Impaired Functional Status Research Articles

OBJECTIVE AND SUBJECTIVE POVERTY AMONG OLDER PEOPLE AND ITS ASSOCIATION WITH HEALTH, FUNCTION, AND MORTALITY

Abstract We examined objective and subjective poverty between ages 70-95, comparing and contrasting frequency, associated subsequent medical, functional, psychosocial impairment, and mortality. Data collection by the Jerusalem Longitudinal Study, following a representative community dwelling sample (born 1920-1921), assessed at ages 70, 78, 85, 90, and 95. We defined "objective poverty" as sole income from "national old-age pension" necessitating "supplemental income benefit" from the National Institute for Social Security; "subjective poverty" as "financial difficulty getting through each month". Subjective and objective poverty differed: frequency of objective poverty remained 13% throughout follow-up period, while subjective poverty was more frequent at younger age, decreasing from 24% at ages 70-85, to 14% at ages 90-95. Subjective poverty was significantly associated with depression at all ages (from HR=3.2, CI 95%:1.73-5.93 at age 70, to HR=2.45, CI 95%:1.32-4.54 at age 95), and poor self-rated health (from HR=2.69, CI 95%:1.63-4.46 at age 70, to HR=1.96, CI 95%:1.11-3.43 at age 95), however no consistent associations with objective poverty was observed. Both objective and subjective poverty were associated with low levels of physical activity, impaired functional and cognitive status. Mortality was significantly increased among subjects with subjective poverty at ages 70, 85, and 90 (ranging from HR=1.33, CI 95%: 1.02-1.74 to HR=1.50, CI 95%:1.11-2.03), while objective poverty was significantly associated with increased mortality at ages 78 and 85 (HR=1.43, CI 95%:1.01-2.03, and HR=1.55, CI 95%:1.16-2.07 respectively). In conclusion, subjective and objective poverty differ in their association with health, functional and psychosocial status, and mortality between ages 70-95.

Impaired Functional Status Increases Fracture Incidence in 10-year Follow-Up: The Results from RAC-OST-POL Study

Introduction: The aim of study was to establish the influence of baseline functional status on fracture incidence. Methodology: In a prospective 10-years observation in epidemiological sample of postmenopausal women from RAC-OST-POL Study a thesis that affected functional status enhance fracture incidence was verified. At baseline, data were collected in 978 women at mean age 66.48±7.6 years and after 10 years of follow-up 640 subjects at mean age 75.04±6.95 years remained in the study. Functional status at baseline was established using Stand up and Go test (SAG) and Activity of Daily Living (IADL). Afterwards, annually data on fracture incidence were collected by phone interviews. Results: In the period of observation 190 low-energy fractures in 129 women were noted. The whole group was divided into subgroups: without fracture (n=511), with one fracture (n=91) and those ones who had more than one fracture (n=38). In fractured and unfractured subgroup mean SAG results were 11.36±4.28 and 10.36±2.76, respectively and differed significantly (p<0.01). With increasing number of fractures the SAG time was longer – it was 11.15±4.49 in one fracture subgroup and 11.87±3.73 in multiple fractures subgroup, with both values significantly higher than in no fracture subjects. The mean value of IADL was 23.56±1.60. In 576 (90%) women IADL reached maximal value of 24 points. In the rest of them (n=64) IADL score was between 11 and 23 points. Mean value of IADL in fractured and unfractured subgroup were 23.27±1.97 and 23.64±1.47, respectively and differed significantly (p<0.01). Conclusion: The measures of functional status predict fractures in a prospective observation of representative epidemiological female sample.

Persistent High Burden and Mortality Associated With Advanced HIV Disease in Rural Tanzania Despite Uptake of World Health Organization "Test and Treat" Guidelines.

Information about burden, characteristics, predictors, and outcomes of advanced human immunodeficiency virus disease (AHD) is scarce in rural settings of sub-Saharan Africa. Human immunodeficiency virus (HIV) infections and associated deaths remain high despite specific guidelines issued by the World Health Organization (WHO). Burden of AHD and 6-month death/loss to follow-up (LTFU) were described among 2498 antiretroviral therapy (ART)-naive nonpregnant people with HIV (PWH) aged >15 years enrolled in the Kilombero Ulanga Antiretroviral Cohort in rural Tanzania between 2013 and 2019. Baseline characteristics associated with AHD and predictors of death/LTFU among those with AHD were analyzed using multivariate logistic and Cox regression, respectively. Of the PWH, 62.2% had AHD at diagnosis (66.8% before vs 55.7% after national uptake of WHO "test and treat" guidelines in 2016). At baseline, older age, male sex, lower body mass index, elevated aminotransferase aspartate levels, severe anemia, tachycardia, decreased glomerular filtration rate, clinical complaints, impaired functional status, and enrollment into care before 2018 were independently associated with AHD. Among people with AHD, incidence of mortality, and LTFU were 16 and 34 per 100 person-years, respectively. WHO clinical stage 3 or 4, CD4 counts <100 cells/µL, severe anemia, tachypnea, and liver disease were associated with death/LTFU. More than 50% of PWH enrolled in our cohort after test and treat implementation still had AHD at diagnosis. Increasing HIV testing and uptake and implementation of the WHO-specific guidelines on AHD for prevention, diagnosis, treatment of opportunistic infections, and reducing the risks of LTFU are urgently needed to reduce morbidity and mortality.

