Higher Functional Capacity Research Articles

Exploring the Association between Health-Related Physical Fitness and Quality of Life in Patients with Cancer: A Cross-Sectional Study.

Whereas an exercise intervention effectively improves patients' quality of life, little information is available about the contribution of each physical fitness component. This study aims to explore the association between physical fitness components and the quality-of-life domain in patients with cancer. Between September 2021 and August 2023, 160 patients with mixed cancer types visiting the Oncology Unit were selected on a consecutive basis according to selection criteria. They underwent a comprehensive baseline assessment including the six-minute walking test, the handgrip strength test, the isometric leg press test, the back scratch, sit and reach tests, their waist-hip ratio, and their body mass index. The European Organization for Research and Treatment of Cancer Quality of Life and Core Questionnaire was used to measure the quality of life. The sample size was based on the use of regression models to study associations between clinical characteristics and fitness outcomes. All of the analyses were performed using the SPSS v.25 statistical package. Patients had a mean age of 58 years, 68% were female, 42% were affected by breast cancer, and all were receiving anticancer treatments. Higher functional capacity was associated with better global health status (p < 0.0001) and physical (p < 0.0001), role (p < 0.0001), emotional (p = 0.026), and social function (p = 0.016) and inversely linked with fatigue (p = 0.001). Lower-limb flexibility was significantly associated with all of the domains except for role and social functions. The waist-hip ratio was inversely associated with physical function (p < 0.0001) and positively related to fatigue (p = 0.037). Exercise programs aiming to improve the quality of life in cancer should be addressed to optimize these fitness components.

Myocardial proteome changes in aortic stenosis rats subjected to long-term aerobic exercise.

The effects of exercise training (ET) on the heart of aortic stenosis (AS) rats are controversial and the mechanisms involved in alterations induced by ET have been poorly clarified. In this study, we analyzed the myocardial proteome to identify proteins modulated by moderate-intensity aerobic ET in rats with chronic supravalvular AS. Wistar rats were divided into four groups: sedentary control (C-Sed), exercised control (C-Ex), sedentary aortic stenosis (AS-Sed), and exercised AS (AS-Ex). ET consisted of five treadmill running sessions per week for 16 weeks. Statistical analysis was performed by ANOVA or Kruskal-Wallis and Goodman tests. Results were discussed at a significance level of 5%. At the end of the experiment, AS-Ex rats had higher functional capacity, lower blood lactate concentration, and better cardiac structural and left ventricular (LV) functional parameters than the AS-Sed. Myocardial proteome analysis showed that AS-Sed had higher relative protein abundance related to the glycolytic pathway, oxidative stress, and inflammation, and lower relative protein abundance related to beta-oxidation than C-Sed. AS-Ex had higher abundance of one protein related to mitochondrial biogenesis and lower relative protein abundance associated with oxidative stress and inflammation than AS-Sed. Proteomic data were validated for proteins related to lipid and glycolytic metabolism. Chronic pressure overload changes the abundance of myocardial proteins that are mainly involved in lipid and glycolytic energy metabolism in rats. Moderate-intensity aerobic training attenuates changes in proteins related to oxidative stress and inflammation and increases the COX4I1 protein, related to mitochondrial biogenesis. Protein changes are combined with improved functional capacity, cardiac remodeling, and LV function in AS rats.

Follow-Up of Eight-Weeks Detraining Period after Exercise Program on Health Profiles of Older Women

Background: The multicomponent training program (MTP) is a physical exercise strategy used to combat the sedentary lifestyle in older women (OW). However, periods of interruption in training are common in this population. The aim of our study was to analyze the 8-week MTP effects followed by two, four, and eight weeks of interruption on the lipid profile (LP) and functional capacity (FC) of OW. Methods: Twenty-one OW (experimental group [EG], 67.6 ± 3.1 years; 1.55 ± 0.35 m) were subjected to an 8-week MTP followed by a detraining period, and 14 OW (control group [CG], 69.4 ± 4.7 years; 1.61 ± 0.26 m) maintained their daily routine. FC (i.e., 30-s chair stand [30-CS], 8-foot up and go [8-FUG], 6-min walk [6-MWT], handgrip strength [HGS], and heart-rate peak during 6-WMT [HRPeak]), total cholesterol (TC) and triglycerides (TG) were assessed before and after MTP and two, four, and eight weeks after MTP. Results: 8-week MTP resulted in higher FC and decreased LP values in EG (p &lt; 0.05); two and four weeks of detraining did not promote changes. After eight weeks of detraining TC (ES: 2.74; p = 0.00), TG (ES: 1.93; p = 0.00), HGS (ES: 0.49, p = 0.00), HRPeak (ES: 1.01, p = 0.00), 6-MWT (ES: 0.54, p = 0.04), and 8-FUG (ES: 1.20, p = 0.01) declined significantly. Conclusions: Periods of more than four weeks of detraining should be avoided to promote a good quality of life and health in OW. If older people interrupt training for a period longer than four weeks, physical-education professionals must outline specific training strategies to maintain the adaptations acquired with MTP. Future studies should establish these criteria based on ideal training volume, intensity, and frequency.

