Impaired Physical Ability Research Articles

Impaired physical ability in patients with transfusion-dependent β-thalassaemia: Can regular physical activity be a countermeasure?

Transfusion-dependent β-thalassaemia (TDβT) is a genetic disorder characterised by reduced or absent β-globin chain synthesis, resulting in chronic anaemia. Treatment consists of regular blood transfusions and chelation therapy to limit iron overload and its negative effects on organs (e.g. heart, lungs and liver). Despite improved life expectancy with transfusions and chelation therapy, TDβT patients experience poor quality of life and impaired exercise capacity (mainly due to muscle deconditioning and reduced cardiac inotropism). The aims of this review are (i) to discuss the role of organ dysfunction in the impairment of exercise capacity and reduced quality of life of TDβT patients; and (ii) to discuss physical activity as a potential therapeutic strategy to alleviate the multifactorial impact of the disease.

Development of a compliant gripper for safe robot-assisted trouser dressing-undressing

In recent years, many countries, including Japan, have rapidly aging populations, making the preservation of seniors' quality of life a significant concern. For elderly people with impaired physical abilities, support for toileting is one of the most important issues. This paper details the design, development, experimental assessment, and potential application of the gripper system, with a focus on the unique requirements and obstacles involved in aiding elderly or hemiplegic individuals in dressing and undressing trousers. The gripper we propose seeks to find the right balance between compliance and grasping forces, ensuring precise manipulation while maintaining a safe and compliant interaction with the users. The gripper's integration into a custom-built robotic manipulator system provides a comprehensive solution for assisting hemiplegic individuals in their dressing and undressing tasks. Experimental evaluations and comparisons with existing studies demonstrate the gripper's ability to successfully assist in both dressing and dressing of trousers in confined spaces with a high success rate. This research contributes to the advancement of assistive robotics, empowering elderly, and physically impaired individuals to maintain their independence and improve their quality of life.

Physical fitness in adolescent patients with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is the most frequent monogenic auto-inflammatory disease worldwide responsible for episodes of fever, serositis and musculoskeletal symptoms. Inflammatory attacks are responsible for sedentary behavior and FMF patients may be at increased cardiovascular risk. Cardiorespiratory Fitness (CRF) and physical capacities during adolescence are associated with cardiovascular mortality in adulthood. In this study, we aimed to describe the physical fitness of FMF adolescents. A monocentric retrospective study at the Versailles Hospital between January 2020 and June 2023. All FMF patients over 14-year-old who had completed a routine physical test were included. Clinical and physical data including results of the 6-minute walking test, timed unipedal stance test, Ruffier-Dickson index, 30-seconds chair-stand test and sit-and-reach test were extracted from medical records. Results were compared with previously published normative reference values and criterion-referenced standards for healthy subjects. Eighteen FMF patients (12 girls, 6 boys) were included. The median age was 16 years old [14-18]. Clinical history included joint symptoms (n = 11), chest pleuritis (n = 8), and leg pain (n = 11). Estimated VO2max was below the recommended thresholds in 13 patients, which predicts cardiovascular risk. Cardiovascular adaptation was poor in 11 patients. Low VO2max was associated with CRP > 5mg/l on test day and history of joint symptoms. FMF patients displayed altered physical capacities compared to normative values of healthy subjects. History of musculoskeletal pain, systemic inflammation and sedentary behavior may participate in impaired physical abilities and promote cardiovascular diseases in adulthood. Specific exercise programs could benefit patients for disease control and cardiovascular risk reduction.

