Functional Disability Status Research Articles

Functional status of Indian children with juvenile idiopathic arthritis.

The functional disability status of Indian children with juvenile idiopathic arthritis is unidentified. In this cross-sectional study functional capacity of 60 juvenile idiopathic arthritis patients was assessed by the Childhood Health Assessment Questionnaire. A total of 60 juvenile idiopathic arthritis patients aged ranges from 1 to 12 years were recruited from a teaching hospital in eastern India. A childhood health assessment questionnaire was used to assess the functional health of children. Pain, patient's/parent's global assessment of general well-being, and physician's global assessment were assessed. Childhood health assessment questionnaire disability index for oligoarticular juvenile idiopathic arthritis differed significantly from polyarticular juvenile idiopathic arthritis (P < 0.001), systemic-onset juvenile idiopathic arthritis (P = 0.018) and undifferentiated juvenile idiopathic arthritis (P < 0.001). There was a good to a strong positive correlation between the childhood health assessment questionnaire disability index with pain score, patient's/parent's global assessment score, and physician global assessment score for the total juvenile idiopathic arthritis cohort. regarding juvenile idiopathic arthritis subtypes, significant correlations were noted between the childhood health assessment questionnaire disability index with the patient's/parent's global assessment and physician's global assessment (except for enthesitis-related arthritis). Assessment and documentation of the functional health status of juvenile idiopathic arthritis patients will improve the management of the disease.

Pooling functional disability and mortality in long-term care insurance and care annuities: A matrix approach for multi-state pools

Mortality risk sharing pools including group self-annuitisation, pooled annuity funds and tontines have been developed as an effective solution for managing longevity risk. Although they have been widely studied in the literature, these mortality risk sharing pools do not consider individual health or functional disability status nor the need for long-term care (LTC) insurance at older ages. We extend these pools to include functional disability and chronic illness and present a matrix-based methodology for pooling mortality risk across heterogeneous individuals classified by functional disability states and chronic illness statuses. We demonstrate how individuals with different health risks can more equitably share mortality risk in a pooled annuity design. A multi-state pool is formed by pooling annuitants considering both longevity and LTC risks and determining the actuarially fair benefits based on individuals' health states. Our methodology provides a general structure for a pooled annuity product that can be applied for general multi-state models. We present an extensive analysis with numerical examples using the US Health and Retirement Study (HRS) data. Our results compare expected annuity benefits for individuals in poor health to those in good health, show the effects of incorporating systematic trends and uncertainty, assess how the valuation of the expected annuity payments interacts with the assumptions used for the multi-state model and assess the impact of pool size.

Psychological Distress and Its Association with Functional Disability Index Among Acne Patients Attending Dermatology Clinics in the Kuantan Tertiary Hospitals

Introduction: Acne is the most common skin disease among adolescents and has significant psychological distress. Our objective is to assess acne severity, functional disability, and its psychological distress among acne patients. Methods: A cross-sectional study was conducted from November 2021 to May 2022 among 163 acne patients attending Dermatology Clinics in the district of Kuantan, Pahang. The severity of acne was graded using the Comprehensive Acne Severity Scale (CASS). The functional disability index was measured using a Cardiff Acne Disability Index (CADI), while Depression, Anxiety and Stress Scale (DASS-21) questionnaires were used as a screening tool to detect the psychological distress of acne. Data were analysed using a Chi-square test, Fisher’s exact test and multiple logistic regression. Results: The mean age was 23 years, 60.1% were female, 94.5% were Malay, and 68.1% were unemployed. The severity of acne was more prominent in the mild (30.7%) and moderate (28.2%) categories. A total of 20.2%, 11.7%, and 4.9% of the respondents had anxiety, depression, and stress symptoms, respectively. Regarding the respondents’ functional disability, 40.5% had mild impairment, 38.0% had moderate impairment, and 13.5% had severe impairment. Acne severity was found to be significantly associated with the functional disability index (P&lt;0.05). The functional disability index was also found to be significantly associated with depression (p=0.019) and anxiety symptoms (p=0.042). Conclusion: Clinical management of acne patients should include not only pharmacological treatment but also consideration of the disease’s functional disability status and psychological distress.

