Impairment In Activities Of Daily Research Articles

Patient-reported assessment of medical care for chronic inflammatory skin diseases: an enterprise-based survey.

Chronic inflammatory skin diseases (CISDs) are among the most common diseases in the Western world. Current estimates of medical care for CISDs are primarily based on surveys among patients in medical care facilities and on health insurance data. Survey-based examination to what extent CISD patients in health-aware environment consider their skin disease to be controlled. The survey of CISD patients was carried out in 2022 among the employees of a pharmaceutical company located in Germany and Switzerland. Software-based, anonymous, self-reported questionnaires were used. The number of employees, who answered the questionnaire, was 905. Of these, 222 participants (24.5%) reported having at least one CISD. 28.7% of participants with CISD described their disease as being hardly or not controlled. Regarding the nature of disease, more than one third of participants suffering from hidradenitis suppurativa (HS) or psoriasis fell into the hardly/not controlled category. In contrast, the largest proportion of participants with chronic spontaneous urticaria (43%) or atopic dermatitis (42%) considered their CISD to be completely or well controlled. Only 35.5% of CISD sufferers stated that they were currently under medical care for their skin condition. Being under medical care, however, had no influence on the extent CISD sufferers considered their skin disease to be controlled. The number of active CISD episodes but not the total number of symptomatic days per year was negatively associated with poor disease control (p = 0.042 and p = 0.856, respectively). Poor disease control had a negative effect on the personal and professional lives of those affected, as deduced from its positive association with the extent of daily activity impairment and presenteeism (p = 0.005 and p = 0.005, respectively). Moreover, 41.4 and 20.7% of participants with hardly/not controlled disease stated that their CISD had a moderate and severe or very severe impact on their overall lives (p < 0.001), respectively. A severe or very severe impact of their CISD on their overall life was most commonly reported by participants with HS. Medical care for CISDs, even in an environment with high socio-economic standard and high health-awareness, still appears to be limited and has a negative impact on individuals and society.

A Core Outcome Set for Efficacy of Acute Treatment of Hereditary Angioedema

BackgroundClinical trials investigating drugs for acute treatment of hereditary angioedema attacks have assessed many different outcomes. This heterogeneity limits comparability of trial results and may lead to selective outcome reporting bias and a high burden on trial participants. ObjectiveTo achieve consensus on a Core Outcome Set comprising key outcomes that should ideally be utilized in all clinical efficacy trials involving acute treatment of hereditary angioedema attacks. MethodsA Delphi consensus study was conducted involving all relevant parties: hereditary angioedema patients, hereditary angioedema expert clinicians and clinical researchers, pharmaceutical companies, and regulatory bodies. Two internet-based survey rounds were conducted. In round 1, panelists indicated the importance of individual outcomes used in clinical trials on a 9-point Likert scale. Based on these results, a core outcome set was developed and voted on by panelists in round 2. ResultsFifty-eight worldwide panelists completed both rounds. The first round demonstrated high importance scores and substantial agreement among the panelists. In the second round, a consensus of ≥90% was achieved on a core outcome set consisting of five key outcomes: change in overall symptom severity at one predetermined time point between 15 minutes and 4 hours after treatment, time to end of progression of all symptoms, need for rescue medication during the entire attack, impairment of daily activities, and treatment satisfaction. ConclusionThis international study obtained a high level of consensus on a core outcome set for acute treatment of hereditary angioedema attacks consisting of five key outcomes.

Psychiatric disorders in patients after hospitalization for COVID-19: Frequency, coping behaviours and associated factors

