Indicator Of Functional Status Research Articles

45. Preliminary Report on Digital Measures as an Index of Functional Status in Older Patients With Chronic Musculoskeletal Pain

45. Preliminary Report on Digital Measures as an Index of Functional Status in Older Patients With Chronic Musculoskeletal Pain

OR3-7 | High-Sensitivity Cardiac Troponin-T as a Prognostic Indicator of Mortality and Functional Status in Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

OR3-7 | High-Sensitivity Cardiac Troponin-T as a Prognostic Indicator of Mortality and Functional Status in Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

E-24 | N-terminal pro-brain natriuretic peptide as a Prognostic Indicator of Mortality and Functional Status in Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

E-24 | N-terminal pro-brain natriuretic peptide as a Prognostic Indicator of Mortality and Functional Status in Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

Dynamic effective connectivity in the cerebellar dorsal dentate nucleus and the cerebrum, cognitive impairment, and clinical correlates in patients with schizophrenia

BackgroundSchizophrenia (SZ) is characterized by disconnected cerebral networks. Recent studies have shown that functional connectivity between the cerebellar dorsal dentate nucleus (dDN) and cerebrum is correlated with psychotic symptoms, and processing speed in SZ patients. Dynamic effective connectivity (dEC) is a reliable indicator of brain functional status. However, the dEC between the dDN and cerebrum in patients with SZ remains largely unknown. MethodsResting-state functional MRI data, symptom severity, and cognitive performance were collected from 74 SZ patients and 53 healthy controls (HC). Granger causality analysis and sliding time window methods were used to calculate dDN-based dEC maps for all subjects, and k-means clustering was performed to obtain several dEC states. Finally, between-group differences in dynamic effective connectivity variability (dECV) and clinical correlations were obtained using two-sample t-tests and correlation analysis. ResultsWe detected four dEC states from the cerebrum to the right dDN (IN states) and three dEC states from the right dDN to the cerebrum (OUT states), with SZ group having fewer transitions in the OUT states. SZ group had increased dECV from the right dDN to the right middle frontal gyrus (MFG) and left lingual gyrus (LG). Correlations were found between the dECV from the right dDN to the right MFG and symptom severity and between the dECV from the right dDN to the left LG and working memory performance. ConclusionsThis study reveals a dynamic causal relationship between cerebellar dDN and the cerebrum in SZ and provides new evidence for the involvement of cerebellar neural circuits in neurocognitive functions in SZ.

Minimally Invasive Interventions on Ganglion Impar in Treatment of Patients with Coccygodynia

Chronic pelvic pain (CPP) is usually treated conservatively, but in patients who do not respond to treatment, ganglion impar (GI) interventions are used as an alternative way to reduce pain. Objective ‒ to study the course of pain syndrome and functional status in patients with coccygodynia (CD) and CPP during the application of minimally invasive interventions on GI. Materials and methods. The analysis of the results of 56 interventions on GI in 50 patients was performed. Inclusion criteria were patients with coccyx pain for ≥3 months aged 23 to 71 years (mean age 47.9±14.8years) who did not respond to conservative treatment methods. 15 (35.7%) of the study participants were male and 27 (64.3%) were female. Interventions were performed on the patients according to five different methods, which were divided into two groups: the first group (n=34) ‒ GI block (GIB) with a local anesthetic and a steroid (patients with CD in whom medical conservative methods of treatment were not effective). The second group (n=14) consisted of persons with recurrent pain syndrome, resistant forms of CD and CPP, including after previously performed steroid injections: n=2 – neurolysis of GI with ethyl alcohol; n=2 – neurolysis of GI by phenol; n=3 – radio frequency modulation of GI; n=7 – radiofrequency ablation of GI. Results. 14.0% of all study participants had post-traumatic CD (history of falling on the coccyx), the vast majority of 86.0% ‒ idiopathic CD. Pain intensity was significantly lower post-intervention compared to baseline VAS mean of 7.6±1.5 cm: 2.5±0.9 cm one-week post-procedure, 1.5±1.9 cm one month, 1.3±1.5 cm three months, 2.1±1.2 cm six months. The average score according to the Karnovsky Scale (KS) before and after the procedure was 73.3±6.3% and 83.9±4.9%, respectively. Conclusions. Interventions on ganglion impar are an effective method of treating patients with coccygodynia of various etiology, which significantly reduce pain according to the VAS scale (p<0.001) and improve the quality of life according to the KS (p<0.001) in dynamics after 1, 3, 6 months. Minimally invasive interventions on ganglion impar make it possible to reduce tissue trauma, to quickly recover for patients after the procedure, and to minimize any complications. In the first and second groups of the study, there was a decrease in the pain on the VAS from 8.0 cm to 2.0 cm (p<0.0001) and from 7.0 cm to 2,7 cm (p<0.001) before and after the procedure, respectively. In the first and second groups of the study, there was an improvement in the indicator of functional status according to the KS from 70% (95% сonfidence interval (CI) 60‒90%) to 90% (95% CI 70‒100%, p<0.0001) and from 70% (95% CI 70‒90%) to 90% (95% CI 80‒100%, p=0.001) before and after the procedure, respectively.