Sex differences in energy metabolism: natural selection, mechanisms and consequences.

Metabolic homeostasis operates differently in men and women. This sex asymmetry is the result of evolutionary adaptations that enable women to resist loss of energy stores and protein mass while remaining fertile in times of energy deficit. During starvation or prolonged exercise, women rely on oxidation of lipids, which are a more efficient energy source than carbohydrates, to preserve glucose for neuronal and placental function and spare proteins necessary for organ function. Carbohydrate reliance in men could be an evolutionary adaptation related to defence and hunting, as glucose, unlike lipids, can be used as a fuel for anaerobic high-exertion muscle activity. The larger subcutaneous adipose tissue depots in healthy women than in healthy men provide a mechanism for lipid storage. As female mitochondria have higher functional capacity and greater resistance to oxidative damage than male mitochondria, uniparental inheritance of female mitochondria may reduce the transmission of metabolic disorders. However, in women, starvation resistance and propensity to obesity have evolved in tandem, and the current prevalence of obesity is greater in women than in men. The combination of genetic sex, programming by developmental testosterone in males, and pubertal sex hormones defines sex-specific biological systems in adults that produce phenotypic sex differences in energy homeostasis, metabolic disease and drug responses.

Phase I / II Study on Infusion of Alloreactive or Ex Vivo il-15 Stimulated Natural Killer Cells after Haploidentical Stem Cell Transplantation in Pediatric Patients with Acute Leukemia (PHINK): A Study of the Spanish Hematopoietic Stem Cell Transplantation Group (GETH)