Characteristics, Antithrombotic Patterns, and Prognostic Outcomes in Claudication and Critical Limb-Threatening Ischemia Undergoing Endovascular Therapy

Purpose: The underlying difference between intermittent claudication (IC) and critical limb-threatening ischemia (CLTI) still remains unclear. This prospective multicenter observational study aimed to clarify differences in clinical features and prognostic outcomes between IC and CLTI, and prognostic factors in patients undergoing endovascular therapy (EVT). Materials and Methods: A total of 692 patients with 808 limbs were enrolled from 20 institutions in Japan. The primary measurements were the 3-year rates of major adverse cardiovascular event (MACE) and reintervention. Results: Among patients, 79.0% had IC and 21.0% had CLTI. Patients with CLTI were more frequently women and more likely to have impaired functional status, undernutrition, comorbidities, hypercoagulation, hyperinflammation, distal artery disease, short single antiplatelet and long anticoagulation therapies, and late cilostazol than patients with IC. Aortoiliac and femoropopliteal diseases were dominant in patients with IC and infrapopliteal disease was dominant in patients with CLTI. Patients with CLTI underwent less frequently aortoiliac intervention and more frequently infrapopliteal intervention than patients with IC. Longitudinal change of ankle-brachial index (ABI) exhibited different patterns between IC and CLTI (pinteraction=0.002), but ABI improved after EVT both in IC and in CLTI (p<0.001), which was sustained over time. Dorsal and plantar skin perfusion pressure in CLTI showed a similar improvement pattern (pinteraction=0.181). Distribution of Rutherford category improved both in IC and in CLTI (each p<0.001). Three-year MACE rates were 20.4% and 42.3% and 3-year reintervention rates were 22.1% and 46.8% for patients with IC and CLTI, respectively (log-rank p<0.001). Elevated D-dimer (p=0.001), age (p=0.043), impaired functional status (p=0.018), and end-stage renal disease (p=0.019) were independently associated with MACE. After considering competing risks of death and major amputation for reintervention, elevated erythrocyte sedimentation rate (p=0.003) and infrainguinal intervention (p=0.002) were independently associated with reintervention. Patients with CLTI merely showed borderline significance for MACE (adjusted hazard ratio 1.700, 95% confidence interval 0.950–3.042, p=0.074) and reintervention (adjusted hazard ratio 1.976, 95% confidence interval 0.999–3.909, p=0.05). Conclusions: The CLTI is characterized not only by more systemic comorbidities and distal disease but also by more inflammatory coagulation disorder compared with IC. Also, CLTI has approximately twice MACE and reintervention rates than IC, and the underlying inflammatory coagulation disorder per se is associated with these outcomes. Clinical Impact The underlying difference between intermittent claudication (IC) and critical limb-threatening ischemia (CLTI) still remains unclear. This prospective multicenter observational study, JPASSION study found that CLTI was characterized not only by more systemic comorbidities and distal disease but also by more inflammatory coagulation disorder compared to IC. Also, CLTI had approximately twice major adverse cardiovascular event (MACE) and reintervention rates than IC. Intriguingly, the underlying inflammatory coagulation disorder per se was independently associated with MACE and reintervention. Further studies to clarify the role of anticoagulation and anti-inflammatory therapies will contribute to the development of post-interventional therapeutics in the context of peripheral artery disease.

The Age, Comorbidities and Albumin (ACA) Index Is Independently Associated with Overall Survival in Patients with Mantle Cell Lymphoma (MCL)

