Mild Disability Research Articles

A Descriptive Study to Assess Prevalence of Smartphone Addiction and Text Neck Syndrome among Undergraduate Students in Selected Colleges at Perinthalmanna with a View to Prepare a Self-Instructional Module

The study conducted to assess the prevalence of Smartphone Addiction and Text Neck Syndrome among under graduate students in selected college of Perinthalmanna with a view to prepare a self-instruction module. The objectives are to assess the prevalence of Smartphone Addiction and Text Neck Syndrome, to determine the correlation between Smartphone Addiction and Text Neck and to determine the association between prevalence of Smartphone Addiction and Text Neck Syndrome with selected demographic variables. Non-experimental descriptive research design was used for the study . The study was conducted in Al Shifa College of Paramedical science and Al Shifa College of Arts and Science Perinthalmanna among 100 undergraduate students selected using quota sampling. Smartphone Addiction Short Version Scale and Neck Disability Index was used for data collection. The study concluded that 62.88% (22) male and 30.7% (20) of female students were addicted to Smartphone , 25.7 %(9) of male and 49.2% (32) of female students were in high risk and remaining 11.42 %(4) male and 20%(13) females students having no risk of Smartphone Addiction .Neck Disability Index result shows that 47%(47) have mild disability 42% (42) having no disability and remaining 11 % (11) have moderate disability of Text Neck Syndrome. The result of the study shows that there is a perfect positive correlation between Smartphone Addiction and Text Neck Syndrome.

Changes in gait performances during walking with head movements in older adults with chronic neck pain.

Chronic neck pain (CNP) can lead to altered gait which is worse when combined with head movement. Gait parameters for indicating speed and symmetry have not been thoroughly investigated in older adults with CNP. This study aimed to compare gait performance in term of speed and symmetry in older adults with and without CNP during walking with head movement. Fifty young older adults, consisting of 36 healthy controls without neck pain (OLDs) and 14 older adults with CNP, participated in the study. Participants completed the Neck Disability Index and Activities-specific Balance Confidence Scale. The 10-Meter Walk Test (10MWT) was used to assess gait performance. Participants were instructed to walk at preferred speed under three different head movement patterns: no head movement (NM), horizontal head movement (HM), and vertical head movement (VM). The Inertial Measurement Unit was used to capture gait performance, and its software was used to analyze gait variables; gait speed, Locomotor Rehabilitation Index (LRI), gait asymmetry index, Phase Coordination Index (PCI). The CNP group reported moderate neck pain with mild disability in activities of daily living, and less balance confidence than the OLD group (p < 0.05). The CNP group showed significantly slower gait speed and lower LRI during walking with both the HM and VM (p < 0.05), which corresponded to lower stride length and cadence. The gait asymmetry index in the CNP group was significantly higher than the OLD group during walking with VM (p < 0.05), whereas the PCI was significantly higher than the OLD group during walking with both HM and VM (p < 0.05). Chronic neck pain affects both speed and symmetry when walking with head movement. Gait parameters in this study could be implemented to identify changes in speed and symmetry of gait in older adults with CNP who have mild disability and high physical functioning.

Randomized Controlled Trial of the Behavioral Intervention for Physical Activity in Multiple Sclerosis Project: Response Heterogeneity and Predictors of Change.