Background: Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) is a highly complicated but effective procedure for high-risk pediatric leukemia in the absence of an HLA-identical donor. Post-transplant relapse is the main problem for patient survival. According to literature, Natural Killer (NK) cells play a potent role as inducers of the graft-versus-leukemia (GvL) effect in haplo-HSCT. The presence of alloreactive NK cells correlates with a lower relapse rate, improved engraftment, decreasing graft-versus-recipient disease (GvHD) and viral infection risk. In the absence of donor-recipient NK cell alloreactivity, other NK cell activation strategies are necessary. We propose a phase I/II clinical trial with dose escalation, multicenter, framed in the GETH, to determine dose-limiting toxicity (DLT) and the maximum tolerated dose (MTD) of a single infusion of alloreactive NK cells (Allo-NK) or NK cells stimulated ex vivo with IL-15 (IL15-NK) after haplo-HSCT in pediatric patients with high-risk leukemias. Methods: Eighteen pediatric patients with high-risk leukemia were recruited between September 16, 2020, and May 12, 2023, at 5 hospitals in Spain, Hospital Universitario La Paz, Hospital Universitario Gregorio Marañón, Hospital Universitario Niño Jesús, Hospital Universitario Central of Asturias and Hospital Santa Creu and Sant Pau. Patients were stratified in 2 treatment groups: Allo-NK (n=9) or IL15-NK (n=9), depending on the KIR disparity between donor and recipient. Our phase I/II clinical trial presents a dose-escalation design (3+3). The treatment cohorts are divided into cohort 1 (up to 2x10 7 cells/kg), cohort 2 (2-5x10 7 cells/kg) and cohort 3 (5-10x10 7 cells/kg). We have monitored infections reactivation, as well as, chimerism and engraftment after transplantation. In Allo-NK group, the KIR clone that provides alloreactivity in the NK cell was also tracked. The phenotypic profile and functional capacity of NK cells present in the patient up to 360 days after transplantation have also been analyzed. Results: Nine patients (4 in Allo-NK and 5 in IL-15NK) were included in cohort 1, 7 patients (4 in Allo-NK and 3 in IL-15NK) in cohort 2 and 2 patients (1 in Allo-NK and 1 in IL-15NK) in cohort 3. We were unable to complete the dose escalation design initially proposed due to the high weight of some patients and the unavailability of ex vivo expanded NK cells. In IL15-NK group patients presented a higher prevalence of B-ALL (p=0.018) and had received a previous transplant (p=0.082). NK cell infusions of IL15-NK group showed higher expression of CD25 and CD69 receptors and higher functional capacity. In the Allo-NK group, the most prevalent KIR-reactive clone was KIR2DL1 (55.6%). We also observed a tendency for KIR2DL1 alloreactive clone to increase from 30 (8,18%) to 360 (25,63%) days after transplantation. Regarding clinical outcomes in 2 study arms, the incidence of severe (Grades III-IV) acute GvHD was 22.2% and severe chronic GvHD was only observed in 1 (5.6%) patient (Table 1). The incidence any infection or endothelial vascular complications were 72% and 33% respectively. No statistical differences were observed in GvHD, infections and endothelial vascular complications. We found 2 relapses, 1 in each study arm (11.1%). Five patients died, 1 (5.6%) because of disease progression and 4 (22.2%) because transplant related complications (TRM) (Table 1). Dividing patients into the 3 dose-escalation cohorts, we found no significant differences between cohorts in the primary clinical outcomes analysed. One-years overall survival (OS) and disease-free survival (DFS) was 72.22% (CI95% 51.93-100) and GvHD-free/relapse-free survival (GRSF) was 64.1% (CI95% 44.62-92.1), finding no significant differences between either 2 study arms or the 3 dose-escalation cohorts. Regarding the analysis of the NK phenotype, we observed a tendency to increase the expression of CD16 and CD57 receptors between 30 to 360 days after transplantation in both groups. Conclusions: Two study arms shows similar data respect to clinical outcome. Patients infused with IL-15-stimulated NK cells showed similar toxicity to the alloreactive NK group. According to dose escalation, we observed no association between increased toxicity and increased number of infused NK cells. We were unfortunately unable to complete cohort 3 because of the cells/kg ratio in some patients.

Association between C-reactive protein, neutrophils, lymphocytes, cognition, and functional capacity in an oldest old population

Systemic inflammatory processes can cause changes in cognition and functional capacity in the general population. Currently there are no accessible biomarkers capable of early detection and monitoring of such pathologies, and only few studies involving older than 80 years-old population were done. The C-reactive protein (CRP) and blood counts are low-cost tests that are often performed in routine basis. From the blood counts it is possible to evaluate the absolute count of neutrophils and lymphocytes, which are peripheral blood inflammatory markers. With these results, it is also possible to evaluate the neutrophils to lymphocytes ratio (NLR). Therefore, these tests may be potential biomarkers in the evaluation of the development of dementia, mild cognitive disorder, and functional dependence, with the possibility of assisting in the clinical management and prevention of such pathologies. To evaluate the association between cognition and functional capacity with C-reactive protein, absolute neutrophil count, lymphocyte count, and NLR in a population of elderly people aged 80 years and older. Observational analytical cross-sectional study conducted in the cohort of the Longevous Project of the Discipline of Geriatrics and Gerontology of UNIFESP. Complete blood counts (CBC) and CRP were collected from 244 patients included in the study between 2010 and 2013. Gender and the presence of hypertension and diabetes mellitus were also characterized. Associations between the absolute values of neutrophils and lymphocytes and the NLR with cognitive tests (mini mental state examination, MMSE, and clock drawing test, CDT) and with functional capacity (basic activities of daily living, BADL or Katz score, and instrumental activities of daily living, IADL or Lawton score) were performed using nonparametric Mann-Whitney and Kruskall-Wallis statistical tests. We found no associations between the markers obtained by the CBC and the cognitive assessment tests. We also found no association between the CRP and the MMSE. However, we obtained a statistically significant difference between the CRP marker and the CDT, with P = 0.003. There was no statistically significant difference between markers obtained by CBC or CRP with the BADLs. But we observed a statistically significant association between the IADLs and the absolute count of neutrophils and lymphocytes, respectively P = 0.0379 and 0.0190. The presented results contribute to the hypothesis that serum inflammatory biomarkers can be useful in the assessment of health outcomes. We identified that patients with lower functional capacity for IADLs have higher absolute neutrophil and lymphocyte counts when compared to patients with higher functional capacity. In addition, we identified that patients with low performance on CDT have CRP at higher levels when compared to patients with higher cognitive ability. Our results suggest that markers of inflammation easily obtainable through CBC and CRP may be useful for monitoring the functional and cognitive ability of long-lived people.