Background: Mantle cell lymphoma (MCL) is a biologically and clinically heterogenous disease with variable outcomes. Numerous prognostic factors have been identified, including blastoid histology, the MCL International Prognostic Index (MIPI) score, high proliferation index, TP53 deletions and/or mutations, complex karyotype, minimal residual disease positivity, and several others. Most prognostic scores do not take patient characteristics into account and require additional testing which may not be routinely available. In particular, older adults have heterogenous outcomes due to the presence of comorbidities, impaired functional and/or nutritional status which is not factored into the MIPI score. The age, comorbidities and albumin (ACA) index is a simple score that can be gleaned from the electronic health record either in real-time or retrospectively and has been validated in patients with diffuse large B cell lymphoma. We evaluated the impact of the ACA index on outcomes in patients with MCL. Methods: The Roswell Park MCL database includes all patients with MCL evaluated at Roswell Park Comprehensive Cancer Center from 2007 to 2019. A serum albumin (SA) level of <3.7 g/dL was defined as "low". The age, comorbidities and albumin (ACA) index included a low SA level, age ≥ 75 years, and a Charlson comorbidity index (CCI) score of ≥3 (representing moderate to severe comorbidity burden), with each variable when present contributing to a score of 1. A score of 0 was defined as "excellent", 1 as "good", 2 as "moderate" and 3 as "poor". The log-rank test was used to compare overall survival (OS), and the Cox-proportional hazard model was used for univariate (UVA) and multivariate (MVA) survival analyses. Results: A total of 245 patients with a median age of 64 years [interquartile range (IQR), 56-73 years] were included in the study, with a median follow-up of 90.2 months (95% CI, 75.1 - 107 months). Overall, 111 (45%) patients were age ≥65 years, 81 (33.1%) were age ≥70 years, and 44 (18.0%) were age ≥75 years; 73% of patients were male, and 11 patients had an ECOG PS ≥2. Older adults (age ≥75 years) had a greater burden of comorbidities (CCI≥3, p<0.001), and poor PS (ECOG ≥2, p=0.006) compared with younger patients. The median SA in the entire cohort was 4.30 g/dL (IQR 3.90, 4.50), with lower median levels in patients age ≥75 versus age <75 years (4.00 vs 4.35, p<0.001); however, there was no difference in frequency of patients with low SA levels (<3.7 g/dL) (19% vs 14%, p=0.4). A low SA level, CCI≥3, high or intermediate MIPIb risk, ki-67>30%, and increased age (≥75 years) were significantly associated with inferior OS. Patients who received an autologous or allogeneic stem cell transplant (SCT) in any line of therapy had improved OS (HR 0.5517, p=0.001). The ACA score could be calculated in 69.8% of patients- 58% of patients had an excellent ACA score (0), 30% of patients had a good score (1) and 9.9% of patients had a moderate score (2). Only 2 (1.2%) patients had a poor score (3). Patients with higher ACA scores had significantly inferior OS (HR 2.117, p<0.0001). In a MVA that adjusted for MIPIb risk and treatment with SCT in any line, this risk remained significant (HR 1.67, p=.007). Conclusion: A simple, patient-factor based scoring system incorporating hypoalbuminemia and the presence of comorbidities is strongly predictive of survival in patients with MCL, irrespective of disease stage, MIPIb risk score, and known molecular risk factors. Further steps include validation of the ACA index in an independent MCL cohort and incorporation of elements from the ACA index into known prognostic models to develop a new score that takes both disease biology and patient physiology into account. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Association between Barthel Index, Grip Strength, and Physical Activity Level at Admission and Prognosis in Community-Acquired Pneumonia: A Prospective Cohort Study.

Background: Impaired functional status is a risk factor for hospitalization in patients with community-acquired pneumonia (CAP). The aim was to determine the influence of functional status and physical activity level on severe outcomes, including length of stay, admission to the intensive care unit (ICU), readmission, and mortality in patients with CAP. Methods: A prospective cohort study among patients hospitalized with CAP. Functional status was assessed with the Barthel index and grip strength, and physical activity level was assessed using the international physical activity questionnaire. Linear regression was used to assess the association with length of stay, and logistic regression was used to assess the risk of severe outcomes. Results: Among 355 patients admitted with CAP, 18% had a low Barthel index (<80), 45% had a low grip strength, and 75% had a low physical activity level. Low Barthel index was associated with increased risk of ICU admission (OR 3.6, 95% CI 1.2−10.9), longer length of stay (27.9%, 95% CI 2.3−59.7%), readmission within 30, 90, and 180 days (OR 2.1−2.4, p < 0.05), and mortality within 90 and 180 days (OR 4.2−5.0, p < 0.05). Low grip strength was associated with increased risk of 90 days readmission (OR 1.6, 95% CI 1.0−2.6, p < 0.05) and mortality within 30, 90, and 180 days (OR 2.6−3.2, p < 0.05). Low physical activity level was associated with increased risk of readmission within 90 and 180 days (OR 1.8−2.1, p < 0.05) and mortality within 30, 90, and 180 days (OR 3.3−5.5, p < 0.05). Conclusions: Impaired functional status and low physical activity level were associated with a longer length of stay and increased risk of ICU admission, readmission, and mortality in patients hospitalized with CAP. Routine assessment of functional status and physical activity level in clinical care could enable early identification of individuals with excess risk for a poor prognosis. Trial registration: ClinicalTrials.gov, NCT03795662.

