Indicator Of Functional Status Research Articles

Specific features of axial spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, in persons of different genders

The increasing number of women with ankylosing spondyloarthritis (SpA) makes it relevant to study the specific features of this disease in persons of different genders. Objective : to study the indicators of activity and functional status in male and female patients with axial SpA. Subjects and methods. The study enrolled 91 patients (43 women and 48 men) with axial SpA admitted to the Rheumatology Unit of the Saratov Regional Clinical Hospital in 2013. The age of the women and men was 41.63±12.04 and 41.94±12.76 years, respectively. All the patients fulfilled the ASAS criteria for axial SpA. 60.43% of the patients had ankylosing spondylitis (AS) meeting the modified New York criteria; 26.37% had psoriatic arthritis (PsA) according to the CASPAR criteria (only patients with axial involvement were included in the study and those with peripheral arthritis were excluded); 9.89% had undifferentiated axial SpA. Age at symptom onset, disease duration, and age at diagnosis of axial SpA were taken into account. The activity of axial SpA (ASDAS, BASDAI, highsensitivity C-reactive protein) and the mobility of the axial skeleton (BASMI and its components) were investigated in patients of different genders. Results . The study has established that the women are hospitalized with diagnosed axial SpA as often as the men. The indicators of activity and axial skeleton mobility are similar in the male and female patients with axial SpA as a whole and with a disease history of less than 10 years. Having a disease history of more than 10 years, the women preserve greater mobility of the lumbar and cervical spine than do the men with the similar disease activity.

Neurocognitive and functional correlates of mobile phone use in middle-aged and older patients with schizophrenia

Objectives: Our objective was to examine the association of mobile phone use and ownership with psychopathology, cognitive functioning, and functional outcome in 196 outpatients aged 40 years and older who were diagnosed with schizophrenia.Method: Participants reported their past and current mobile phone use on a standardized self-report scale and they were administered tests of global cognition, functional capacity, and informant-rated functional outcome.Results: The great majority of subjects had used a mobile phone (78%) but few currently owned one (27%). After adjusting for age (mean age 51), any past mobile phone use was associated with less severe negative symptoms, and higher global cognitive performance, functional capacity, and functional outcome. A total of 60% of participants reported being comfortable with mobile phones, but comfort was not associated with any cognitive or functional outcomes.Conclusion: Most of the older patients with schizophrenia have used mobile phones and lifetime mobile phone use is a positive indicator of cognitive and functional status.

Pulmonary artery diastolic pressure gradient as an indicator of severity of illness in patients with pulmonary hypertension related to left-sided heart disease

Pulmonary hypertension (PH) due to left-sided heart disease (Group 2 PH) is most commonly due to passive backward transmission of elevated left-sided heart pressures. A subgroup of these patients develop pulmonary artery remodeling, resulting in systolic and mean pulmonary artery pressures that are 'reactive' or 'out of proportion' to the elevated left-sided heart pressures. These patients have historically been identified by a transpulmonary gradient (TPG) > 12 mmHg. However, since diastolic pulmonary artery pressures are less susceptible to changes in pulmonary blood flow, a diastolic pulmonary gradient (DPG) ⩾ 7 mmHg may be a superior indicator of worse clinical function and prognosis. Based on measurements from a right-heart catheterization (RHC) database (Baylor College of Medicine, Houston, TX, USA), comparisons of several clinical parameters were made among three Group 2 PH patients: normal TPG and DPG (Group 2A), elevated TPG and normal DPG (Group 2B), and elevated TPG and DPG (Group 2C). Among 173 RHCs, 39 were found to have Group 2 PH. Among these 39 cases, 10 (32%), 13 (32%), and 16 (36%) cases were categorized into Groups 2A, 2B, and 2C, respectively. Group 2C patients had significantly worse 6-min walk distance (308 ± 69 m) than Group 2A (425 ± 81 m) and Group 2B (350 ± 103 m) (p = 0.038). There was no significant difference in cardiac output, cardiac index, and right atrial pressure among the three subgroups. Among patients with Group 2 PH, elevated DPG proved to be a more specific indicator of worse functional status than the historically used TPG. International guidelines and protocols for performing RHC for the assessment and diagnosis of PH should include the measurement of DPG.