We reported that a social cognitive theory-based (SCT), Internet-delivered behavioral intervention increased device-measured minutes/day of moderate-to-vigorous physical activity (MVPA) over a 6-month period among persons with multiple sclerosis (MS). This paper examined the pattern and predictors of heterogeneity in change for MVPA. Based on previous research, we hypothesized that mild MS disability, fewer MS symptoms, lower baseline MVPA, and positive SCT characteristics (e.g., high exercise self-efficacy) would be associated with greater change in MVPA. Persons with MS (N = 318) were randomized into behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions that were administered via Internet websites and supported with behavioral coaching. Demographic, clinical, symptom, behavioral, and SCT data were from before the 6-month period of delivering the conditions, and MVPA data were from before and after the 6-month period. We examined heterogeneity based on waterfall plots, box plots, and the Levene statistic. We identified predictors of MVPA change using bivariate correlation and multiple, linear regression analyses per condition. The Levene statistic indicated statistically significant heterogeneity of variances for MVPA change between conditions (p = .003), and the waterfall plots and box plots indicated greater heterogeneity in MVPA change for the behavioral intervention. MVPA change score was correlated with baseline MVPA (r = - .33 and r = - .34, p = .0004 and p = .0001) in both conditions and walking impairment (r = - .188, p = .047) and race (r = .233, p = .014) in the behavioral intervention condition. The regression analysis indicated that baseline MVPA (Standardized B = - .449, p = .000002), self-reported walking impairment (Standardized B = - .310, p = .0008), and race (Standardized B = .215, p = .012) explained 25.6% of variance in MVPA change for the behavioral intervention condition. We provide evidence for walking impairment, baseline MVPA, and race as predictors of the heterogeneity in the pattern of MVPA change with a behavioral intervention.

In patients with mild disability NMOSD: is the alteration in the cortical morphological or functional network topological properties more significant.

To assess the alteration of individual brain morphological and functional network topological properties and their clinical significance in patients with neuromyelitis optica spectrum disorder (NMOSD). Eighteen patients with NMOSD and twenty-two healthy controls (HCs) were included. The clinical assessment of NMOSD patients involved evaluations of disability status, cognitive function, and fatigue impact. For each participant, brain images, including high-resolution T1-weighted images for individual morphological brain networks (MBNs) and resting-state functional MR images for functional brain networks (FBNs) were obtained. Topological properties were calculated and compared for both MBNs and FBNs. Then, partial correlation analysis was performed to investigate the relationships between the altered network properties and clinical variables. Finally, the altered network topological properties were used to classify NMOSD patients from HCs and to analyses time- to-progression of the patients. The average Expanded Disability Status Scale score of NMOSD patients was 1.05 (range from 0 to 2), indicating mild disability. Compared to HCs, NMOSD patients exhibited a higher normalized characteristic path length (λ) in their MBNs (P = 0.0118, FDR corrected) but showed no significant differences in the global properties of FBNs (p: 0.405-0.488). Network-based statistical analysis revealed that MBNs had more significantly altered connections (P< 0.01, NBS corrected) than FBNs. Altered nodal properties of MBNs were correlated with disease duration or fatigue scores (P< 0.05/6 with Bonferroni correction). Using the altered nodal properties of MBNs, the accuracy of classification of NMOSD patients versus HCs was 96.4%, with a sensitivity of 93.3% and a specificity of 100%. This accuracy was better than that achieved using the altered nodal properties of FBNs. Nodal properties of MBN significantly predicted Expanded Disability Status Scale worsening in patients with NMOSD. The results indicated that patients with mild disability NMOSD exhibited compensatory increases in local network properties to maintain overall stability. Furthermore, the alterations in the morphological network nodal properties of NMOSD patients not only had better relevance for clinical assessments compared with functional network nodal properties, but also exhibited predictive values of EDSS worsening.

Nature of student housing in Ghana: drivers of physical health condition effects on students living with disability (SWD) in Purpose-Built university housing

PurposeProviding student housing designed to support students living with a disability is a global challenge. This study assesses buildings' physical health condition systems and drivers of physical health condition effects on students living with disability (SWD) in purpose-built university housing in Ghana.Design/methodology/approachThe study used quantitative design and methods based on the theory of supportive design premises. Using the partial least square structural equation model, a survey of 301 students living with a physical disability, mild visual disability and mild hearing disability was collected in 225 student housings.FindingsThe study found that insect control and cleaning services are a priority in off-campus building design and management and directly positively affected the sense of control and physical health of SWD. The nature of lightning systems, noise and thermal comfort directly negatively affected SWD disability learning and discomfort.Practical implicationsReviewing and enforcing student housing design drawings at the preliminary development stage by university management is critical. More broadly, physical health systems that control cleaning, noise and thermal comfort are essential for SWD health in student housing.Originality/valueStudies on all-inclusive building designs have consistently focused on lecture theaters and libraries with limited attention on the physical health condition systems in student housing that support the quality healthcare of university campuses. Research on physical health condition systems in student housing is significant for all-inclusiveness and student housing management.