Functional status and caregiver burden of patients on maintenance haemodialysis in Cameroon: a two-centre cross-sectional study

BackgroundData on the functional status (FS) of patients on maintenance haemodialysis (MHD) and their caregiver burden (CGB) in SSA where patients have fewer weekly dialysis sessions and pay out-of-pocket for dialysis-related costs is sparse. ObjectivesTo assess the functional status of Patients on MHD in Cameroon, and the burden of their Caregivers, and to determine the factors associated with functional status impairment (FSI), and high caregiver burden (HCGB). MethodsWe consecutively enrolled patients on MHD at the Bamenda Regional, and Yaounde General Hospitals over a period of 3 months. We included patients on MHD for ≥ 3 months and their caregivers. Patients and/or caregivers with documented dementia were excluded. Through a face-to-face interview, FS was assessed by combining self-reports of 8 instrumental, and 5 basic activities of daily living using the Lawton-Brody and the Katz (LBKQ) scales, and CGB was assessed using the Zarit Caregiver Burden Scale (ZCGBS). We defined functional status impairment (FSI) as a score ≥ 1 on the LBKQ scale, and a high CGB as a ZCGBS score ≥ 41. Data were analysed using the IBM-SPSS version 26.0ResultsA total of 115 patients and 51 caregivers (CGs) were enrolled. The mean age of the patients was 46.9 ± 15.0 years, and 54.8% (n = 63) were males, whereas the mean age of the CGs was 38.30 ± 13.10 years with 72.5% (n = 39) being females. A total of 90 (78.3%) patients had functional status impairment (FSI), while 78.4% (n = 40) of caregivers experienced a burden (41.2% classified as moderate, and 37.2% as high). Anaemia (aOR = 9.2, CI = 3.9–29.4, p < 0.001), and a high daily pill burden (aOR = 4.4, CI = 1.1–18.5, p = 0.043) were independently associated with FSI, while age of caregiver ≥ 45 years (aOR 9.9, CI = 1.7–56.8, P = 0.01) was independently associated with a high CGB. There was a strong positive correlation between FS and CGB.ConclusionThere is a high prevalence of functional status impairment in patients on maintenance haemodialysis in Cameroon, resulting in high a physical and psychological burden on their caregivers.

Foot function in rheumatoid arthritis: Correlation between the Rheumatoid and Arthritis Outcome Score and performance-based physical tests.

Foot function is usually assessed using self-reported outcome measures which remain subjective in patients with rheumatoid arthritis (RA). Physical performance tests were recommended for functional assessment in lower limb osteoarthritis. However, foot function assessment's guidelines in RA are lacking. We aimed to investigate the correlation between a self-reported outcome measure and two performance-based physical tests for assessing foot function in RA patients. A cross-sectional study was performed over 7months' period including RA patients. We used Rheumatoid and Arthritis Outcome score (RAOS) as a self-reported functional tool. Physical performance tests were 4-min walk test (4-MWT) and Timed up and go test (TUGT). Fifty RA patients were included with 96% females and a mean age of 54.7±10.4years. Foot involvement occurred since the diagnosis of RA in 36% of patients. Foot pain was reported by 68% of patients (48% forefoot), and foot stiffness in 46% of patients. Skin lesions of the feet were found in 78% of patients, 90% had foot deformities and 56% had inflammatory disorders of feet. Radiographic lesions were found in 94% of patients. The most impaired RAOS subscales were Sports and Recreation and Quality of life. Poor physical-based performance was found in 34% of RA patients according to 4-MWT, in 42% of RA patients according TUGT, and in 46% of patients based on at least one performance test. RAOS was negatively correlated to the 4-MWT and positively correlated in the subscales pain, other symptoms, activities of daily living, and Sport/Rec of the RAOS. Poor performance-based physical tests were significantly associated with advanced age, sedentary lifestyle, higher disease activity score and impaired functional status. Foot-related parameters significantly associated with poor performance-based physical tests were: foot pain, foot deformity and inflammatory disorders. Multivariate analysis identified foot deformities and higher functional impairment as predictive factors for lower gait speed (4-MWT) and older age and higher functional impairment for higher duration of TUGT. RAOS was significantly associated with performance-based physical function. In the era of connected technologies, these results encourage the regular assessment of rheumatoid foot function by the RAOS score through a connected programme using wearable trackers.