Medication discrepancies in older patients admitted to non-geriatric wards: An exploratory study

BackgroundDiscrepancies between actual home medication and those recorded at admission are a recognised safety concern for older inpatients. Few studies have investigated discrepancies on non-geriatric wards where pharmaceutical care may be less tailored to the needs of older patients. PurposeTo assess home medication discrepancies categorised by type and clinical impact and, to explore the relationship with patients’ clinical profiles. Materials & methodsThis was an observational study in non-geriatric wards in a single hospital without electronic communication with community pharmacies. Subjects were inpatients≥70 years. Home medication assessment occurred through standard care (physician/nurse) and structured medication reconciliation (hospital pharmacist). Discrepancies, defined as any difference in the medications lists resulting from the two methods, their relationship with patient profiles and their potential clinical impact were assessed. ResultsPatients’ (n=78) mean age was 79 years and 63% were females; 60% of patients (n=47) were affected by 92 discrepancies, mean 1.96/affected patient (range 1–6). Predominant discrepancies were doses or medications (errors of omission or commission). Discrepancies of moderate clinical impact (31% of affected patients) concerned the majority of respiratory and cardiovascular drugs. The proportion of discrepancies was higher in patients with polypharmacy (P=0.001) and with an indication of lower functional status (P=0.032). Discussion & conclusionMedication discrepancies occurring at admission to non-geriatric wards are common in older inpatients and their potentially moderate clinical impact reinforces their importance to patient safety.

Dynamic testing of learning potential in adults with cognitive impairments: A systematic review of methodology and predictive value

Dynamic testing includes procedures that examine the effects of brief training on test performance where pre- to post-training change reflects patients' learning potential. The objective of this systematic review was to provide clinicians and researchers insight into the concept and methodology of dynamic testing and to explore its predictive validity in adult patients with cognitive impairments. The following electronic databases were searched: PubMed, PsychINFO, and Embase/Medline. Of 1141 potentially relevant articles, 24 studies met the inclusion criteria. The mean methodological quality score was 4.6 of 8. Eleven different dynamic tests were used. The majority of studies used dynamic versions of the Wisconsin Card Sorting Test. The training mostly consisted of a combination of performance feedback, reinforcement, expanded instruction, or strategy training. Learning potential was quantified using numerical (post-test score, difference score, gain score, regression residuals) and categorical (groups) indices. In five of six longitudinal studies, learning potential significantly predicted rehabilitation outcome. Three of four studies supported the added value of dynamic testing over conventional testing in predicting rehabilitation outcome. This review provides preliminary support that dynamic tests can provide a valuable addition to conventional tests to assess patients' abilities. Although promising, there was a large variability in methods used for dynamic testing and, therefore, it remains unclear which dynamic testing methods are most appropriate for patients with cognitive impairments. More research is warranted to further evaluate and refine dynamic testing methodology and to further elucidate its predictive validity concerning rehabilitation outcomes relative to other cognitive and functional status indices.

Markers of vitamin B6 status and metabolism as predictors of incident cancer: the Hordaland Health Study.