The development and validation of a nomogram-based risk prediction model for mortality among older adults

ObjectiveThis research aims to construct and authenticate a comprehensive predictive model for all-cause mortality, based on a multifaceted array of risk factors. MethodsThe derivation cohort for this study was the Chinese Longitudinal Healthy Longevity Survey (CLHLS), while the Healthy Ageing and Biomarkers Cohort Study (HABCS) and the China Health and Retirement Longitudinal Study (CHARLS) were used as validation cohorts. Risk factors were filtered using lasso regression, and predictive factors were determined using net reclassification improvement. Cox proportional hazards models were employed to establish the mortality risk prediction equations, and the model's fit was evaluated using a discrimination concordance index (C-index). To evaluate the internal consistency of discrimination and calibration, a 10x10 cross-validation technique was employed. Calibration plots were generated to compare predicted probabilities with observed probabilities. The prediction ability of the equations was demonstrated using nomogram. ResultsThe CLHLS (mean age 88.08, n = 37074) recorded 28158 deaths (179683 person-years) throughout the course of an 8–20 year follow-up period. Additionally, there were 1384 deaths in the HABCS (mean age 86.74, n = 2552), and 1221 deaths in the CHARLS (mean age 72.48, n = 4794). The final all-cause mortality model incorporated demographic characteristics like age, sex, and current marital status, as well as functional status indicators including cognitive function and activities of daily living. Additionally, lifestyle factors like past smoking condition and leisure activities including housework, television viewing or radio listening, and gardening work were included. The C-index for the derivation cohort was 0.728 (95% CI: 0.724–0.732), while the external validation results for the CHARS and HABCS cohorts were 0.761 (95% CI: 0.749–0.773) and 0.713 (95% CI: 0.697–0.729), respectively. ConclusionThis study introduces a reliable, validated, and acceptable mortality risk predictor for older adults in China. These predictive factors have potential applications in public health policy and clinical practice.

Comparative study of the effects of left ventricular and biventricular pacing on indices of cardiac function and clinical status of heart failure patients: preliminary results of READAPT study