Associations Between Head Injury, Strangulation, Cardiometabolic Health, and Functional Disability Among Female Survivors of Intimate Partner Violence

ObjectiveHead injury and strangulation are highly prevalent in intimate partner violence (IPV) contexts, but there is little research examining the potential implications of these injuries on physical health and functional status. This pilot study explored the extent to which injury type (head injury, strangulation) and severity (no injury, subconcussive head injury, traumatic brain injury; no strangulation, strangulation, strangulation with loss of consciousness) were associated with biomarkers of cardiometabolic health and self-reported functioning among female survivors of IPV. MethodsParticipants were 51 individuals assigned female at birth who experienced IPV during their lifetime and screened positive for probable posttraumatic stress disorder (PTSD) on the PTSD Checklist for DSM-5 (average age = 32.6 years, SD = 7.1). ResultsHead injury was associated with statistically significant increases in blood glucose levels (p = .01, d = 1.10). Shifts toward more high-risk values with moderate-strong effect sizes were also found in high-density lipoprotein, low-density lipoprotein, and waist-to-hip ratio (ps: .06–.13; ds: 0.51–1.30). Strangulation was associated with increased cholesterol levels, with a moderate effect size (p = .20, d = 0.59). Regression models accounting for age, education, PTSD symptoms, childhood trauma, strangulation, and head injuries predicted functional disability status (R2 = 0.37, p < .01) and several of its associated domains: cognition (R2 = 0.34, F(8,42) = 2.73, p = .01), mobility (R2 = 0.47, F(8,42) = 4.82, p < .001), and participation in society (R2 = 0.33, F(8,42) = 2.59, p = .02). ConclusionsFindings suggest the need to develop integrated treatments that address physical health comorbidities among female survivors of IPV with a history of head injury to improve daily function and quality of life.

Marijuana use disorder among adults with functional disabilities-A US population-based cross-sectional study.

Recent studies suggest a growing trend in marijuana use, compared to a stable prevalence of marijuana use disorder among US adults over the first 15 years of the 21st century. This study investigated the recent patterns of marijuana use disorder among people with disabilities (PWD). We extracted a nationally representative sample (N = 209,058) from the 2015-2019 National Survey on Drug Use and Health data set and examined associations by functional disability status (any disability, disability by type, and number of disabling limitations) with marijuana use disorder using a series of independent multivariable logistic regression models. We also performed trend analyses during the study period. The prevalence of marijuana use disorder (from 1.7% to 2.3%) increased significantly among PWD between 2015 and 2019 (p-trend < .001). PWD were significantly more likely to report marijuana use disorder (odds ratio [OR], 1.37, 95% confidence interval [CI], 1.24-1.52) than people without disability (PWoD). Those with cognitive limitation only (OR, 1.78, 95% CI, 1.53-2.06) and ≥2 limitations (OR, 1.29, 95% CI, 1.10-1.51) were more likely to report marijuana use disorder than PWoD. PWD had a consistently higher prevalence of marijuana use disorder than PWoD. Additionally, the level of risk for marijuana use disorder varied by disability type and number of disabling limitations. Our study provided new nuance on disparities in marijuana use disorder between PWD and PWoD and further revealed the varied risks for marijuana use disorder across different disability statuses.

Comparative Effectiveness of Sacroiliac Belt versus Lumbar Orthosis Utilization on Nonspecific Low Back Pain: a Crossover Randomized Clinical Trial.

