Physical Functional Limitations Research Articles

Development of a Conceptual Model of Physical Functioning Limitations Experienced by Patients with Late-Stage Chronic Kidney Disease: A Qualitative Interview Study

Development of a Conceptual Model of Physical Functioning Limitations Experienced by Patients with Late-Stage Chronic Kidney Disease: A Qualitative Interview Study

Static posture weightbearing joint angle differences in patients with varus ankle osteoarthritis

BackgroundAdvanced varus ankle osteoarthritis is a debilitating disease that can present with limited physical function, severe pain, and diminished quality of life. Weightbearing computed tomography enables submillimeter 3-dimensional visualization, computational analyses, and enhanced diagnoses in reporting complex degenerative changes more accurately. Research questionThis study set to compare static posture weightbearing joint angle differences in healthy and varus ankle osteoarthritis patients (compensated and non-compensated). MethodsOur retrospective assessment included 70 individuals, 44 of whom were diagnosed with advanced varus ankle osteoarthritis, and the remaining 26 were healthy participants to serve as controls. An automatic anatomic coordinate system was applied to each patient’s 3-dimensional talus and calcaneus bone reconstructions from weightbearing computed tomography scans. Subtalar and midtarsal joint angles were calculated using Euler angles. ResultsWe report statistical differences between the healthy group and both advanced varus osteoarthritis groups for midtarsal inversion/eversion. Specifically, both osteoarthritis groups’ midtarsal joints were more inverted and plantarflexed as compared to healthy participants. Compensated and non-compensated subtalar joints were statistically different with respect to inversion/eversion. Non-compensated ankles exhibited a similar mean to healthy ankles who were both less inverted than compensated ankles. SignificanceOur study helps physicians to better understand underlying mechanisms of peritalar compensation in varus ankle osteoarthritis. Patients featuring hindfoot compensation on average had a greater subtalar joint angle indicating greater inversion than healthy and non-compensated patients.

Mental fatigue and chronic fatigue syndrome in clinical practice

Fatigue is an extremely disabling symptom both in healthy people and in various diseases. Physical fatigue is characterized by limitations in physical functioning, while mental/cognitive fatigue involves difficulties in concentrating and performing cognitive tasks. Mental and physical fatigue exist in both pathological and physiological fatigue. Fatigue is primarily an adaptive physiological process. It is a signal to have a rest and helps conserve energy to prevent injury, which can be useful after intense work, or when the body’s defenses need to be redistributed, for example, during infectious disease. It is important to distinguish between fatigue or tiredness and chronic fatigue syndrome in clinical practice. Chronic fatigue syndrome has multisystem manifestations and affects millions of people globally. Although the exact aetiology of chronic fatigue syndrome is uncertain, the studies point to neurological, immunological, autonomic and energy disorders. The main sings of chronic fatigue syndrome are debilitating fatigue that is worsened by activity, poor exercise tolerance, unrefreshing sleep and cognitive impairment. Reduced information processing speed is the most common cognitive impairment in chronic fatigue syndrome. Other manifestations include decreased reaction time, working memory, and attention. These symptoms must persist for at least 3–6 months for a diagnosis to be made. As there are no specific tests for chronic fatigue syndrome, a diagnosis can be established on the basis of a medical history and physical examination.Although there are no standards-based methods specific to chronic fatigue syndrome, clinicians can reduce the severity of symptoms using pharmacological and non-pharmacological treatment approaches that have proved their efficacy in clinical practice. In particular, nootropics are widely used in asthenic conditions and chronic fatigue syndrome. Fonturacetam is a nootropic drug that directly activates brain integration activities, promotes memory consolidation, and improves concentration and mental activity.

