify factors associated with ADL difficulty in ambulatory HD patients.MethodsSubjects were 216 Japanese outpatients (130 men, 86 women; mean age, 67 years) undergoing maintenance HD three times a week. Clinical characteristics, depressive symptoms, motor function (leg strength, balance, and walking speed), and ADL difficulty related to lower-limb function such as mobility issues were compared across three difficulty levels (higher, middle, and lower) as classified according to the percentages of patients with perceived difficulty. Multivariate logistic regression analysis was performed to examine whether clinical characteristics, depressive symptoms, and motor function could discriminate ADL difficulty at each level. Receiver operating characteristic curve analysis was performed to determine cut-off values of motor function for predicting ADL difficulty at each level.ResultsADL difficulty was independently associated with age (odds ratio (OR) = 1.05, 95% confidence interval (CI) 1.00–1.10; P = 0.039), presence of depressive symptoms (OR = 4.24, 95%CI 1.13–15.95; P = 0.033), and usual walking speed (OR = 0.94, 95%CI 0.90–0.97; P < 0.001) for higher level difficulty; age (OR = 1.06, 95%CI 1.02–1.10; P = 0.006), maximum leg strength (OR = 0.97, 95%CI 0.94–1.00; P = 0.043), and usual walking speed (OR = 0.96, 95%CI 0.93–0.98; P = 0.001) for middle level difficulty; and age (OR = 1.06, 95%CI 1.02–1.10; P = 0.006) and usual walking speed (OR = 0.93, 95%CI 0.90–0.6; P < 0.001) for lower level difficulty. Cut-off values of usual walking speed for predicting ADL difficulty for higher, middle, and lower level difficulty were 83.7, 75.5, and 75.1 m/min, respectively.ConclusionsA slow walking speed and old age were significantly and independently associated with ADL difficulty in ambulatory HD patients. Presence of depressive symptoms was significantly and independently associated with ADL difficulty at the higher level of difficulty in ambulatory HD patients. These findings provide useful data for planning effective therapeutic regimens to prevent ADL difficulty in ambulatory HD patients.

Disability due to knee pain and somatising tendency in Japanese adults

BackgroundKnee pain is common and related to knee osteoarthritis. However, there is a discrepancy between knee pain and radiographic osteoarthritis. In the general population, knee pain is associated with psychological and cognitive factors, which would be one explanation for the discrepancy. Limited evidence demonstrates that somatization is associated with knee pain. This study examined the association between disability due to knee pain and a high somatising tendency.MethodsJapanese adults (aged 20–64 years) who had experienced knee pain in the past four weeks were included in this study (n = 14,695, 50% women). Data were extracted from a large internet survey. Somatising tendency was assessed using the Somatic Symptom Scale-8 (SSS-8). Disability due to knee pain was categorized into three levels: 1) knee pain without difficulty with activities of daily living (ADL), 2) knee pain with ADL difficulty but without requiring sick leave, and 3) knee pain requiring sick leave. The association between ≥ high somatising tendency (SSS-8 score ≥ 12) as well as very high somatising tendency (SSS-8 score ≥ 16) and disability due to knee pain was examined using logistic regression models adjusted for age, sex, body mass index, depressive symptoms, education level, regular exercise, chronicity of knee pain (≥3 months), osteoarthritis, rheumatoid arthritis, and fibromyalgia.ResultsGreater disability due to knee pain was associated with a higher odds ratio for ≥ high somatising tendency (adjusted odds ratio (aOR) = 2.36 [2.10–2.66] in group 2 vs. group 1, aOR = 3.23 [2.66–3.92] in group 3 vs. group 1). Stronger associations were found for a very high somatising tendency (aOR = 2.80 [2.42–3.23] in group 2 vs. group 1, aOR = 4.51 [3.64–5.58] in group 3 vs. group 1).ConclusionsSomatization may play a role in disability due to knee pain in the general adult population with knee pain, similar to the role of somatization in low back pain.