Normalization of technology for social contact in a Norwegian care facility during COVID-19

BackgroundThe COVID-19 pandemic has seen unprecedented growth in the use of interactive technologies in care facilities for social contact between residents and their close contacts due to the need for social distancing. As the pandemic is transitioning into a new phase, there is a need to critically examine the new practices associated with technology usage.ObjectiveOur analysis is based on a case study of how a care facility in western Norway adopted a novel technology called KOMP. We empirically investigate the stability of practices with KOMP for maintaining social communication between residents and their relatives and consider whether these practices are likely to last beyond the pandemic. We draw on normalization process theory (NPT) to interpret our findings and critically examine how stable embedding of new technologies for social communication occurs under extraordinary circumstances.MethodsWe conducted a case study based on participant observation and interviews, and the data were analyzed through inductive thematic analysis. Participants are health care professionals from a public care facility in western Norway.ResultsFour major themes emerged from the data. The first revolved around the pressing need for communications between residents and relatives with a suitable tool. Second, staff showed engagement through motivation to learn and adapt the technology in their practices. A third theme centered on how staff and the organization could work effectively to embed KOMP in daily practice. Our fourth theme suggested that the professionals continuously assessed their own use of the technology.ConclusionFrom the perspective of NPT, practices with KOMP have been partially embedded by developing a shared understanding, engaging through cognitive participation, working collectively with staff and the organization, and reflexively monitoring the benefits of using KOMP. However, staff engagement with the technology was continuously threatened by factors related to diverging staff preferences, the burden of facilitating KOMP for residents with impaired cognitive and physical abilities, issues of privacy and ethics, and the technical skills of the residents’ relatives. Our analysis suggests that caring practices via KOMP have become relatively stable despite barriers to engagement and are therefore likely to persist beyond the pandemic.

Polymyalgia Rheumatica.

Polymyalgia rheumatica (PMR) is among the most common inflammatory rheumatic diseases in older adults. Presumed risk factors include female sex, previous infections, and genetic factors. No epidemiological data on PMR in Germany have been available until now. This review is based on publications retrieved by a selective literature search in PubMed. Moreover, the administrative incidence and prevalence of PMR in the years 2011-2019 was determined from data of the AOK Baden-Württemberg statutory health insurance carrier for insurees aged 40 and older. In addition, we quantified the number of consultations with physicians involved in the diagnosis. The annual age- and sex-standardized incidence and prevalence of PMR from 2011 to 2019 were 18.6/100 000 persons and 138.8/100 000 persons, respectively. The incidence was higher in women than in men (21.8/100 000 vs. 12.8/100 000 persons per year). 60% of the cases were diagnosed in primary care practices. The treatment of PMR with orally administered glucocorticoids usually results in a treatment response within a few days to weeks. Approximately 43% of patients experience recurrent symptoms within a year, requiring adjustment of the glucocorticoid dose. For older patients with impaired physical ability, additional non-pharmacological treatment with exercise programs plays an important role. PMR usually takes an uncomplicated course under treatment and can be managed in primary care, but these patients are often multimorbid and require frequent follow-up. Along with research on the etiology of the disease, further studies are needed to identify the risk factors for a chronic course and to evaluate the potential effects of non-pharmacological measures.

MO843: Prevalence of Knee Pain in Maintenance Hemodialysis Patients and its Relation to Quality of Life, Depression and Anxiety