Implementation of Frailty Assessment Improves Veterans Affairs Surgical Quality Improvement Program Risk Assessment in General and Vascular Surgery Patients

INTRODUCTION: Frailty has been recognized as an important factor in preoperative risk evaluation. The Veterans Affairs Surgical Quality Improvement Program (VASQIP) Surgical Risk Calculator, derived from chart elements, predicts surgical risk and incorporates many factors now recognized as markers of frailty. We examined the impact on VASQIP Surgical Risk prediction after implementation of a robust frailty assessment. METHODS: A prospective frailty assessment quality improvement project was implemented in general surgery (GenS) and vascular surgery (VascS) for new and preoperative VA patients starting October 2020. We examined the effectiveness of this assessment by comparing VASQIP Surgical Risk prediction with and without use of frailty assessment data. For comparison purposes, 3 operative case complexity groups were identified. RESULTS: A total of 205 patients were screened: 145 (71%) GenS and 60 (29%) VascS. Frailty screening identified issues not captured on routine surgical assessment in 77 (38%) patients; 20 (26%) of these patients were less than 65 years of age. The most common frailty factors captured include cognitive impairment (46% GenS, 47% VascS), dyspnea (19% GenS, 20% VascS), and impaired functional status (14% GenS, 13% VascS). Frailty identification increased VASQIP risk prediction with significant differences post–frailty assessment (p < 0.005; Table 1). Risk of 30-day surgical site infection, ICU admission, and postoperative admission also increased: 1% to 1.2%, 23% to 27.4%, and 72% to 79%, respectively (p < 0.001). Increasing case complexity was associated with higher score differences (p < 0.0001; Table 1). Table 1. - VASQIP Surgical Risk Score Comparison Variable 30-d mortality risk: pre-/postscreen * 180-d mortality risk: pre-/postscreen * 30-d morbidity risk: pre-/postscreen * p Value † Entire group 0.24%/0.31% 1.03%/1.17% 3.55%/3.84% <0.0001 Cases with differences 0.33%/0.61% 1.27%/2.21% 4.18%/4.77% <0.0001 Low case complexity 0.13%/0.15% 0.53%/0.66%‡ 1.78%/1.78%‡ <0.005‡ Moderate case complexity 0.17%/0.20% 0.85%/1.14% 2.14%/2.62% <0.0001 High case complexity 0.30%/0.38% 1.11%/1.42% 4.8%/6.14% <0.0001 Vascular surgery 0.51%/0.62% 1.20%/1.52% 4.24%/4.29% <0.005 General surgery 0.14%/0.18% 0.71%/1.01% 2.80%/3.48% <0.0001 *Median risk percentage displayed. Risk scores calculated with VASQIP Surgical Risk Calculator.†Wilcoxon Signed Ranks Test performed.‡Only 30-day mortality is <0.005; 180-day morality and 30-day morbidity differences were not statistically significant. CONCLUSION: Implementation of frailty assessment, in general, and vascular surgery patients significantly improves VASQIP Surgical Risk prediction. These findings emphasize the prevalence of frailty and the importance of presurgical frailty assessment for both geriatric and nongeriatric patients.

Follow-Up of a Cohort of Patients with Post-Acute COVID-19 Syndrome in a Belgian Family Practice

Fifty-five patients who suffered from COVID-19, who were still very ill after several months, with extreme fatigue, effort exhaustion, brain fog, anomia, memory disorder, anosmia, dysgeusia, and other multi-systemic health problems have been followed in a family practice setting between May 2021 and July 2022. Data extracted from the medical records of the 55 patients (40 women), mean age 42.4 (12 to 79 years), and a qualitative study of 6 of them using a semi-open-ended questionnaire allowed to highlight the clinical picture described by WHO as post-acute COVID-19 syndrome (PACS) also known as long COVID. We used brain single-photon emission computed tomography (SPECT-CT) in thirty-two patients with a high severity index and a highly impaired functional status, demonstrating vascular encephalopathy in twenty nine patients and supporting the hypothesis of a persistent cerebral vascular flow disorder in post COVID-19 condition. The patients will benefit from the consortium COVID Human Genetic Effort (covidhge.com) to explore the genetic and immunological basis of their problem, as 23/55 cases don’t have immunological certainty of a COVID-19 infection. There is no known verified treatment. Analyzing the data from the first 52 patients, three categories of patients emerged over time: 16 patients made a full recovery after 6–8 months, 15 patients were able to return to life and work after 12–18 months with some sequelae, both groups being considered cured. In the third group, 21 patients are still very ill and unable to resume their work and life after 18 months. The biopsychosocial consequences on patients’ lives are severe and family doctors are left out in the cold. It is necessary to test the reproducibility of this description, conducted on a small number of patients. Nevertheless, identifying, monitoring and supporting these patients is a necessity in family medicine.

The National Home-Based Primary Care Learning Network: A Practice-Based Quality Improvement and Research Network.