Abstract Nonresponse to cardiac resynchronization therapy (CRT) has been related with right ventricular dysfunction. Preferential left ventricular pacing (pLVP) can overcome iatrogenic right ventricular dysfunction by achieving left ventricle resynchronization and by allowing for intrinsic activation of the right side, with ramifications extending beyond cardiac output and atrial fibrillation occurrence. Moreover, the AdaptivCRT® algorithm also automatically adjusts interventricular (V-V) delay every minute, optimizing it by means of comparing relative activation delay between right and left ventricles (electrically – driven optimization). In the present study we evaluated the effects of a pLVP algorithm on 50 heart failure patients (all Caucasians, 49% male; 66 +/- 8 years old; 46% ischemic cardiomyopathy; 41% diabetics; NYHA II-III) following randomization to standard biventricular pacing and pLVP, on echocardiographic and cardiopulmonary exercise test indices of functional status, as well as a self-reported quality of life questionnaire. Device programming was based on echocardiography-evaluated maximization of stroke volume and subsequent interventricular and atrioventricular delay adjustments delegated to the device. The follow-up consisted of 6 and 12-months visits; after the 1rst month of optimizing maximum CRT response. Results Significant comparative effects of LVP over optimized CRT were noted regarding RV systolic velocity in TDI even from 6-months from baseline (6% increase, p=0.01); while end-systolic diameter of left ventricle was increased by 4% in 6-months in CRT group (p=0.01), while no significant difference was observed in LVP group. At 12 months endsystolic volume was significantly decreased (16%, p=0.01) and left ventricular systolic longitudinal strain was improved in 12 months in LVP group compared to CRT group (p- for interaction =0.001). Additionally, in cardiorespiratory exercise test LVP group showed improved inotropic reserve compared to CRT group according to maximum SBP achieved (20% increase, p<0.01 for interaction); while all other cardiorespiratory indices shoed borderline significant changes at 12 -months. Minnesota score was significantly reduced in LV-P group by 70% at 6-months; whereas no significant change was observed in CRT group (p for interaction <0.01). Conclusions In the preliminary findings of READAPT study, it seems that LV pacing optimized by a standardized echocardiographic protocol in patients with preserved AV conduction, LBBB, can achieve a higher percentage of synchronized LV pacing associated with improved patient quality of life; right ventricular function and endsystolic volume at 6 and 12-months of follow-up, over echo-optimized CRT pacing.

Latent transition analysis to explore patterns of physical functional decline among older adults in China: A national 6-year longitudinal study

Background and aimsMultiple limitations often co-occur and accumulate, leading to subsequent function decline. However, there is a scarcity of longitudinal studies examining the progression of physical function among the general population of older adults in China. This study aimed to define typical physical function status and its change, which were characterized by the coexistence and accumulation of diverse limitations targeting a Chinese sample of older adults. MethodsThis study used the three recent public data waves of the Chinese Longitudinal Healthy Longevity Survey during a 6-year follow-up period. 9765 individuals who were over 65 and participated in the 2011 survey were included. Latent transition analysis was used to identify the latent physical function status and explore the transition of older adults among different latent statuses. ResultsSeven latent statuses of physical function were identified, with visual impairment and related limitations being particularly prevalent among older adults. Upper limb mobility appeared to be a differentiated indicator of physical functional status. Physical function decline mainly started with the limitations in squatting, carrying weights and walking, then to the status with intact upper limb mobility and hearing function only, or converted directly into the latter, then to complete dysfunction. ConclusionsOur findings suggest some indicative limitations and critical steps in the process of functional decline among older adults. These results may provide insight for researchers and policymakers to develop tailored preventive and rehabilitation care and provide support for physically limited elderly according to their latent status and course of functional decline.

Relationship between body weight and indicators of physical and emotional status in 12-13-year-old girls

This article is focused on assessing the influence of body weight on the indicators of physical and emotional status of 12-13-year-old girls. The aim of the study was to examine the relationship between body weight and indicators of physical and emotional status in 12-13-year-old girls. The study involved 108 girls aged 12 and 30 girls aged 13. The following methods were used: analysis of scientific and methodological literature, anthropometric, pedagogical, physiological methods, and methods of mathematical statistics. Results. The study revealed statistically significant (p < 0.05) correlations between body mass index (BMI) and indicators of physical development, functional status, physical fitness, physical activity, and value orientations of 12-13-year-old girls, as well as factors negatively influencing their attitude towards physical education classes. The study also identified a direct statistically significant relationship between BMI and the value orientations in the subjects. An increase in BMI was associated with the reinforcement of terminal values such as independence and love, as well as instrumental values like cheerfulness. The research revealed that normal body weight has a positive impact on the development of physical abilities of 12-13-year-old girls, specifically agility and trunk flexor muscular strength and endurance. According to the obtained data, the number of correlations between BMI and other studied indicators of physical and emotional status, physical activity, and value orientations increased with age. While 12- year-old girls had 12 such correlations, 13-year-old girls had 15. Conclusions: The abovementioned necessitates the consideration of these findings in the justification and development of exercise programs based on the use of health fitness means for girls with insufficient body weight.

