Multiple Impairments Research Articles

Prevalence, Incidence, Influence Factors, and Cognitive Characteristics of Amnestic Mild Cognitive Impairment Among Older Adult: A 1-Year Follow-Up Study in China.

BackgroundThe risk and protective factors of amnestic mild cognitive impairment (aMCI) and its prevalence as well as incidence among old adult in Chinese community are still unclear.MethodsWe carried out this 1-year longitudinal study to survey a random sample of 3,246 community elders aged 60 and over in China. All subjects were required to complete a comprehensive clinical assessment, physical examination and several neuropsychological tests at baseline and follow-up. What’s more, we also collected their lifestyle information by a standardized questionnaire.ResultsWe found that the prevalence of aMCI was 17.1%, while the incidence of aMCI among Chinese old adult was 70.57 per 1,000 person-years. By using Cox regression analysis, we found that male sex (p = 0.001, OR = 0.489, 95%CI 0.319~0.751) and reading (p = 0.023, OR = 0.533, 95%CI 0.310~0.917) were protective factors for against aMCI. Old adult who developed aMCI in the future showed multiple cognitive impairments (such as immediate memory, associative learning memory and executive function) in their early stage, and Wechsler’s Block Design (p = 0.027, OR = 0.969, 95%CL 0.943~0.996) could predict whether subjects would turn into aMCI in the future.ConclusionsThe present study suggests that aMCI is a considerable health problem in China. Executive dysfunction may be an indicator of future development of aMCI in the old normal adult.

Association of Multisensory Impairment With Quality of Life and Depression in English Older Adults

Sensory acuity tends to decrease with age, but little is known about the relationship between having multiple sensory impairments and well-being in later life. To examine associations between concurrent multisensory impairments and aspects of well-being and mental health, namely quality of life and depressive symptoms. Cross-sectional analysis of participants in the English Longitudinal Study of Aging wave 8 (May 2016 to June 2017). This is a representative sample of free-living English individuals 52 years and older. Analysis began April 2018. Linear and logistic regression models were used to assess the association of self-reported concurrent impairments in hearing, vision, smell, and taste with quality of life (0-57 on the 19-item CASP-19 scale; Control, Autonomy, Self-realization and Pleasure) and depressive symptoms (≥4 items on the 8-item Centre for Epidemiologic Study Depression Scale). Using a representative sample of 6147 individuals, 52% (weighted) were women (n = 3455; unweighted, 56%) and the mean (95% CI) age was 66.6 (66.2-67.0) years. Multiple sensory impairments were associated with poorer quality of life and greater odds of depressive symptoms after adjustment for sociodemographic characteristics, lifestyle factors, chronic conditions, and cognitive function. Compared with no sensory impairment, quality of life decreased linearly as the number of senses impaired increased, with individuals reporting 3 to 4 sensory impairments displaying the poorest quality of life (-4.68; 95% CI, -6.13 to -3.23 points on the CASP-19 scale). Similarly, odds of depressive symptoms increased linearly as the number of impairments increased. Individuals with 3 to 4 senses impaired had more than a 3-fold risk of depressive symptoms (odds ratio, 3.36; 95% CI, 2.28-4.96). In this cross-sectional study, concurrent sensory impairments were associated with poorer quality of life and increased risks of depressive symptoms. Therefore, assessing and managing sensory impairments could help improve older adults' well-being.

