Levels Of Functional Disability Research Articles

Cutoff points of adiposity anthropometric indices for low muscle mass screening in middle-aged and older healthy women

BackgroundThe reduction of female sex hormones causes changes in the contractile properties of muscles as well as infiltration of fat in the muscle tissue. This results in a consequent decline in muscle strength. These changes are related to higher levels of functional impairment and physical disability. In this sense, several anthropometric indices have been used to quantify body and visceral fat. Thus, the objective of this paper is to propose cutoff points for adiposity anthropometric indices in order to identify low muscle mass, as well as to analyze the relationship between these indices and low muscle mass in middle-aged and older women.MethodsCross-sectional analytical study carried out in the Northeast of Brazil. The sample was formed by 593 women between 40—80 years old. Data collection included anthropometric assessment (BMI: Body Mass Index – WC: Waist Circumference – WHR: Waist-to-hip Ratio – WHtR: Waist-to-height Ratio – CI: Conicity Index – BAI: Body Adiposity Index – VAI: Visceral Adiposity Index – LAP: Lipid Accumulation Product), bioimpedance test and biochemical dosage. Moreover, sociodemographic data and practice of physical activity were collected. Descriptive statistics, Student's t-test, ROC curves, chi-squared and logistic regression were performed.ResultsThe participants had a mean age of 53.11 (8.89) years, BMI of 28.49 (5.17) kg/m2 and WC of 95.35 (10.39). The prevalence of low muscle mass was 19.4%. Based on sensitivity and specificity of adiposity anthropometric indices, cutoff points were developed to identify the presence of low muscle mass (p < 0.05), except for VAI. After logistic regression, WC (OR = 6.2; CI 95%: 1.4—28.1), WHR (OR = 1.8; CI: 1.0—3.4), WHtR (OR = 5.0; CI 95%: 1.0—23.7) and BAI (OR = 14.5; CI 95%: 6.6—31.7) were associated with low muscle mass.ConclusionsAll anthropometric indices, except VAI, showed adequate accuracy in identifying low muscle mass in women, especially those that took into account WC. This suggests that they can become accessible and also be cost-effective strategies for assessing and managing health outcomes related to muscle mass analysis.

Predictors and outcomes of experienced and anticipated discrimination in patients treated for depression: A 2-year longitudinal study

BackgroundStigma is both common and associated with greater depressive morbidity in depressives. Surprisingly few longitudinal studies have explored the predictors and consequences of stigma and discrimination. MethodA total of 230 patients with depression who were commencing treatment were enrolled. Experienced and anticipated discrimination were assessed using the Discrimination and Stigma Scale at the 1-year follow-up. The Hamilton Rating Scale for Depression, Hospital Anxiety and Depression Scale, Clinical Global Impression Scale-Severity, Social and Occupational Functioning Assessment Scale (SOFAS), EuroQol-5 Dimension (EQ-5D) questionnaire, and Sheehan Disability Scale were administered at baseline, 1 year, and 2 years, to assess various depression outcomes. Baseline personality was evaluated using the Big Five Inventory-10. ResultsA previous depressive history and low agreeableness predicted experienced discrimination; a higher level of education, non-married status, and higher functional disability predicted anticipated discrimination. Higher-level experienced discrimination during the first year of treatment was significantly associated with poorer improvements in all six measured outcomes after 1 year of treatment, and again after 2 years of treatment (with the exception of the EQ-5D score). Higher anticipated discrimination was significantly associated with less improvement in the SOFAS scores after both 1 and 2 years of treatments. LimitationsThe study was a single-center work; this maximized consistency but may limit generalizability. ConclusionsDiscrimination exerts negative effects on depression outcomes that can be predicted at the initiation of treatment. Interventional studies are required to prevent and manage stigmatization of persons with depression

Aquatic versus Land-Based Exercise in Treatment of Chronic Mechanical Low Back Pain