Abstract BACKGROUND AND AIMS Maintenance hemodialysis (MHD) patients have higher morbidity and mortality compared with general population. Musculoskeletal symptoms causing chronic pain are prevalent among them. Knee pain is one of these symptoms, which may lead to impaired physical ability and health-related quality of life (HRQOL) as well as it may afflict mental state of these patients. Thus, the aims of the current study are to assess prevalence of knee pain, and its relation to HRQOL, anxiety and depression in MHD patients. METHOD This cross-sectional multi-centric study was conducted on 271 patients who had been on hemodialysis (HD) for >6 months. These patients were recruited from multiple HD centers in two governorates in Egypt from June to December 2021. Socioeconomic, clinical and laboratory data were obtained from the patients. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to evaluate knee pain [1]. Mood disorders in the form of anxiety and depression were assessed by the hospital anxiety and depression scale (HADS). Kidney Disease Quality of Life (KDQOLTM-36) was used to measure HRQOL of these patients. The studied patients were divided into 2 groups according to the presence of knee pain. The severity of knee pain was defined by visual analogue scale as follows: mild (1–3), moderate (4–6) and sever (7–10). Comparison between two groups of patients was carried out as regards socioeconomic, clinical and laboratory data, anxiety, depression and 5 components of HRQOL. RESULTS The present study involved 271 (160 males). The median age of the patients was 51 years with median duration of HD of 6 years. Knee pain was present in 158 patients (58.3%). Patients with knee pain were significantly older than those without (P = 0.013). Females (50% versus 28.3%), patients who not had a job (34.8% vas 26.5%) and patients with psychiatric disorders (5.7% versus 0) constituted significantly higher percentages in group of patients with knee pain than other group. On the other hand, there were no statistically significant differences between both groups regarding marital status, residence, educational level, socioeconomic status and smoking. HD duration was significantly longer in patients with knee pain than those without (P = 0.004). Patients with knee pain had significantly lower blood hemoglobin than without (10.26 ± 1.3 versus 10.67 ± 1.3, P = 0.02). Median and min-max of WOMAC scores were 34.4(0–36), 55.2(12–78 and 53.1(4–100) in mild, moderate, and sever knee pain, respectively. Patients with abnormal anxiety score were significantly more in group of patients with knee pain than those without (P = 0.002). Four components of HRQOL were significantly worse MHD patients with knee pain (Table 1). CONCLUSION Knee pain is prevalent among MHD patients. Older age, female gender, longer duration of hemodialysis, and psychiatric disorders are risk factors that may contribute to knee pain. Knee pain in MHD patients is associated with impaired HRQOL and anxiety. Pain, stiffness and physical function are worsening with increased severity of knee pain among these patients.

Physical Function in Critically Ill Patients during the Duration of ICU and Hospital Admission.

BackgroundImpaired physical activity and functional ability is a significant problem in critical illness survivors. Measurement of physical functioning through intensive care unit (ICU) stay determines patients at risk of poor physical outcomes, monitors efficacy of intervention, and informs recovery trajectories.ObjectivesStudy objective was to assess physical function trajectory and identify residual functional limitations in critically ill patients admitted to ICU at the point of discharge from the hospital using robust clinical measures.Materials and methodsFollowing ethical approval, 100 patients (78 males and 22 females) admitted to medical and surgical ICUs were recruited. Scores on Functional Status Score in ICU (FSS-ICU), Physical Function ICU Test (PFIT), and Functional Independence Measure (FIM) were recorded. Day of physiotherapy reference in the ICU was considered as day of ICU admission. Data were collected at three points, namely ICU admission, ICU discharge, and hospital discharge.ResultsScores on all outcome measures increased linearly, and an upward functional trajectory was observed in patients from the point of ICU admission till hospital discharge (p >0.001).ConclusionDeficits in functional recovery exist until hospital discharge, substantiating the need to implement home-based rehabilitation to recover optimum physical function and independence in activities of daily living.How to cite this articleAglawe DR, Agarwal BM, Sawant BD. Physical Function in Critically Ill Patients during the Duration of ICU and Hospital Admission. Indian J Crit Care Med 2022;26(3):314–318.

Analysis of Relationship between Natural Standing Behavior of Elderly People and a Class of Standing Aids in a Living Space.

As the world’s population ages, technology-based support for the elderly is becoming increasingly important. This study analyzes the relationship between natural standing behavior measured in a living space of elderly people and the classes of standing aids, as well as the physical and cognitive abilities contributing to household fall injury prevention. In total, 24 elderly standing behaviors from chairs, sofas, and nursing beds recorded in an RGB-D elderly behavior library were analyzed. The differences in standing behavior were analyzed by focusing on intrinsic and common standing aid characteristics among various seat types, including armrests of chairs or sofas and nursing bed handrails. The standing behaviors were categorized into two types: behaviors while leaning the trunk forward without using an armrest as a standing aid and those without leaning the trunk forward by using an arrest or handrail as a standing aid. The standing behavior clusters were distributed in a two-dimensional map based on the seat type rather than the physical or cognitive abilities. Therefore, to reduce the risk of falling, it would be necessary to implement a seat type that the elderly can unconsciously and naturally use as a standing aid even with impaired physical and cognitive abilities.

Symptoms and health-related quality of life 5 years after catheter ablation of atrial fibrillation.