Abstract PO5-11-07: Short- and long-term treatment-related effects on physical health in breast cancer survivors

Abstract Background. Breast cancer (BC) survivors experience greater physical health declines compared to cancer-free women of the same age, which is thought to be caused by their cancer and its treatment. However, the short- and long-term effects of different types of treatment on physical health are not well understood, especially for hormone therapy. Moreover, whether specific aspects of physical health, such as activities of daily living (ADL), are affected by treatment is unknown. Methods. This analysis was conducted in the Cancer Prevention Study 3 (CPS-3), a prospective cohort study with approximately 300,000 participants enrolled between 2006-2013. Participants returned a baseline survey and triennial follow-up surveys beginning in 2015. Incident, non-metastatic, female BC patients were included in this analysis if they returned a survey at least 90 days after their diagnosis through June 30, 2020, the end of follow-up for this analysis. All 2,551 BC patients included in this study had pre- and post-diagnostic surveys and underwent breast surgery if they were diagnosed with invasive disease. They were matched to up to five cancer-free women on age and year of survey returns (N=12,704). Self-reported physical health and ADL were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Scale instrument. Treatment information was obtained from cancer registries and self-report and included surgery, chemotherapy, radiation and hormonal therapy. Odds Ratios (OR) and 95% confidence intervals (CI) between treatment received and self-reported physical function were estimated using multivariable ordinal logistic regression models at three time points relative to the case’s diagnosis date: before diagnosis, within 90 days to 5 years after diagnosis, and more than 5 years after diagnosis. Results. Median age at diagnosis was 56 years (interquartile range (IQR): 50-62). Approximately 82% of the tumors were hormone-receptor positive. The median times from the three physical health measurements to diagnoses were 1.7 years before diagnosis (IQR: 0.9 – 2.7), 1.7 years (IQR: 0.9 – 2.5) from 90 days to 5 years post-diagnosis and 6.6 years (IQR: 5.5-7.0) for more than 5 years post-diagnosis. There was a significant risk of physical decline within 5 years of diagnosis for women who received chemotherapy or hormonal therapy compared to cancer-free women (Table 1). However, more than 5 years after diagnosis, the risk of physical decline was only observed among those who received chemotherapy. Treatment combinations that included chemotherapy were also associated with a decline in the ability to carry out ADL during the first 5 years. Patients who received hormonal therapy without chemotherapy were comparable to cancer-free women in their ability to carry out ADL during the post-diagnosis period. BC patients who received surgery only or surgery and radiation reported physical health and ADLs similar to cancer-free women within 5 and >5 years after diagnosis. Conclusions. Post-diagnosis physical health decline is time and treatment dependent. Patients receiving chemotherapy have the greatest overall physical health decline and it is long-lasting. Beyond five years from diagnosis, physical health of breast cancer patients who did not receive chemotherapy were similar to cancer-free women. Strategies are needed to help BC patients receiving chemotherapy overcome the long-term physical function limitations of their cancer treatment. Table. Associations between treatment received and physical health and ability to carry out activities of daily living. OR: Odds Ratio; CI: confidence interval; chemo: chemotherapy; radio: radiation therapy; horm: hormonal therapy. *Associations were adjusted for matching factors, which included age and time from diagnosis to measurement of physical health. Citation Format: Clara Bodelon, Matthew Masters, Lauren McCullough, Alpa Patel, Lauren Teras. Short- and long-term treatment-related effects on physical health in breast cancer survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-07.

Disease Burden and Health-Related Quality of Life (HRQoL) of Chronic Obstructive Pulmonary Disease (COPD) in the US - Evidence from the Medical Expenditure Panel Survey (MEPS) from 2016-2019.

Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with reduced life expectancy, increased morbidity, mortality, and cost. This study characterized the US COPD burden, including socioeconomic and health-related quality of life (HRQoL) outcomes. In this retrospective, cross-sectional study using nationally representative estimates from Medical Expenditures Survey (MEPS) data (2016-2019), adults (≥18 years) living with and without COPD were identified. Adults living without COPD (control cohort) and with COPD were matched 5:1 on age, sex, geographic region, and entry year. Demographics, clinical characteristics, socioeconomic, and generic HRQoL measures were examined to include a race-stratified analysis of people living with COPD. A total of 4,135 people living with COPD were identified; the matched dataset represented a weighted non-institutionalized population of 11.3 million with and 54.2 million people without COPD. Among people living with COPD, 66.3% had ≥1 COPD-related condition; 62.7% had ≥1 cardiovascular condition, compared to 33.5% and 50.5% without COPD. More people living with COPD were unemployed (56.2% vs 45.3%), unable to work due to illness/disability (30.1% vs 12.1%), had problems paying bills (16.1% vs 8.8%), reported poorer perceived health (fair/poor: 36.2% vs 14.4%), missed more working days due to illness/injury per year (median, 2.5 days vs 0.0 days), and had limitations in physical functioning (40.1% vs 19.4%) (all P<0.0001). In race-stratified analyses for people living with COPD, people self-reporting as Black had higher prevalence of cardiovascular-risk conditions, poorer socioeconomic and HRQoL outcomes, and higher healthcare expenses than White or Other races. Adults living with COPD had higher clinical disease burden, lower socioeconomic status, and reduced HRQoL than those without, with greater disparities among Black people living with COPD compared to White and other races. Understanding the characteristics of patients helps address care disparities and access challenges.

Longitudinal examination of cognitive function in older adults after the death of a child

This study examined the relationship between the death of a child and cognitive function, considering how this association varies with the timing and number of losses. Utilizing four waves of the China Health and Retirement Longitudinal Study, linear mixed models assessed the impact of child loss on cognition, while mediation analysis was conducted using the Karlson-Holm-Breen method. Findings indicate a detrimental effect of child loss on cognitive function, particularly for losses occurring before age 30 and after age 60. A dose-response relationship was noted, suggesting greater cognitive decline with increasing instances of child loss. Mediation analysis revealed that psychological distress, physical functioning limitations, and social engagement partly explain this link. Moreover, the negative effect was more significant in mothers. These insights underscore the need for targeted support and cognitive monitoring for bereaved parents.

Quality of Life in Females with PCOS

The study aimed to assess the quality of life in females with Polycystic Ovarian Syndrome(PCOS) and identify the domains or health factor which most significantly impacted by this condition. This study involved 40 unmarried females diagnosed with PCOS. After completing demographic formalities, participants filled out the self-administered Polycystic ovarian syndrome quality of life (PCOSQOL) questionnaire, followed by the SF36 generic health quality of life measuring scale. The findings from the PCOSQOL questionnaire revealed that menstrual problems had the lowest mean score, while infertility issues had the highest mean score. Additionally, the SF36 results showed that emotional well-being and energy fatigue had the lowest scores, whereas role limitations in social and physical functioning had the highest scores. In conclusion, this study found that PCOS significantly diminishes the quality of life in affected females, particularly due to menstrual problems and emotional well-being.

Exploring previously used thresholds for computed tomography-defined low skeletal muscle mass in predicting functional limitations among lung cancer patients.

Various cutoffs have been used to diagnose computed tomography (CT)-defined low skeletal muscle mass; however, the impact of this variability on predicting physical functional limitations (PFL) remains unclear. In the present study we aimed to evaluate the diagnostic test metrics for predicting PFLs using a fixed cutoff value from previous reports and sought to create a prediction score that incorporated the skeletal muscle index (SMI) and other clinical factors. In this cross-sectional study including 237 patients with lung cancer, the SMI was assessed using CT-determined skeletal muscle area at the third lumbar vertebra. Physical function was assessed using the short physical performance battery (SPPB) test, with PFL defined as an SPPB score ≤9. We analyzed the diagnostic metrics of the five previous cutoffs for CT-defined low skeletal muscle mass in predicting PFL. The mean age of participants was 66.0 ± 10.4 years. Out of 237 patients, 158 (66.7%) had PFLs. A significant difference was observed in SMI between individuals with and without PFLs (35.7 cm2/m2 ± 7.8 vs. 39.5 cm2/m2 ± 8.4, p < 0.001). Diagnostic metrics of previous cutoffs in predicting PFL showed suboptimal sensitivity (63.29%-91.77%), specificity (11.39%-50.63%), and area under the receiver operating characteristic curve (AUC) values (0.516-0.592). Age and the SMI were significant predictors of PFL; therefore, a score for predicting PFL (age - SMI + 21) was constructed, which achieved an AUC value of 0.748. Fixed cutoffs for CT-defined low skeletal muscle mass may inadequately predict PFLs, potentially overlooking declining physical functions in patients with lung cancer.