Home-based primary care (HBPC) provides interdisciplinary, comprehensive care at home for homebound older adults and has been largely excluded from the national conversation on care quality and quality improvement. In this Pragmatic Innovations article, we describe the work of the National HBPC Learning Network (LN), which focuses on fostering a continuous learning culture among HBPC practices to improve practice quality, elevate the field of HBPC, and create a community of continuous growth and quality of care accountability. The LN recruits HBPC practices in waves of 9 to 10 practices. It currently comprises 38 HBPC practices that care for 58,000 patients across 25 states (approximately 26% of all patients receiving HBPC in the United States). In a Kickoff meeting, the HBPC practices in each wave are instructed in the basics of quality improvement, develop project aim statements and their first plan-do-study-act cycle, receive an introduction to the LN quality improvement software platform, and review plans for LN engagement. Each month, practices submit updates and receive real-time feedback on their quality improvement work. Monthly virtual workshops are held with all practices that include sharing results of a "1-minute survey" (a monthly 1-to 3-question survey sent to all LN participants on a topic relevant to HBPC practices), a didactic and discussion related to the 1-minute survey topic, and interactive progress updates from LN participants regarding their quality improvement work. Each wave ends with "Moving-up Day," where practices report on their overall project and reflect on how their practice has changed as a result of the LN. LN practices have addressed and improved performance in multiple HBPC-related quality areas including assessment of functional status and cognitive impairment, falls prevention, advanced care planning, COVID-19 vaccination, and others. We present case studies of 3 LN practices and how LN participation strengthened their practices.

Serum fibrinogen to albumin ratio in patients with ankylosing spondylitis: correlation with disease activity and severity

BackgroundThe fibrinogen to albumin ratio (FAR) has risen to prominence as a novel biomarker for various conditions, including systemic inflammation. Therefore, this study aims to assess the role of FAR in ankylosing spondylitis (AS) and its correlation with disease activity, severity, and functional status of AS patients. Thirty adult patients with AS were enrolled, along with 20 healthy age- and sex-matched subjects as controls. Bath Indices were used to determine the disease activity, severity, and functional status.ResultsThe patients’ mean age was 35.3 years, including 22 males (73.3%) and eight females (26.7%). The median disease duration was 10 years, ranging from 1 to 28 years. AS cases showed higher FAR than the control group (P < 0.001). Active cases were associated with significantly higher FAR when compared to cases in remission (P < 0.001). FAR showed significant positive correlations with Bath Indices including BASDAI, BASFI, and BASMI scores (P = 0.002, 0.002, < 0.001, 0.019, 0.022).ConclusionFAR has been increased in AS, particularly in active cases. FAR has also been associated with the impaired functional status of AS patients. FAR can represent a novel inflammatory parameter for monitoring disease activity and severity in AS.

Physical activity in patients with amyotrophic lateral sclerosis: Prevalence, patients' perspectives and relation to the motor performance.

There are no recommendations for physical activity in amyotrophic lateral sclerosis (ALS) patients. (i) To describe the prevalence and pattern of physical activity (PA) in ALS patients; (ii) to explore patients' attitude towards PA; and (iii) to investigate the relationship between PA at home environment and the rate of functional decline. 96 ALS patients were followed for 6 months at 3-month intervals and assessed by site of disease onset, disease duration, diagnosis delay, functional status, muscle strength, fatigue and prevalence of PA. Over 70% of patients performed regular exercise and reported a positive effect of PA on functional status and mood. Regularly exercising individuals showed a higher ALSFRS-R bulbar score (11.0 vs 9.0, p = 0.011) and a lower decline of respiratory sub-score of ALSFRS-R compared to non-regularly exercising patients (0 vs 1.0, p = 0.026). Bulbar onset was a negative prognostic factor for regular exercise (odds ratio [OR]: 5.2, p = 0.004). The majority of ALS patients perform regular PA and find it positively influence their motor performance and mood. Bulbar disease onset, but not functional status, is a negative prognostic factor for regular exercise in ALS patients. Regular mild PA may result in a slower deterioration of functional status, especially the respiratory function.

The predictive validity of the Hessisch Oldendorf Risk of Falling Scale (HOSS) decreases during the course of rehabilitation.

Falls are highly frequent among neurological patients during rehabilitation and subsequent risk assessments are crucial to prevent falls. This study aims to determine the predictive values of the Hessisch Oldendorf Risk of Falling Scale (HOSS, "Hessisch Oldendorfer Sturzrisiko Skala") for two timeframes: the first month of rehabilitation and from the second month to the end of rehabilitation. Scale performances were assessed for 512 patients during inpatient neurological rehabilitation by calculating the sensitivity and the specificity. HOSS items were entered into a binary logistic regression model. Fall rates were calculated and used for correlation analyses and group comparisons. Initial HOSS assessment showed a sensitivity of 80.4% and a specificity of 60.7%. The HOSS re-assessment resulted in a sensitivity of 67.3% and a specificity of 69.5%. Only a non-somnolent state was identified to increase the risk of falling in both timeframes. Patients with a moderate impaired functional status (Barthel-Index between 20 and 50 points) showed the highest fall rates. The predictive validity of the HOSS decreases during the rehabilitation course. This might be caused by an altered relevance of the HOSS items during the re-assessment compared to the initial assessment for which the HOSS was developed for.