Abstract Background: Mechanical Low Back Pain (MLBP) is a major cause of illness and disability, especially in people of working age. Aim of Study: The study was conducted to compare be-tween the effect of aquatic exercise and land-based exercises on pain level, functional disability and lumbar Range of Motion (ROM) in subjects with Chronic Mechanical Low Back Pain (CMLBP). Material and Methods: Sixty patients with chronic me-chanical low back pain of both gender participated in the study: 17 male and 43 female between 25 and 40 years old. They were divided randomly and equally into two groups: A study group (A), in which patients received land based exercise program; and study group (B), in which patients received aquatic exercise program. Both groups received the treatment program for 50min, three times per week, for one month assessment of patients in each group for pain level, functional disability and lumbar range of motion before and after treatment. Results: There were statistically significant differences in all outcome measures in favor of the water exercises group (p 0.05). However, there were statistically significant differ-ences regarding all outcome measure in water exercise group (p < 0.0001) when comparing the pre-treatment with post-treatment results. Conclusion: Aquatic therapy is effective in decreasing pain severity, level of functional disability and improved lumbar range of motion in patient with chronic mechanical low back pain than land-based exercise.

Barthel Index-based functional status as a prognostic factor in young and middle-aged adults with newly diagnosed gastric, colorectal and lung cancer: a multicentre retrospective cohort study

ObjectivesFunctional status assessments of activities of daily living may improve prognostic precision during initial diagnostic evaluations in young and middle-aged adults with cancer. However, the association between pretreatment functional status...

Alteration of Smell Sensation: Brief Review With Implications for Nursing Care During the COVID-19 Pandemic.

BACKGROUND: Alteration in olfaction, the sense of smell, can lead to a surprisingly high level of functional disability. Effects can range from mild changes in nutrient intake to a significant decrease in quality of life. Olfactory dysfunction can follow clinical problems such as trauma to the brain and nose. During recent months, in the setting of the current worldwide pandemic of coronavirus disease 2019 (COVID-19), the infection caused by severe acute respiratory syndrome coronavirus 2, it has become clear that olfaction can also be damaged by viruses that enter the body through the nose. METHODS: To learn more about this important clinical problem, we reviewed the current literature about smell sensation and the contextual application of altered olfaction in the setting of COVID-19. Knowledge about this topic, along with other clinical aspects of COVID-19, is expanding quickly. CONCLUSION: Nurses perform assessments, assist with implementing treatment interventions, and provide vital education to patients and their families. These interventions help patients with olfactory dysfunction achieve the best possible functional outcome.

Effects of Laser Therapy on Rheumatoid Arthritis: A Systematic Review and Meta-analysis.

The aim of the study was to examine the effects of laser therapy on rheumatoid arthritis. A search of controlled trials was conducted in different medical electronic databases. The primary outcome was immediate pain relief after treatment. Secondary outcomes were level of functional disability, morning stiffness duration, and 3-mo follow-up for pain. Ten trials met the inclusion criteria. Rheumatoid arthritis treatment with laser therapy significantly improved immediate pain relief (standardized mean difference = -0.839, 95% confidence interval = -1.336 to -0.343) and overall functional score (standardized mean difference = -0.309, 95% confidence interval = -0.587 to -0.031). There was no significant improvement in morning stiffness duration (standardized mean difference = -0.519, 95% confidence interval = -1.176 to 0.138), and 3-mo follow-up for pain (standardized mean difference = -1.125, 95% confidence interval = -2.311 to 0.061). There was no publication bias (Egger regression, P = 0.277). However, heterogeneity was noted despite the removal of an outlier (Q = 18.646, I2 = 57.096). Results of subgroup analyses suggested that high-intensity laser therapy and nerve irradiation are better suited for immediate pain relief. Meta-regression analyses showed no significant linear relationship between the treatment effect with laser wavelength or number of treatment sessions. Laser therapies provide significant immediate pain relief and improve function for rheumatoid arthritis patients, but without significant improvement in morning stiffness duration and 3-mo follow-up for pain.Systematic review registration number: CRD42020192906.

Perfectly Tired: Perfectionism and Sleep in Adolescents With Chronic Pain.