Dietary intake and/or circulating concentrations of vitamin B6 have been associated with risk of cancer, but results are inconsistent and mechanisms uncertain. Pyridoxal 5'-phosphate (PLP) is the most commonly used marker of B6 status. We recently proposed the ratio 3-hydroxykynurenine/xanthurenic acid (HK/XA) as an indicator of functional vitamin B6 status, and the 4-pyridoxic acid (PA) /(pyridoxal (PL) +PLP) ratio (PAr) as a marker of vitamin B6 catabolism during inflammation. We compared plasma PLP, HK/XA and PAr as predictors of cancer incidence in a prospective community-based cohort in Norway. This study included 6,539 adults without known cancer at baseline (1998-99) from the Hordaland Health Study (HUSK). HR and 95% CI were calculated for the risk of overall and site-specific cancers using multivariate Cox proportional hazards regression with adjustment for potential confounders. After a median follow-up time of 11.9 years, 963 cancer cases (501 men and 462 women) were identified. Multivariate-adjusted Cox-regression showed no significant relation of plasma PLP or HK/XA with risk of incident cancer. In contrast, PAr was significantly associated with risk of cancer with HR (95% CI) = 1.31 (1.12-1.52) per two standard deviation (SD) increment (p < 0.01). Further analysis showed that PAr was a particular strong predictor of lung cancer with HR (95% CI) = 2.46 (1.49-4.05) per two SD increment (p < 0.01). The present results indicate that associations of vitamin B6 with cancer may be related to increased catabolism of vitamin B6, in particular for lung cancer where inflammation may be largely involved in carcinogenesis.

Arm measurements as determinants of further survival in centenarians

Being indicators of nutritional and functional status, anthropometric characters may have great prognostic significance for survival at extremely advanced ages. For ethical and practical reasons however it is advisable to use characters such as arm measurements easily measurable even in bedridden subjects. This study compares the influence of some upper arm measurements and of Body Mass Index (BMI) on survival of the 77 subjects aged 98years and over (98+) recruited within the MALVA project, one of the first Italian population-based studies on extremely old people. Adopting methods for multiple imputation of missing values, Gompertz regression models adjusted for gender and age were estimated for each anthropometric character or combination of characters, i.e. BMI; mid-upper arm circumference (MUAC)+elbow breadth (EB)+triceps skinfold thickness (TSF); corrected arm muscle area (CAMA). Being underweight and having a low CAMA and a low MUAC/high EB were positively associated with an increased risk of death, while no significant association was found with the condition of being overweight/obese and the triceps skinfold thickness. When anthropometric variables were included in regression models along with covariates relating to nutritional and functional status, BMI and MUAC, but not CAMA, emerged as protective factors.It is suggested that MUAC can be recommended in evaluating the health status of extremely old people and that measuring EB may help to estimate the non-boney component of the arm.

The association between post-polio symptoms as measured by the Index of Post-Polio Sequelae and self-reported functional status

ObjectiveTo evaluate the association between self-reported severity of polio sequelae and current functional status among polio survivors. MethodsThis was a cross sectional study of 195 polio survivors attending a polio outpatient clinic at a university hospital. The main outcome measures of demographic, medical, social, and functional data were gleaned from a questionnaire adapted for the polio population. The severity of polio sequelae was evaluated with the self-reported Index of Post-Polio Sequelae (IPPS). ResultsThe mean age of our sample was 57.6±10.5years, 53% were men, 38% had acquired higher education and 37% were employed. We found significant correlations between the total IPPS score and independence in activity of daily living (P<0.05), the use of walking aids (P<0.005) and mobility in and out-of-doors (P<0.0001). A positive correlation was also found between the total IPPS score and subjective assessment of physical and mental health (P<0.0001). ConclusionsHigher disability in ADL and mobility and lower perception of physical and mental health in polio survivors were associated with a higher score on the IPPS, reflecting greater severity of polio sequelae. These findings demonstrate the IPPS as a useful tool in the clinical evaluation of the polio population, however further data is needed in order to determine if this index can assess clinically significant changes over time.

Relationships between nutritional screening and functional impairment in institutionalized Spanish older people