85 A Cross-Sectional Study Assessing Agreement Between Self-Reported and General Practice Recorded Health Conditions Among Community Dwelling Older Adults

Abstract Introduction Self-reported data regarding health conditions are utilised in both clinical practice and research, however, their agreement with general practice records is variable. The extent of this variability is poorly studied among older adults, particularly among those with multiple health conditions, cognitive impairment or frailty. This study investigates the agreement between self-reported and general practice recorded data among such patients and the impact of participant factors on this agreement. Methods Data on health conditions was collected from participants in the Community Ageing Research 75+ (CARE75+) study (n=964) by self-reporting during face to face assessment and interrogation of the participants’ practice health records. Agreement between self-report and practice records was assessed using Kappa statistics and the effect of participant demographics using logistic regression. Results Agreement ranged from K=0.25-1.00. The presence of ≥2 health conditions modified agreement for cancer (odds ratio, OR:0.62, 95% confidence interval, CI:0.42-0.94), diabetes (OR:0.55, 95%CI:0.38-0.80), dementia (OR:2.82, 95%CI:1.31-6.13) and visual impairment (OR:3.85, 95%CI:1.71-8.62). Frailty reduced agreement for cerebrovascular disease (OR:0.45, 95%CI:0.23-0.89), heart failure (OR:0.40, 95%CI:0.19-0.84) and rheumatoid arthritis (OR:0.41, 95%CI:0.23-0.75). Cognitive impairment reduced agreement for dementia (OR:0.36, 95%CI:0.21-0.62), diabetes (OR:0.47, 95%CI:0.33-0.67), heart failure (OR:0.53, 95%CI:0.35-0.80), visual impairment (OR:0.42, 95%CI:0.25-0.69) and rheumatoid arthritis (OR:0.53, 95%CI:0.37-0.76). Conclusions Significant variability exists for agreement between self-reported and general practice recorded comorbidities. This is further affected by individuals’ baseline demographics. This study is the first to assess frailty as a factor modifying agreement and highlights the importance of utilising the general practice records as the gold standard for data collection from older adults.

Determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation: Perspectives of rehabilitation professionals and wheelchair users.

ObjectiveThis study aims to identify determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation, from the perspectives of both wheelchair users and rehabilitation professionals. The findings should contribute to the field of health promotion programs for wheelchair users.MethodsFive focus groups were held with wheelchair users (n = 25), and two with rehabilitation professionals (n = 11). A thematic approach was used for data analysis in which the determinants were categorized using an integrated International Classification of Functioning, Disability and Health and Attitude, Social influence and self-Efficacy model.ResultsReported personal factors influencing dietary behaviour in wheelchair users were knowledge, boredom, fatigue, stage of life, habits, appetite, self-control, multiple lifestyle problems, intrinsic motivation, goal setting, monitoring, risk perception, positive experiences, suffering, action planning, health condition, function impairments, attitude and self-efficacy. Reported environmental factors influencing dietary behaviour in wheelchair users were unadjusted kitchens, monitoring difficulties, eating out, costs, unfavourable food supply, nutrition education/counselling, access to simple healthy recipes, eating together, cooking for others, and awareness and support of family and friends.ConclusionsImportant modifiable determinants of dietary behaviour in wheelchair users that might be influenced in lifestyle interventions are knowledge, fatigue, habits, self-control, intrinsic motivation, risk perception, attitude and self-efficacy. It is recommended to involve relatives, since they appear to significantly influence dietary behaviour.

The Importance of Cellular Senescence in Frailty and Cardiovascular Diseases.

Frailty is a complex clinical syndrome, progressively described in the last thirty years, resulting from multiple impairments across many organs and systems and characterized by a reduction in physiological reserves and increased vulnerability to stressors, as well. Cardiovascular diseases (CVDs) are a common health problem in very old populations. Age-related changes occur throughout the body and in all organs, including the cardiovascular system. Cellular senescence links age-related CVDs and frailty by many mechanisms of particular interest in the aging biology and geriatric syndromes. Cellular senescence may represent the pivotal factor with its senescence-associated secretory phenotype (SASP) leading to systemic inflammation. In this context, SASP may represent the key element in the association between aging, frailty and the development of age-related CVDs.

Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum.