ObjectivesTo investigate the effect of catheter ablation (CA) on symptoms and health‐related quality of life (HRQoL) after 5 years, and analyze predictors of recurrence of symptoms.BackgroundThe primary indication for CA of atrial fibrillation (AF) is to reduce symptoms and improve HRQoL where long‐term follow‐up are sparse.MethodsIn this observational, long‐term, single‐center study, patients were recruited from Linköping University Hospital, Sweden. They were aged ≥18 years and had been referred for CA from November 2011 until June 2019. Arrhythmia‐specific symptoms and HRQoL were assessed by patient‐reported outcome measures (PROMs) with the Arrhythmia‐Specific questionnaire in Tachycardia and Arrhythmia (ASTA).ResultsIn the study were 1521 patients, 69% men, mean age 62 years. At baseline, 87% of the patients and at the 5‐year follow‐up 80% of those eligible filled out the ASTA questionnaire. At follow‐up, 50% reported freedom from symptoms, 18% had >50% symptom reduction, 14% had a minor reduction, while 18% reported no effect or a worsening of symptoms. Factors predicting symptoms were female gender (hazard ratio [HR]: 1.8; 1.2–2.8), body mass index ≥ 35 (HR: 3.9; 1.6–9.8), and ischemic heart disease (IHD) (HR: 2.6; 1.2–5.9). After 5 years, breathlessness during activity, weakness/fatigue, and tiredness were still the most common symptoms; regarding HRQoL they were impaired physical ability and deteriorated life situation.Conclusions and Clinical ImplicationsThis clinical cohort of patients with AF evaluated through PROMs showed that CA had long‐lasting effects on symptoms and HRQoL and that the use of PROMs in clinical routines was feasible. Factors predicting symptoms after CA were female gender, IHD, and obesity, an important reminder to encourage lifestyle management.

Work status and work ability of patients receiving kidney replacement therapy: results from a European survey.

ABSTRACTBackgroundEmployment is important for the quality of life and financial security of patients of working age receiving kidney replacement therapy (KRT). We aimed to examine self-reported work status and general, physical and mental work ability and to determine associations between demographic, disease-related, work-related and macroeconomic factors and employment. MethodsEuropeans from 37 countries, ages 19–65 years, treated with dialysis or kidney transplantation, filled out the web-based or paper-based cross-sectional EDITH kidney patient survey between November 2017 and January 2019. We performed descriptive analyses and multivariable generalized logistic mixed models.ResultsOf the 3544 patients, 36.5% were employed and working [25.8% of dialysis patients, 53.9% of kidney transplant recipients (KTRs)]. The mean general work ability was 5.5 out of 10 (dialysis: 4.8, KTRs: 6.5). Non-working patients (all: 4.1, dialysis: 3.9, KTRs: 4.7) scored lower than working patients (all: 7.7, dialysis 7.3, KTRs: 8.0). Working dialysis patients scored lower on physical and mental work ability (7.1 and 8.1) than working KTRs (8.0 and 8.4; P < 0.001). Impaired physical work ability (42.7%) was more prevalent than impaired mental work ability (26.7%). Male sex, age 40–49 years, higher education, home dialysis or kidney transplantation as current treatment, treatment history including kidney transplantation, absence of diabetes mellitus, better general work ability and higher country gross domestic product were positively associated with employment (P < 0.05).ConclusionsLow employment rates and impaired work ability were prevalent among European patients receiving KRT. Demographic, disease-related, work-related and macro-economic factors were associated with employment.

Physical ability and comorbidity and oral health among home-dwelling older people in the Finnish population.