Sequential Geriatric Assessment in Older Patients with Colorectal Cancer during Chemotherapy: Subgroup Analysis of a Prospective, Multicenter Study EpiReal 75

Introduction: Colorectal cancer (CRC) is a disease of older patients, but evidence-based guidelines for chemotherapy in older patients are scarce. Geriatric assessment (GA) evaluates a patient’s functional status (FS) and helps in decision-making when choosing chemotherapy for older patients. However, the change of FS during chemotherapy is rarely studied as GA is mostly performed once instead of sequentially. Methods: We performed a subgroup analysis of a prospective, multicenter study EpiReal 75. Patients aged ≥75 years with gastrointestinal malignancy prior to initiation of chemotherapy or receiving palliative chemotherapy were screened. We defined geriatric core assessments including the Eastern Cooperative Oncology Group score, Barthel’s activities of daily living (ADL) scale, Lawton’s instrumental activities of daily living (IADL) scale, and G-8 questionnaire, which were performed at baseline and repeated every 3 months. Quality of life (QoL) assessed by QLQ-C30 questionnaire was also re-evaluated every 3 months. We defined any deterioration in any of the geriatric parameters as unstable in the corresponding function. Results: 28 patients with CRC were enrolled between April 2014 and December 2018. 20 patients were evaluable for statistical analysis with a mean age of 78.5 years (range, 75–88). Most patients received chemotherapy in palliative setting. During 3 months of chemotherapy, 25% of patients became more dependent as measured by ADL or IADL. During a median follow-up of 15 months, patients with unstable ADL or IADL had a significantly shorter overall survival (OS) than those with stable ADL or IADL (p_logrank = 0.0055 and 0.0253, respectively), without a significant difference in progression-free survival (PFS). Also, unstable IADL correlated with a deterioration in aspects of QoL such as role functioning and emotional functioning (p = 0.0189 and 0.0239, respectively). 20% of patients experienced treatment-related grade 3 adverse events (AEs), no grade 4–5 AEs occurred. Conclusion: Sequential GA revealed changes in FS in older patients with CRC receiving chemotherapy. A deterioration of FS during chemotherapy did not influence PFS but had a negative impact on OS and QoL. It is therefore important to maintain FS in older patients with cancer, and regular performance of geriatric core assessments should be encouraged in the clinical practice.

Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer.

BackgroundImpairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group.MethodsThe REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes.ResultsA total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%).ConclusionA substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters.

Molecular-genetic substantiation of combined therapy in the early postoperative period in diffuse peritonitis

The OBJECTIVE was to give a molecular genetic foundation of combination therapy in the early postoperative period for peritonitis.METHODS AND MATERIALS. 70 patients with diffuse peritonitis were studied: the first (n=35) – patients underwent basic treatment, the second (n=35) – combined treatment with the inclusion of Remaxol and laser irradiation. The severity of endotoxemia and oxidative stress, the state of the hemostasis system and the functional status of the liver were determined. Molecular genotyping of the following genes was performed: beta subunits of platelet fibrinogen receptor (T1565C, ITGB3), fibrinogen (G(-455)A, FGB), catalase (-262C/T, CAT), superoxide dismutase (C47T, SOD2).RESULTS. It was found that the early postoperative period in patients with peritonitis is accompanied by endotoxemia, oxidative stress, impaired functional status of the liver, hypercoagulation and hypofibrinolysis. In patients with conditionally «mutant» genotypes of the studied genes, peritonitis is more severe, the severity of changes in the studied indicators of homeostasis is greater. At the same time, the effectiveness of therapy decreased, the number of complications increased, and the stay of patients in the hospital increased. The early inclusion of Remaxol and laser radiation in basic therapy increases the overall effectiveness of treatment: the severity of endotoxemia and oxidative stress decreases, the functional state of the liver and hemostasis system is restored relatively quickly, and as a result, an improvement in clinical results has been registered (a 37.5 % decrease in the frequency of complications (χ2=3.360, p=0.047) and a reduction in the length of stay of patients in the hospital by 16.6 % (p&lt;0.05)).CONCLUSION. The inclusion of Remaxol and laser therapy in the early postoperative period in the treatment regimen of patients with peritonitis makes it possible to influence pathogenetically important links of the disease relatively quickly, which improves treatment results. This type of therapy is particularly effective in patients with polymorphic genotypes T1565C and C1565C of the ITGB3 gene.