Background:Protracted withdrawal syndrome (PWS) after stopping antidepressants (frequently also referred to as post-acute withdrawal syndrome or PAWS) has been described in a few case reports. However, a detailed quantitative analysis of specific symptom manifestations in antidepressant PWS is still lacking.Methods:We extracted patient narratives from a large English-language internet forum SurvivingAntidepressants.org, a peer support site concerned about withdrawal from antidepressants. PWS was ascertained based on diagnostic criteria proposed by Chouinard and Chouinard, specifically ⩾6 months of continuous antidepressant use, with emergence of new and/or more intense symptoms after discontinuation that last beyond the initial 6 weeks of acute withdrawal. We assessed medication history, outcome of PWS, and the prevalence of specific symptoms.Results:In total, n = 69 individual reports of protracted withdrawal were selected for analysis. At time of the subjects’ most recent reports, duration of PWS ranged from 5 to 166 months, mean = 37 months, median = 26 months. Length of time on the antidepressant causing protracted withdrawal ranged from 6 to 278 months, mean = 96 months, and median = 79 months. Throughout the withdrawal experience, affective symptoms, mostly anxiety, depression, emerging suicidality and agitation, were reported by 81%. Somatic symptoms, mostly headache, fatigue, dizziness, brain zaps, visual changes, muscle aches, tremor, diarrhea, and nausea were reported by 75%. Sleep problems (44%) and cognitive impairments (32%) were mentioned less frequently. These broad symptom domains were largely uncorrelated.Conclusion:PWS or PAWS from antidepressants can be severe and long-lasting, and its manifestations clinically heterogeneous. Long-term antidepressant exposure may cause multiple body system impairments. Although both somatic and affective symptoms are frequent, they are mostly unrelated in terms of occurrence. Proper recognition and detection of PWS thus requires a comprehensive assessment of medication history, duration of the withdrawal syndrome, and its various somatic, affective, sleep, and cognitive symptoms.

Can Healthy Diets, Regular Exercise, and Better Lifestyle Delay the Progression of Dementia in Elderly Individuals?

Alzheimer's disease (AD) is a progressive neurodegenerative disease characterized by memory loss and multiple cognitive impairments. Current healthcare costs for over 50 million people afflicted with AD are about $818 million and are projected to be $2 billion by 2050. Unfortunately, there are no drugs currently available that can delay and/or prevent the progression of disease in elderly individuals and in AD patients. Loss of synapses and synaptic damage are largely correlated with cognitive decline in AD patients. Women are at a higher lifetime risk of developing AD encompassing two-thirds of the total AD afflicted population. Only about 1-2% of total AD patients can be explained by genetic mutations in APP, PS1, and PS2 genes. Several risk factors have been identified, such as Apolipoprotein E4 genotype, type 2 diabetes, traumatic brain injury, depression, and hormonal imbalance, are reported to be associated with late-onset AD. Strong evidence reveals that antioxidant enriched diets and regular exercise reduces toxic radicals, enhances mitochondrial function and synaptic activity, and improves cognitive function in elderly populations. Current available data on the use of antioxidants in mouse models of AD and antioxidant(s) supplements in diets of elderly individuals were investigated. The use of antioxidants in randomized clinical trials in AD patients was also critically assessed. Based on our survey of current literature and findings, we cautiously conclude that healthy diets, regular exercise, and improved lifestyle can delay dementia progression and reduce the risk of AD in elderly individuals and reverse subjects with mild cognitive impairment to a non-demented state.

Molecular Basis of Alzheimer's Disease: Focus on Mitochondria.