To examine how physical ability and comorbidity associate with oral health. The study population comprised 161 individuals belonging to the Oral Health GeMS study. Outcome variables were the number of teeth with dental caries and deepened periodontal pockets and self-perceived oral health (pain/discomfort in mouth). Physical ability was determined by measuring limitations in daily activities (activities of daily living [ADL] and instrumental activities of daily life [IADL]) and the number of comorbidities with Functional Comorbidity Index (FCI). Poisson's multivariate regression model was used to estimate prevalence rate ratio (PRR) and their 95% confidence intervals (CI). The physical ability or number of comorbidities did not associate consistently with oral diseases, but ADL, IADL and FCI associated all with self-perceived oral discomfort (PRR: 1.74, CI: 1.01-3.03; PRR: 1.20, CI: 1.06-1.35; PRR: 1.20, CI: 1.05-1.36, respectively). Furthermore, IADL associated also with poor self-perceived oral health (PRR: 1.27, CI: 1.03-1.57). Older people with impaired physical ability and comorbidities are more likely to have oral discomfort and have poorer self-perceived oral health.

Oral dysfunctions and cognitive impairment/dementia.

With global increases in the aging population, the number of patients with dementia is greatly increasing, which has become a big social problem. Many studies have shown strong associations between oral disorders and systemic disorders, such as diabetes, arthritis, sepsis, aspiration pneumonia, arteriosclerosis, bacterial endocarditis, and other cardiovascular diseases. Similarly, numerous cross-sectional studies showed that patients with dementia usually have poor oral conditions and tooth loss. These have long been considered as a result of difficulty with oral care due to impaired cognitive function, memory, and physical ability in patients with dementia. Indeed, even in patients with mild cognitive impairment, oral care becomes insufficient owing to decreases in spontaneity of grooming and finger dexterity. However, recent studies have shown that tooth loss and occlusal dysfunction may affect brain function and trigger the onset of dementia found in neurodegenerative diseases including Alzheimer's disease. In this review, we highlight the relationships among aging, oral dysfunction, and the development of dementia. Increasing evidence suggests that oral dysfunction is not only a result of dementia in the elderly people, but could also be a causative factor for the onset of dementia.

Five year follow-up of symptoms and health-related quality of life in patients with atrial fibrillation treated with catheter ablation

Abstract Background In accordance with current guidelines the primary indication for catheter ablation (CA) of atrial fibrillation (AF) is to reduce symptoms and thereby improve health-related quality of life (HRQoL). Even though, there are data showing patients' symptom situation before treatment, long-term follow up data are sparse. Purpose To assess symptoms and HRQoL five years after CA with the validated arrhythmia-specific questionnaire ASTA, in a large cohort of patients treated with catheter ablation due to AF. Methods 1323 consecutive patients who underwent CA of AF at one university hospital in Sweden filled out the ASTA questionnaire before the procedure, mostly electronically, and 418 patients at five years follow-up. If not responded within 1 month the patient got a reminder. Results Five years after CA and after 1.6 procedures/patient, half of the patients (50%) reported freedom of symptoms, 18% had a major reduction of symptoms (&amp;gt;50% symptom reduction compared to baseline assessments) and 14% had a minor reduction of symptoms (between 10% – 50% reduction) while only 9% of the patients reported no effect on symptoms after the CA and 9% experienced a worsening of their symptoms after the treatment. Factors predicting presence of symptoms at the five-year follow-up were female sex (HR: 1.8; 1.2–2.8), Body Mass Index &amp;gt;35 (HR: 3.9; 1.6–9.8) and having ischemic heart disease (IHD) (HR: 2.6; 1.2–5.9). At the five years follow-up the symptoms breathlessness during activity, weakness/fatigue and tiredness were still the most commonly reported as well as regarding HRQoL it was impaired physical ability and deteriorated life situation. Conclusions Catheter ablation has a long-lasting effect and change the natural course of AF, as more than 50% of patients did not experience any symptoms and 32% were improved, while 18% had no treatment effect or worsening of symptoms. Factors predicting remaining symptoms five years after CA were female sex, presence of IHD and obesity, a reminder to encourage life style managements. ASTA symptom scale Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Carldavid Jönsson Research Foundation and the County Council of Östergötland (FORSS).