Iron supplementation in patients with chronic inflammatory bowel disease: recommendations for a practical approach

Iron deficiency is the predominant cause of anemia. Iron deficiency anemia plays a major role, especially in patients with inflammatory bowel disease (IBD), and is the most common extraintestinal manifestation and IBD-associated systemic complication. The presence of anemia leads to a reduction in quality of life in patients with IBD associated with limitations in physical, emotional, and cognitive function. In addition, it is associated with an increased hospitalization rate. For this reason, iron supplementation is of particular importance. Oral and intravenous iron supplements are used to treat iron deficiency. Due to the lack of absorption and gastrointestinal side effects of oral substitution, intravenous supplementation is becoming increasingly important. However, there are still certain concerns about intravenous administration.With the help of this review, we want to address the topic of iron substitution in patients with IBD, summarize current guideline recommendations, and provide a practical approach.

Sex differences in osteoarthritis prevalence, pain perception, physical function and therapeutics

ObjectiveWomen have a higher prevalence of osteoarthritis (OA) and worse clinical courses than men. However, the underlying factors and therapeutic outcomes of these sex-specific differences are incompletely researched. This review examines the current state of knowledge regarding sex differences in OA prevalence, risk factors, pain severity, functional outcomes, and use and response to therapeutics. MethodsPubMed database was used with the title keyword combinations “{gender OR sex} AND osteoarthritis” plus additional manual search of the included papers for pertinent references, yielding 212 references. Additional references were added and 343 that were reviewed for appropriateness. ResultsGlobally, women account for 60% of people with osteoarthritis with a greater difference after age 40. The higher risk for women may be due to differences in joint anatomy, alignment, muscle strength, hormonal influences, obesity, and/or genetics. At the same radiographic severity, women have greater pain severity than men, which may be explained by biologically distinct pain pathways, differential activation of central pain pathways, differences in pain sensitivity, perception, reporting, and coping strategies. Women have greater limitations of physical function and performance than men independent of BMI, OA severity, injury history, amount of weekly exercise. Women also have greater use of analgesic medications than men but less use of arthroplasty and poorer prognosis after surgical interventions. ConclusionsThe recognition of sex differences in OA manifestations and management could guide tailoring of sex-specific treatment protocols, and analysis of sex as a biological variable in future research would enhance development of precision medicine.

Physical Functional Impairment in Breast Cancer Patients: A Cross-Sectional Expert Survey.

Anti-cancer treatment imparts a variety of physical impairments that cause limitations in physical functioning among women with breast cancer. The aim of the study was to explore the opinions of healthcare professionals (HCPs) working with breast cancer patients on various aspects of physical functional impairments in breast cancer patients and survivors (BCP&S). The study was a cross-sectional survey. Taking into consideration the literature definition of 'physical function', its determinants, and literature published on relevant clinical factors in breast cancer, a survey questionnaire containing 29 questions was constructed. Thirty-seven HCPs, including physiotherapists, occupational therapists, and medical cancer experts, participated in the study. The participant's responses were obtained using a 5-point 'Agreement' Likert scale. Data analysis included a frequency table and the reliability test (Cronbach's alpha). The reliability of the questionnaire used in the survey was found to be acceptable (Cronbach's alpha = 0.891). The majority of the participants were of the opinion that various parameters and determinants of 'physical function' get adversely affected in BCP&S, leading to limitations in the performance of activities of daily living (e.g., dressing and bathing), particularly in elderly and frail women. Participants agreed that such impairments in physical functioning affect social and role functioning and the overall quality of life (QoL) of women with breast cancer negatively. This study found that various parameters and determinants of physical functioning are adversely affected in BCP&S, and physical functional impairments are prevalent in women with breast cancer, affecting their QoL negatively. Implications for breast cancer patients: This study points out the need for long-term surveillance of BCP&S for physical functional limitations and a proactive treatment approach to prevent such limitations.