The nutrient uptake bioassay (NUB): A method to estimate the nutrient uptake capacity of biofilms for the functional assessment of river ecosystems

River ecosystems host a large biodiversity and provide essential ecosystem services but are threatened by multiple anthropogenic activities that degrade their structure and functioning. Although both structure and functioning are key components of ecological status, river monitoring programmes rely almost exclusively on structural indicators, such as community structure, or water quality, neglecting functional attributes. Scientists have pointed towards some promising functions, such as organic matter decomposition, as potential indicators of river functional status. However, it may not be the best indicator to assess the ecosystem functioning of river ecosystem subjected to certain impacts, such as nutrient inputs. Additionally, managers have seldom used functional indicators, probably because of the lack of simple, routine protocols. Here we present the nutrient uptake bioassay (NUB), a simple and straightforward method to measure nutrient uptake by river biofilm that could be developed as a functional indicator of river ecological status. The NUB consists in deploying biofilm carriers in the river for a specific period, allowing biofilm colonization. Biofilm carriers are then incubated in the field in a nutrient-enriched standard solution for one hour and finally the remaining nutrient concentration in the standard medium is measured. Nutrient uptake is calculated from the difference between the initial and final nutrient concentrations. Chlorophyll in the biofilm carriers can also be measured to calculate biofilm accrual rates. The NUB has been developed based on a mesocosm and a field experiments, which showed that the NUB provides additional, non-redundant information to current biomonitoring techniques. Overall, the NUB is a cheap, robust and reliable method that can be applied by most river monitoring practitioners and can be adapted to most river types and situations. As nutrient uptake is linked to the self-purification capacity of rivers, the NUB results provide information about an important ecosystem service. Therefore, we suggest that the NUB can be developed as part of the monitoring toolbox available for managers to improve the assessment of river ecological status and to diagnose the causes of ecosystem impairment.

Stratifying Risk of Nonadherence in Lingual Strengthening Dysphagia Rehabilitation.

Exercise-based treatments may improve swallowing safety and efficiency; yet, it is not clearly understood which factors predict nonadherence to recommended treatment protocols. The aim of this study was to construct an algorithm for stratifying risk of nonadherence to a lingual strengthening dysphagia treatment program. Using recursive partitioning, we created a classification tree built from a pool of sociodemographic, clinical, and functional status indicators to identify risk groups for nonadherence to an intensive lingual strengthening treatment program. Nonadherence, or noncompletion, was defined as not completing two or more follow-up sessions or a final session within 84 days. The study cohort consisted of 243 Veterans enrolled in the Intensive Dysphagia Treatment program across six sites from January 2012 to August 2019. The overall rate of nonadherence in this cohort was 38%. The classification tree demonstrated good discriminate validity (C-statistic = 0.74) and contained eight groups from five variables: primary diagnosis, marital status, Penetration-Aspiration Scale (PAS) severity score, race/ethnicity, and age. Nonadherence risk was categorized as high (range: 69%-77%), intermediate (27%-33%), and low risk (≤ 13%-22%). This study identified distinct risk groups for nonadherence to lingual strengthening dysphagia rehabilitation. Additional research is necessary to understand how these factors may drive nonadherence. With external validation and refinement through prospective studies, a clinically relevant risk stratification tool can be developed to identify patients who may be at high risk for nonadherence and provide targeted patient support to mitigate risk and provide for unmet needs.