Functional Status Associations With Treatment Receipt and Outcomes Among Older Adults Newly Diagnosed With Multiple Myeloma.

Multiple myeloma (MM) is a prevalent hematologic malignancy in older adults, who often experience physical disability, increased health care usage, and reduced treatment tolerance. Home health (HH) services are frequently used by this group, but the relationship between disability, HH use, and MM treatment receipt is unclear. This study examines the connections between disability, treatment receipt, and survival outcomes in older adults with newly diagnosed MM using a nationwide data set. The SEER-Medicare data set was used to identify adults aged 66 years and older diagnosed with MM from 2010 to 2017, who used HH services the year before diagnosis. Disability was assessed with the Outcome and Assessment Information Set, using a composite score derived from items related to ability to complete activities of daily living. Mortality, therapy receipt, and health care utilization patterns were evaluated. Of 37,280 older adults with MM, 6,850 (18.2%) used HH services before diagnosis. Moderate disability at HH assessment resulted in similar MM-directed therapy receipt as mild disability, with comparable health care usage after diagnosis to severe disability. HH users had a higher comorbidity burden and higher mortality (adjusted risk ratio for 3-year mortality: 1.59 [95% CI, 1.55 to 1.64]). Severe functional disability before diagnosis was strongly related to postdiagnosis mortality. Among older adults with MM receiving HH services, disability is a predictor of early mortality. Moderately disabled individuals undergo similar therapy intensity as the mildly disabled but experience increased acute care utilization. Previous HH use could identify patients with MM requiring intensive support during therapy initiation.

Abstract TP255: Racism, Resilience, and Quality of Life in Black Stroke Survivors

Introduction: Stroke impairs stroke survivor (SS) quality of life (QoL). Black SS in the US also endure stress from structural, cultural, and interpersonal racism. Resilience is a dynamic process of maintaining stable functioning after an event such as stroke. This observational study aimed to assess the effects of racism and resilience on Black SS QoL. Methods: Participants were community-dwelling SS (age ≥ 18) who identified as African American or Black and experienced a stroke within 8 weeks. Baseline data collection included exposure (discrimination, vigilance, resilience), demographic, clinical, and psychosocial variables. Outcome data for QoL was gathered after 6 months. The effects of exposure variables and covariates on QoL were analyzed with multiple linear regression. Results: Participants (n=74) had a mean age of 56.2, 32% were in marital or partner relationships, and 58% were female. Most participants (84%) had ischemic stroke, with no more than mild disability (mRS 0-2 for 80%). Over half of participants had some college (32%) or a college degree (20%). The remaining 46% had a high school education or less. Work status included 32% currently working, 15% not working, 28% retired, and 24% disabled. Half reported an annual household income of &lt; $25,000, with 63% living at ≤ 200% above the US poverty level. Participants reported moderate (64%) to high (8%) perceived stress, and 14% had moderate to moderately severe anxiety. Resilience was correlated with stress (r=-.59, p&lt;.001) and anxiety (r=-.66, p&lt;.01). At 6-month follow-up (n=44), QoL domains were very low for social relations ( M =36.83, SD=17.76) and environment ( M= 35.04, SD=14.57), and moderately low for physical ( M =46.49, SD=19.22) and psychological ( M =54.39, SD=17.23). Higher vigilance and higher disability explained 23.3% of the variance in social relations QoL (F=7.545, p=.002). Higher resilience and higher socioeconomic status explained 25.7% of the variance in psychological QoL (F=5.524, p=.009). Conclusions: This sample had significant baseline socioeconomic disadvantage and increased psychosocial stress at baseline, and diminished QoL 6 months post-stroke. Future research with larger samples is warranted.