Alzheimer's disease (AD) is a progressive neurodegenerative disease, characterized by memory loss and multiple cognitive impairments. With the increased aging population, AD is a major health concern in society. Morphological and pathological studies revealed that AD is associated with the loss of synapses, defective mitochondria, and the proliferation of reactive astrocytes and microglia, in addition to the presence amyloid-β and phosphorylated tau in learning and memory regions of the brain in AD patients. AD occurs in two forms: early-onset familial and late-onset sporadic. Genetic mutations in APP, PS1, and PS2 loci cause familial AD. Multiple factors are reported to be involved in late-onset AD, including APOE4 genotype, polymorphisms in several gene loci and type 2 diabetes, traumatic brain injury, stroke, and age-related factors, including increased reactive oxygen species production and dysfunction in mitochondria. It is widely accepted that synaptic damage and mitochondrial dysfunction are early events in disease process. The purpose of this article is to highlight molecular triggers to the disease process. This article also reviews factors, including age, gender, lifestyle, epigenetic factors, and type 2 diabetes, that are involved in late-onset AD. This article also discusses recent developments in research of mitochondrial structure, function, physiology, dynamics, biogenesis, mitophagy, and mitochondrial DNA changes in healthy and diseased states.

Behavioral measures of attention and cognitive control during a new auditory working memory paradigm

Proactive control is the ability to manipulate and maintain goal-relevant information within working memory (WM), allowing individuals to selectively attend to important information while inhibiting irrelevant distractions. Deficits in proactive control may cause multiple cognitive impairments seen in schizophrenia. However, studies of cognitive control have largely relied on visual tasks, even though the functional deficits in schizophrenia are more frequent and severe in the auditory domain (i.e., hallucinations). Hence, we developed an auditory analogue of a visual ignore/suppress paradigm. Healthy adults (N = 40) listened to a series of four letters (600-ms stimulus onset asynchrony) presented alternately to each ear, followed by a 3.2-s maintenance interval and a probe. Participants were directed either to selectively ignore (I) the to-be-presented letters at one ear, to suppress (S) letters already presented to one ear, or to remember (R) all presented letters. The critical cue was provided either before (I) or after (S) the encoding series, or simultaneously with the probe (R). The probes were encoding items presented to either the attended/not suppressed ear (“valid”) or the ignored/suppressed ear (“lure”), or were not presented (“control”). Replicating prior findings during visual ignore/suppress tasks, response sensitivity and latency revealed poorer performance for lure than for control trials, particularly during the suppress condition. Shorter suppress than remember latencies suggested a behavioral advantage when discarding encoded items from WM. The paradigm-related internal consistencies and 1-week test–retest reliabilities (n = 38) were good to excellent. Our findings validate these auditory WM tasks as a reliable manipulation of proactive control and set the stage for studies with schizophrenia patients who experience auditory hallucinations.

The need for improved cognitive, hearing and vision assessments for older people with cognitive impairment: a qualitative study.

BackgroundHearing and vision (sensory) impairments are highly prevalent in people with dementia (PwD) and exacerbate the impact of living with dementia. Assessment of sensory or cognitive function may be difficult if people have concurrent dual or triple impairments. Most standard cognitive assessment tests are heavily dependent on having intact hearing and vision, and impairments in these domains may render the assessments unreliable or even invalid. Likewise, dementia may impede on the accurate reporting of symptoms that is required for most hearing and vision assessments. Thus, there is an urgent need for hearing, vision and cognitive assessment strategies to be adapted to ensure that appropriate management and support can be provided.ObjectiveTo explore the perspectives of PwD and the care partners regarding the need for accurate hearing, vision and cognitive assessments.MethodsWe conducted focus groups and semi-structured interviews regarding the clinical assessment for cognitive, hearing and visual impairment. Participants (n = 18) were older adults with mild to moderate dementia and a sensory impairment as well as their care partners (e.g. a family member) (n = 15) at three European sites. The qualitative material was analysed according to Mayring’s summative content analysis approach.ResultsParticipants reported that hearing, vision and cognitive assessments were not appropriate to the complex needs of PwD and sensory comorbidity and that challenges in communication with professionals and conveying unmet needs and concerns by PwD were common in all three types of clinical assessments. They felt that information about and guidance regarding support for the condition was not adequate in the assessments and that information sharing among the professionals regarding the concurrent problems was limited. Professionals were reported as being concerned only with problems related to their own discipline and had limited regard for problems in other domains which might impact on their own assessments.ConclusionsThe optimal assessment and support for PwD with multiple impairments, more comprehensive, yet easy to understand, information regarding these linked to conditions and corrective device use is needed. Communication among health care professionals relevant to hearing, vision and cognition needs to be improved.