Employment transitions for spouses of stroke survivors: evidence from Swedish national registries

BackgroundThe sudden occurrence of stroke often leads to impaired physical, emotional, and cognitive abilities. Many stroke survivors therefore require support from their family members. However, little is known about the effects of a stroke event on the spouses’ employment transition probabilities. The aim of this study was twofold 1) to investigate whether a first ever stroke has an effect on employment transition probabilities for employed and unemployed spouses and 2) to analyze whether heterogeneity with respect to age, gender, education and comorbidities influence the size of the effect.MethodData for this population-based cohort study were extracted from Swedish national registries from 2005 to 2016. The national sample consisted of 1818 spouses of first ever stroke survivors during 2010 and 2011, and 7399 matched controls that were employed or unemployed during 5 years prior stroke onset. Effects of stroke on spousal employment transitions were analyzed using linear regression, stratified by employment status prior to stroke onset.ResultsEmployed spouses prior stroke onset reduced their employment by − 1.3 percentage points (95% CI, − 2.4, − 0.2). The data also indicated that employed spouses with lower age, comorbid conditions, and low educational attainment may be at even greater risk of transitioning to unemployment. On the other hand, stroke events appear to have limited impact on spouses that were unemployed prior to stroke onset.ConclusionThe risk of transitioning to unemployment appears to increase after stroke onset for spouses of stroke survivors, and disadvantaged groups may be at even greater risk. Thus, it is important for policy-makers to implement interventions to ensure that these groups of spouses have the possibilities to combine their caregiving role and remaining in the labor market.

Necessity of Attention to Mental Health of the Front Line Nurses against COVID-19: A Forgotten Requirement.

Today, emergence of infectious diseases has overshadowed many health beliefs and played a greatrole in the history of health development. The United Nations Secretary-General has introduced“Communicable diseases” as one of the challenges of our time. Viruses can be one of the causes ofcontagious diseases. The Coronavirus disease 2019 (COVID-19) outbreak, recently launched fromWuhan, China, has spread to more than two-thirds of the world, including Iran, and has reached thepandemic stage.1 In particular, COVID-19 disease further affects the healthcare sector and leads tomany challenges for this important part of society.These challenges include increasing need for medicalstaff; increasing costs for preventive and personal protective equipment for personnel, diagnosticand laboratory costs and treatment costs; increasing the need for Intensive Care Unit (ICU) beds andventilators; and increasing mortality.1In the meantime, health care professionals play an important role in managing such crises.Nurses, as the largest group of health care workers, spend more time with patients than otherhealthcare professionals and play an important role in the care, control and treatment of thesediseases. During the epidemic of emerging diseases, all social organizations, even the patients’family members, are distanced from him/her, and it is the duty of the medical staff to take careof the patient despite the potential health risks.2 To understand the significance of the issue, it issufficient to know that about 50% of those who died in the Severe Acute Respiratory Syndrome(SARS) coronavirus epidemic were health workers who were somehow exposed to patients inthe hospital.3Past studies show that mental disorders, including post-traumatic stress disorders, anxiety,depression, panic attacks, irritability, delirium, mistrust, and even suicidal thoughts, wereprevalent among nurses who cared for patients with SARS. Developed mental disorders can leadto psychological disorders, loss of appetite, fatigue, impaired physical ability, sleep disorders,irritability, apathy, numbness, fear, and hopelessness.4In accordance with the ethical Reciprocity Principle, hospitals have a reciprocal duty towardsthe health care staff. Health facilities should provide the necessary infra-structure to support thestaff in the care of patients with emerging diseases, including communicating with the staff tocontrol infection, providing sufficient support to increase the staff motivation, providing personalprotective equipment, and especially psychological screening for nurses, psychiatric counselingand psychological support.2 According to a recent report by the National Federation of Nurses inItaly, the second Italian nurse has committed suicide after being informed of a positive coronavirus test.5 Therefore, the importance of paying attention to the psychological issues of nursesduring and after caring for patients with COVID-19 is obvious.However, due to the increasing prevalence of the virus and also the increasing number of deathsof nurses, which can be a stressor for other nurses, it is necessary to pay attention to mental healthof nurses. Stress and mental disorders can, like a vicious cycle, weaken the immune system andlead to coronavirus infection, especially where nurses with a history of mental disorders are moreconcerned. Nurses’ mental disorders can also significantly reduce their quality of care. Despitethe major importance of this issue and the findings of previous studies, this issue has not beenaddressed yet. Therefore, it is imperative to pay attention to the mental and psychological issuesof nurses in the care of patients with coronavirus 19 as the current priority of care for nurses.In this regard, experiences and measures can be used in the epidemic of SARS, Middle EastRespiratory Syndrome-related coronavirus (MERS) and Ebola patients, including screening ofnurses for mental health, psychological counseling, or training courses to provide comprehensiveand patient-centered care.