IntroductionThe COVID-19 pandemic caused an unprecedented major health crisis. Current data suggest that psychiatric sequelae may persist for a long time in survivors after infection.ObjectivesThe objectives of our study were to determine the frequency of anxiety, depression, sleep disorders, and posttraumatic stress disorder in patients after hospitalization for COVID-19 infection, and to investigate factors associated with their occurrence as well as to identify coping behaviors in these patients.MethodsThis was a descriptive cross-sectional study conducted at Ibn Jazzar Kairouan Hospital between September and December 2021 among patients who consulted three months after their hospitalizations for COVID-19 infection. The assessment of the different psychiatric disorders was performed using the validated Arabic versions of the Hospital Anxiety and Depression Scale, Post-traumatic Stress Disorder Checklist for DSM-5 and the Pittsburgh Sleep Quality Index. Coping behaviors were studied using the Brief-COPE scale.ResultsOur work included 104 patients. The median age was 55.5 years [IQR:47-64]. The gender ratio M/F was 1.12. Anxiety and depressive symptoms were found in 26.9% and 25% of cases, respectively. The frequency of post-traumatic stress disorder was 22.1% and that of sleep disorders was 41.3%. Problem-solving strategies were the most widely adopted, followed by emotion-focused strategies. Younger age, female gender, persistence of a physical symptom, impairment of daily activity, and stigma were factors independently associated with psychological distress. No association was found between the intensive care unit stay and psychiatric disorders. Problem-focused and emotion-focused coping were negatively correlated with the different psychological outcomes studied.ConclusionsPsychological distress in COVID-19 survivors persists beyond the acute phase and results from an intricacy of several factors. This highlights the importance of regular psychiatric follow-up after hospitalization in order to identify and treat, as early as possible, psychiatric disorders.Disclosure of InterestNone Declared

Awareness and cognitive rehabilitation in Alzheimer's disease and frontotemporal dementia.

Awareness influences the evolution of neurodegenerative dementias. We gathered participants' and caregivers assessments of dependence in daily activities and we studied how each score would be related to next year participant autonomy, independently of other explicative variables. We retrospectively analyzed data from mildly demented participants with a clinical diagnosis of Alzheimer's disease (AD, n = 186) and frontotemporal dementia (FTD, n = 29) and their relatives. A research tool was used to assess participant dependence in 98 daily activities and associated caregiver burden. A discrepancy score between the patient's and relative's judgment was calculated to evaluate awareness of dependence in activities at baseline. This dependence scores, as well as sex, age, education, and 1 year difference in Mini-Mental State Examination were taken as possible explicative variables for dependence in activities adapted by therapists during a 1-year cognitive rehabilitation program. Patients with FTD showed less awareness for daily dependence (discrepancy 20.9% vs. 11.8% in AD). Both groups benefited from cognitive rehabilitation (25% decrease in dependence) and subjective burden of relatives was decreased in both groups. In the AD group, there was a significant positive relationship between both caregiver (P < 0.001) and participant's (P < 0.02) evaluation of dependence in daily activities at inclusion and dependence of participants in adapted activities after 1 year. Awareness of impairment in daily activities is a clinical symptom that is more important at inclusion in FTD than in AD. However, in participants with AD who, as a group, significantly benefit from a cognitive rehabilitation program, not only caregiver's but also participant's assessment of dependence at baseline is correlated to subsequent, next year greater dependence in daily activities adapted by the therapists. Although discrepant, both caregiver and participant evaluations appear to be important variables to understand the evolution and the benefit of care in participants at early stages of dementia.

Effect of low-intensity aerobic cycling ergometer on disease severity and depression of patients with myasthenia gravis in “Dr. Soetomo” General Hospital, Surabaya

Background and objectives. Myasthenia gravis (MG) is a chronic autoimmune disease characterized by muscle weakness. Muscle weakness leads to impairment of daily activities and leads to psychiatric symptoms, including depression. The lack of exercise methods in MG patients is a problem in rehabilitation. This study evaluates the effect of an 8-week low-intensity aerobic exercise program on Myasthenia Gravis Composite (MGC) and Beck Depression Inventory (BDI) scores in MG patients. Materials and methods. This is a randomized controlled trial conducted from May to June 2023. Twenty subjects were randomly divided into treatment group and control group. The treatment group received low-intensity aerobic exercise with cycle ergometer 3 sessions per week for 8 weeks. Both groups were informed about lifestyle changes and effective breathing exercises. MGC and BDI scores were measured and compared before and after intervention. Results. In the treatment group, MGC and BDI scores was significantly decreased with strong effect size after 8 weeks (5.4 ± 2.32 to 2.4 ± 1.84, p = 0.001, Cohen’s D = 1.57; and 10.4 ± 2.88 to 5.9 ± 2.77, p = 0.001, Cohen’s D = 1.86). In the control group, MGC and BDI scores were not significantly different (5.4 ± 2.68 to 6.0 ± 2.49, p = 0.193, Cohen’s D = 0.44; and 10.4 ± 1.71 to 9.6 ± 1.65, p = 0.247, Cohen’s D = 0.39). The MGC score strongly correlated with the BDI score (r = 0.50). Conclusion. 8 weeks of low-intensity aerobic exercise with cycling ergometer reduces disease severity and depression severity in myasthenia gravis.