Abstract HUP11: Racism, Resilience, and Quality of Life in Black Stroke Survivors

Introduction: Stroke impairs stroke survivor (SS) quality of life (QoL). Black SS in the US also endure stress from structural, cultural, and interpersonal racism. Resilience is a dynamic process of maintaining stable functioning after an event such as stroke. This observational study aimed to assess the effects of racism and resilience on Black SS QoL. Methods: Participants were community-dwelling SS (age ≥ 18) who identified as African American or Black and experienced a stroke within 8 weeks. Baseline data collection included exposure (discrimination, vigilance, resilience), demographic, clinical, and psychosocial variables. Outcome data for QoL was gathered after 6 months. The effects of exposure variables and covariates on QoL were analyzed with multiple linear regression. Results: Participants (n=74) had a mean age of 56.2, 32% were in marital or partner relationships, and 58% were female. Most participants (84%) had ischemic stroke, with no more than mild disability (mRS 0-2 for 80%). Over half of participants had some college (32%) or a college degree (20%). The remaining 46% had a high school education or less. Work status included 32% currently working, 15% not working, 28% retired, and 24% disabled. Half reported an annual household income of &lt; $25,000, with 63% living at ≤ 200% above the US poverty level. Participants reported moderate (64%) to high (8%) perceived stress, and 14% had moderate to moderately severe anxiety. Resilience was correlated with stress (r=-.59, p&lt;.001) and anxiety (r=-.66, p&lt;.01). At 6-month follow-up (n=44), QoL domains were very low for social relations ( M =36.83, SD=17.76) and environment ( M= 35.04, SD=14.57), and moderately low for physical ( M =46.49, SD=19.22) and psychological ( M =54.39, SD=17.23). Higher vigilance and higher disability explained 23.3% of the variance in social relations QoL (F=7.545, p=.002). Higher resilience and higher socioeconomic status explained 25.7% of the variance in psychological QoL (F=5.524, p=.009). Conclusions: This sample had significant baseline socioeconomic disadvantage and increased psychosocial stress at baseline, and diminished QoL 6 months post-stroke. Future research with larger samples is warranted.

The Medium-Term Outcomes of Patients With Suspected Scaphoid Fractures: A Single-Centre Retrospective Cohort Study.

Background The medium-termoutcomesof patients (six to 14 months post-injury) with non-specific wrist injuries managed as suspected scaphoid fractures are not clear from the current literature. These patients' wrists are immobilized in casts or splints, and some receive physiotherapy. They receive serial imaging and follow-up appointments as needed. Aims This study aims to describe the medium-term outcomes of patients with non-specific wrist injuries managed as suspected scaphoid fractures. Methods This is a single-centre retrospective cohort study. Patients with suspected scaphoid fractures were identified from a consecutive database and were included.Patients diagnosed with a definitive scaphoid fracture at any point in time were excluded. Patients with any pre-existing wrist pathology were also excluded. In total 113 patients were posted the Patient-Rated-Wrist-Evaluation (PRWE) questionnaire at six to 14 months post-injury with a self-addressed return envelope. Demographic and PRWE data were collated and described. Results Twenty-two patients (19% of totalpatients) returned a completed questionnaire. The median PRWE score was 32 out of 100 indicating mild pain and disability. 45.5% of patients were in this category. A minority of patients (9%)continued to suffer severe or very severe pain and disability. Patients with PRWE scores <40, representing pain and disability that is mild or less, reported very low difficulty completing work and recreational activities. Patients tended not to have pain at rest and experienced the most difficulty lifting heavy objects. Conclusion Most patients with non-specific wrist injuries managed as suspected scaphoid fractures experience some pain and disability in the medium term. For most this is minimal or mild, however some patients experience significant pain and disability. This study adds to existing evidence that this is the case. The reasons why these patients suffer are unclear. This study highlights the need to refine clinical practice to improve the outcomes of these patients.

Severe Preoperative Disability Is Associated With Greater Mental Health Improvements Following Surgery for Degenerative Spondylolisthesis: A Cohort Matched Analysis.