Association between car driving and successful ageing. A cross sectional study on the "S.AGES" cohort.

Assessing successful ageing (SA) is essential to identify modifiable factors in order to enforce health promotion and prevention actions. SA comprises 3 dimensions: an active engagement with life, a low probability of disease and disease-related disability, and a high cognitive and physical functional capacity. Driving seems to be linked to SA as it is a mean to preserve social interactions and requires preserved functional and cognitive status. This study aims to investigate whether driving status can be considered a proxy of SA, by describing determinants associated with driving status in the 65+. This cross-sectional study is ancillary to the S.AGES (Sujets AGÉS-Aged Subjects) study, an observational prospective cohort study which included patients suffering from chronic pain, type-2 diabetes mellitus or atrial fibrillation from 2009 to 2014. SA was defined by the success of three dimensions: physiological comprised of comorbidity and autonomy scores, psychological comprised of cognitive status and emotional state, and a social dimension. 2,098 patients were included of whom 1,226 (58.4%) reported being drivers. 351/2,092 (16.7%) were classified as successful agers: 292/1,266 (23.8%) in the driver group vs. 59/872 (6.8%) in the non-driver group; p < .001. In the final logistic model, after adjustment for relevant variables, SA was associated with driver status OR 1.94 [1.36-2.77]. Driving may be considered as a proxy to SA: it reflects elders' independence, cognitive ability and a means to maintain social interactions. To preserve their mobility and enable them to achieve SA, regular screening of driving skills, specific rehabilitation programs are needed. Moreover development and communication on special transports services, communal rides or even driverless car to avoid apprehension around older adults driving could be solutions.

Pre-existing SARS-CoV-2-reactive CD4 +T cells are established and highly functional in early childhood

Abstract The pre-existing SARS-CoV-2-reactive T cells identified in unexposed individuals are likely induced by prior infections with seasonal coronaviruses and may modulate disease outcomes. By assessing humoral and cellular immunity in paired samples from SARS-CoV-2 unexposed children at ages 2 and 6 (n=16), and SARS-CoV-2 seronegative adults (n=94, ages 26–83), this study aims to elucidate how age influences the immune responses against coronaviruses. Using flow cytometry, the phenotype and function of seasonal coronavirus OC43-specific and pre-existing SARS-CoV-2-reactive memory (m) CD4 +T cells were characterized after a 10h stimulation with viral peptides. The frequency of SARS-CoV-2-reactive mCD4 +T cells were closely linked with the OC43-specific responses in all age groups. However, a positive response to either OC43- or SARS-CoV-2-derived peptides was more common at age 6 than in adults. Similarly, the functional capacity, defined by IFN-γ, IL-2 and TNF expression, of both OC43-specific and SARS-CoV-2-reactive mCD4 +T cells peaked at age 6 and then declined with age. Age-dependent phenotypic markers were also identified, including CD226, TIGIT and CD38. Lastly, in contrast to Rhinovirus, EBV, Influenza and other coronaviruses, OC43 seroprevalence did not increase between ages 2 and 6, or from childhood to adulthood, further establishing OC43 as a childhood infection. Our results show that memory responses to coronaviruses develop at a young age and exhibit age-dependent qualities, findings which may aid in future vaccine development. In addition, the high prevalence and functional capacity of pre-existing SARS-CoV-2-reactive mCD4 +T cells at age 6 may contribute to the low incidence of severe COVID-19 in this age group.

Trajectories of Successful Aging Among Older Adults in Aotearoa New Zealand.

Successful aging was defined as having no multimorbidity, high functional capacity, active life engagement, and good health-related quality of life. This study analyzed data from 1433 older adults who were followed up for 12years across seven waves from the New Zealand Health, Work and Retirement study by examining the trajectories of successful aging. Latent growth curve modeling was used to assess the growth factors of successful aging trajectories of older adults. The mean successful aging score was 3.53 (range: 0-6) in 2006 and linearly declined by 0.064 units every year. Those with higher successful aging scores at baseline had a slower decline. Successful aging scores were lower among females, Māori, and those aged 65years and above at baseline. The findings from this study suggest that gender and ethnic inequalities play significant roles in successful aging among older adults in New Zealand.