Absorbent hygiene products disposal behaviour in informal settlements: identifying determinants and underlying mechanisms in Durban, South Africa

BackgroundWithin South Africa, many low-income communities lack reliable waste management services. Within these contexts, absorbent hygiene product (AHP) waste, including nappies (diapers), are not recycled, and are often dumped, ending up in watercourses and polluting the local environment. The structural barriers to collection which have been well explored, however the behavioural determinants of safe disposal for AHPs remains poorly understood. The purpose of this study is to determine the psycho-social factors driving AHP disposal behaviour for caregivers, while identifying potential underlying mechanisms (such as mental health), which may be influencing disposal behaviour, with the intention of informing a future, contextually appropriate and sustainable, collection system.MethodsThe cross-sectional study was conducted within three low-income communities located within eThekwini Municipality (Durban), South Africa. The study included a pre-study and a quantitative survey of 452 caregivers, utilising the RANAS approach of behaviour change. The quantitative questionnaire was based on the RANAS model to measure psycho-social factors underlying sanitary disposal of AHPs. Mental health was assessed using the Self-Reporting Questionnaire (SRQ-20). Statistical analysis involved regressing psycho-social factors onto disposal behaviour and exploring their interaction with mental health through a moderation model.ResultsOur findings suggest that one third of caregivers do not dispose of nappies sanitarily, despite intent (86.9%). Regression analysis revealed ten psycho-social factors which significantly predict the desired behavioural outcome, the sanitary disposal of AHPs. Caregivers with poor mental health were less likely to dispose of AHP sanitarily, which reflects previous research linking poor mental health and the impairment of health-related daily activities, particularly within vulnerable groups. Specifically, several psycho-social factors underlying were moderated by poor mental health, the prevalence of sanitary disposal of AHPs depended on mental condition of caregiver.ConclusionsOur findings confirmed the link between poor mental health and unsanitary AHPs disposal. This is especially relevant because poor mental health is common within South Africa. Addressing mental health problems within these communities is an essential step to providing sustainable waste management services. The findings informed an intervention strategy to implement a future collection system for these communities, and similar low-income or informal contexts within South Africa.

Quality of life and work functionality in severe asthma patients: the impact of biological therapies

BackgroundSevere asthma can cause poor health status, poor health-related quality of life (HRQoL) and an impaired functioning at work. However, to date, limited data are available on the impact of the biological therapies on such outcomes. Therefore, aim of the present study was to prospectively assess the clinical, quality of life and work functionality issues in severe asthma patients both at baseline and after 6 months of biological therapies and determine which individual, pathological and occupational factors can influence such parameters.MethodsFifty-two patients were enrolled between December 2022 and June 2023. Patients’ personal, clinical, functional and occupational features were assessed. The Short Form Health Survey (SF-12), the Work Productivity and Activity Impairment (WPAI) questionnaire and the Work Ability Index (WAI) were employed to assess HRQoL, the employee’s productivity and perception of work ability, respectively.ResultsAmong the enrolled patients, 30 (57.70%) were employed. Biological therapy induced a significant improvement in clinical and functional parameters, e.g., FEV1% (72 ± 12 vs.87 ± 13%; 72 ± 14 vs. 86 ± 14%), FVC% (92 ± 11 vs. 101 ± 11%; 90 ± 13 vs. 98 ± 14%) and FEV1/FVC (62 ± 11 vs. 71 ± 8%; 64 ± 9 vs. 70 ± 8%) in workers and non-workers, respectively (P < 0.001). Comparably, the perception of life quality significantly improved, as physical and mental health scores, in the overall cohort, increased from 40.7 ± 10.3 and 48.5 ± 8.5 to 46.8 ± 8.6 and 51.6 ± 6.4, respectively (P < 0.001). The work ability perception significantly improved from a moderate to a good one (34 ± 6 vs. 40 ± 6, P = 0.001). A significant reduction in the absenteeism (19 ± 15 vs. 3 ± 11%; P < 0.001) and presenteeism rate (53 ± 24 vs. 29 ± 26%; P < 0.001), and an improvement in daily (40 ± 27.5% vs. 28.9 ± 24.7%, P < 0.001, in the overall population) and work activities (57 ± 25 vs. 29 ± 27%, P < 0.001) was determined. Gender, age, symptoms control and pulmonary functionality were correlated with the physical and mental health perception, daily activity impairment and work ability.ConclusionsOur study pointed out that biological therapies improved clinical, general life and occupational outcomes in patients with severe asthma. The correlation between clinical aspects and psychological and occupational issues suggest the relevance for a multidisciplinary management of the disease for an effective participation of patients in the world of work.