Gaps in access and school attainments among people with and without disabilities: a case from Nepal

Aim Many children with disabilities in low- and middle-income countries do not attend school and one-third are out of school. In order to ensure that education is for all including children with disabilities, research is needed on barriers to schooling to identify targets for intervention. The study will examine the determinants of school achievement among persons with and without disabilities as well as among each type of impairment. Methods The study will utilize data from a recent national, representative household survey on living conditions among persons with and without disabilities. The individual level data used in this article comprise 2123 persons with and 2000 persons without disabilities. Results The results show that an alarmingly high proportion of persons in Nepal have not accessed formal education, with access being significantly lower among persons with disabilities. While the results may be influenced by the assumed relationship between disability and poverty, results from analyzing the cross-sectional data cannot be conclusive on the influence of disability vs. poverty in determining differences in access and school attainments. Increased environmental barriers, higher age, rural location, and increased levels of disability were found to be associated with lower educational achievement. Pronounced differences in access to education were found between impairment types, with individuals with physical impairments achieving the highest level and individuals with multiple impairments, hearing and mental impairments achieving lowest. Conclusions It is necessary both to strengthen the entire educational sector and at the same time allocate resources that will ensure that all children are on board and that particular efforts are implemented to cater for those who are easily side-lined. Implications for rehabilitation An alarmingly high proportion of persons in Nepal have not attended school. Substantially more individuals with than without disabilities have never attended school. Increased environmental barriers, higher age, rural location, and increased levels of disability were found to be associated with lower educational achievement. Pronounced differences in access to education were found between impairment types, with individuals with physical impairments achieving the highest level and individuals with multiple impairments, hearing and mental impairments achieving lowest. It is necessary both to strengthen the entire educational sector in Nepal and at the same time ensure that particular efforts are implemented to cater for those who are easily sidelined.

Chemicals used for the induction of Alzheimer’s disease-like cognitive dysfunctions in rodents

Alzheimer's disease (AD) is the most frequent and multifactorial form of dementia, characterised by multiple cognitive impairments and personality changes. Different methods including chemicals have been used to induce AD-like symptoms in rodent in order to screen many therapeutic drugs for a variety of cognitive dysfunctions. Articles from reliable databases such as Google Scholar, Science Direct, PubMed, Scopus, and Ovid were searched and retrieved with the following descriptors: 'Alzheimer's Disease', Cognitive impairments', Neurotoxins that induce AD', Alzheimerogenic chemicals', excitotoxins', Amyloid beta', neurofibrillary tangles. A number of chemicals have been studied to develop an animal model of AD on the basis of their mechanism of action for cognitive dysfunctions. Some of such chemicals are Heavy metals, Scopolamine, Ethanol, Colchicine, Streptozotocin, Lipopolysaccharide, and Okadaic acid among others, with a view to understanding the pathogenesis of this devastating disease. The purpose of this review is to put forward some AD pathophysiology including AD causative theories and also highlight some Alzheimerogenic chemicals for the purpose of enriching our existing knowledge. It is worth mentioning that not all the biochemical, histopathological, cognitive and behavioural abnormalities can be recapitulated. Nonetheless, experimental models of AD produced by chemicals offer insights to unravelling the pathogenesis of the disease.