Sexual Function, Behavior, and Satisfaction in Masters Athletes

Objectives Masters athletes are endowed with high functional capacity, long-term health, and psychological outlook. However, their sexual activity and function are largely unknown. We investigated the influence of sustained moderate to vigorous exercise on sexual life using a model of masters athletes. Methods A 55-item survey adapted from previous American Association of Retired People (AARP) sexuality study were distributed to masters athletes associations. The responses from 166 masters athletes were compared with AARP dataset that represented a general population. Results Both male and female masters athletes demonstrated more frequent sexual desire and greater involvements in different types of sexual activities (i.e., kissing or hugging, touching or caressing, sexual intercourse, oral sex, and self-stimulation; all p < 0.05). Sexual satisfaction was greater in female masters athletes than in female general population (p = 0.025), but no such group difference was observed in men. Male athletes had a lower degree of erectile dysfunction. No difference was observed in orgasm frequency between the two population groups. Age-associated decline in sexual activity was apparent in general population (p < 0.05) but absent in masters athletes. Females recorded lower engagements in partner-involved sexual behaviors than men in the general population, but no such gender difference was observed in women. The primary factor predicting improvement in sexual satisfaction was “better health for myself” (29.7%) in the general population, whereas master athletes identified “better health for partner” (23.5%). Conclusion Masters athletes in general and female athletes in particular demonstrate superior sexual function, satisfaction, and behavior presumably due to their better overall health status.

Upper extremity self-efficacy correlates with daily hand-use of individuals with high functional capacity post-stroke

Purpose To understand the role of affected upper extremity (UE) self-efficacy for explaining daily-hand-use in individuals post-stroke. Specifically, to describe UE self-efficacy and to assess the associations between UE self-efficacy to UE motor and functional capacity and daily hand-use. Materials and methods This cross-sectional study included individuals post-stroke receiving rehabilitation with high UE functional capacity [Action Research Arm Test (ARAT) > 50]. The Rating of Everyday Arm-Use in the Community and Home (REACH) assessed perceived UE daily use and the Confidence in Arm and Hand Movement scale (CAHM) assessed UE self-efficacy. Functional capacity was assessed by the ARAT and the Fugl-Meyer-motor-assessment assessed motor impairment. Correlations between measures were assessed. Results Twenty-two individuals, aged 19–80, with high UE functional capacity [median (IQR) ARAT-56.5 (54–57)] and varying UE self-efficacy [median (IQR) CAHM-76.7 (58–84.4)], were included. UE self-efficacy was significantly correlated with the ARAT (rs = 0.53, p < 0.01) and REACH (rs = 0.51, p < 0.01) but ARAT was not significantly correlated with REACH. Conclusions UE self-efficacy is correlated with perceived daily hand-use in individuals with high functional capacity. Further research and a deeper understanding of the clinical implications of UE self-efficacy are warranted. UE self-efficacy should perhaps be assessed during rehabilitation. IMPLICATIONS FOR REHABILITATION Individuals with stroke with high affected upper extremity functional capacity do not necessarily use this hand for daily living. Upper extremity self-efficacy is correlated with perceived daily hand-use in individuals with high functional capacity; participants with higher upper extremity self-efficacy also reported more daily hand-use. Upper extremity self-efficacy seems to be upper extremity task or situation-specific. Upper extremity self-efficacy should be assessed during rehabilitation and the clinical implications of (low) upper extremity self-efficacy should be further researched.