The Effectiveness of Neurofeedback on Improving Social Interactions and Activity of Daily Living in Children with Autism Spectrum Disorder: A Narrative Review

Context: Impairment in social interactions and daily activities of autism spectrum disorder (ASD) patients is one of the negative and important consequences of ASD. Recently, the use of non-pharmacological methods to improve behavior and rehabilitation in patients with ASD has attracted the attention of researchers and specialist physicians. According to the mentioned topic, This study aimed to evaluate the effectiveness of neurofeedback (NF) in improving social interactions and activity of daily living (ADL) in children with ASD. Evidence Acquisition: This narrative review obtained the desired results by collecting previous similar studies related to the study's primary purpose. First, 182 articles were extracted through the search of MeSH (medical subject headings) terms associated with the particular objectives of the study in international reliable databases. Then, twenty-five studies were selected as final studies considering the inclusion and exclusion criteria. Results: The results of the present study showed that NF can help to improve the performance of children with ASD through brain waves as a new treatment method based on conditioning and reinforcement. NF helps identify cognitive problems and improve cognitive processes in autistic children by improving self-regulation of the brain. In addition, NF leads to better cognitive performance by increasing beta waves and decreasing theta waves. On the other hand, increasing beta waves increases alertness, concentration, and metabolism, which can improve cognitive and social functioning. Conclusions: Based on the results, NF has a positive and significant effect in improving social interactions and ADL in children with autism spectrum disorder. Therefore, this method should be used to improve behavioral disorders and strengthen the ADL of patients with ASD, considering the side effects of pharmacological intervention methods.

Work Productivity and General Health Through 2 Years of Guselkumab Treatment in a Phase 3 Randomized Trial of Patients With Active Psoriatic Arthritis.

To evaluate the effect of guselkumab on work productivity and nonwork daily activity impairment and general health status through 2years in patients who were biologic-naïve with active psoriatic arthritis (PsA) in the phase 3 DISCOVER-2 clinical trial. Adult patients with PsA were randomized to subcutaneous injections of guselkumab 100mg every 4weeks (Q4W); at weeks 0, 4, then every 8 weeks (Q8W); or placebo (throughweek 24 with crossoverto guselkumab Q4W). Work productivity and nonwork daily activity impairment were assessed using the Work Productivity and Activity Impairment Questionnaire for PsA (WPAI-PsA) and patient-reported general health status using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) Index and EQ-Visual Analog Scale (EQ-VAS). Least-squares (LS) mean changes from baseline in WPAI-PsA domains and EQ-5D-5L/EQ-VAS were assessed through week 100. Changes in employment status were utilized to estimate potential indirect savings from improved work productivity. Of 739 randomized patients, 738 had available baseline data for the analyses (Q4W 245; Q8W 248; placebo 245). At week 24, greater improvements in work productivity, nonwork daily activity, and EQ-5D-5L/EQ-VAS were observed in the Q4W and Q8W groups versus the placebo group. At week 100, LS mean reductions in work productivity impairment (- 23.8% to - 28.0%) and nonwork daily activity impairment (- 26.6% to - 29.2%) and improvements in EQ-5D-5L/EQ-VAS (0.14 to 0.15/21.2 to 25.0) were maintained in patients receiving guselkumab. Among patients employed at baseline, 12.1-16.4% were not employed at week 100, and 20.0-25.3% shifted from not employed at baseline to employed at week 100. Potential yearly indirect cost savings (USD) from improved work productivity at week 100 ranged from $16,529 to $19,409. Patients with active PsA treated with guselkumab demonstrated reduced impairment in work productivity and nonwork daily activity, together with improvement in general health status and substantial potential cost savings, over a 2-year period. Clinicaltrials.gov identifier: NCT03158285.