Conceptual links between perfectionism and chronic pain have been proposed yet minimal empirical data exists. Poor sleep is associated with high levels of perfectionism and is common among youth with chronic pain. This study explores associations between perfectionism and sleep quality in adolescents with chronic pain while considering levels of functional disability. Adolescents (ages 12-18) with chronic pain (N = 423) completed baseline measures of self-oriented perfectionism (SOP), socially prescribed perfectionism (SPP), sleep quality, and functional disability as part of routine clinical care at an outpatient chronic pain clinic and a pain rehabilitation day treatment program. Multivariate multiple regression assessed associations between perfectionism (SOP and SPP) and sleep (falling asleep/reinitiating sleep, returning to wakefulness, and going to bed). Two moderation models explored how relations between perfectionism (SOP and SPP) and sleep quality (total score) varied depending on level of functional disability. All analyses controlled for clinic setting. Results indicated SPP was associated with more difficulties across all sleep subdomains in adolescents with chronic pain, while SOP was unrelated to sleep quality. Associations between perfectionism and sleep quality were dependent on functional disability; perfectionism was most strongly associated with worse sleep quality for adolescents with less functional disability. This study highlights the relationship between perfectionism and sleep quality in adolescents with chronic pain and suggests that perfectionistic youth with less disability are at the greatest risk for sleep problems. Longitudinal research is needed to understand how perfectionism, sleep, and disability interact over time in youth with chronic pain.

Extracellular-to-intracellular water ratios are associated with functional disability levels in patients with knee osteoarthritis: results from the Nagahama Study.

To test the hypothesis that greater extracellular-to-intracellular water (ECW/ICW) ratios in lower-limb muscles are associated with worsened functional abilities in patients with knee osteoarthritis (OA). We analyzed data from 787 participants (82.2% female; mean age, 69.6 ± 5.3 years) from the Nagahama Prospective Cohort who were ≥60 years old and had radiographically confirmed bilateral knee OA. The Knee Scoring System (KSS) was used to assess functional abilities. Lower-limb ECW/ICW ratios and skeletal mass index values were determined with multi-frequency bioelectrical impedance analysis (BIA). Multiple linear regression analysis was used to test for associations between ECW/ICW ratios and functional abilities. Subgroup analyses based on OA severities and symptomaticity were also conducted. Increased ECW/ICW ratios were associated with a 4.38-point decrease in the KSS function scores (95% confidence interval [CI], 3.15-5.62 points) after adjusting for covariates. This association varied according to the degree of knee symptoms, especially in individuals with radiologically mild OA. ECW/ICW ratios in individuals with asymptomatic mild OA were associated with a 2.14-point decrease in the KSS function score (95% CI, 0.32-3.96 points), whereas those in individuals with severe symptomatic mild OA were associated with a 6.16-point decrease (95% CI, 2.13-10.19 points). Our findings indicate that higher ECW/ICW ratios are associated with greater functional disability in patients with knee OA. Therefore, ECW/ICW ratio measurements with multi-frequency BIA can serve as valuable indicators for functional disability in patients with knee OA. Key Points • Higher extracellular-to-intracellular water (ECW/ICW) ratios are associated with greater functional disability levels in patients with knee osteoarthritis (OA). • ECW/ICW ratios are useful clinical signs as a biomarker for poor functional abilities in patients with knee OA.

Assessing functional disability in individuals with MCI and dementia

AbstractBackgroundMild cognitive impairment (MCI) and dementia are among the most disabling conditions. Patients with MCI and dementia may experience difficulties in executing instrumental activities of daily living (IADL), resulting in distress for patients and families. Measuring and understanding abilities to execute IADL is important to understand how MCI and dementia impacts patients’ functioning. We explored the factor structure of the Functional Activities Questionnaire as a measure of functional disability in a sample with MCI and dementia.MethodsParticipants were 198 enrollees in the Wisconsin ADRC who had MCI, and dementia. Not applicable responses were counted as missing data, resulting in 98 participants in main analyses. The majority of participants were male (61.1%) and Caucasian (88.4%). Average age at baseline was 73.76 (SD=8.90). We conducted the following analysis: exploratory factor analysis (EFA), reliability analysis, correlation analysis, and Mann‐Whitney U test.ResultsThe Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy was .89, and the Barlett’s test of sphericity was significant, χ 2(45,N=98)=717.24, p&lt;.001, indicating suitability for factor analysis. Kaiser–Guttman’s criterion and Cattell’s scree test both indicated a single‐factor measurement structure, accounting for 64% of the total variance. The Cronbach’s alpha was found to be .94 for the FAQ. Functional disability was positively correlated with neuropsychiatric symptoms (r=.43, p&lt;.001), CDR global score (r=.79, p&lt;.001), and lack of independence (r=.66, p&lt;.001). A Mann‐Whitney U test showed that individuals with dementia had significantly higher levels of functional disability than those with MCI (U=214.00, p&lt;.001).ConclusionThe FAQ was found to be a unidimensional, reliable, and valid measure of functional disability. Participants with higher scores on the FAQ endorsed greater levels of neuropsychiatric symptoms, symptoms of cognitive impairment, and dependence to others. As expected, those with dementia had higher levels of functional disability/limitations. Future research may examine whether functional disability/limitations predicts incident MCI or dementia in cognitively normal individuals.