Back braces are commonly utilized in the management of low back pain (LBP). The aim of this study is to evaluate (1) user satisfaction with a sacroiliac belt versus a lumbar orthosis and (2) the effect of a sacroiliac belt versus a lumbar orthosis on pain, functional disability status, and analgesic use for subjects with subacute or chronic non-specific LBP. This is a prospective randomized crossover study. For the two-week study period, control group subjects wore the Horizon 627 Lumbar Brace ("lumbar orthosis") during the first week and the Serola Sacroiliac Belt ("sacroiliac belt") during the second week; experimental group subjects wore the sacroiliac belt during the first week and the lumbar orthosis during the second week. User satisfaction (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 [QUEST 2.0] score), functional disability status (Oswestry Disability Index [ODI]), pain, and analgesic use were recorded. Overall, the sacroiliac belt demonstrated significantly higher user satisfaction than the Horizon brace (QUEST Score = 20.31 vs.16.17, p = 0.0375) for the entire study period. Significant negative correlations were identified between user satisfaction and functional disability (t = -4.71, p < 0.0001), pain magnitude (t = -6.81, p < 0.0001) as well as pain frequency (t = -6.66, p < 0.0001). In this prospective randomized crossover study, subject satisfaction was associated with improvements in functional disability, pain magnitude and pain frequency. The sacroiliac belt demonstrated significantly higher user satisfaction and similar effectiveness compared to the lumbar orthosis.

Effect of TheraBand Flex Bar versus Strengthening Exercise in Patients with Lateral Epicondylitis

Abstract Background Lateral epicondylitis (LE) is an exertion or sporting-connected aching condition of the extensor muscles of the forearm. The core warning signs are pain and soreness of the outside on the elbow and grip strength weakness. The investigation aims to differentiate the effect of TheraBand flex bar versus strengthening exercise on pain, grip strength, range of motion, and functional status. Objectives To find the effects of TheraBand flex bar, strengthening exercise, and compare the effects of Thera band flex bar versus strengthening exercise on the elbow pain, handgrip strength, elbow and wrist range of motion, and functional disability status in lateral epicondylitis. Design Quasi-experimental study. Methods Thirty (30) patients with lateral epicondylitis were enrolled, both male and female, randomly assigned to control or 6-week training groups. They were subdivided into two groups. Subjects were pre-tested and post-tested using a hand-held dynamometer, the VAS, PRTEE Questionnaire Functional status, and goniometer. Results The results showed a statistically significant difference between pre and post-treatment in the study batch. The results show that Batch-1 and Batch-2 were significantly improved with p-values of 0.000, 0.004, 0.000, 0.001, 0.001, 0.004 at p &lt; 0.05. Conclusion In this study, the TheraBand flex bar and the strengthening exercise for lateral epicondylitis effectively reduced pain, enlarged the functional status, and improved the range of function within 30 subjects with lateral epicondylitis. The study concluded that TheraBand flex bar in Batch-1 and strengthening exercise in Batch-2 significantly improved VAS, PRTEE, handgrip strength, and ROM. The study's outcome suggests that TheraBand flex bar and strengthening exercise of extensors muscles of the wrist can be productive for the treatment among lateral epicondylitis (LE) sufferers.

Measuring equity of access to eye health outreach camps in rural Malawi.

IntroductionEquity in the access and use of health services is critical if countries are to make progress towards universal health coverage and address the systematic exclusion of the most vulnerable groups. The purpose of this study was to assess if the Co-ordinated Approach To Community Health programme implemented by Sightsavers was successful in reaching the poorest population, women, and people living with disabilities in Kasungu district, Malawi.MethodsBetween April and September 2017, data on socio-economic status, household characteristics and functional disability were collected from patients attending at eye camps in Kasungu district, Malawi. Using asset-based tools to measure household wealth (EquityTool© and Simple Poverty Scorecard©) and the Washington Group Short Set of Questions, individuals were categorised by wealth quintiles, poverty status, and functional disability status and then compared to relevant representative national household surveys. In addition, a follow-up household survey was conducted to check the validity of self-reported household characteristics at eye camps.ResultsA total of 1,358 individuals participated in the study. The study shows that self-reported data on household characteristics and assets are reliable and can be collected in clinical settings (instead of relying on direct observations of assets). Individuals attending outreach camps were poorer in terms of relative wealth and absolute poverty rates compared to the rest of the population in Kasungu. It was estimated that 9% of the participants belonged to the poorest quintile compared to 4% for the population in Kasungu (DHS 2015–2016). The ultra-poverty rate was also lower among respondents (13%) compared to 15% for Kasungu district (IHS 2017). The functional disability rate was 27.5% for study participants, and statistically higher than the general population (5.6%, SENTIF 2017). Even though women are more at risks than men, 54% of the participants were men.ConclusionsOur study shows that existing tools can be reliably used, and combined, if based on recent population data, to assess equity of access to health services for vulnerable groups of the population. The findings suggest that the programme was successful in reaching the poorest people of the Kasungu district population as well as those with disabilities through outreach camps but that more men than women were reach through the programme. Subsequently, our study showed that self-reported household characteristics are a reliable method to measure asset-based wealth of camps’ attendee. However, it is essential to use sub-national data (district or regional level) from recent surveys for the purpose of benchmarking in order to produce accurate results.