Daratumumab in Patients with Multiple Myeloma and Renal Impairment - Real-World Data from a Single-Center Institution

Background: Renal impairment is a frequent complication of multiple myeloma (MM) associated with poor prognosis and decreased overall survival; and can complicate drug dosing, limit treatment options and lead to a higher incidence of adverse events. Daratumumab is an anti-CD38 monoclonal antibody indicated for the treatment of patients with MM which does not require dose modification in the setting of renal impairment. Real-world data regarding its efficacy in patients with renal impairment and the rate of renal response are lacking. Methods: We performed a retrospective, single-center analysis of patients with relapsed/refractory MM treated with daratumumab as monotherapy or in combination with novel agents. Patients were grouped by renal function as calculated by their eGFR using the MDRD equation: <30, 30-59, >=60 mL/min/1.73m2. Renal response was defined as an eGFR >= 60 in two consecutive visits for patients with baseline renal impairment. Results: We identified 91 patients who started treatment with daratumumab between 2015-06-11 and 2018-08-16. The median age was 69 years old (range 40-93) and 25% were over the age of 75; 49 patients (54%) were female. Six patients (9%) were Hispanic, 16 (20%) were African American and 57 (71%) were Caucasian. High-risk cytogenetics were present in 58% of patients; defined as the presence of a complex karyotype, 1q gain, t(4;14), t(14;16), t(14;20) or del17p. Patients underwent a median of 5 prior lines of therapy (range 1-13), 45% had received an autologous stem cell transplant, 91% had been exposed to an immunomodulatory agent, 96% to a proteasome inhibitor, and 89% to both. Upon initial treatment, 53 patients (58%) had an eGFR >=60 mL/min/1.73m2, while 27 (30%) and 11 (12%) patients had an eGFR of 30-59 and <30 mL/min/1.73m2, respectively. The overall response rate (ORR) was 81% with a very good partial response (VGPR) or better of 47% and an unconfirmed complete response rate (uCR) of 23%. The median progression-free survival (mPFS) was 17.5 months while median overall survival (mOS) was not reached. There was no difference in mPFS or mOS between renal function groups. Of the 38 patients with baseline renal impairment (eGFR <60 mL/min/1.73m2), 11 patients (29%) achieved a renal response, however, none of these patients had severe renal impairment. When compared to patients with chronic renal impairment, those with acute renal impairment were more likely to achieve a renal response (80% vs 21%, p=0.02). No significant difference in mPFS or mOS was observed by renal response (mPFS: 25.7m vs 17.5m, p=0.2; mOS: NR vs NR, p=0.8). Each renal function group was well balanced for the above parameters, including adverse events of interest and concurrent myeloma therapy as shown in the table, except where indicated (*). Discussion: The results of this analysis provide comparable efficacy - independent of the degree of baseline renal impairment - to the results seen in clinical trials of combination therapy with daratumumab. Furthermore, the high renal response rate (29%) seen, as compared to the one in the subgroup analysis of ENDEAVOR (15%), highlights the utility of daratumumab in reversing renal end-organ damage in patients with relapsed/refractory MM without an increase in adverse events compared to patients with preserved renal function. These results suggest that daratumumab may be able to abrogate the adverse prognostic factor that impaired baseline renal function portends. A limitation of this study is its retrospective nature, the confounding effect of concurrent myeloma therapy and the small number of patients included with renal impairment. Table Disclosures Coleman: Merck: Research Funding; Pharmacyclics: Speakers Bureau; Kite Pharmaceuticals: Equity Ownership; Gilead, Bayer, Celgene: Consultancy, Research Funding, Speakers Bureau. Niesvizky:Takeda, Amgen, BMS, Janssen, Celgene: Consultancy, Research Funding. Rossi:Janssen, Celgene, Amgen: Consultancy; BMS: Research Funding.