Spousal collaboration mediates the relation between self-rated health and depressive symptoms of Chinese older couples: an actor-partner interdependence approach

BackgroundDyadic coping resources have been considered a potential explanatory mechanism of spousal interdependence in health, but the mediation of spousal collaboration for the relationship between self-rated health and depressive symptoms has yet to be examined. This study aimed to investigate the within- (actor effect) and between-partner effects of self-rated health on depressive symptoms in community-dwelling older couples facing physical functioning limitations and to examine the role of spousal collaboration in mediating the actor and cross-partner effects of self-rated health on depressive symptoms.MethodData from 185 community-dwelling older Chinese married couples were analyzed using the actor–partner interdependence mediation model (APIMeM). Couples were interviewed through trained research assistants using the 5-item common dyadic coping subscale of the Dyadic Coping Inventory (DCI), the Visual Analog Scale (VAS) of the QoL questionnaire EQ-5D and the Patient Health Questionnaire-9 (PHQ‐9).ResultsHusbands’ self-rated health had an actor effect on their own depressive symptoms and a partner effect on their wives’ depressive symptoms. Wives’ self-rated health had an actor effect on their own depressive symptoms. The actor effects between self-rated health and depressive symptoms were partially mediated by their own perception of spousal collaboration. Furthermore, husbands’ self-rated health not only affects wives’ depressive symptoms directly but also indirectly by influencing wives’ perceptions of spousal collaboration.DiscussionThe findings from this study underscored the importance of viewing couples’ coping processes from a dyadic and gender-specific perspective, since more (perceived) collaborative efforts have beneficial effects on both partners’ mental health outcomes.

Proses Penanganan Kasus Kekerasan Seksual Pada Anak Berkebutuhan Khusus di Unit Pelaksana Teknis Daerah Perlindungan Perempuan dan Anak (UPTD PPA) Kota Medan

Children with Special Needs are those with limitations in intellectual, mental, physical, social, or emotional functioning. Individuals with disabilities are at a high risk of experiencing sexual violence due to social isolation, limited sexual education, dependence on others for intimate hygiene, reduced physical defenses, and communication barriers hindering the disclosure of abuse. The implementation of child protection is crucial to ensure that all children are nurtured and raised in a supportive environment that meets their basic rights in terms of physical, psychological, and social needs, enabling them to grow and develop optimally while protecting them from various forms violence. UPTD PPA Kota Medan is one of the organizations providing protection for women and children experiencing violence and discrimination, established by the local government. The aim of this research is to understand the process of handling cases of sexual violence against children with special needs at UPTD PPA Kota Medan. This qualitative descriptive study employs data collection techniques such as in-depth interviews, literature review, and documentation with a triangulation approach. The collected data are qualitatively analyzed by the researcher, and the study concludes with findings drawn from the research results. The research reveals that handling of cases involving children with special needs comprises three stages: the initial stage involving case reporting, case outreach, and case identification; the middle stage involving obtaining informed consent, interviews and screening, as well as victim needs assessment; and the final stage involving the provision of necessary services such as legal assistance, healthcare support, and psychological support.