Is Transcatheter Aortic Valve Replacement Futile in Patients Over Ninety Years of Age?

BackgroundClinical outcomes and quality of life (QoL) indices are not well described after transcatheter aortic valve replacement (TAVR) in patients aged ≥ 90 years. MethodsWe conducted a retrospective cohort study of TAVR among nonagenarian patients between 2008 and 2020. The survival of TAVR patients among nonagenarians was compared to the provincial estimated survival for an age- and sex-matched general population. QoL was assessed up to 1 year postintervention, using standardized questionnaires. ResultsDuring the study period, n = 268 patients aged ≥ 90 years were evaluated for severe aortic stenosis. TAVR was performed in n = 171 (48% female; median [IQR] Rockwood Clinical Frailty Scale score: 4 [3-4]); n = 84 underwent medical therapy; and n = 13 underwent surgical aortic valve replacement. Survival was significantly better following TAVR, compared to that after MT (adjusted hazard ratio [95% CI]: 1.99 [1.37-2.88], P < 0.001). TAVR patients demonstrated a survival advantage compared with the general population, with an estimated relative mortality of 0.86 (0.75-0.87). TAVR patients showed sustained improvements in functional status and QoL up to 1 year compared to baseline (all P < 0.05): the 6-minute walk test results improved from 192 to 252 m; the Kansas City Cardiomyopathy Questionnaire score improved from 64 to 81; the Duke Activity Status Index score improved from 13 to 16; and the health state scale result of the Euro Quality of life - 5 Dimensions improved from 63% to 74%. ConclusionsNonagenarians undergoing TAVR experience a slightly better survival rate, compared to that of an age- and sex-matched general population, and they have significant improvements in functional status and several QoL indices following the procedure.

Association of grip strength and comorbidities with all-cause mortality in the older hypertensive adults.

With growing concerns about global population aging, comorbidity, and disability have emerged as key variables that influence the health of the older adults in terms of disease and function. This study sought to examine the impact of comorbidity and impairment using disease and functional status indicators of all-cause mortality in the older adults. Hypertension, which was chosen as the indicator chosen for disease, has the greatest prevalence in the older population. A total of 15 self-reported chronic conditions were added as indicators of comorbidity, and grip strength was chosen as a measure of functional status. The study also evaluated the association between grip strength and comorbidity, as well as its consequences on all-cause death and survival in a hypertensive senior population. We chose a total of 2,990 hypertensive participants aged ≥60 years whose data for grip strength were collected in the National Health and Nutrition Examination Survey conducted between 2011 and 2014. The association of all-cause death with grip strength and comorbidity was examined using a Cox proportional hazard regression model. The interaction between comorbidity and all-cause mortality, as well as its association with grip strength, was also examined. The hazard ratio [95% confidence intervals (CIs)] for all-cause mortality in the highest grip strength tertile was 0.266 (0.168-0.419), compared to the lowest grip strength tertile. The all-cause mortality decreased with an increase in the number of co-morbidities [2.677 (1.557-4.603) in the group with ≥3 chronic diseases]. The weighted generalized model revealed a negative correlation between grip strength and comorbidities in more than three groups after accounting for all possible variables (β = -2.219, -3.178 ~ -1.260, p < 0.001). The risk of mortality reduced with increasing grip strength in patients with ≥3 comorbidities (p-value for trend <0.05), but no meaningful difference was found in the interaction between comorbidities and grip strength (p-value for interaction >0.05). In older hypertension patients, grip strength and comorbidities were correlated with all-cause death, and there was a negative correlation between grip strength and comorbidities. Higher grip strength was associated with fewer fatalities in patients with ≥3 comorbidities, suggesting that functional exercise can improve the prognosis of comorbidities.

Outcomes in elderly patients undergoing hepatic resection compared to ablative therapy for hepatocellular carcinoma.