RELATIONSHIPS BETWEEN ANXIETY AND PERSONALITY DISORDER FEATURES IN YOUNGER AND OLDER ADULTS

Introduction: Anxiety is a prevalent problem that has been found to be associated with multiple other mental disorders, functional impairments, and poor quality of life. Specifically, it appears that personality may play a major role in anxiety based on preferred dispositional coping methods and presence of normal and dysfunctional personality traits. The purpose of this study was to examine associations between anxiety and personality disorder (PD) features. It was hypothesized that anxiety would have positive associations with the avoidant, dependent, obsessive-compulsive, schizotypal, paranoid, and borderline PD scales. Method: Community-dwelling older adults (N = 130) and younger adults (N = 243) completed the Geriatric Anxiety Scale (GAS) and the Coolidge Axis Two Inventory (CATI) as part of a larger assessment battery. Correlations were computed between the GAS total score and the 14 PD scales from the CATI. Results: Results showed that anxiety was significantly and positively associated with all 14 PD scales. Specifically, as expected, the schizotypal (.52), paranoid (.55), avoidant (.56), obsessive-compulsive (.60), dependent (.62), and borderline (.69) PD scales were all significantly positively associated with anxiety. The remaining 8 PD scales also showed strong, positive correlations with anxiety: sadistic (.27), antisocial (.28), schizoid (.32), histrionic (.42), narcissistic (.44), passive-aggressive (.59), self-defeating (.64), and depressive (.69). Discussion: These results indicate that anxiety and abnormal personality traits are highly associated, showing a strong comorbidity. An implication is that PDs may play a role in the development of anxiety, or vice versa. Longitudinal studies are needed to clarify temporal and causative relationships.

A cross-sectional study assessing agreement between self-reported and general practice-recorded health conditions among community dwelling older adults.

self-reported data regarding health conditions are utilised in both clinical practice and research, but their agreement with general practice records is variable. The extent of this variability is poorly studied amongst older adults, particularly amongst those with multiple health conditions, cognitive impairment or frailty. This study investigates the agreement between self-reported and general practice-recorded data amongst such patients and the impact of participant factors on this agreement. data on health conditions was collected from participants in the Community Ageing Research 75+ (CARE75+) study (n = 964) by self-report during face-to-face assessment and interrogation of the participants' general practice electronic health records. Agreement between self-report and practice records was assessed using Kappa statistics and the effect of participant demographics using logistic regression. agreement ranged from K = 0.25 to 1.00. The presence of ≥2 health conditions modified agreement for cancer (odds ratio, OR:0.62, 95%confidence interval, CI:0.42-0.94), diabetes (OR:0.55, 95%CI:0.38-0.80), dementia (OR:2.82, 95%CI:1.31-6.13) and visual impairment (OR:3.85, 95%CI:1.71-8.62). Frailty reduced agreement for cerebrovascular disease (OR:0.45, 95%CI:0.23-0.89), heart failure (OR:0.40, 95%CI:0.19-0.84) and rheumatoid arthritis (OR:0.41, 95%CI:0.23-0.75). Cognitive impairment reduced agreement for dementia (OR:0.36, 95%CI:0.21-0.62), diabetes (OR:0.47, 95%CI:0.33-0.67), heart failure (OR:0.53, 95%CI:0.35-0.80), visual impairment (OR:0.42, 95%CI:0.25-0.69) and rheumatoid arthritis (OR:0.53, 95%CI:0.37-0.76). significant variability exists for agreement between self-reported and general practice-recorded comorbidities. This is further affected by an individual's health conditions. This study is the first to assess frailty as a factor modifying agreement and highlights the importance of utilising the general practice records as the gold standard for data collection from older adults.

Monitoring of OSNR Using an Improved Binary Particle Swarm Optimization and Deep Neural Network in Coherent Optical Systems

A novel technique is proposed to implement optical signal-to-noise ratio (OSNR) estimation by using an improved binary particle swarm optimization (IBPSO) and deep neural network (DNN) based on amplitude histograms (AHs) of signals obtained after constant modulus algorithm (CMA) equalization in an optical coherent system. For existing OSNR estimation models of DNN and AHs, sparse AHs with valid features of original data are selected by IBPSO algorithm to replace the original, and the sparse sets are used as input vector to train and test the particle swarm optimization (PSO) optimized DNN (PSO-DNN) network structure. Numerical simulations have been carried out in the OSNR ranges from 10 dB to 30 dB for 112 Gbps PM-RZ-QPSK and 112 Gbps PM-NRZ-16QAM signals, and results show that the proposed algorithm achieves a high OSNR estimation accuracy with the maximum estimation error is less than 0.5 dB. In addition, the simulation results with different data input into the deep neural network structure show that the mean OSNR estimation error is 0.29 dB and 0.39 dB under original data and 0.29 dB and 0.37 dB under sparse data for the two signals, respectively. In the future dynamic optical network, it is of more practical significance to reconstruct the original signal and analyze the data using sparse observation information in the face of multiple impairment and serious interference. The proposed technique has the potential to be applied for optical performance monitoring (OPM) and is helpful for better management of optical networks.