Network Structures of Social Functioning Domains in Schizophrenia and Bipolar Disorder: A Preliminary Study.

ObjectiveThis study used network analyses to examine network structures reflecting interactions between specific domains of social functioning in schizophrenia (SZ) and bipolar disorder (BD).MethodsWe used the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) to assess six domains of social functioning (‘cognition’, ‘mobility’, ‘self-care’, ‘getting along’, ‘life activities’, and ‘participation’) in 143 patients with SZ, 81 patients with BD, and 106 healthy subjects. We constructed regularized partial correlation networks, estimated network centrality and edge strength, tested network stability, and compared SZ and BD network structures.ResultsPatients with SZ showed a significantly higher level of functional disability than patients with BD. In the networks we constructed, ‘cognition’ was the most central domain of social functioning in both SZ and BD. The ‘cognition’ domain was primarily associated with the ‘getting along’ domain in the SZ network and the ‘life activities’ domain in the BD network. We found no significant group-level differences in network structures for SZ vs. BD.ConclusionOur results suggest that cognition may play a pivotal role in social functioning in both SZ and BD. In addition, domains of social functioning in SZ and BD have similar network structures despite the higher level of disability in SZ compared to BD.

Measurement of disability among people with severe mental disorders - pilot study to examine environmental impacts on mental health outcomes in Ghana

Background/aim: Mental Disorders are a leading cause of morbidity and suicide globally; around 2.15 million people live with mental disabilities in Ghana. While neurotoxic impacts of air pollution have been reported, little is known about effects on mental health outcomes. Possible impacts of household fossil fuel air pollution and mental disorders are largely unknown. In this exploratory study, we assessed participants’ level of self-reported disability and explore differences in disability scores by important sociodemographic/environmental characteristics. Methods: This pilot study was conducted among patients living with severe mental disorders in the Kintampo North Municipality and Kintampo South District of Ghana. The 12-item validated WHO Disability Assessment Schedule (WHODAS) 2.0 was used to measure participant’s level of functional disability. Descriptive statistics were calculated for all outcomes and patient characteristics. Household primary cookstove and fuel use for cooking or heating were assessed. We examined WHODAS scores by several characteristics, including gender, employment and marital status.Results: There were 70 participants who completed the survey within the pilot study period. The mean age was 38 years; the majority of participants were male (57%; 40/70). Most (31%; 22/70) of the study participants had Junior High/Middle School education, have never been married (57%; 40/70) and were not currently employed (83%; 58/70). More than half of the study participants (57%; 40/70) were living independently in their communities compared to 43% who needed assistance from family members. Overall, participants reported elevated WHODAS scores indicating their inability to function well on daily basis due to their mental disorder. About 93% (65/70) participants used traditional cookstove (3-stone fires) for cooking, with wood as the primary fuel. Conclusion: This pilot study provides preliminary findings to further explore environmental exposures, particularly household air pollution in relation to mental health outcomes and severity in a mixed-method study in Ghana.

The structure and functional correlates of social support networks of people in advanced old age living in chosen urban and rural areas in Poland: a cross-sectional study

The purpose of the study was to identify the different types of social support networks (SSNs) among community-dwelling people aged 75+ years in selected areas of Poland, and to evaluate any associations between the network type and demographic and health variables of the population studied. The two most prevalent SSN types identified using the Practitioner Assessment of Network Type were “family dependent” (35.8%) and “locally integrated” (32.2%). “Local self-contained” (6.4%), “wider community focused” (2.8%) and “private restricted” (5.6%) SSNs were observed less frequently. In 17.2% of cases, it was not possible to identify the type of network unequivocally. Older people with a locally integrated SSN, in contrast to the family dependent type, were generally younger, living alone, and less likely to be homebound, rate their health as poor, suffer from depression or dementia, and had lower levels of functional disability. Locally integrated SSNs are recognized in the literature as being the most robust in terms of facilitating well-being and providing sufficient support to help maintain the older person in the community. This may reflect the higher levels of independence of older people able to sustain these support networks, which are then transformed into family-dependent types as their health deteriorates, but confirmation of this would require prospective studies. An improved understanding of the prevalence of different types of social networks among older people in Poland would help to guide a systematic approach to recognizing unmet needs in this population and provide crucial information in the planning of formal services.