Hepatic resection is an excellent option in the care of patients with hepatocellular carcinoma (HCC). Elderly patients often forego hepatic resection in favor of liver-directed ablative therapies due to the increased likelihood of adverse postoperative outcomes due to age. We sought to determine long-term outcomes in patients who underwent hepatic resection compared to liver-directed ablative therapy in this patient population. We queried the National Cancer Database for elderly patients (≥70 years) diagnosed with HCC between 2004 and 2018. The primary outcome was overall survival (OS) computed using the Kaplan-Meier method and Cox proportional hazard regression. A total of 10 032 patients were included in this analysis. On unadjusted analysis (p < 0.001) as well as multivariable analysis (hazard ratio: 0.65, 95% confidence interval: 0.57-0.73), hepatic resection was associated with improved OS. The protective association between hepatic resection and OS persisted after 1:1 propensity score matching. Hepatic resection is associated with improved survival for well-selected elderly patients with HCC. While age is often thought of as influencing the decision to offer surgery, our study, in combination with others, demonstrates that it should not. Instead, other objective indicators of performance and functional status may be considered.

ГІМНАСТИКА ХАДУ: ОЗДОРОВЧИЙ ЕФЕКТ І ВІДНОВЛЕННЯ ОРГАНІЗМУ

The article highlights the idea of complex use of gymnastics and Hadu exercises in physical education classes, aimed at solving problems of a health-improving nature, harmonious physical development of the individual as well as the improvement of his motor abilities and health strengthening. The author accentuates on the necessity to effectively include Khadu gymnastics not only in the educational process of classroom or extracurricular activities but also in everyday lives and practices. The research is based on the experience of Zviad Arabuli, who developed the system based on a specifically organized set of exercises. The author underlines the idea of an adequate application of the above-mentioned methodology in order to increase its the positive effect in the restoration of the musculoskeletal system of trainees, enhance the effectiveness of the health-improving processes as well as restoring impaired functions of the human body as a whole. The major component of Hadu gymnastics is exercising with simultaneous tension of opposing muscles that has to be accompanied by proper breathing. When recognizing Zviad Arabuli's methodology as one of the innovative health techniques in the sports industry we focus on its compliance with the socio-cultural demands of society regarding increasing work capacity, stress resistance in order to obtain a health-improving result. Testing of indicators of functional status and analysis of survey results of representatives of different age groups testified to positive changes during the subjective assessment of their health. The study, in which 20 women and 15 men participated, was conducted for 7 months at the sports complex of the Mariupol State University. During the interview, 54% of the respondents confirmed the disappearance of back and neck pain, 20% of the respondents underlined the reduction of pain in the lower back, 28% of the respondents noted the improvement of vision, 12% of the respondents indicated the reduction of pain in the joints, 63% of them confirmed the ease of walking and straightening the posture, 15% of women and men improved their sleep after a few weeks of doing the blitz complex exercises. Appealing to the balance of the spiritual, aesthetic and physical qualities of a modern person, Hadu gymnastics, represented by a system of specially developed physical exercises and scientifically based techniques, confirms in practice its target focus on maintaining person’s proper physical shape as well as strengthening his health and restoring impaired body functions. Key words: Khadu gymnastics, exercises, physical fitness, health improvement result, body rejuvenation.

Study of the problems of ageism and assessment of attitudes towards age in the medical environment

BACKGROUND: Ageism pervades all areas of life, including the areas of medical and social care. Gerontological ageism has a significant negative impact on indicators of physical, mental health, functional status and well-being of older people. In the conditions of an aging society, the study of the scale and characteristics of this problem in various spheres of life is very relevant.&#x0D; AIM: To assess the prevalence of stereotypes of attitudes towards older age among primary health care physicians, senior students of a medical university and directly elderly people.&#x0D; MATERIALS AND METHODS: In the period from 2018 to 2022, 538 people aged 20 to 75 were interviewed in 3 subgroups: 1) senior students of a medical university of medical specialties, 2) young and middle-aged primary health care doctors, 3) elderly people.&#x0D; RESULTS: It was revealed that the opinions about the problems in this age period in the elderly and the beliefs of doctors and medical students often do not coincide.&#x0D; CONCLUSIONS: When training medical personnel, it is necessary to form the correct attitude to age and skills of communicative competence with different age groups of patients.