Financial burden following adult liver transplantation is common and associated with adverse recipient outcomes.

The financial impact of liver transplantation has been underexplored. We aimed to identify associations between high financial burden (≥10% annual income spent on out-of-pocket medical costs) and work productivity, financial distress (coping behaviors in response to the financial burden), and financial toxicity (health-related quality of life, HRQOL) among adult recipients of liver transplant. Between June 2021 and May 2022, we surveyed 207 adult recipients of liver transplant across 5 US transplant centers. Financial burden and distress were measured by 25 items adapted from national surveys of cancer survivors. Participants also completed the Work Productivity and Activity Impairment and EQ-5D-5L HRQOL questionnaires. In total, 23% of recipients reported high financial burden which was significantly associated with higher daily activity impairment (32.9% vs. 23.3%, p =0.048). In adjusted analyses, the high financial burden was significantly and independently associated with delayed or foregone medical care (adjusted odds ratio, 3.95; 95% CI, 1.85-8.42) and being unable to afford basic necessities (adjusted odds ratio, 5.12; 95% CI: 1.61-16.37). Recipients experiencing high financial burden had significantly lower self-reported HRQOL as measured by the EQ-5D-5L compared to recipients with low financial burden (67.8 vs. 76.1, p =0.008) and an age-matched and sex-matched US general population (67.8 vs. 79.1, p <0.001). In this multicenter cohort study, nearly 1 in 4 adult recipients of liver transplant experienced a high financial burden, which was significantly associated with delayed or foregone medical care and lower self-reported HRQOL. These findings underscore the need to evaluate and address the financial burden in this population before and after transplantation.

Psichikos sutrikimų simptomai, sergant Alzheimerio liga

Alzheimer’s disease is one of the most common neurodegenerative diseases among older people that manifests as deterioration of cognitive functions, impaired daily activities, and progressive degeneration of cerebral cortex neurons. Even up to 90% of Alzheimer’s patients develop neuropsychiatric symptoms at different stages of the disease. In some cases, neuropsychiatric symptoms appear earlier than cognitive symptoms. Neuropsychiatric symptoms worsen everyday activities, quality of life, and ability to socialise of people with Alzheimer's disease, making the diagnosis and treatment of these symptoms increasingly important. Evaluation of both cognitive and neuropsychiatric symptoms together with differentiation from primary psychiatric disorders is crucial for the correct diagnosis of Alzheimer’s disease. Furthermore, neuropsychiatric symptoms can be considered as risk factors for the development of Alzheimer’s disease. Treatment is recommended with combined pharmacological and non-pharmacological measures. Despite the large number of studies, the pathogenesis of the neuropsychiatric symptoms has not been studied in depth, therefore the treatments provided are not always effective. It is recommended that neuropsychiatric symptoms should be treated through a combined approach using pharmacological and non-pharmacological measures.

The Relationship Between Nurses' Psychological Well-Being and Their Work Productivity Loss: A Descriptive Correlational Study.