ObjectivesAn association between functional status and nutritional status has previously been demonstrated and the value of the Mini Nutritional Assessment (MNA) as an indicator of functional status has been investigated. However, experience in nursing homes is still limited. The objectives of this survey were to study the relationships between functional impairment as measured by the Barthel Index (BI) and broad nutritional assessment categories as measured by the MNA. Study designCross-sectional study developed with data collected from 895 residents in 34 nursing homes all over the province of Albacete (Spain). Main outcome measuresNutritional and functional statuses were assessed using the MNA and the BI, respectively. Correlations between MNA and BI were evaluated. Analyses of BI against the MNA were utilized to obtain cut-off points for three broad categories of the MNA, “well”, “at risk” and “malnourished”. Multiple logistic regression analyses were used to assess the association of the MNA items with the BI. ResultsMNA and BI were significantly correlated. The BI cut-off point that best determined malnourished versus well or at risk was 40.5. The BI cut-off point that best determined well versus malnourished or at risk was 85.5. The BI was positively associated with the following MNA items: mobility, mode of feeding, self view of health status and mid-arm circumference. ConclusionsBoth tests, MNA and BI, are positively associated. The scores of BI can help determine who may be at risk of poor nutrition.

Simultaneous Measurement of Individual Mitochondrial Membrane Potential and Electrophoretic Mobility by Capillary Electrophoresis

Mitochondrial membrane potential varies, depending on energy demand, subcellular location, and morphology and is commonly used as an indicator of mitochondrial functional status. Electrophoretic mobility is a heterogeneous surface property reflective of mitochondrial surface composition and morphology, which could be used as a basis for separation of mitochondrial subpopulations. Since these properties are heterogeneous, methods for their characterization in individual mitochondria are needed to better design and understand electrophoretic separations of subpopulations of mitochondria. Here we report on the first method for simultaneous determination of individual mitochondrial membrane potential and electrophoretic mobility by capillary electrophoresis with laser-induced fluorescence detection (CE-LIF). Mitochondria were isolated from cultured cells, mouse muscle, or liver, and then polarized, labeled with JC-1 (a ratiometric fluorescent probe, which indicates changes in membrane potential), and separated with CE-LIF. Red/green fluorescence intensity ratios from individual mitochondria were used as an indicator of mitochondrial membrane potential. Reproducible distributions of individual mitochondrial membrane potential and electrophoretic mobility were observed. Analysis of polarized and depolarized regions of interest defined using red/green ratios and runs of depolarized controls allowed for the determination of membrane potential and comparison of electrophoretic mobility distributions in preparations containing depolarized mitochondria. Through comparison of these regions of interest, we observed dependence of electrophoretic mobility on membrane potential, with polarized regions of interest displaying decreased electrophoretic mobility. This method could be applied to investigate mitochondrial heterogeneity in aging or disease models where membrane potential is an important factor.

Outcomes reported in high-impact surgical journals

With advances in operative technique and perioperative care, traditional endpoints such as morbidity and mortality provide an incomplete description of surgical outcomes. There is increasing emphasis on the need for patient-reported outcomes (PROs) to evaluate fully the effectiveness and quality of surgical interventions. The objective of this study was to identify the outcomes reported in clinical studies published in high-impact surgical journals and the frequency with which PROs are used. Electronic versions of material published between 2008 and 2012 in the four highest-impact non-subspecialty surgical journals (Annals of Surgery, British Journal of Surgery (BJS), Journal of the American College of Surgeons (JACS), Journal of the American Medical Association (JAMA) Surgery) were hand-searched. Clinical studies of adult patients undergoing planned abdominal, thoracic or vascular surgery were included. Reported outcomes were classified into five categories using Wilson and Cleary's conceptual model. A total of 893 articles were assessed, of which 770 were included in the analysis. Some 91·6 per cent of studies reported biological and physiological outcomes, 36·0 per cent symptoms, 13·4 per cent direct indicators of functional status, 10·6 per cent general health perception and 14·8 per cent overall quality of life (QoL). The proportion of studies with at least one PRO was 38·7 per cent overall and 73·4 per cent in BJS (P < 0·001). The proportion of studies using a formal measure of health-related QoL ranged from 8·9 per cent (JAMA Surgery) to 33·8 per cent (BJS). The predominant reporting of clinical endpoints and the inconsistent use of PROs underscore the need for further research and education to enhance the applicability of these measures in specific surgical settings.