Low Back Pain during Pregnancy and Delivery Outcomes.

To evaluate low back pain (LBP) incidence and impact throughout pregnancy in terms of women's well-being and delivery outcomes. Cross-sectional prospective study conducted on singleton pregnancies at ≥37th gestational age admitted for delivery. Localization of LBP, intensity and frequency as well as derived functional disability status were assessed with a self-reported questionnaire. Main delivery outcomes including mode of delivery, and maternal or neonatal complications were recorded. A total of 229 women participated in the study. LBP prevalence amounted to 55.9%, with the pain already present before pregnancy in 14.0% of the cases. The pain was mostly localized in the lower back (40.6%), symphysis (23.3%), and coccyx (20.5%). Both the frequency and intensity of pain gradually increased significantly during pregnancy, reaching 20 days/month (IQR=10-30) and 6/10 points (IQR=5-8) on a visual analog scale in the 3rd trimester (p<0.05). The extent of functional impairment also progressively increased up to 39/100 points (IQR=25-55, p<0.05). Women affected by LBP during pregnancy had a higher cesarean section rate during labor than women without LBP (11.9% vs. 28.9%, p<0.05). The risk was also significant in the multivariate analysis (OR=4.0, 95%CI=1.1-15.0, p<0.05). There was no difference in the rate of operative vaginal births or in the other outcomes considered. LBP is a common issue in pregnant women, accounting for increasing morbidity and invalidity, and leading to an increased cesarean section risk during labor.

Socioeconomic and demographic correlates of nonenrolment onto the national health insurance scheme among children in Ghana: Insight from the 2017/18 Multiple Indicator Cluster Survey.

The goal of Ghana's health insurance scheme is to achieve universal coverage. Despite NHIS' benefits to children, not all children in Ghana are covered. This study investigates the sociodemographic covariates of nonenrolment onto the national health insurance scheme among children in Ghana. We used the child dataset of the 2017/18 Ghana Multiple Indicator Cluster Survey (G-MICS). We used STATA version 14 for the data analyses. We described each study variable using frequency and percentages. We used Poisson regression to estimate crude and adjusted prevalence ratios of the relationship between the covariates and the outcome variable. Approximately 57% of children were covered with health insurance in Ghana. In the adjusted multivariable model, male children, children within the ages of 10-14 or 15-17years, and children who have some form of functional disability and those with no information on their functional disability status, children of mothers with lower than post-secondary education, and children residing in households of less than the fifth quantile on the household wealth index were associated with a higher likelihood of nonenrolment onto the national health insurance scheme. Finally, compared to the children in greater Accra, children in the other nine regions were associated with a lower likelihood of nonenrolment onto the national health insurance scheme. Given the results, improvement in health insurance coverage should be done, taking into consideration variations across the socio-demographic characteristics of the child, mother, and households.

Disability, violence, and mental health among Somali refugee women in a humanitarian setting.