Nurses play a vital role in ensuring effective patient care delivery and organizational productivity. Hence, it becomes imperative to prioritize their psychological well-being and explore how its impairment may be associated with their productivity loss. The study aims to investigate the relationship between nurses' psychological well-being and their work productivity loss by examining how nurses self-reported their own psychological well-being and work productivity loss. A descriptive correlational design was conducted at an Egyptian university hospital. A convenience sample of 400 nurses completed two tools: (a) Outcome Questionnaire-45 was used to assess the psychological well-being of nurses and (b) the Work Productivity and Activity Impairment - General Health Questionnaire was used to measure nurses' work productivity. Among the 400 surveyed nurses, 66.7% reported overall poor psychological well-being. Regarding work productivity loss, 22.8% of nurses missed an average of 974.81 work hours due to absenteeism, and 62.0% lost an average of 10,630 work hours due to presenteeism. Additionally, 75.5% experienced impaired daily living activities. Approximately 13.4% of total working hours were missed due to health problems or psychological distress. Regression analysis revealed that poor psychological well-being significantly predicts work productivity loss, accounting for 2.0% of absenteeism, 11.0% of presenteeism, 17.0% of daily activity impairment, and 9.0% of overall productivity loss, with the model being significant (p < 0.01). Nurses often experience poor psychological well-being and distress that hinder their daily activities and cause work productivity loss. Therefore, hospital management should prioritize improving nurses' physical and mental health and bolstering their self-efficacy and resilience to minimize the effects of symptom distress on productivity. Investing in nurses' well-being through managerial caring, organizational support, and fostering a supportive work environment are vital strategies for promoting quality patient care and enhancing their work productivity.

Health-related quality of life and its influencing factors in patients with primary cutaneous B-cell lymphomas: A multicentric study in 100 patients.

Primary cutaneous B-cell lymphomas (CBCL) are a group of rare malignant skin diseases that represent approximately 20%-30% of all primary cutaneous lymphomas (PCL). Previous studies revealed impaired health-related quality of life (HRQoL) in patients diagnosed with primary cutaneous T-cell lymphoma (CTCL). Currently, only small-sized studies investigated HRQoL in CBCL patients and lacked detailed analysis of respective subtypes. This study aims to investigate HRQoL in CBCL patients to identify independent factors of HRQoL impairment in CBCL patients. One hundred CBCL patients were recruited from eight German PCL centres in this multicentric, cross-sectional study from 2021 to 2022. The patients completed the dermatologic HRQoL questionnaire Skindex-29 and an investigator-designed 'CBCL-Questionnaire' with additional questions on HRQoL and clinical characteristics. The Skindex-29 revealed that HRQoL in CBCL patients is impaired on a mild to moderate level. The multiple regression analysis identified parameters like worries about dying, feeling prejudiced/discriminated and impairment of daily activities to be independently associated with impairment of HRQoL. Highest scores for HRQoL impairment were found in patients with primary cutaneous follicle centre lymphoma while on rituximab treatment and in patients with primary cutaneous marginal zone lymphoma while on watchful waiting. HRQoL is impaired in CBCL patients, even though, in the face of indolent disease course and favourable prognosis in the majority of cases. Of note, our investigator-designed tool identified worries about dying, feeling prejudiced/discriminated, and the type of treatment to have a negative impact on patients' HRQoL. Our study highlights the importance of a thorough patient-doctor communication to capture overall disease burden because generic HRQoL tools might lack of disease-specific items.

Cognitive impairment in cerebrovascular diseases

Cognitive impairment, which is highly prevalent, especially among older people, leads to a decrease in the quality of life of patients, impairment of daily activities, and an increased risk of dementia and mortality. Currently, much attention is paid to mild cognitive impairment. The article discusses diagnostic criteria and possible clinical variants of this syndrome. Given the high rate of progression of mild cognitive impairment to dementia, it is necessary to identify risk groups and carry out therapeutic preventive measures. Correction of potentially modifiable risk factors is considered as a promising direction of therapy. Sufficient physical and mental activity, proper diet, normalization of sleep, visual acuity and hearing are necessary. Preventing stroke and controlling vascular risk factors may reduce the risk of mild cognitive impairment progressing to dementia.

Quality of life of older adults in Family Health Strategy: a cross-sectional study.