To evaluate preoperative disability's influence on patient-reported outcomes (PROs) following surgery for degenerative spondylolisthesis (DS). DS patients who underwent surgical intervention were retrospectively identified from a single-surgeon spine registry. Cohorts based on Oswestry Disability Index (ODI) < 41 (milder disability) and ≥ 41 (severe disability) were created. Demographic differences were accounted for with 1:1 propensity score matching. For the matched sample, perioperative and PRO data were additionally collected. PROs assessed included mental health, physical function, pain, and disability. Pre- and up to 2-year postoperative PROs were utilized. Average time to final follow-up was 15.7 ± 8.8 months. Improvements in PROs and minimal clinically important difference (MCID) rates were calculated. Continuous variables were compared through Student t-test and categorical variables were compared through chi-square tests. Altogether, 214 patients were included with 77 in the milder disability group. The severe disability group had worse postoperative day (POD) 1 pain scores and longer hospital stays (p ≤ 0.038, both). The severe disability group reported worse outcomes pre- and postoperatively (p < 0.011, all), but had greater average improvement in 12-item Short Form health survey mental composite score (SF-12 MCS), 9-Item Patient Health Questionnaire (PHQ-9), visual analogue scale (VAS)-back, and ODI by 6 weeks (p ≤ 0.037, all) and PHQ-9, VAS-back and ODI by final follow-up (p ≤ 0.015, all). The severe disability cohort was more likely to achieve MCID for SF-12 MCS, PHQ-9, and ODI (p ≤ 0.003, all). Patients with greater baseline disability report higher POD 1 pain and discharge later than patients with milder disability. While these patients report inferior physical/mental health before and after surgery, they report greater improvements in mental health and disability postoperatively.

Assessing the impact of atrial fibrillation on symptoms and quality of life in hypertrophic cardiomyopathy.

In hypertrophic cardiomyopathy (HCM), atrial fibrillation (AF) has historically been regarded to have a deleterious impact on clinical course, strongly associated with progressive heart failure (HF) symptoms. However, there is a paucity of information regarding the impact of AF on HCM employing validated quality of life (QoL) surveys. Therefore, we evaluated the impact of AF on QoL utilizing patient reported outcome measures (PROMs). 218 consecutive HCM patients with or without AF at the Lahey HCM center in 2022 completed PROMs at their most recent visit evaluating HF (Kansas City Cardiomyopathy Questionnaire [KCCQ]) and AF symptoms (AF Effect on QoL [AFEQT]). Among the 218 patients, 50 (23%) had a history of AF and comprise the primary study cohort. AF was diagnosed at 55 ± 10 years of age, median of 5.5 years before PROM, with 66% of patients treated with a rhythm control strategy with antiarrhythmic drug and/or AF ablation. AFEQT indicated that 52% of patients experienced no or minimal AF-related disability, mild to moderate in 22%, and severe in 26%. There was no substantial difference in HCM phenotype in patients with no or minimal AF disability compared to those with severe disability. HF symptoms for most HCM patients with prior AF history was consistent with no or minimal (59%) or only mild (27%) disability as measured by KCCQ overall summary scores. In addition, with multivariate analysis, AF history was associated with less HF symptoms and improved QoL (OR 0.4, p = 0.02). In contrast to prior perceptions, HCM patients with prior AF history were less likely to incur HF symptoms impairing QoL compared to HCM patients without AF. After treatment, prior history of AF did not substantially impact current QoL. These data provide a realistic appraisal for the impact that AF has on HCM patients and also offers a measure of reassurance for this patient subgroup.