Association of One-Leg Standing Time with Discontinuation of Injectable Medications During Hospitalization Among Patients with Type 2 Diabetes.

IntroductionPersons with type 2 diabetes (T2D) are known to experience impaired physical ability even at the early stages of the disease. However, less attention has been paid to increasing physical ability than to increasing physical activity in the treatment of T2D. The aim of this study was to assess whether improved physical ability parameters are associated with the discontinuation of injectable medications once glycemic targets have been achieved among inpatients with inadequately controlled T2D across a wide range of ages.MethodsForty-three patients with glycated hemoglobin levels of ≥ 7.5% (58 mmol/mol) aged between 19 and 82 years who received insulin, glucagon-like peptide-1 receptor agonists or both at admission were enrolled in the study. Muscle strength for knee extension, one-leg standing time with eyes open test(OLST), whole-body reaction time and maximal oxygen uptake were assessed as parameters of physical ability.ResultsAt admission, patients who during hospitalization discontinued injectable medications (n = 29; Discontinued group) had a shorter duration of diabetes, lower fat mass and higher skeletal muscle mass and performed better on all of the physical ability test parameters than those who continued on injectable medications during hospitalization (n = 14; Continued group). At discharge, patients in the Discontinued group had achieved better glycemic control than those in the Continued group, as indicated by lower mean plasma glucose levels according to the 7-point profile. Stepwise logistic regression analysis that included those variables that were significantly different between the Continued group and the Discontinued group, with the aim to identify candidate(s) of explanatory variables, revealed that only OLST was significantly associated with the discontinuation of injectable medication. Patients with an OLST of ≥ 60 s were more likely to discontinue injectable medication than those with an OLST of < 60 s (odds ratio 18.9; 95% confidence interval 2.0–178.8; p = 0.011).ConclusionsAmong inpatients with inadequately controlled T2D diabetes, longer OLST appear to be associated with discontinuing injectable medications during hospitalization. OLST could possibly be useful as a novel patient factor to consider in de-intensifying injectable medication.

Corticotropin releasing factor-overexpressing mouse is a model of chronic stress-induced muscle atrophy.

Chronic stress and continually high glucocorticoid levels can induce muscle atrophy. Unfortunately, there is a lack of appropriate animal models for stress-induced muscle atrophy research. Corticotropin releasing factor-overexpressing (CRF-OE) mice are a transgenic model of chronic stress that exhibit increased plasma corticosterone levels and Cushing’s syndrome; however, the skeletal muscle pathology of the CRF-OE mouse has not been well studied. We observed that male, 19-week-old CRF-OE mice had significantly lower skeletal muscle mass, average cross-sectional myofiber area, and total muscle protein content than their wild type (WT) littermates. Muscle function determined by grip strength, wire-hang, and open field tests showed that 19-week-old male CRF-OE mice had impaired physical ability. Additionally, the skeletal muscles of CRF-mice exhibited decreased expression of factors involved in the IGF-1/AKT/mTOR protein synthesis pathway and increased ubiquitin proteasome pathway activity compared to the WT control mice. In conclusion, 19-week-old CRF-OE mice display numerous features of muscle atrophy and thus serve as a model for investigating stress-induced muscle atrophy and interventions to target the deleterious effects of stress on skeletal muscle.