The Huntington’s Disease Health Index: Initial Evaluation of a Disease-Specific Patient Reported Outcome Measure

When developed properly, disease-specific patient reported outcome measures have the potential to measure relevant changes in how a patient feels and functions in the context of a therapeutic trial. The Huntington's Disease Health Index (HD-HI) is a multifaceted disease-specific patient reported outcome measure (PROM) designed specifically to satisfy previously published FDA guidance for developing PROMs for product development and labeling claims. In preparation for clinical trials, we examine the validity, reliability, clinical relevance, and patient understanding of the Huntington's Disease Health Index (HD-HI). We partnered with 389 people with Huntington's disease (HD) and caregivers to identify the most relevant questions for the HD-HI. We subsequently utilized two rounds of factor analysis, cognitive interviews with fifteen individuals with HD, and test-retest reliability assessments with 25 individuals with HD to refine, evaluate, and optimize the HD-HI. Lastly, we determined the capability of the HD-HI to differentiate between groups of HD participants with high versus low total functional capacity score, prodromal versus manifest HD, and normal ambulation versus mobility impairment. HD participants identified 13 relevant and unique symptomatic domains to be included as subscales in the HD-HI. All HD-HI subscales had a high level of internal consistency and reliability and were found by participants to have acceptable content, relevance, and usability. The total HD-HI score and each subscale score statistically differentiated between groups of HD participants with high versus low disease burden. Initial evaluation of the HD-HI supports its validity and reliability as a PROM for assessing how individuals with HD feel and function.

Multimodal Correlates of Cannabis Use among U.S. Veterans with Bipolar Disorder: An Integrated Study of Clinical, Cognitive, and Functional Outcomes

Objective: Cannabis use (CU) is common among persons with bipolar disorder (BD). Evidence suggests that CU is associated with poorer outcomes among persons with BD; however, these findings remain inconsistent. The present exploratory study aims to examine clinical, functional, and cognitive correlates of CU among persons with BD. Methods: U.S. veterans with BD type I who participated in a large-scale, nationwide study were categorized into four groups: current CU, past CU, past other drug use, and no drug use. Bivariate analyses, univariate analyses of covariance, and Levene’s Test for Equality of Variance were used to compare groups on clinical, cognitive, and functional measures. Results: Of 254 (84.6% male) veterans with BD type I included in the analyses, 13 (5.1%) had current CU, 37 (14.5%) past CU, 77 (30.3%) past other drug use, and 127 (50%) reported no drug use. BD with CU was associated with post-traumatic stress disorder (PTSD) and experiencing lifetime suicidal ideation. Notably, current CU was associated with higher working memory performance, compared to both past CU and no drug use. Likewise, current CU was associated with higher functional capacity, compared to past CU as well as no drug use. Conclusions: These findings contribute to the growing literature on the complex effects of cannabis on BD. As the commercialization and legalization of cannabis increases, further research in this area is warranted to quantify posed risks to this population, and thereby guide clinical decision-making.

Prevalence of Computer Use among Geriatric In- and Outpatients.

Objective: Despite its many benefits, tele-rehabilitation is not widely used by the older generations. This study aimed to investigate the opportunity to offer tele-rehabilitation in a geriatric population by determining the prevalence of computer use and to examine whether the patients’ characteristics affect computer use. Design: Cross-sectional study. Patients: Cognitive well-functioning in- and outpatients aged 65 years or older. Methods: Patients were consecutively included and surveyed. Results: A total of 249 patients participated in the survey. Among them, 124 were computer users. Four of these never went online. Compared to non-users, computer users were younger OR: 0.91 (95% CI: 0.87; 0.94) p = 0.001, less frail OR: 0.37 (95% CI: 0.25;0.55) p = 0.001, had a higher functional capacity OR: 1.02 (95% CI 1.01; 1.03) p = 0.001 and more often had an education at high school level or higher OR: 1.7 (95% CI: 1.41; 2.40). Conclusion: Only half of the geriatric patients are computer users. If tele-rehabilitation is to be adopted by a wider geriatric population challenged by reduced mobility, long transportation times, or frailty, computer training, user friendly devices and computer support should be considered beforehand.

Optimism is associated with respiratory symptoms and functional status in chronic obstructive pulmonary disease