EVALUATION OF ULTRASOUND REMISSION CRITERIA IN PATIENTS WITH RHEUMATOID ARTHRITIS DURING TOCILIZUMAB THERAPY

Objective: to study the association of ultrasound (US) remission criteria with the clinical and laboratory indicators of inflammatory activity, functional status, and X-ray changes in patients with rheumatoid arthritis (RA) during tocilizumab (TCZ) therapy. Subjects and methods. The trial included 36 patients with RA (meeting the 1987 American College of Rheumatology (ACR) criteria) who had received TCZ for 6 months. The authors made a clinical and laboratory assessment of RA activity (DAS28-CRP, and SDAI), functional impairments (HAQ index) and US verification of wrist joint synovitis (a Voluson-i device, GE, 4-13-MHz linear transducer) at baseline and 6 months after therapy. No signs of grey-scale (B-mode) and power Doppler (PD) synovitis (B = 0; PD = 0) or minimal B-mode synovitis, and not more one PD hypervascular signal (В ≤1; PD ≤1) were arbitrarily taken as US remission criteria. Destruction changes were evaluated by hand and foot X-ray using the Sharp method modified by van der Heijde (SHS). Results. After 6 months of therapy, about 80% of the patients in clinical remission retained moderate or significant synovitis, as evidenced by US studies. There were no clinical differences in clinical activity indices and functional impairments between the patients who were and were not in US remission (p > 0.05). The 12-month follow-up SHS score was significantly higher with the preservation of 6-month therapy signs of B-mode synovitis and PD hypervascularization (of not more than one signal) than that in US remission (p 0.05). Conclusion. Subclinical synovitis is observed even in clinical remission of RA. Destruction progression is significantly related to synovitis persistence, as shown by ultrasonography.

Abstract A33: Therapeutic potential of sapacitabine in ovarian cancers defective in homologous recombination

Abstract Background: Sapacitabine is an oral nucleoside analogue that is metabolised in-vivo to CNDAC (2′-C-cyano-2′-deoxy-1-β-D-arabino-pentofuranosylcytosine). It has a novel mechanism of action by causing single-strand breaks and replication-associated double-strand breaks (DSBs) after its incorporation into DNA. DSB, if unrepaired, are cytotoxic and are predominantly repaired by homologous recombination (HR). Over 50% of high-grade serous ovarian cancers are estimated to be defective in HR, only a small proportion of which are accounted for by germline BRCA mutations. HR-defective ovarian cancers have been shown to be sensitive to PARP inhibitors ex-vivo and platinum in-vivo and we therefore hypothesised that HR defective ovarian cancers would be sensitive to CNDAC and aimed to explore the potential use of CNDAC in ovarian cancer stratified for HR function. Methods: Primary cultures (PCO) were generated from ascitic fluid collected from patients undergoing ovarian cancer surgery, characterised and confirmed to be ovarian and epithelial in origin based upon morphology, expression of immunofluorescent-labelled markers and cross-referencing with formal examination of FFPE tissue and cytology of ascites. The functional status of HR was determined for each cell line and PCO culture by quantification of nuclear Rad51 focus formation following induction of DNA DSB. SRB assays were used to calculate the GI50 for cisplatin and CNDAC, (Cyclacel, UK), in cell lines nad PCO cultures. Results: As hypothesised, HR defective cell lines were highly sensitive to CNDAC (VC8 BRCA2 mutant: GI50=366 nM) in comparison to their matched HR competent cell lines (VC8-BRCA2 reconstructed: GI50=18 μM; VC8-PARPi-resistant BRCA revertant: GI50=3 μM). Sensitivity to CNDAC in patient PCO cultures (n=39) was heterogeneous with a mean GI50 of 297 nM (95% CI 136-646 nM). Stratifying PCO cultures according to their HR status demonstrated greater sensitivity in HR defective cultures with a mean GI50 of 135 nM (46-394; n=12) in defective cultures, compared to 477 nM in HR competent cultures (164-1386; n=27). Of the 34 cisplatin resistant PCO cultures (GI50 &amp;gt;5 μM), 20 (59%) remained sensitive to CNDAC with a mean GI50 of 426 nM (148-1223; n=13) in HR competent cultures and a GI50 of 230 nM (70-759; n=7) in HR defective cultures. CNDAC sensitivity was evaluated in base excision repair (BER) defective EM9 cell line (GI50=374 nM) compared with parental wild type AA8 cells (GI50=6.9 μM), p&amp;lt;0.0001. Using detection of 8-hydroxy-2′-deoxyguanosine (8-OHdG) as an indicator of BER functional status in PCO cultures, a trend between BER dysfunction and sensitivity to CNDAC was seen with a mean GI50 of 42 nM (18-97; n=2) in BER defective PCO cultures in comparison to 187 nM (74-473; n=15) in BER competent cultures. Conclusions: Cell lines defective in HR or BER are highly sensitive to CNDAC suggesting a possible use of HR or BER status as biomarkers for the stratified use of CNDAC in the treatment of ovarian cancer. When applied to ex-vivo studies HR status as a single marker cannot reliably predict sensitivity and a panel of pathways may therefore be needed to enable reliable treatment stratification. Nevertheless, stratification based on these markers is likely to permit enrichment of patients more likely to respond to CNDAC. Additionally CNDAC may have a role in the treatment of platinum resistant disease as approximately 60% of patients with resistant disease may benefit. Further work is required to explore the possibility of CNDAC as a chemosensitiser in platinum sensitive disease and as a second line agent in platinum resistant disease. Citation Format: Rachel L. O'Donnell, James CC Murray, Adriana GB Buskin, Sheelagh Frame, David G. Blake, Michelle Dixon, Aiste McCormick, Angelika Kaufmann, E Ruth Plummer, Richard J. Edmondson, Nicola J. Curtin. Therapeutic potential of sapacitabine in ovarian cancers defective in homologous recombination. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: From Concept to Clinic; Sep 18-21, 2013; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2013;19(19 Suppl):Abstract nr A33.