With the increase in the older adult population, it is essential to identify the living and health conditions that can impact the quality of life of these individuals. To identify the domains and factors associated with the quality of life of older adults under the Family Health Strategy program. This was a cross-sectional analytical study was conducted in the municipality of Palmas, Tocantins, Brazil. We assessed 449 older adults enrolled in the Family Health Strategy program. Data were collected between April and July, 2018. World Health Organization Quality of Life Assessment (WHOQOL-OLD) was used to assess the quality of life (QoL) and multiple linear regression was used to estimate the factors associated with QoL. The QoL domain with the highest score was death and dying (mean = 70.4), and the lowest score was for sensory functions (mean = 61.0 points). The factors associated with QoL were single marital status (β = -4.55; P = 0.014), level of independence for daily living activities (β = 4.92; P < 0.001), self-assessment of regular health (β = 5.35; P < 0.001), and poor health (β = -8.67; P < 0.001). The death and dying domain of QoL presented the highest score. Marital status, impairment in daily activities, and health self-assessment were associated with QoL.

The Effects of Neuropsychiatric Symptom Clusters in People with Dementia on Family Caregiver Burden.

Neuropsychiatric symptoms are a robust risk factor for caregiver burden in family dementia caregivers. By grouping these symptoms, clinical interpretations regarding neuropsychiatric symptoms may facilitated because different groups of symptoms may require a different approach for intervention, thereby reducing caregiver burden. As clustering of neuropsychiatric symptoms could be clinically relevant, we aimed to explore the effects of these clusters on burden in family dementia caregivers. 152 family dementia caregivers were included. Caregiver burden was measured using the Ervaren Druk door Informele Zorg (EDIZ)/Self-Perceived Pressure from Informal Care, a Dutch questionnaire. Caregivers also reported the neuropsychiatric symptoms and functional impairments in daily activities of the people with dementia they cared for. Multiple regression analyses were used in this cross-sectional study. Adjusted for functional impairments and sociodemographic variables, neuropsychiatric symptoms were associated with more caregiver burden (p < 0.001). However, this association did not differ between the three neuropsychiatric symptom clusters (p = 0.745). Neuropsychiatric symptoms were associated with more family caregiver burden, but no conclusive evidence was found that this association differed for the three clusters. Clustering of neuropsychiatric symptoms is, however, worth exploring further in future studies with more participants. If specific links are found, these could be targeted in clinical practice in order to prevent, reduce and/or postpone caregiver burden.

Factors affecting work productivity and activity impairment among chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease (COPD) can negatively affect patients' employment and work-life activities with a significant indirect economic impact. The current study aimed to measure unemployment, work productivity, activity impairment, and their associated factors among COPD patients. A cross-sectional study was conducted in the Chest outpatient clinic, Mansoura University Hospital, Egypt. COPD patients completed an interviewer-administered questionnaire including sociodemographic, occupational data, clinical history, medical research council (mMRC) dyspnea scale, the COPD assessment test (CAT), and work productivity and activity impairment Questionnaire (WPAI-COPD). A total 140 patients were included in the study and 22.1% of them gave up their jobs because of their COPD. Due to COPD, the mean percentage of daily activity impairment was 39.8 among all patients. The mean percentages of absenteeism, presenteeism, and overall work impairment among the 84 working patients were 0.07, 24.4, and 24.5. The CAT score was the significant predictor of all components of WPAI. In conclusion, COPD causes early retirement, high work productivity loss, and impaired daily activities. Higher CAT scores and increased disease severity significantly increase absenteeism, presenteeism, overall work, and activity impairment. Thus, timely diagnosis of COPD with appropriate management can help improve outcomes and lower the disease burden and economic impact.

Visual Event-Related Potentials under External Emotional Stimuli as Early Signs for Mild Cognitive Impairment.