Impact of a Bedside Activity Device on the Functional Status of Hospitalized Older Adults: A Randomized Controlled Trial.

Older adults may have difficulty maintaining their functional capabilities during hospitalization. This pilot study aimed to investigate the impact of a bedside activity device on the functional status of hospitalized older adults. For this single-site randomized controlled trial, 48 participants were recruited between July 2019 and March 2021. Participants were randomized into one of two groups: the intervention group, which was given the use of a bedside activity device plus standard care, and the control group, which received standard care. Katz Index of Independence in Activities of Daily Living (Katz ADL) scores and Timed Up and Go (TUG) test times were used as indicators of functional status and were collected on admission (baseline) and at discharge.Mann-Whitney U and χ2 tests were used to test for baseline similarities between groups. The Wilcoxon signed rank test was used to determine within-group pre-post changes in TUG and Katz ADL scores. The Mann-Whitney U test was used to determine between-group differences in TUG and Katz ADL change scores. Within-group pre-post analysis showed significant increases in Katz ADL scores in the intervention group and no significant changes in the control group. TUG times decreased significantly in the intervention group and increased significantly in the control group. Between-group analyses showed significant differences in both TUG and Katz ADL change scores. The use of the bedside activity device in addition to standard care may prevent functional decline and increase independence in performing basic ADLs.

Assessment of the functional status of patients with rheumatoid arthritis as a result of the physical therapy programme

Annotation. A differentiated strategy for the rehabilitation treatment of patients with rheumatoid arthritis is the development and implementation of a comprehensive therapeutic programme that includes the use of non-drug measures in addition to conservative therapy. The purpose of the paper is to evaluate the functional status of patients with rheumatoid arthritis as a result of the proposed physical therapy programme. Materials and methods. A total of 188 patients with rheumatoid arthritis were examined, with an average age of 44.9±7.6 years. All patients were randomly assigned to the control (n=92) and intervention (n=96) groups. Patients in the control group underwent rehabilitation in accordance with the recommendations of the regulatory document of the Ministry of Health of Ukraine. The physical therapy programme for patients of the main group is developed in accordance with the domains of the ICF, taking into account the factors that affect the level of functional impairment, health status and quality of life. The effectiveness of the proposed physical therapy programme on the functional status of patients with rheumatoid arthritis was assessed by the results of the Stanford Health Assessment Questionnaire. Results. At the beginning of the study, the total score for patients in the control group was 6.3±0.7 points and for the intervention group - 6.5±9.5 points. The greatest difficulties arose in getting dressed, including tying laces and fastening buttons, opening and closing a tap, bringing a full cup to the mouth, bending over and picking up an object from the floor. After 3 months, significantly better changes occurred in patients of the main group compared to the control group. So, in the patients of the main group, the total score decreased to 3.9±11.1 points, in the control group this score was worse and amounted to 4.7±2.3 points. After the treatment and physical therapy in 6 months, the functional status of patients in both groups improved, but the total score in the main group was significantly better and closer to normal (1.8±12.2 points) than in patients in the control group (2.9±4.1 points). Significantly better results of functional status indicators in patients of the main group indicate the effectiveness of the proposed physical therapy programme. Conclusion. Increased motor activity in the joints, muscle strength in the affected upper extremities as a result of the proposed physical therapy programme contributed to the improvement of daily activities and functional status of patients in the main group, as evidenced by the results of the Stanford Health Interview. Thus, significantly better changes occurred in the patients of the main group compared to the control group, where conventional rehabilitation treatment was performed.