Comparison of Predictors of Heart Failure–Related Hospitalization or Death in Patients With Versus Without Preserved Left Ventricular Ejection Fraction

Heart failure with preserved ejection fraction (HFpEF) is recognized as a major cause of cardiovascular morbidity and mortality. An ability to identify patients with HFpEF who are at increased risk for adverse outcomes can facilitate their more careful management. We studied the patients having heart failure (HF) using data from the Heart Failure Adherence and Retention Trial (HART). HART enrolled 902 patients in the New York Heart Association (NYHA) class II or III who had been recently hospitalized for HF to study the impact of self-management counseling on the primary outcome of death or HF hospitalization. In HART, 208 patients had HFpEF and 692 had HF with reduced ejection fraction (HFrEF) and were followed for a median of 1,080days. Two final multivariate models were developed. In patients having HFpEF, predictors of primary outcome were male gender (odds ratio [OR] 3.45, p= 0.004), NYHA class III (OR 3.05, p= 0.008), distance covered on a 6-minute walk test (6-MWT) of <620 feet (OR 2.81, p= 0.013), and <80% adherence to prescribed medications (OR 2.61, p= 0.018). In patients having HFrEF, the predictors were being on diuretics (OR 3.06, p= 0.001), having ≥3 co-morbidities (OR 2.11, p= 0.0001), distance covered on a 6-MWT of <620 feet (OR 1.94, p= 0.001), NYHA class III (OR 1.90, p= 0.001), and age >65years (OR 1.63, p= 0.01). In conclusion, indicators of functional status (6-MWT and NYHA class) were common to both patients with HFpEF and those with HFrEF, whereas gender and adherence to prescribed therapy were unique to patients having HFpEF in predicting death or HF hospitalization.