There is limited evidence on the relationship between disability, experiences of gender-based violence (GBV), and mental health among refugee women in humanitarian contexts. A cross-sectional analysis was conducted of baseline data (n = 209) collected from women enrolled in a cohort study of refugee women accessing GBV response services in the Dadaab refugee camps in Kenya. Women were surveyed about GBV experiences (past 12 months, before the last 12 months, before arriving in the refugee camps), functional disability status, and mental health (anxiety, depression, post-traumatic stress), and we explored the inter-relationship of these factors. Among women accessing GBV response services, 44% reported a disability. A higher proportion of women with a disability (69%) reported a past-year experience of physical intimate partner violence and/or physical or sexual non-partner violence, compared to women without a disability (54%). A higher proportion of women with a disability (32%) experienced non-partner physical or sexual violence before arriving in the camp compared to women without a disability (16%). Disability was associated with higher scores for depression (1.93, 95% confidence interval (CI) 0.54-3.33), PTSD (2.26, 95% CI 0.03-4.49), and anxiety (1.54, 95% CI 0.13-2.95) after adjusting for age, length of encampment, partner status, number of children, and GBV indicators. A large proportion of refugee women seeking GBV response services have disabilities, and refugee women with a disability are at high risk of poor mental health. This research highlights the need for mental health and disability screening within GBV response programming.

DEPRESSION, FUNCTIONAL DISABILITY, AND ACCESSING HEALTH CARE AMONG OLDER MEN AND WOMEN IN GHANA AND SOUTH AFRICA

Objectives. To inform a preventive approach to mild depression among older Ghanaians and South Africans, this study will investigate the association and possible variabilities between mild depression, functional disability, accessing health care, sociodemographic, and socioeconomic factors across genders in both countries. Methods. Cross-sectional wave 1 (2007-2010) data from WHO’s Study on Global Ageing and Adult Health (SAGE) are used, and a sample of 3871 for Ghana and 3076 for South Africa are analyzed. Binary multiple logistic regression is used to identify the association between mild depression, functional disability status, socioeconomic and sociodemographic factors, and health status. Results. The proportion of mild depression (MD) is 3.78% and 8.15% for older Ghanaian men and women, and 2.29% and 11.91% for South African older men and women, respectively. At 95% CI, increased severity (mild and high levels) of functional disability are associated with increased odds of MD in Ghanaian and South African older men and women. Apart from South African older men, older people in the study who do not receive healthcare when needed have increased odds of MD. Sociodemographic and socioeconomic factors are also associated with MD. Discussion. An untreated, persistent MD may lead to worse conditions with fatal outcomes. Since, mental health care is lacking in both countries, this study recommends policies directed towards support for formal and informal long-term care, and healthcare access to reduce the risks of depression. Thus, this study’s findings may provide relevant information for managing depression among older Ghanaians and South Africans.

Comparison of Radial Extracorporeal Shock Wave Therapy and Traditional Physiotherapy in Rotator Cuff Calcific Tendinitis Treatment.

This study aims to investigate the efficacy of radial extracorporeal shock wave therapy (rESWT) in relieving pain and improving range of motion (ROM) and functionality besides conventional physiotherapy methods in the treatment of chronic rotator cuff calcific tendinitis (RCCT). We studied 80 patients (35 males, 45 females; mean age 53.3±9.6 years; range, 40 to 70 years) with chronic RCCT. Patients were randomly divided into two groups: rESWT group (n=40) treated with conventional physiotherapy and rESWT, and control group (n=40) treated only with a conventional physiotherapy program. The traditional physiotherapy program included ultrasound, transcutaneous electrical nerve stimulation, shoulder joint ROM and stretching exercises, and ice applications. All patients received a total of 20 treatments, five days a week for four weeks. rESWT was applied once a week for four weeks in total. Before and after treatment, all patients were evaluated for age, height, weight, Body Mass Index (BMI), pain intensity with a Visual Analog Scale, shoulder ROM, and functional disability status with the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Mean BMI value of the participants was 26.1±3.0 kg/m2. Although all parameters of the patients in both groups improved significantly, patients in the rESWT group had a statistically significant improvement in pain, ROM and QuickDash scores (p<0.001, p<0.001, and p<0.001, respectively). We assume that rESWT is an effective and noninvasive method of reducing pain and increasing ROM and functional status without the need for surgery.