The Long-term Effects of Percutaneous Laser Disc Decompression (PLDD) Treatment on Lumbar Disc Protrusion: A 2-Year Follow-up.

Introduction: Nowadays many physicians have focused their attention on using low invasive methods for the treatment of disc protrusion. Thus, the current study was carried out to evaluate the effect and therapeutic outcomes of clinical percutaneous laser disc decompression (PLDD) in the treatment of chronic low back pain caused by disc protrusion during a two-year follow-up. Methods: This historical cohort study was conducted on 40 patients, who were suffering from chronic low back pain caused by disc protrusion diagnosed, and referred to the pain clinic of Akhtar Hospital from March to August 2016 were treated with PLDD and were followed up for at least two years after performing PLDD (from 2018 to 2019). All the information has been extracted using medical records and patient interview. The severity of pain was measured by the Numeric Rating Scale (NRS), and the Oswestry disability index (ODI) was measured before and two years after the treatment. Results: The most common sites for two-level PLDD were L4-S1 and L3-L5, and the most common sites for one-level PLDD were L5-S1 and L4-L5. Overall, the levels of pain and functional disability two years after PLDD showed significant improvements (P =0.0001). The results revealed no statistically significant differences in NRS and ODI scores between the two groups of men and women two years after PLDD (P >0.05). Furthermore, they indicated no statistically significant differences in NRS and ODI scores between the different disc protrusion levels two years after PLDD (P >0.05). Conclusion: It seems that the PLDD is a low-invasive, safe, and effective method that can be used in patients with chronic low back pain caused by a disc protrusion. Therefore, it can be considered as a suitable choice in treating patients with chronic low back pain caused by a disc protrusion.

Autonomy and competence satisfaction as resources for facing chronic pain disability in adolescence: a self-determination perspective

ABSTRACT This study aimed to test empirically the developmental goal pursuit model of paediatric chronic pain, which draws upon Self-Determination Theory for understanding risks and resources for living with chronic pain. This study examined the relationship between basic psychological need satisfaction (i.e. the satisfaction of the needs for autonomy, relatedness and competence) and the fear-avoidance model of pain in adolescents suffering from chronic pain. Hundred and twenty adolescents (mean age = 14.52, 71.6% female), receiving treatment through paediatric pain centres for chronic pain, were enrolled. Adolescents completed measures of basic psychological need satisfaction, fear and avoidance of pain, and pain-related functional impairment. Path analyses model indicated that higher levels of autonomy and competence satisfaction were associated with lower levels of functional disability, through the mediation of fear and avoidance of pain. Relatedness satisfaction was not significatively related to fear of pain, avoidance, and functional disability. The integration of Self-Determination Theory in the paediatric pain literature may further our understanding of potential resources for decreasing functional disability in children living with chronic pain.

Depression and Functional Disability in Stroke Patients

Background: Stroke patients often suffer from depression, a mental disorder that worsens their condition and slows down the recovery process. Depression is the leading cause of functional disability due to inability to cope with daily stressors and to function independently in their activities. The purpose of this study is to analyze the relationship between depression and functional disability levels in post-stroke patients.Design and Methods: This is an analytic observational research with a cross-sectional approach. The population in exam consisted of all 4-12 week post-stroke patient in the hospital (about 139 patients). The study focused on 104 respondents, who were selected using simple random sampling techniques.Results: The results show that 62.5% stroke patients suffered mild depressive episodes after the stroke while 58.7% experienced mild disabilities. Analysis results using the Pearson Product Moment Test obtained P=0,000. This shows there is a relationship between the level of depression and the degree of functional disability in post-stroke patients.Conclusions: It can be concluded that there is a significant relationship between the levels of post-stroke depression and the functional disability. Families are expected to provide a safe, supportive, and comfortable environment to lessen the level of depression.Significance for public healthPost-stroke depression should be perceived as a psychological reaction to the clinical consequences caused by stroke. This condition can cause functional disability due to inability to cope with daily stressors and to function independently in activities. This study highlights the relationship between depression and functional disability levels in post-stroke patients.