Sleep problem and its association with physical activity and functional limitation: Brazilian national health survey

ObjectivesTo evaluate the association of sleep problems with physical activity and functional limitations in Basic Activities of Daily Living (BADL) in non-institutionalized Brazilian older adults and to investigate if there is a moderating effect of functional limitations in the association between physical activity and sleep problems. MethodThis was a cross-sectional study of 22,728 older adults aged 60 or older interviewed in the National Health Survey in 2019. The outcome variable was self-reported sleep problems. The independent variables of interest were the practice of physical activity and functional limitations in BADL. The association between the independent variables and the outcome was assessed using logistic regression models adjusted for covariates. ResultsThe prevalence of sleep problems was 24.8% (95% CI 23.8–25.8). Physically active individuals were less likely to have sleep problems (OR 0.85; 95% CI 0.72–0.99), while those with functional limitations in BADL (OR 2.10; 95% CI 1.77–2.49) were more likely to have sleep problems, after adjustment for covariates. There was a significant interaction between physical activities and functional limitations in BADL. ConclusionsThe prevalence of sleep problems in the Brazilian older adults was associated with physical activity and functional limitations in BADL. Physical activity is associated with lower odds of sleep problems among older adults with functional limitations in BADL.

Patient Risk-Benefit Preferences for Transcatheter Versus Surgical Mitral Valve Repair.

Transcatheter edge-to-edge repair (TEER) of mitral regurgitation is less invasive than surgery but has greater 5-year mortality and reintervention risks, and leads to smaller improvements in physical functioning. The study objective was to quantify patient preferences for risk-benefit trade-offs associated with TEER and surgery. A discrete choice experiment survey was administered to patients with mitral regurgitation. Attributes included procedure type; 30-day mortality risk; 5-year mortality risk and physical functioning for 5 years; number of hospitalizations in the next 5 years; and risk of additional surgery in the next 5 years. A mixed-logit regression model was fit to estimate preference weights. Two hundred one individuals completed the survey: 63% were female and mean age was 74 years. On average, respondents preferred TEER over surgery. To undergo a less invasive procedure (ie, TEER), respondents would accept up to a 13.3% (95% CI, 8.7%-18.5%) increase in reintervention risk above a baseline of 10%, 4.6 (95% CI, 3.1-6.2) more hospitalizations above a baseline of 1, a 10.7% (95% CI, 6.5%-14.5%) increase in 5-year mortality risk above a baseline of 20%, or more limited physical functioning representing nearly 1 New York Heart Association class (0.7 [95% CI, 0.4-1.1]) over 5 years. Patients in general preferred TEER over surgery. When holding constant all other factors, a functional improvement from New York Heart Association class III to class I maintained over 5 years would be needed, on average, for patients to prefer surgery over TEER.

Association of cancer diagnosis with disability status among older survivors of colorectal cancer: a population-based retrospective cohort study.

Older cancer survivors likely experience physical function limitations due to cancer and its treatments, leading to disability and early mortality. Existing studies have focused on factors associated with surgical complications and mortality risk rather than factors associated with the development of poor disability status (DS), a proxy measure of poor performance status, in cancer survivors. We aimed to identify factors associated with the development of poor DS among older survivors of colorectal cancer (CRC) and compare poor DS rates to an age-sex-matched, non-cancer cohort. This retrospective cohort study utilized administrative data from the Texas Cancer Registry Medicare-linked database. The study cohort consisted of 13,229 survivors of CRC diagnosed between 2005 and 2013 and an age-sex-matched, non-cancer cohort of 13,225 beneficiaries. The primary outcome was poor DS, determined by Davidoff's method, using predictors from 12 months of Medicare claims after cancer diagnosis. Multivariable Cox proportional hazards regression was used to identify risk factors associated with the development of poor DS. Among the survivors of CRC, 97% were 65 years or older. After a 9-year follow-up, 54% of survivors of CRC developed poor DS. Significant factors associated with future poor DS included: age at diagnosis (hazard ratio [HR] = 3.50 for >80 years old), female sex (HR = 1.50), race/ethnicity (HR = 1.34 for Hispanic and 1.21 for Black), stage at diagnosis (HR = 2.26 for distant metastasis), comorbidity index (HR = 2.18 for >1), and radiation therapy (HR = 1.21). Having cancer (HR = 1.07) was significantly associated with developing poor DS in the pooled cohorts; age and race/ethnicity were also significant factors. Our findings suggest that a CRC diagnosis is independently associated with a small increase in the risk of developing poor DS after accounting for other known factors. The study identified risk factors for developing poor DS in CRC survivors, including Hispanic and Black race/ethnicity, age, sex, histologic stage, and comorbidities. These findings underscore the importance of consistent physical function assessments, particularly among subsets of older survivors of CRC who are at higher risk of disability, to prevent developing poor DS.