Somatodendritic 5-hydroxytryptamine1A(5-HT1A) autoreceptor function in major depression as assessed using the shift in electroencephalographic frequency spectrum with buspirone

Positron emission tomography and post-mortem studies of the number of somatodendritic 5-hydroxytryptamine(1A) (5-HT(1A)) autoreceptors in raphé nuclei have found both increases and decreases in depression. However, recent genetic studies suggest they may be increased in number and/or function. The current study examined the effect of buspirone on the electroencephalographic (EEG) centroid frequency, a putative index of somatodendritic 5-HT(1A) receptor functional status, in a cohort of medication-free depressed patients and controls. A total of 15 depressed patients (nine male) and intelligence quotient (IQ)-, gender- and age-matched healthy controls had resting EEG recorded from 29 scalp electrodes prior to and 30, 60 and 90 min after oral buspirone (30 mg) administration. The effect of buspirone on somatodendritic 5-HT(1A) receptors was assessed by calculating the EEG centroid frequency between 6 and 10.5 Hz. The effect of buspirone on postsynaptic 5-HT(1A) receptors was assessed by measuring plasma growth hormone, prolactin and cortisol concentrations. Analysis of variance revealed a significantly greater effect of buspirone on the EEG centroid frequency in patients compared with controls (F1,28 = 6.55, p = 0.016). There was no significant difference in the neuroendocrine responses between the two groups. These findings are consistent with an increase in the functional status of somatodendritic, but not postsynaptic, 5-HT1A autoreceptors, in medication-free depressed patients in line with hypotheses based on genetic data. This increase in functional status would be hypothesized to lead to an increase in serotonergic negative feedback, and hence decreased release of 5-HT at raphé projection sites, in depressed patients.

Walking Smoothness Is Associated With Self-Reported Function After Accounting for Gait Speed

Gait speed has shown to be an indicator of functional status in older adults; however, there may be aspects of physical function not represented by speed but by the quality of movement. The purpose of this study was to determine the relations between walking smoothness, an indicator of the quality of movement based on trunk accelerations, and physical function. Thirty older adults (mean age, 77.7±5.1 years) participated. Usual gait speed was measured using an instrumented walkway. Walking smoothness was quantified by harmonic ratios derived from anteroposterior, vertical, and mediolateral trunk accelerations recorded during overground walking. Self-reported physical function was recorded using the function subscales of the Late-Life Function and Disability Instrument. Anteroposterior smoothness was positively associated with all function components of the Late-Life Function and Disability Instrument, whereas mediolateral smoothness exhibited negative associations. Adjusting for gait speed, anteroposterior smoothness remained associated with the overall and lower extremity function subscales, whereas mediolateral smoothness remained associated with only the advanced lower extremity subscale. These findings indicate that walking smoothness, particularly the smoothness of forward progression, represents aspects of the motor control of walking important for physical function not represented by gait speed alone.

Health, physical education and physical development of students in historically and personally developing paradigm

It is considered the general health situation of the population of Europe. It is shown that in the last decade in the European Union there is a steady trend towards better health. It is noted that in the countries of the former Soviet Union, including Ukraine, the reverse process. Revealed the possibility of improved system of physical education students in improving indicators of physical development, functional status and health of students and the general population. It is noted that the intense physical activity of young people is only 3 - 4 minutes per day, and moderate and total - just over 1 hour. It is noted that the enhancement of the educational component of university discipline Physical Education is defined professional and personal characteristics of teachers of physical education departments, their willingness to self-improvement and development. The prospects for the use of personal-oriented campaign in the reform of university academic discipline Physical Education.

Determinants of self-rated health and the role of acculturation: implications for health inequalities