BackgroundOptimism is the general belief that good things will occur in the future; optimism is modifiable by cognitive behavioral therapy (CBT). Previous studies have associated higher optimism with improved health outcomes and lower all-cause mortality.Research questionInvestigate association between optimism and disease-related characteristics in chronic obstructive pulmonary disease (COPD).Study design and methodsCurrent and former smokers with/without COPD and Preserved Ratio Impaired Spirometry (PRISm) from the 10-year follow-up visit for the Genetic Epidemiology of COPD (COPDGene) study were included. Optimism was assessed at the 10-year visit using the Life Orientation Test-Revised. Models of optimism as a predictor of lung function, COPD-associated phenotypes including exacerbations, and functional assessments, were adjusted for demographic confounders, smoking status, and comorbidities.ResultsAmong 1967 subjects, higher optimism was significantly associated with older age, non-Hispanic white race, marital status, quitting smoking status, absence of COPD, and absence of depression. In multivariable analysis, higher optimism was independently associated with fewer prior exacerbations of COPD (coef = − 0.037, P < 0.001). Higher optimism was also related to better MMRC scores (coef = − 0.041, P < 0.001), CAT scores (coef = − 0.391, P < 0.001), SGRQ scores (coef = − 0.958, P < 0.001), BODE index (coef = − 0.059, P < 0.001), and longer 6-min walk distance (coef = 10.227, P < 0.001). After stratification by severity of COPD, these associations with optimism were still significant in all groups. No significant association was observed for cross-sectional FEV1 (%) or FVC (%) with optimism score.InterpretationFewer exacerbations and less severe respiratory symptoms and higher functional capacity were associated with higher optimism, which may impact health outcomes in current and former smokers with and without COPD. Optimism is a modifiable trait and these results may further support a role for CBT to improve outcomes in COPD.

Lung Function Reserve and Physical Function in Healthy Older Adults: Findings from BLSA

Forced Expiratory Volume in 1-second (FEV1) that falls below the lower limit of normal (LLN) is a well-established correlate of functional limitation and disability. However, less is known about the functional implications of gradations of lung function above the LLN. We examined the cross-sectional association between gradations of healthy lung function and usual gait speed, reported walking ability, and fast 400m walk performance in 750 persons (50.7% men) aged 55-95 free from respiratory disease and mobility limitations, participating in the Baltimore Longitudinal Study of Aging (BLSA). The 2012 Global Lung Initiative (GLI) reference equations were used to calculate FEV1 Z-scores, with healthy lung function categorized as follows: -1.6 < Z ≤ -1.0 (pre-clinical), -1.0 < Z ≤ -0.3 (low normal), -0.3 < Z ≤ 0.3 (normal), 0.3 < Z ≤ 1.0 (high-normal), and Z > 1.0 (high). Associations between gradations of healthy lung function and physical function were evaluated using multivariate linear regression, adjusting for age, sex, height, weight, and waist circumference. Compared to the ‘pre-clinical’ category, the difference in 400m walk time was 0.71 (p>.05), -6.60 (p>.05), -12.21 (p<0.05), and -15.52 (p<0.01) seconds for the ‘low normal’, ‘normal’, ‘high-normal’, and ‘high’ categories, respectively. No associations between gradations of healthy lung function and normal gait speed or walking ability were found (p>0.05). Higher levels of lung function reserve are associated with better 400m walking performance, thus efforts to promote and/or reduce loss of lung function reserve may help individuals maintain high functional capacity in later life.

Patophysiologic and gender differences regarding exercise responses in decompensated heart failure patients

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart Failure patients often present impairment on their functional capacity. Exercise training is the key component of cardiac rehabilitation and must be early implemented. Knowing the characteristics that lead a patient to be a good responder to an exercise intervention would be useful to identify the ones that could benefit from this same intervention. Purpose Identify the characteristics of good responses to an aerobic exercise training in decompensated heart failure (HF) patients and understand if there are gender differences. Methods Cross sectional study with 76 inpatients who performed an aerobic exercise training program (AET). Functional capacity was evaluated at admission and discharge using three different tools: the London Chest of Activity of Daily Living (LCADL) scale, the Barthel Index (BI) and the 6-minute walking test (6MWT). Multivariate linear regression was performed by gender to understand which variables lead a patient to have better performance. Since it is known that men and women have different responses to exercise training, the results and analysis of the data collected were performed by gender. Results Seventy-six patients (52 men) were included. The mean age was 67 ± 10 years, 15.8% were New York Heart Association (NYHA) class IV and 76.3% had reduced ejection fraction. The major etiology of HF was ischemic disease (35.5%). Six predictive equations were obtained, one for each functional capacity (FC) tool divided by gender. NYHA class III patients do not differ from class IV in terms of FC at discharge. However, HFreduced ejection fraction patients presented higher 6MWT distance (309,6m vs 231m) and lower LCADL score (11 vs 15) compared to non-reduced. Gender analysis showed that women had an average of 4 days longer in-hospital stay and a considerable difference in the 6MWT. At admission women walked 15 meters less than man and at discharge 69 meters less, presenting also lower score at BI and higher at LCADL. However, only the discharge 6MWT distance presents a statistical significant difference (69 meters; p = 0.01). Traditionally women are more sedentary and present less fitness level than men. The linear regression model shows that gender is a independent variable that contributes to the change in the 6MWT - favouring men. Conclusions The AET program appears to be more effective in younger patients, with low FC at admission and who are less impaired. Those with left systolic ventricular function apparently interfered with progression during the program. Gender influences the performance of patients undergoing exercise training. Men present higher FC at discharge but the predictive models are stronger for women. These results are consistent with the idea that gender plays an important role in determine the performance of patients in exercise training programs.