Functional Disability Status among the Elderly Persons and its Predictors in Kerala and Maharashtra: An Analysis of BKPAI, 2011 Data

This paper examines the magnitude of functional disability among the elderly persons and its predictors in Kerala and Maharashtra. It is measured with Lawton and Brody's Instrumental Activities of Daily Living (IADL) Scale by assigning scores to elderly persons' ability to do or not eight day-to-day activities by adopting correlation and multiple linear regression techniques. In both the states the magnitude of functional disability status of the elderly has shown an increasing trend with an increase in their current age, whereas such pattern has decreased with an increase in their years of schooling. Further, while the likelihood of functional disability among the elderly noted to be much lower among those who are working for wages and self-reported health status as fair / good, such likelihood is observed to be higher among those who are co-residing with children / others than their respective counterparts (p<0.001 for all cases). Place of residence, gender, marital status, wealth index of households, number of chronic morbidities and physical disability index have also exhibited their independent net effects on the functional disability of the elderly, but differentially across the states.

Normal plantar weight distribution pattern and its variations with change of functional position and its comparison with patients of knee osteoarthritis

Early osteoarthritic changes at the knee result in altered plantar weight distribution pattern during stand, minisquat, squat and one leg stand positions. To study and quantify these plantar weight distribution variations with changes in static functional position, a cross-sectional study was conducted. A total of 202 subjects, 92 healthy people (control group) and 110 with early knee osteoarthritis, participated in the study. The plantar weight distribution and its variations with change in functional position were assessed using footplate, while the functional disability status was assessed using WOMAC (Western Ontario and McMaster Universities Arthritis Index) & CIFKAS (Composite Indian Functional Knee Assessment Scale). The participants were allocated into two groups i.e. group-1 and group-2. The participants in group-1 had no knee complaint and those in group-2 had diagnosis of early knee osteoarthritis. Independent test was used for the statistical analysis. Significant difference between the groups was observed for the percentage plantar weight (load) distribution during stand (p value <.001 to .005), minisquat (p value <.001 to .022), left leg stand (p value <.001 to .003) and right leg stand (p value <.001 to .008) and Pain f Footplate; Functional position; Functional Disability; Plantar weight distribution

Global Issues of Concern for Improving Functional Disability Status in Knee Osteoarthritis

Knee osteoarthritis is a common problem among elderly population caused by degenerative changes around knee. The degenerative changes involves a combination of mechanical, cellular and biochemical processes resulting in pain, muscle dysfunction, abnormal stress loading and sensorimotor dysfunctions affecting neuromusculoskeletal integrity. Although there are number of treatments techniques available but they lack specific guidelines. Hence, the present article aimed at understanding the Neurophysiological basis of pain & physical dysfunction to formulate Multi-Joint Coupling Intervention Strategy that would serve as an important guiding and therapeutic tool for health care practitioners in improving functional disability status of patients with early knee osteoarthritis.

Patterns of angiotensin converting enzyme insertion/deletion gene polymorphism among an Egyptian cohort of patients with rheumatoid arthritis

This case control study was designed to determine the patterns of angiotensin converting enzyme insertion/deletion (ACE I/D) gene polymorphism in rheumatoid arthritis (RA) patients and healthy controls. The study population was divided into two groups: the study group included 66 RA patients diagnosed according to the American College of Rheumatology (ACR) classification criteria for RA, and the control group included 66 healthy adults who were age-and sex-matched to the RA group. All RA patients were assessed by Disease Activity Score (DAS28), ACR Classification of Global Functional Disability Status and Sharp's score as outcome measures. Gene investigations for ACE I/D polymorphism were performed by polymerase chain reaction (PCR) in both groups. The ACE I/D polymorphism was the (D/D) genotype in 60.6% (n = 40) of RA patients, the (I/D) genotype in 31.8% (n = 21) and the (I/I) genotype in 7.6% (n = 5). The frequency of (D) carriage was significantly higher in the RA cases than in the control group (76.5% vs. 53.8%, respectively, P = 0.0002). ACE D allele carriers were at higher risk of RA, 2.8 times higher than (I) carriers and those who had the homozygote (DD) genotype had 5.6 times the possibility of having RA. No correlations were observed between the homozygote (DD) genotype and disease activity or severity in RA patients. Our study suggests that high frequency of the ACE D allele contributes to the heritability of RA susceptibility compared to other ACE alleles. On the other hand, no association was detected between ACE I/D polymorphism and the severity of RA.