ObjctivesSelf-rated health (SRH) is an important indicator of overall health, predicting morbidity and mortality. This paper investigates what individuals incorporate into their self-assessments of health and how acculturation plays a part in this assessment. The relationship of acculturation to SRH and whether it moderates the association between indicators of health and SRH is also examined.DesignThe paper is based on data from adults in the Boston Puerto Rican Health Study, living in the greater Boston area (n=1357) mean age 57.2 (SD = 7.6). We used multiple regression analysis and testing for moderation effects.ResultsThe strongest predictors of poor SRH were the number of existing medical conditions, functional problems, allostatic load and depressive symptoms. Poor SRH was also associated with being female, fewer years of education, heavy alcohol use, smoking, poverty, and low emotional support. More acculturated Puerto Rican adults rated their health more positively, which corresponded to better indicators of physical and psychological health. Additionally, acculturation moderated the association between some indicators of morbidity (functional status and depressive symptoms) and SRH.Self-assessments of overall health integrate diverse indicators, including psychological symptoms, functional status and objective health indicators such as chronic conditions and allostatic load. However, adults' assessments of overall health differed by acculturation, which moderated the association between health indicators and SRH. The data suggest that when in poor health, those less acculturated may understate the severity of their health problems when rating their overall health, thus SRH might thus conceal disparities. Using SRH can have implications for assessing health disparities in this population.

Insufficient Vitamin D Intake and Low Vitamin D Status in Men Over 80 Y of Age: Intervention is Required To Meet Dietary Targets in Long-Term Care Facilities

Vitamin D is important to bone health. This study examined vitamin D intake and status in institutionalized elderly men in relation to biomarkers of bone metabolism and functional indicators. Materials and Methods: Elderly male veterans were studied in Phase I (n=40) for 16 weeks (April, June, August 2008) and Phase II (n=30) for another 16 weeks (October and December 2008 and February 2009) for dietary vitamin D using 5 day menu selection (Phase I) and using 3×3-d weighed food records (Phase II). Anthropometric data, Mini-Mental State Evaluation (MMSE) scores and sun exposure were collected. Functional capacity was assessed using the Frail Elderly Functional Assessment Tool (FEFA) and handgrip strength. Biochemistry included serum 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), osteocalcin (OC) and C-terminal telopeptides of Type 1 collagen (CTX). Mixed model ANOVA and Pearson correlations analyses were used. Results: Participants were relatively healthy (Age: 85 ± 3 years (Mean ± SD), BMI: 26.1 ± 4.3 kg/m2, MMSE: 25 ± 5, FEFA: 13 ± 8, grip strength: 22 ± 8 kg). Sixty-six percent (280 ± 120 IU) of the planned dietary vitamin D was consumed. Vitamin D came mainly from fortified milk and meal supplements and 33% took pill supplements (400-800 IU/d). Serum 25(OH) D concentration rose by summer (Phase I: 60.9 ± 24.4, 68.2 ± 24.6 and 76.1 ± 22.4 nmol/L, respectively) and declined thereafter (Phase II: 57.7 ± 24.1, 62.9 ± 30.7 and 61.3 ± 29.2 nmol/L). PTH was lower in spring compared to late summer through winter whereas CTX and OC did not change. Serum 25(OH) D was correlated to BMI, but not to indicators of functional status. Conclusions: In long-term care, vitamin D from foods and supplements fails to meet recommendations of 800 IU (20 μg) for those over 70 y.

Correlates of Functional Status Among OEF/OIF Veterans With a History of Traumatic Brain Injury

This study was conducted to identify factors related to functional status within a clinical sample of Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) with a history of traumatic brain injury (TBI). Medical chart review was conducted for a consecutive group of OEF/OIF Veterans who were referred for neuropsychological evaluation within a Veterans Affairs Medical Center Polytrauma Program related to history of TBI (n = 57). Level of involvement in occupational and academic activity, presence or absence of housing insecurity, and clinician ratings of overall functioning served as indicators of functional status. Reduced functional status was most strongly related to poorer cognitive function, particularly motor function, processing speed, and executive function. Lower levels of functioning were also related to increased severity of postconcussive symptoms, lower levels of education, and ongoing medication treatment for sleep or psychiatric symptoms. Comprehensive evaluation of cognitive, affective, and behavioral functioning among OEF/OIF Veterans with a history of TBI is likely to provide valuable information to inform rehabilitation strategies and identify potential warning signs for poor postdeployment reintegration. Increased awareness of these factors may aid clinicians in identifying patients at risk for poor outcomes and in more effectively targeting symptoms for intervention.