Relationship between MRI perfusion and clinical severity in multiple sclerosis.

Perfusion alterations within several brain regions have been shown in multiple sclerosis patients using different magnetic resonance imaging (MRI) techniques. Furthermore, MRI-derived brain perfusion metrics have been investigated in association with multiple sclerosis phenotypes, physical disability, and cognitive impairment. However, a review focused on these aspects is still missing. Our aim was to review all the studies investigating the relationship between perfusion MRI and clinical severity during the last fifteen years to understand the clinical relevance of these findings. Perfusion differences among phenotypes were observed both with 1.5T and 3T scanners, with progressive multiple sclerosis presenting with lower perfusion values than relapsing-remitting multiple sclerosis patients. However, only 3T scanners showed a statistically significant distinction. Controversial results about the association between MRI-derived perfusion metrics and physical disability scores were found. However, the majority of the studies showed that lower brain perfusion and longer transit time are associated with more severe physical disability and worse cognitive performances.

Facilitating the Creative Process Through Collaboration

Miles Parker Scharfenberg, an artist based in Richland, Michigan, provided the cover art for the Fall 2019 edition of The Open Journal of Occupational Therapy (OJOT). “Late Night Fireworks” is a 30” x 40” painting made from acrylic on canvas. Born 15 weeks premature, Miles’ multiple health impairments have made it difficult to engage in meaningful occupations, such as painting. With support from his mother, Carol; occupational therapy students; and members of the community; Miles creates colorful abstract expressionist paintings. Collaboration is part of his creative process. In this fifth anniversary issue of OJOT, Occupation and the Artist is following up with a past artist for the first time. Over the last five years, Miles has further developed his skill and abilities as a painter while discovering his potential as an artist.

A pilot randomized controlled trial of Internet-delivered parent training for parents of teenagers.

Adolescents with externalizing behaviors are at risk for multiple social and health impairments that may persist into adulthood. Although empirically supported treatments are available for teenagers with severe externalizing behavior and their families, only a few parenting programs have been evaluated for adolescents with subclinical levels of behavior problems. In the present randomized controlled trial (N = 75), we examined the feasibility and efficacy of the Parent-Web, a new Internet-based parenting program for parents of teenagers. Participants reported high satisfaction with the program, 74% completed all five modules and dropout was only 14%. Generalized linear mixed models showed short-term (8 weeks) improvements in parent-reported teenager externalizing behaviors, family conflicts, and family warmth compared to a waitlist control condition. Receiving the Parent-Web was also associated with more improvements in parent-reported teenage emotional symptoms and peer problems, as well as parental stress and depression. No differences regarding parenting behaviors between the two groups were found. Those in the intervention group maintained their posttreatment gains on primary outcomes at the follow-up assessment, 6- to 9-months after the program. Although limited by relying solely on parent report, and by a relatively small sample size, we conclude that our study contributes some preliminary evidence for the utility of supporting parents of adolescents at risk of developing behavior problems through an Internet-based intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Are the knowledge of non-malignant asbestos-related diseases and lung function impairment differentially associated with psychological well-being? A cross-sectional study in formerly asbestos-exposed workers in Germany

ObjectivesThe knowledge of past asbestos exposure may lead to chronic psychological strain. In addition, the information about an increased cancer risk can place a psychological burden on individuals triggering mental...