Concurrent predictors of mathematics achievement for 9-year-old children with Williams syndrome

Research on mathematics achievement by children with Williams syndrome (WS) has been very limited. We describe the math achievement of 72 9-year-olds with WS, compare their math and reading achievement, and explore concurrent predictors of math achievement using the Wechsler Individual Achievement Test-III (WIAT-III) to measure achievement and the Differential Ability Scales-II (DAS-II) to measure cognitive abilities. For both Numerical Operations and Math Problem Solving, mean standard scores (SSs) were in the mild disability range with a full range from severe disability to average ability. Bayesian robust estimation indicated decisive evidence that average reading performance was higher than average math performance. Bayesian multiple linear regression models with informative priors accounted for 60% of the variance in Numerical Operations SS with decisive evidence supporting an effect of Working Memory SS and strong evidence for Nonverbal Reasoning SS and Spatial SS and 71% of the variance in Math Problem Solving SS with decisive evidence supporting effects of Working Memory and Nonverbal Reasoning SS, strong evidence for Verbal SS, and substantial evidence for Spatial SS. These predictors are consistent with those for typically developing individuals, supporting consideration of interventions that have been highly effective for children with math difficulties in the general population.

Long-Term Outcomes of Survivors of COVID-19 with Moderate to Severe Infection and Children with Multisystem Inflammatory Syndrome or MIS-C.

The study aims to evaluate the long-term outcomes - functional, pulmonary and non-pulmonary (other organs)- in children hospitalized with COVID-19 infection or with Multisystem inflammatory syndrome (MIS-C) after 1-2 y of discharge. All children with moderate or severe COVID-19 or MIS-C were enrolled. Out of 45 enrolled subjects, 19.8% had COVID-19 infection and 82% had MIS-C. Four children (8.9%) had abnormal baseline echocardiography; two each with cardiac dysfunction and coronary dilatation. At baseline, 44% had moderate disability and 24% had mild disability as per Pediatric Cerebral Performance Category (PCPC). On follow-up, only 8.9% (n = 4) had mild and 2.2% (n = 1) had moderate disability as per the PCPC score. One child developed new onset tuberculosis of the bone. None had any pulmonary morbidities. Follow-up echocardiogram was also within normal limits for children with abnormal findings. Further studies in different populations (settings) are required to draw meaningful conclusions about long-term effects of COVID-19 on children.

Indirect intervention with staff to support a male with mild learning disability navigate the community setting: A clinical case study

AbstractBackgroundPeople with learning disabilities following a long‐term stay in forensic settings may experience difficulties reintegrating in the wider community. Indirect interventions can be helpful for care providers and family members to reflect on their practices and improve the quality of life of people with learning disabilities. Although indirect interventions are being implemented in learning disability settings, research is limited.MethodsThis clinical case study recounts an indirect intervention with care providers of a male with mild learning disability.FindingsWe recount the referral and assessment processes, the initial hypotheses and formulation of the service users' presenting difficulties. We demonstrate how a systemically informed indirect intervention with staff can be used to improve the living conditions of a man with mild learning disability and provide reflections on working with multiple interdependent systems surrounding vulnerable individuals in a specialist learning disability setting.ConclusionIndirect interventions with the care networks supporting an individual with a learning disability can be a useful way to conceptualise the barriers and facilitators for community integration. Indirect interventions can also offer a reflective space for staff to share their own difficulties and prevent burnout.

Application of A System Dynamics Model in Forecasting the Effect of Self-care Ability on the Quality of Life of Mildly Disabled Elderly in Nursing Homes

Background: The large number of mildly disabled elderly people in China has resulted in the occupation of a large amount of public social resources. They have also imposed a serious social burden on the society. This study predicts that changes in the level coefficients of physical functioning, motor participation, and external environment are associated with quality of life (QoL) among the elderly with mild disabilities in nursing homes. Methods: A simulation model was created using the system dynamics method. Meanwhile, a 50-day simulation was used to predict the subsequent changes in the level of QoL of the elderly. This study was completed in the nursing homes of Chengdu, China, using random sampling and 85 elderly subjects participated to obtain the primary data. The data were analyzed using the Vensim software. Results: The results showed that the level of physical functioning (pain value of 0.241, autonomy of 0.163, and chronic disease of 0.192), the level of motor participation (education value of 0.186, and rehabilitation partner of 0.21), and the level of external environment (medical care value of 0.26, and rehabilitation environment value of 0.184) lead to subsequent changes in the level of QoL of mildly disabled elderly in nursing homes in 30 days. Conclusion: Considering the results of this simulation study, changes in the level of physical functioning, exercise participation, and external environment could forecast the QoL of mildly disabled elderly in the nursing homes of Chania, China. It is necessary to make the required changes in the nursing homes to promote the QoL of these groups.