Mental Disorders and the Impacts in Older Adults with Intellectual Disabilities

Mental disorders and physical health problems are common among adults with intellectual disabilities, as they accompanied with mental disorders are always present higher levels of functional disability than those with intellectual disabilities only. This review aims to describe the characteristics and the impacts of older people with intellectual disabilities accompanied with mental disorders in their daily livings. Results reveal that the prevalence of MD is high in adults of all ages with ID; there was no significant difference in older people with ID and younger people with ID. Individuals with ID attending psychiatric services were more likely to be older and polypharmacy was commonplace for older adults with ID. Higher family impact was also found between caregivers to adults with intellectual disabilities and mental disorders. This review highlights that adults with intellectual disabilities have higher mental disorder service needs which require recognition and the allocation of specific resources to protect the same right to healthy ageing as their counterparts living without ID. Further research is needed to improve our understanding of the adverse effects of ageing on the mental disorders and care needs of older people with intellectual disabilities.

Somatic symptom and related disorders in pediatric patients: Associations with parent psychiatric and substance use histories.

Parental response to pediatric patients with somatic symptom and related disorders (SSRDs) can impact symptom presentation. However, little is known about the impact of parent psychiatric and substance use disorder (SUD) history on the functional status and medical healthcare utilization of patients with SSRDs. The current study explored the associations between parent psychiatric & SUD history and patient somatic symptoms, functional disability, and hospital course in a medically hospitalized sample of pediatric patients with SSRDs. The electronic medical records of 375 pediatric patients with SSRDs, ages 5 to 18, admitted at a tertiary pediatric hospital were retrospectively reviewed. Parent psychiatric histories were identified in 45.1% of the sample. Parent SUD history and maternal psychiatric history were associated with more patient reported somatization. Parent psychiatric and SUD history were not associated with pediatric patients' level of functional disability or healthcare utilization during admission, including admission length, number of tests, and number of consultations obtained. This study has implications regarding reduction of potential stigma towards parents with psychiatric or SUD histories whose children are hospitalized with SSRDs. While such histories may provide insights regarding somatization presentation of pediatric patients with these disorders, it may not necessarily impact level of functional disability or hospital course.

AB0241 PREVALENCE OF ANXIOUS SYMPTOMS AND DEPRESSION IN A SAMPLE OF PATIENTS WITH RHEUMATOID ARTHRITIS (RA) AND OTHER CHRONIC RHEUMATIC DISEASES

Background:Clinical practice with patients suffering from chronic diseases highlights the presence of psychological symptoms of discomfort fed by biological and non-biological mechanisms linked to disease and treatment. In rheumatic diseases, literature detects the presence of anxious symptoms and depressed mood of clinical and sub-clinical importance with a multifactorial genesis1.Objectives:To detect the impact on the state of health of anxious symptoms and depressed mood in a population suffering from RA and other rheumatic diseases in order to implement the effectiveness of psychological intervention through the selection of patients who present critical levels of discomfort.Methods:Patients afferent to the Rheumatology outpatient clinic of Mauriziano Hospital have been screened from May 2018 to July 2018 with two self-administered questionnaires: HADS-A and HADS-D (Hospital Anxiety and Depression Scale), specifically developed for the evaluation of anxious and depressive symptoms in medical pathologies, and HAQ (Health Assessment Questionnaire) to explore functional disability. Data about rheumatic diagnosis and socio-demographic characteristics were also collected. Data were analyzed with descriptive statistics; the Student Test and the ANOVA test were used to evaluate prevalence and to compare the presentation of symptoms in the different diseases and the Pearson correlation coefficient was used to evaluate the relationship between symptoms and disability.Results:A total of 427 subjects were screened (317 females and 110 males), aged between 19 and 90 years (mean 60 ± 14 yrs). 156 subjects (36.5%) had a diagnosis of RA, 76 (17.8%) of psoriatic arthritis, 42 (9.8%) of ankylosing spondylitis, 14 (3.3%) of systemic lupus erythematosus and 139 (32.6%) of other rheumatic diseases (including Sjogren, osteoarthritis, fibromyalgia).A high prevalence of anxious symptoms and depressed mood has been found and the number of subjects reporting scores indicating a clinically relevant uncomfortable situation (HADS ≥ 11) was also relevant (Table 1); an increased prevalence in female patients was observed. There were no differences in the presentation of symptoms between RA and the other included pathologies (Table 2).Table 1.Prevalence of anxiety and depression according to the HADS questionnaire in rheumatic diseasesMeanSDHADS-A7.564.63HADS-D7.124.59HADS-A ScoreN%0-722452.47-108419.711-2111927.9HADS-D ScoreN%0-723154.17-109221.511-2110424.4Table 2.Comparison between RA and other rheumatic diseases in anxiety and depression symptoms presentation (ANOVA test).NMeanSDSECIHADS-ARA1562.345.200.411.52PsA762.304.470.511.28AS421.513.190.490.51SLE141.773.741.00-0.38other1392.465.080.431.61HADS-DRA1561.743.510.281.19PsA762.034.210.481.07AS420.690.540.080.52SLE140.930.680.180.54other1391.683.790.321.04There was a positive and significant correlation between anxious symptoms or depressed mood and functional disability (0.49 and 0.60 respectively, p&lt;0,01).Conclusion:The results show a significant presence of uncomfortable situations that could evolve in a psychopathological sense. The discomfort expressed through anxious and depressive symptoms is related to the level of functional disability. Recognizing the presence of psychological distress allows to orient the treatment plan and facilitate the patient’s adaptation to the disease condition.