Efficiency of classes in the psychological obstacle course to the formation of physical readiness future officers

The purpose of the work is to investigate the effectiveness of practical classes on the psychological obstacle course to the formation of physical readiness of future officers of the Armed Forces of Ukraine for training and professional combat activities during studies at a higher military educational institution. Cadets of 4–5 courses (n=64) of the Zhytomyr Military Institute named after SP Korolyov took part in the research. Two groups were formed: experimental (EG, n = 32), with cadets of which additional practical classes were held on the psychological obstacle course during hours of sports-mass and independent work, and control (KG, n = 32), whose cadets additionally engaged in physical exercises according to the current instructions on physical training in the system of the Ministry of Defense of Ukraine also in the hours of sports-mass and independent work. Research methods: theoretical analysis and generalization of educational and methodical recommendations, information sources on research topics, documentary method, pedagogical observation, pedagogical testing, methods of mathematical statistics.&#x0D; The results of the study confirmed the high level of physical fitness of future officers of the Armed Forces of Ukraine of the experimental group, which will allow them to perform training, and in the future - combat and other tasks as assigned in accordance with modern combat. Indicators of physical fitness and functional status of future officers who were engaged in the psychological obstacle course at the end of the study are better than those who were engaged in the current instructions on physical training in the Ministry of Defense of Ukraine during sports-mass work. The most pronounced impact of training on the psychological obstacle course was found on the level of endurance of future officers (3 km running) and the degree of their formation of military-applied motor skills and abilities (overcoming the general control exercise on a single obstacle course and shuttle running 6x100 m with gun and bag for shops with two shops).

Echocardiographic Evaluation of Initial Ambrisentan Plus Phosphodiesterase Type 5 Inhibitor on Right Ventricular Pulmonary Artery Coupling in Severe Pulmonary Arterial Hypertension Patients.

Introductionambrisentan and phosphodiesterase type 5 inhibitor (PDE5i) have been approved for treating patients with pulmonary arterial hypertension (PAH). Echocardiographic right ventricular pulmonary artery coupling (RVPAC) has been shown to be a valid non-invasive and alternative measurement method to assess the predicted outcomes in PAH patients. The aim of this study was to study the effect and clinical correlates of initial ambrisentan plus PDE5i combination therapy on RVPAC in patients with severe PAH.Method and ResultsWe retrospectively studied and analyzed comprehensive clinical data, hemodynamics, and echocardiography in 27 patients with severe PAH before and after 6 months of initial combination therapy. Compared with the baseline, significant improvements in RVPAC ratios were observed, including RVFAC/PASP (0.31 ± 0.10 vs. 0.44 ± 0.15%/mmHg, p < 0.001), TAPSE/PASP (0.15 ± 0.05 vs. 0.21 ± 0.06 mm/mmHg, p = 0.001), S’/PASP (0.10 ± 0.03 vs. 0.14 ± 0.05 cm/s∙mmHg, p = 0.001), and RVSV/RVESV (0.79 ± 0.22 vs. 1.02 ± 0.20, p < 0.001). Functional status indices [World Health Organization functional classifications (WHO-FC) and 6 min walk distance (6MWD) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels] showed significant improvements. Right heart catheterization (RHC) evaluations for hemodynamic measurements between baseline and the 6–12 month follow-up were sPAP (96 ± 22 vs. 86 ± 24 mmHg, p = 0.002), mPAP (64 ± 18 vs. 56 ± 17 mmHg, p < 0.001) and TPVR (17.3 ± 6.7 vs. 12.1 ± 5.4 WU, p = 0.001). Simultaneously, significant associations between RVPAC ratios and NT-proBNP levels and WHO-FC and 6MWD were observed.ConclusionAmbrisentan plus PDE-5i combination therapy resulted in a significant improvement in RVPAC in severe PAH. Importantly, RVPAC parameters correlated with known prognostic markers of PAH.