Exercise for People with Parkinson's Disease: Updates and Future Considerations.

Parkinson's disease (PD) is now the world's fastest-growing neurological disorder with rapidly rising prevalence and increasing demand for effective health services. Recent research has focused on the importance of early diagnosis and proactive management of physical function. Accumulating evidence indicates that reduced physical activity levels and mild pre-clinical disability are present in many people prior to a clinical diagnosis, perhaps developing over years. Early referral to a physiotherapist at the time of diagnosis is now recommended in global guidelines. Multiple forms of exercise have been found to have benefits in early and mid-stage disease across a range of motor and non-motor symptoms. Evidence from longitudinal studies confirms that disability is delayed when regular exercise is sustained over long periods. Exercise is now recognized as an essential component of treatment, in combination with medical therapies. Contemporary physiotherapy interventions now combine health behavior change techniques with physical exercise to promote the development of long-term exercise adherence. Advances in technology and digital health have progressed quickly and now offer opportunities for remote assessment and monitoring, remote exercise supervision, and support adherence through feedback and motivational strategies. Recent biomedical discoveries forecast improved earlier and more accurate diagnosis of PD, allowing opportunities for earlier interventions. Current research in progress will provide important insights into the dose and intensity of aerobic exercise in PD. Physiotherapists have important roles in advocacy and education in conjunction with care delivery to support access to evidence-based care for all people with PD.

Optimal patient profile for ofatumumab treatment: analysis of Russian data from the Phase 3 study

The article provides an analysis of the features of the action of ofatumumab in subgroups of patients with multiple sclerosis (MS) who participated in phase 3 ASCLEPIOS I and II studies both in the general subgroup of 1882 patients and among 352 patients from the Russian Federation who participated in these studies. The results of the influence of age, gender, body weight of patients, as well as the basic level of disability on the EDSS scale, the presence of active foci on MRI and previously received therapy with drugs that alter the course of MS (PITRS) are presented. In a total group of 1.882 patients, a more positive effect of ofatumumab compared with teriflunomide was noted on the average annual incidence of exacerbations in men, younger people and with a mild baseline disability level - with a baseline EDSS level less than or equal to 3. In a subgroup of 352 patients from Russia, the same trends were noted, but dependencies were also revealed from the number of previously taken PITRS: a more significant difference was noted in patients with the lowest number of PITRS in the anamnesis. This feature was also confirmed by analyzing the secondary endpoints of the study: the number of active foci on MRI and the confirmed progression of disability according to the EDSS scale. Analysis in clinical subgroups makes it possible to clarify the profile of patients in whom the greatest clinical effect can be expected when using this new drug for the treatment of MS.

A study on the falls factors among the older adult with cognitive impairment based on large-sample data.

This study explored the correlative factors of falls among the older adult with cognitive impairment, to provide distinct evidence for preventing falls in the older adult with cognitive impairment compared with the general older adult population. This study was based on a cross-sectional survey, with an older adult population of 124,124 was included. The data was sourced from the Elderly Care Unified Needs Assessment for Long-Term Care Insurance in Shanghai. Binary and multivariable logistic regression analyses were conducted sequentially on the correlative factors of falls. Multivariable logistic regression was performed on variables that were significant, stratified by cognitive function levels. The incidence of fall in the past 90 days was 17.67% in this study. Specific variables such as gender (male), advanced age (≥80), residence with a elevator (or lift), mild or moderate disability, quality of sleep (acceptable/poor) were negatively correlated with falls, while higher education level, living alone, residence with indoor steps, unclean and untidy living environment, MCI or dementia, chronic diseases, restricted joints, impaired vision, and the use of diaper were positively correlative factors of falls. Comparing with older adult with normal cognitive functions, older adult with dementia faced a higher risk of falling due to accessibility barrier in the residence. For general older adults, less frequency of going outside and poor social interactions were positively correlated with falls, while for older adult with cognitive impairments, going outside moderately (sometimes) was found positively correlated with falls. Older adults with cognitive impairments have increased fall risks associated with chronic diseases, restricted joints, and the use of diaper. The risk of falling escalated with the greater number of chronic diseases. For older adult with cognitive impairments, it is advisable to live with others. Additionally, creating an accessible living environment and maintaining the cleanness and tidiness can effectively reduce the risk of falls, particularly for those with MCI or dementia. Optimal outdoor activity plans should be developed separately based on the cognitive function of older adults. Older adult with dementia who have comorbidities should be paid special attention in fall prevention compared to the general older adult population.