Identifying risk factors for developing obesity: a record linkage longitudinal study in metropolitan Sydney using the 45 and Up Study.

Primary care clinicians have key responsibilities in obesity prevention and weight management. We aimed to identify risk factors for developing obesity among people aged ≥45 years. We conducted a record linkage longitudinal study of residents of metropolitan Sydney, Australia using data from the: (1) 45 and Up Study at baseline (2005-2009) and first follow-up (2012-2015); (2) Medicare claims; (3) Pharmaceutical Benefits Scheme; and (4) deaths registry. We examined risk factors for developing obesity (body mass index [BMI]: 30-40) at follow-up, separately for people within the: (1) healthy weight range (BMI 18.5-<25) and (2) overweight range (BMI 25-<30) at baseline. Covariates included demographics, modifiable behaviours, health status, allied health use, and medication use. Crude and adjusted relative risks were estimated using Poisson regression modelling. At follow-up, 1.1% (180/16,205) of those in the healthy weight range group, and 12.7% (1,939/15,266) of those in the overweight range group developed obesity. In both groups, the following were associated with developing obesity: current smoking at baseline, physical functioning limitations, and allied health service use through team care planning, while any alcohol consumption and adequate physical activity were found to be associated with a lower risk of developing obesity. In the healthy weight group, high psychological distress and the use of antiepileptics were associated with developing obesity. In the overweight group, female sex and full-time work were associated with developing obesity, while older age was found to be associated with a lower risk of developing obesity. These findings may inform the targeting of preventive interventions for obesity in clinical practice and broader public health programs.

Open-label, single-center, clinical study evaluating the safety, tolerability and clinical effects of pentosan polysulfate sodium in subjects with mucopolysaccharidosis I.

Lysosomal enzyme deficiency in mucopolysaccharidosis (MPS) I results in glycosaminoglycan (GAG) accumulation leading to pain and limited physical function. Disease-modifying treatments for MPS I, enzyme replacement, and hematopoietic stem cell therapy (HSCT), do not completely resolve MPS I symptoms, particularly skeletal manifestations. The GAG reduction, anti-inflammatory, analgesic, and tissue remodeling properties of pentosan polysulfate sodium (PPS) may provide disease-modifying treatment for musculoskeletal symptoms and joint inflammation in MPS I following ERT and/or HSCT. The safety and efficacy of PPS were evaluated in four subjects with MPS I aged 14-19 years, previously treated with ERT and/or HSCT. Subjects received doses of 0.75 mg/kg or 1.5 mg/kg PPS via subcutaneous injections weekly for 12 weeks, then every 2 weeks for up to 72 weeks. PPS was well tolerated at both doses with no serious adverse events. MPS I GAG fragment (UA-HNAc [1S]) levels decreased at 73 weeks. Cartilage degradation biomarkers serum C-telopeptide of crosslinked collagen (CTX) type I (CTX-I) and type II (CTX-II) and urine CTX-II decreased in all subjects through 73 weeks. PROMIS scores for pain interference, pain behavior, and fatigue decreased in all subjects through 73 weeks. Physical function, measured by walking distance and dominant hand function, improved at 49 and 73 weeks. Decreased GAG fragments and cartilage degradation biomarkers, and positive PROMIS outcomes support continued study of PPS as a potential disease-modifying treatment for MPS I with improved pain and function outcomes.