Multifunctional polyether grafted dendritic solid supports: Novel class of solvent like high loading hybrid supports for solid phase organic synthesis

Three novel multifunctional polyether grafted dendritic solid supports for organic synthesis were developed via single step, grafting from and hypergrafting strategies. In order to improve both the swelling capacity and loading capacity of conventional resins simultaneously, the hybrid supports were developed by grafting either multivalent linear polymers or dendritic architectures to the conventional resin. The ring opening polymerization of strained cyclic monomers was explored for the development of multivalent polymer grafts on the solid support. The physico-chemical properties of the dendritic solid supports were studied by various characterization techniques and analytical methods. Among the hybrid supports, Het-PG was found to be a novel solvent like high loading solid support. High functional group capacity of 7 mmol g−1 which was introduced via single step approach, increased accessibility of functional sites even at high loading etc. make Het-PG a versatile solid support for organic synthesis. The applicability of dendritic solid support (Het-PG) as a high loading hybrid support for multistep solid phase organic synthesis of small peptides was investigated. The high functional group capacity and increased accessibility of functional sites in Het-PG were exploited for addressing the poor industrial scalability issue of solid phase organic synthesis. A novel approach to solid phase peptide synthesis using solvent like high loading hybrid solid support is presented.

Pharmaceutical mobile application for visually-impaired people in Thailand: development and implementation

BackgroundMost mobile pharmaceutical applications produced for people with visual disabilities in Thailand fail to meet the required standard due to poor-quality regulations, defective design, lack of user support and impracticality; as a result, visually-impaired people are unable to use them. This research is motivated by the limited use of this technology in primary medical services and its aim is to enable people with disabilities to access effective digital health information. The research objective is to analyse, design and develop a mobile pharmaceutical application with functions that are appropriate for visually-impaired users, and test its usability.ResultsBased on the design and development of the application, it contained five necessary functions. When testing the usability and users’ satisfaction, it was found that the input or fill of information in the application was of low usability. According to the test results, the medicinal database function was missing 71 times and the voice command function was missing 34 times. Based on users’ satisfaction results, users who had the highest level of usage gave higher average scores to users’ attitude, users’ confidence, user interface and system performance than those with lower levels of usage. The scores of both groups were found to be the same when discussing the implementation of the development.ConclusionsThis mobile application, which was developed based on the use of smart technology, will play an important role in supporting visually-impaired people in Thailand by enhancing the efficacy of self-care. The design and development of the application will ensure the suitability of many functions for visually-impaired users. However, despite the high functional capacity of the application, the gap in healthcare services between the general public and disabled groups will still exist if users have inadequate IT skills.

Testing results of the digital app for teaching calligraphy to elementary school students

The subject of this research, which is dedicated to testing the digital app &amp;ldquo;Calligraphy.rus &amp;ndash; Learning to Write Letters&amp;rdquo; for teaching calligraphy to elementary school students, is the quality, effectiveness and convenience of using this educational app in working with elementary school students. The object of this research is the assessments and opinions of elementary school teachers acquired in the course of testing of this app. Testing involved over 400 pedagogues from more than 30 Russian regions; it was conducted based on the method of situation modeling of using digital app in practice, as well as the survey technique. The scientific novelty lies in obtaining objective assessments on the practical effectiveness of modern digital educational resource in the format of digital app for teaching skills of calligraphic writing to elementary school students. The conclusion is made on the high functional capacity of the indicated digital resource based on the assessment given by the pedagogues on such parameters as convenience, design and characters, ease of understanding, task description and feedback. The pedagogues consider this digital app as a promising instrument to be implemented in the educational process and extracurricular activities.