Chapter 5 - Congenital myasthenic syndromes

The neuromuscular junction is a prototypic synapse that has been extensively studied and provides a model for smaller and less accessible central synapses. Central to transmission at the neuromuscular synapse is the muscle acetylcholine receptor cation channel. Studies of the genetic disorders affecting the neuromuscular junction, termed congenital myasthenic syndromes, have illustrated how impaired signal transmission may be caused by a variety of mutations both within the ion channel itself and by the context of the ion channel within the synapse. Thus, multiple pathogenic mutations are also identified in proteins affecting the clustering, location, and density of the receptor within the overall synaptic structure. Disease severity ranges from death in childhood to mild disability throughout life. In addition, in utero, fetal akinesia due to impaired neuromuscular transmission may cause developmental abnormalities. Early studies identified mutations in the genes encoding the acetylcholine receptor subunits that impair ion channel gating or reduce the number of endplate receptors or a combination of the two, giving rise to "slow channel," "fast channel," or deficiency syndromes. Subsequently, it became clear that myasthenic syndromes also stem from mutations in proteins involved in neurotransmitter release, the formation and maintenance of the neuromuscular synapse, or glycosylation. This chapter describes the patient phenotypes, the diverse range of molecular mechanisms for synaptic dysfunction, and the corresponding therapeutic strategies, including drug combinations, that can be tailored to the many subtypes.

Ab. No. 174 Physiotherapists-Led Workplace Health Promotion Program: A Cross-Sectional Need Analysis

Introduction: Workplace health promotion programs are an effective strategy for improving health status of large number of participants. They have several advantages and recently, INDIA-WORKS Trial demonstrated that standardized programs can be scaled to different worksites. Many chronic-health conditions benefit from physiotherapy interventions but physiotherapists roles in workplace health programs have not been established. Developing physiotherapists-led workplace programs have the potential to scale-up access to physiotherapy interventions. The aim is to determine the burden of chronic-health conditions and need for physiotherapy interventions among selected health professionals in a workplace setting. Methods: 39 nurses (Age: 48±4 years; 90% women) with leadership roles (Assistant Nursing Superintendents-3, Floor Supervisors–4, Patient Care Coordinators-5 &amp; Ward In-charges–27) participated in the study. In the previous year, physiotherapy screening was included as part of annual health check-up of employees in tertiary-care teaching hospital wherein 1135 employees were screened using standardized proforma. This identified several opportunities for developing workplace health promotion programs. The current study represents phase 1 of program development, wherein nurses in leadership roles were shortlisted for determining the burden of chronic health conditions amenable to physiotherapy interventions and their willingness to participate in workplace health promotion program using a standardized questionnaire. Result: Among the participants, 18(46%) had diabetes or hypertension or both, 19(49%) were stratified as low-moderated risk using STarT Back Screening Tool (NPRS=5.2±1.4) and 14(36%) had mild disability due to back pain. Musculoskeletal pain at other sites were also common. All participants expressed willingness to participate in workplace health promotion program. Conclusion: There is significant burden of chronic health conditions in select group of healthcare professionals and all identified problems are amenable to workplace health promotion programs. Implications: There is significant potential for developing physiotherapists-led workplace health promotion program.