Alzheimer's disease (AD) is a neurodegenerative disorder featured by progressive cognitive decline, which manifests in severe impairment of memory, attention, emotional processing and daily activities, leading to significant disability and social burden. Investigation on Mild Cognitive Impairment (MCI), the prodromal and transitional stage between normal aging and AD, serves as a key in diagnosing and slowing down the progression of AD. Numerous effects have been made up to date, however, the attentional mechanisms under different external emotion stimuli in MCI and AD are still unexplored in deep. To further explore the attentional mechanisms under different external emotion stimuli in both MCI and AD patients. In 51 healthy volunteers (Controls, 24 males and 27 females), 52 MCI (19 males and 33 females), and 47 AD (15 males and 32 females) patients, we administered the visual oddball event-related potentials (ERPs) under three types of external emotional stimuli: Neutral, Happiness and Sadness, in which the components N1, P2, N2 and P3 as well as the abnormal cortical activations corresponding to the significant ERP differences in the three groups were observed. Under all three external emotions, in AD patients, N2 and P3 latencies were significantly prolonged compared to both Controls and MCI. In addition, under Happiness, in MCI, P3 latencies were significantly delayed compared to Controls. Meanwhile, under both Happiness and Sadness, in AD patients, P3 amplitudes were significantly decreased compared to Controls and MCI, respectively. During N2 time window, under Neutral emotion, significant hypoactivation in the right superior temporal gyrus was found in AD patients compared to Controls, and under Happiness, the activation of the right inferior frontal gyrus was significantly attenuated in MCI compared to Controls. Under Sadness, in AD patients, the activation of the right superior frontal gyrus was significantly decreased compared to MCI. During P3 time window, under both Happiness and Sadness, when AD patients compared to MCI, the significantly attenuated activations were located in the right fusiform gyrus and the right middle occipital gyrus, respectively. Our results demonstrated visual attentional deficits under external emotional stimuli in both MCI and AD patients, highlighting the function of Happiness for early detecting MCI, in which the P3 latency and the hypoactivation of right inferior frontal gyrus during N2 time window can be early signs. The current study sheds further light of attentional mechanisms in MCI and AD patients, and indicates the value of emotional processing in the early detection of cognitive dysfunction.

Improving Cadres' Knowledge and Skills through Isotonic Movement Training in Reducing Joint Pain and Stiffness in the Elderly

Joint pain and stiffness is one of the complaints of joint disorders that are generally experienced by the elderly (elderly). If left unchecked over time, it will result in disability and functional impairment in daily activities. Therapy to reduce complaints can be in the form of giving pain medication and without giving drugs with joint motion exercises. Isotonic movements can help reduce joint pain and stiffness. The role of cadres in supporting the prevention of joint disorders is important. This activity is called isotonic movement training to reduce joint pain and stiffness in the elderly. The target of the training was 21 elderly posyandu cadres. The methods used in providing training are lectures, practices and discussions. The purpose of the training is to increase cadres' knowledge of isotonic exercises and improve cadres' basic skills about isotonic exercises. After the training, the knowledge and skills of cadres increased. Isotonic movement exercises can help reduce joint pain and stiffness in the elderly.

Frequency of Plantar Heel Pain among Hospital Staff of Memon Medical Institute Hospital

Background: Plantar heel pain (PHP) is recognized as a widespread issue among adults, particularly affecting those with occupations necessitating prolonged standing. This condition not only causes severe pain but also leads to significant disability and impairment in daily activities. Prior research has indicated a higher incidence of PHP among specific demographics and job functions within hospital settings. Objective: The primary objective of this study was to assess the prevalence and contributory occupational factors of plantar heel pain among the staff at Memon Medical Institute Hospital, Karachi. Methods: Employing a cross-sectional study design, data was collected over a three-month period at MMIH. Participants were informed of the voluntary nature of the study and their right to withdraw at any time. A semi-structured questionnaire was administered to a sample of the medical staff to gather data on the incidence of PHP and related factors. Results: The study included 203 participants, with a gender distribution of 48.8% female (n=99) and 51.2% male (n=104). The prevalence of diagnosed heel pain was 14% among males and 25% among females. Professional breakdown revealed the highest incidence of foot pain in nurses, followed by doctors, radiographers, CCTs, NAs, URs, and physiotherapists, respectively. Conclusion: A substantial portion of the hospital staff reported experiencing heel and mid-foot pain, primarily due to the extensive standing inherent in their jobs. The lack of diagnosis and treatment, mainly attributable to a lack of awareness, suggests an urgent need for educational interventions and workplace ergonomic assessments to prevent the progression to plantar fasciitis.