Handgrip Strength Values Depend on Tumor Entity and Predict 180-Day Mortality in Malnourished Cancer Patients

Background: Cancer-related malnutrition is a prevalent condition associated with a loss of muscle mass and impaired functional status, leading to immunodeficiency, impaired quality of life and adverse clinical outcomes. Handgrip strength (HGS) is a practical measure to assess muscle strength in individual patients during clinical practice. However, HGS reference values refer to populations of healthy people, and population-specific values, such as those in the population of cancer patients, still need to be defined. Methods: Within a secondary analysis of a previous randomized controlled nutritional trial focusing on hospitalized cancer patients at risk for malnutrition, we investigated sex-specific HGS values stratified by age and tumor entity. Additionally, we examined the association between HGS and 180-day all-cause mortality. Results: We included data from 628 cancer patients, which were collected from eight hospitals in Switzerland. Depending on the age of patients, HGS varied among female patients from 7 kg to 26 kg and among male patients from 20.5 kg to 44 kg. An incremental decrease in handgrip strength by 10 kg resulted in a 50% increase in 180-day all-cause mortality (odds ratio 1.52 (95%CI 1.19 to 1.94), p = 0.001). Conclusion: Our data provide evidence of the prognostic implications of HGS measurement in cancer patients and validate the prognostic value of handgrip strength in regard to long-term mortality. In addition, our results provide expected HGS values in the population of hospitalized malnourished cancer patients, which may allow better interpretation of values in individual patients.

Medicare spending associated with a dementia diagnosis among older adults.

Over 6 million Americans have Alzheimer's Disease or Related Dementia (ADRD) but whether spikes in spending surrounding a new diagnosis reflect pre-diagnosis morbidity, diagnostic testing, or treatments for comorbidities is unknown. We used the 1998-2018 Health and Retirement Study and linked Medicare claims from older (≥65) adults to assess incremental quarterly spending changes just before versus just after a clinical diagnosis (diagnosis cohort, n=2779) and, for comparative purposes, for a cohort screened as impaired based on the validated Telephone Interview for Cognitive Status (TICS) (impairment cohort, n=2318). Models were adjusted for sociodemographic and health characteristics. Spending patterns were examined separately by sex, race, education, dual eligibility, and geography. Among the diagnosis cohort, mean (SD) overall spending was $4773 ($9774) per quarter - 43% of which was spending on hospital care ($2048). In adjusted analyses, spending increased by $8400 (p < 0.001), or 156%, from $5394 in the quarter prior to $13,794 in the quarter including the diagnosis. Among the cohort in which impairment was incidentally detected using the TICS, adjusted spending did not change from just before to after detection of impairment, from $2986 before and $2962 after detection (p=0.90). Incremental spending changes did not differ by sex, race, education, dual eligibility, or geography. Large, transient spending increases accompany an ADRD diagnosis that may not be attributed to impairment or changes in functional status due to dementia. Further study may help reveal how treatment for comorbidities is associated with the clinical diagnosis of dementia, with potential implications for Medicare spending.

The level of melatonin and serotonin neurohormones in blood serum in patients with non-alcoholic fatty liver disease and kidney lesions infected with COVID-19 virus

Background. Research aimed at determining the possible mechanisms of progression in the damage to various organs and systems against the background of COVID-19 infection is an urgent, not thoroughly studied issue in contemporary clinical medicine. The purpose was to determine the peculiarities of changes in serum melatonin (МТ) and serotonin (ST) neurohormone levels in patients with non-alcoholic fatty liver disease (NAFLD) and kidney damage infected with the COVID-19 virus. Materials and methods. 84 patients with NAFLD (steatohepatitis) combined with increased body mass index were examined. NAFLD patients were divided into two groups depending on the presence or absence of type 2 diabetes mellitus (DM), and namely: Group 1 included 34 NAFLD and insulin resistance (IR) patients; Group 2 comprised 38 patients with NAFLD and type 2 DM. All examined patients were tested for MT and ST levels in blood serum. Results. There was a significant decrease in serum MT level in both examined groups— by 2.2 and 3.2 times respectively in group 1 and 2 patients at the time of admission to the hospital. The same trend was identified in the indicators of serum MT level in both groups of patients on day 1 of inpatient treatment (IT)— and namely, its decrease by 1.5 and 2.3 times. Revealed a correlation between the progression of liver damage and the decrease of MT and ST levels in blood serum, which is probably a consequence of its toxic damage against the background of the conducted treatment of patients infected with COVID-19. The decreased serum neurohormone levels also correlate with the insulin level and IR index. There is also a strong correlation between renal damage occurring at the IT stage in NAFLD patients and impaired carbohydrate metabolism during COVID-19 infection and decreased levels of MT and ST in the blood, according to glomerular filtration rate MDRD MDRD (r=0,88; р&lt;0,01 and r=0,94; р&lt;0,01 accordance). Conclusions. COVID-19 infection and its treatment in NAFLD patients with impaired carbohydrate metabolism lead to impaired renal functional status. In patients with NAFLD and carbohydrate metabolism disorders, a decrease in serum levels of the neurohormones MT and ST was found, which progressively decreased against the background of COVID-19 infection and kidney damage in these patients.