The Haematological Profile of Patients with Multiple Sclerosis

Background: Patients with multiple sclerosis experience various disabilities, depending on the number and placement of lesions in the brain. Red blood cells with impaired membrane fluidity, as has been reported in patients with multiple sclerosis are known to be further targeted by phospholipase A2 during inflammatory activation. Objectives: The objective of the present study was therefore to investigate the haematological profile of patients with multiple sclerosis and to correlate this with their functional disability and inflammatory status. Methods: Differential full blood counts of 31 patients with multiple sclerosis and 30 age- and gender-matched control subjects were determined on a Beckman Coulter. The functional disability status of each patient was measured using the Kurtzke Expanded Disability Status Scale. C-reactive protein was determined on a Beckman auto-analyser. Results: The haemoglobin was significantly decreased in patients: 13.9 ± 1.40 g/dl, controls: 14.7 ± 1.60 g/dl, P = 0.01, while platelets were increased in patients: 292 ± 133 × 109/l, controls: 258 ± 88.0 × 109/l, P = 0.04. The number of red blood cells correlated inversely with the Kurtzke Expanded Disability Status Scale (R = –0.41; P = 0.02). Platelets correlated inversely with the haemoglobin (P = 0.04) and positively with Visual and Brainstem Scores (P < 0.01, P = 0.07 respectively), but inversely with the Sensory Score (P = 0.02). Conclusions: It is not clear from the results whether the compromised red blood cell profile in patients was due to unknown agents involved in the disease aetiology or from the resulting inflammatory responses, but the inverse correlation between the red blood cell count and the Kurtzke Expanded Disability Status Scale, a measure of neuronal function, suggested a relationship between red blood cell count and disease outcome. Furthermore, the inverse correlation of platelets with the haemoglobin suggested immunological involvement. Platelets, similar to white blood cells, supply fatty acids for pro-inflammatory eicosanoid synthesis.

Efficient management of rheumatoid arthritis significantly reduces long-term functional disability

Objectives:The aim of this study was to examine the effect of efficient management of rheumatoid arthritis (RA) in relation to disability levels in a large cohort of patients with RA...

The impact of cognitive functioning on mortality and the development of functional disability in older adults with diabetes: the second longitudinal study on aging

BackgroundFor older adults without diabetes, cognitive functioning has been implicated as a predictor of death and functional disability for older adults and those with mild to severe cognitive impairment. However, little is known about the relationship between cognition functioning on mortality and the development of functional disability in late life for persons with diabetes. We examined the relative contribution of cognitive functioning to mortality and functional disability over a 2-year period in a sample of nationally representative older US adults with diabetes who were free from cognitive impairment through secondary data analyses of the Second Longitudinal Study of Aging (LSOA II).MethodsParticipants included 559 US adults (232 males and 327 females) ≥ 70 years old who had diabetes and who were free from cognitive impairment were examined using an adapted Telephone Interview of Cognitive Status (TICS), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL).ResultsMultivariate logistic regression was conducted to investigate the independent contribution of cognitive functioning to three mutually exclusive outcomes of death and two measures of functional disability status. The covariates included in the model were participants' sex, age, race, marital status, educational level, duration of diabetes, cardiovascular disease (CVD) status, and self-rated health. Persons with diabetes who had the lowest levels of cognitive functioning relative to the highest level of cognitive functioning had a greater odds of dying (AOR = 0.80, 95% CI = 0.67–0.96) or becoming disabled (AOR = 0.87, 95% CI = 0.78–0.97) compared to those people who were disability free.ConclusionOlder adults with diabetes and low normal levels of cognition, yet within normal ranges, were approximately 20% more likely to die and 13% more likely to become disabled than those with higher levels of cognitive functioning over a 2-year period. Brief screening measures of cognitive functioning could be used to identify older adults with diabetes who are at increased risk for mortality and functional disability, as well as those who may benefit from interventions to prevent or minimize further disablement and declines in cognitive functioning.