Glyphosate exposure, muscular health and functional limitations in middle-aged and older adults

BackgroundGlyphosate is the most widely used herbicide worldwide, both in domestic and industrial settings. Experimental research in animal models has demonstrated changes in muscle physiology and reduced contractile strength associated with glyphosate exposure, while epidemiological studies have shown associations between glyphosate exposure and adverse health outcomes in critical biological systems affecting muscle function. MethodsThis study used data from a nationally representative survey of the non-institutionalized U.S. general population (NHANES, n = 2132). Urine glyphosate concentrations were determined by ion chromatography with tandem mass spectrometry. Hand grip strength (HGS) was measured using a Takei Dynamometer, and relative strength estimated as the ratio between HGS in the dominant hand and the appendicular lean mass (ALM) to body mass index (ALMBMI) ratio. Low HGS and low relative HGS were defined as 1 sex-, age- and race-specific SD below the mean. Physical function limitations were identified as significant difficulty or incapacity in various activities. ResultsIn fully-adjusted models, the Mean Differences (MD) and 95% confidence intervals [95%CI] per doubling increase in glyphosate concentrations were −0.55 [-1.09, −0.01] kg for HGS in the dominant hand, and −0.90 [-1.58. −0.21] kg for HGS/ALMBMI. The Odds Ratios (OR) [95% CI] for low HGS, low relative HGS and functional limitations by glyphosate concentrations were 1.27 [1.03, 1.57] for low HGS; 1.43 [1.05; 1.94] for low relative HGS; 1.33 [1.08, 1.63] for stooping, crouching or kneeling difficulty; 1.17 [0.91, 1.50] for lifting or carrying items weighting up to 10 pounds difficulty; 1.21 [1.01, 1.40] for standing up from armless chair difficulty; and 1.47 [1.05, 2.29] for ascending ten steps without pause difficulty. ConclusionsGlyphosate exposure may be a risk factor for decreased grip strength and increased physical functional limitations. More studies investigating the influence of this and other environmental pollutants on functional aging are needed.

Associations Between Patterns of Daily Stepping Behavior, Health-Related Quality of Life, and Pain Symptoms Among Older Adults with Chronic Pain: A Secondary Analysis of Two Randomized Controlled Trials.

One's amount, intensity, and distribution of physical activity may have implications for whether it has positive or negative effects on pain and quality of life for older adults living with chronic pain. Thus, we investigated baseline patterns of stepping related to pain symptoms and health-related quality of life at baseline and over a 12-week follow-up period. Participants were low-active older adults (69.54±6.74 years) with obesity and chronic pain who enrolled in one of two randomized controlled trials. Participants completed measures of pain intensity, interference, and health-related quality of life and wore an accelerometer for 7 days at baseline and week 12. Functional principal components analysis identified patterns of within-day stepping behavior at baseline, and linear regressions were used to investigate how these component scores related to pain and health-related quality of life at baseline and over 12 weeks. Two patterns were extracted; one describing more vs less stepping and the second capturing movement later vs earlier in the day. More baseline stepping was associated with better physical functioning (B=0.148, p<0.001) and energy (B=0.073, p=0.033), while a later start in the day was associated with worse social functioning (B=-0.193, p=0.031). More stepping at baseline predicted positive changes in physical functioning (B=0.094, p=0.019), emotional role limitations (B=0.132, p=0.049), energy (B=0.112, p<0.001), social functioning (B=0.086, p=0.043), pain (B=0.086, p=0.009), general health (B=0.081, p=0.003) and pain intensity (B=-0.039, p=0.003). A later start to the day was associated with worsening physical functioning (B=-0.229, p<0.001), physical (B=-0.282, p=0.047) and emotional role limitations (B=-0.254, p=0.048), general health (B=-0.108, p=0.041), and pain interference (B=0.055, p=0.043). Findings suggest there is value in activity patterns as an indicator for additional behavioral intervention, as those who move little and/or delay daily movement are likely to experience subsequent decrements in quality of life and pain symptoms.