Prevalence and associated factors of depressive symptoms among chronic kidney disease patients in China: Results from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE)

ObjectiveDepression is the most common mental disorder in patients with chronic kidney disease (CKD), and previous studies have found that: (a) depression can accelerate the progression of CKD; and (b) depression is an independent risk factor for hospitalization and death among patients with CKD. Therefore, the objective of the current study was to investigate the prevalence of depression in Chinese patients with CKD, and to identify variables associated with depression. MethodsThe study analyzed baseline data from a multicenter prospective cohort study of Chinese patients with chronic kidney disease (the C-STRIDE study). In all, 2995 participants in CKD stages 1 to 4 who completed a survey of depressive symptoms were included in the analyses. Depressive symptoms were assessed by the Zung Self-Rating Depression Scale (ZSDS). A ZSDS ≥50 was used as the cut-off score for the presence of depressive symptoms. Multivariable logistic regression was used to identify variables associated with depression. ResultsThe mean estimated glomerular filtration rate (eGFR) in the study sample was 51.59±29.49 ml/min/1.73 m2. The prevalence of depressive symptoms was 37.8% and increased significantly with CKD stage. Being female, a higher level of education, a low income, a larger economic impact of disease cost, comorbid cardiovascular disease, anemia, and impaired physical ability were independently associated with depressive symptoms. ConclusionOur study revealed that depressive symptoms were common among patients with CKD in China. Sociodemographic variables and the clinical characteristics of disease severity were strongly associated with depressive symptoms.

Approved claims for compensation from gynecological patients in Norway-What characterizes the cases? A 14-year nationwide study.

The Norwegian System of Patient Injury Compensation (NPE) evaluates all patient-reported claims in Norway. Our aim was to study the cases from gynecological patients approved by NPE in order to identify the main reasons for the injuries, the consequences of the treatment failure for the women, and the time course when the treatment failure occurred. A retrospective, descriptive study of approved gynecological compensation claims during a 14-year period, based on patient files from NPE. In all, 1454 women claimed compensation for injury related to gynecological treatment in Norway from 2000 to 2013. Compensation was approved for 438 (30.1%) women. Eleven women declined participation in the study and 16 cases were excluded, leaving 411 cases for further analyses. Consent to participate was given by 211 (51.3%) women, who gave full access to all their NPE files. Anonymized resumes and expert statements were used for the 138 (33.6%) women who did not respond and the 62 (15.1%) women who were deceased. Guidelines or good clinical practice were not followed in 40.5% of the cases. The most common reasons for injury were surgical complications (67.6%), delayed (22.4%) and incorrect (17.0%) diagnoses, and failure of communication (11.7%). The main consequences of injuries were need for extensive treatment (64.2%), permanent injury (55.2%) and impaired physical ability (41.9%). Worsening of cancer prognosis occurred in 58 women (14.1%) and death due to treatment failure in 29 (7.1%) women. Most failures occurred during the treatment period (75.2%). We found that the main reason for injuries in gynecological patients was non-adherence to guidelines or good clinical practice. Surgery-related injuries were most common. Increased focus on adherence to guidelines and surgical skills might improve patient safety for gynecological patients in Norway.

Asthma-COPD overlap syndrome: recent advances in diagnostic criteria and prognostic significance.

The term asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) has been proposed for individuals with features of both asthma and COPD. Several attempts have been done to define ACOS on the basis of medical history, symptoms, and functional findings. The main diagnostic criteria include airflow obstruction with a strong although incomplete reversibility to bronchodilation tests, a significant exposure to cigarette or biomass smoke, and a history of atopy or asthma. Additional diagnostic elements include eosinophilic airway and systemic inflammation, a good response to corticosteroid treatment, and a high concentration of exhaled nitric oxide. ACOS should be distinguished from asthma with not fully reversible bronchial obstruction due to airway remodeling, thus the lack of smoking exposure should exclude the diagnosis of ACOS. In patients without a documented history of asthma before 40 years of age, an increase in FEV1 after bronchodilator >400 mL should be required to diagnose ACOS. ACOS has been found to be associated with impaired physical performance, functional ability, and health-related quality of life. The prevalence of ACOS increases with aging, then it is relatively stable in elderly individuals (>65 years). Long-term mortality of subjects with ACOS is similar to COPD, and worse than asthma and healthy controls. Future research is still needed to improve the understanding and management of ACOS.