Depression, functional disability, and accessing health care among older Ghanaians and South Africans: a comparative study based on WHO study on global ageing and adult health (SAGE)

Objectives The study explored the association and variabilities between mild depression, functional disability, and healthcare access among older Ghanaians and South Africans. Method The data used in this study was based on the Cross-sectional wave 1 (2007–2010) data from WHO's Study on Global Ageing and Adult Health (SAGE). Using multiple binary logistic regression, responses from a sample of 4558 Ghanaians and 3076 South Africans were analyzed to investigate hypothesized patterns. Results The proportion of mild depression (MD) is 6.0 % and 7.53% for older Ghanaians and older South Africans, respectively. At 95% Confidence Interval, increased severity (mild and high levels) of functional disability are associated with increased odds of MD in Ghanaian and South African older adults. Apart from South African older adults, older Ghanaians in the study who do not receive healthcare when needed have increased odds of MD than those who do. Sociodemographic and socioeconomic factors are also associated with MD. Discussion An untreated, persistent MD may lead to worse conditions with fatal outcomes. Since mental health care is lacking in both countries, this study may inform policies directed towards support for formal and informal long-term care, and healthcare access to reduce the risks of depression.

Discriminative ability of fall efficacy scale international in Iranian people with multiple sclerosis

BackgroundThe discriminative validity of fall efficacy scale international (FES-I) in differentiating between fallers and non-fallers, levels of functional mobility, dynamic balance and disability has not been assessed in Persian speaking people with multiple sclerosis (MS). ObjectiveTo assess reliability, factor structure, construct and known group validity, sensitivity and specificity of FES-I for differentiating individuals with and without a history of fall and determining a cutoff point of the Persian version of the FES-I in people with MS. MethodOne hundred thirty people with all subtypes of MS were included. The ability of FES-I in differentiating fall history was assessed using receiver operating characteristic (ROC). Also the FES-I score of groups based on expanded disability status scale (EDSS) 1-3.5 low and 4–6 moderate, time up and go (TUG) ≥14 sec and functional reach test (FRT) ≥25 cm were compared. The correlation between FES-I with EDSS, TUG, FRT and short form health survey (SF-36) was assessed. ResultsThe ROC curve analysis revealed that the FES-I could differentiate people with MS based on fall history at a cutoff score of 35.5. The area under the curve (AUC) was 0.86 (sensitivity 76%; specificity 95%). Significant difference was observed between the FES-I score of groups with moderate and low EDSS scores (d = 2.98), higher than 14 sec TUG (d = 2.18) and lower than 25 cm FRT(d = 2.53). Significant high correlation was observed between FES-I with TUG (r = 0.88), EDSS (r = 0.91), FRT (r = -0.83), SF-36 physical (r = -0.87) and mental (r = -0.70) subscales. ConclusionsThe Persian versions of the FES-I could differentiate people with MS with fall history, higher disability, lower functional mobility and balance deficiency.