Physical Inability Research Articles

The impact of cancer diagnosis on employment status in a working population

The aim of this study was to investigate the status of return to work and the influencing factors in patients with common cancers referring to three medical centers during the years 2020 to 2022. Material and Methods. In the present study (a retrospective cohort), all patients who visited three medical centers during the years 2020–2022 and were diagnosed with common cancers (non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, gastrointestinal cancers and sarcoma), were included in the study. Work ability index (WAI) was assessed based on selected questions from the WAI questionnaire. Hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety, and Multidimensional Fatigue Inventory (MFI-20) was used to assess the level of fatigue. Then, the data obtained from individuals who returned to work were compared with those who did not return. Results. Out of 750 eligible patients, 135 individuals were enrolled in the study. 114 patients were male (84.4 %). The mean age of individuals was 50.2 ± 10.4 years. The most of individuals were diagnosed with gastric cancer (n=66, 48.9 %). After treatment, 36 (26.7 %) individuals returned to work, with the majority (24 individuals: 66.6 %) reporting a decrease in physical ability to do work. Sixty-six (73.3 %) patients did not return to work, with the most common reason being physical inability to work in 60 (66.6 %) individuals. Higher quality of life score was reported in individuals who returned to work. Conclusion. The rate of return to work was approximately 27 %. The return to work rate was highest among individuals with non-Hodgkin’s lymphoma and lowest among individuals with oesophageal cancer and Hodgkin’s lymphoma. The most influential factors affecting the return to work include disease recurrence and quality of life.

Deep Learning based Brain Stroke Detection using Improved VGGNet

Brain stroke is one of the critical health issues as the after effects provides physical inability and sometimes death. The inability of focus in the brain due to bleeding or clogged blood vessels leads to stroke. Early treatment and diagnosis are crucial in and following manual procedures takes more time which further increases the criticalness. Artificial intelligence and machine learning techniques hands together in medical domain and numerous applications are developed to reduce the diagnosis time and to improve the accuracy. Incorporating machine learning techniques in brain stroke detection is a familiar research arena and numerous research works are evolved with better solutions. However, the drive towards developing better system for brain stroke detection is still in progress. Thus, in this research work, deep learning-based brain stroke detection system is presented using improved VGGNet. Simulation analysis using a set of brain stroke data and the performance of learning algorithms are measured in terms of accuracy, sensitivity, specificity, precision, f-measure, and Jaccard index. The better performance of proposed model is comparatively analyzed with traditional machine learning algorithms like support vector machine, Naïve Bayes, Decision tree, K-Nearest neighbor, and recent deep learning models like ResNet, Squeeze Net, Alex Net, and Google Net algorithms. Experimental results validates that the Improved VGG model attained better performance for all the parameters. Specifically with 96.86% of detection accuracy improved VGG model detects the brain strokes effectively compared to other learning algorithms.

Physical inability rather than depression and cognitive impairment had negative effect on centenarian prognosis: A prospective study with 5-year follow-up

AimScarce study has involved the effects of physical inability, depression and cognitive impairment on the prognosis of older individuals, especially in Chinese centenarians. This prospective study was designed to investigate the effects with 5-year follow-up in Chinese centenarians. MethodsAccording to the list of centenarians provided by Department of Civil Affairs, an household survey was conducted on all centenarians residing in 18 cities and counties of Hainan province. A total of 423 centenarians were followed up, including 84 survival centenarians and 261 dead centenarians, with 78 cases lost to follow-up. ResultsDead centenarians had less females and more physical inability than survival centenarians (P < 0.05 for all). Univariable Cox regression analyses indicated that physical inability [EXP(B): 2.038, 95 % confidence interval (CI): 1.413–2.939], urea nitrogen [EXP(B): 1.116, 95 % CI: 1.039–1.199], and creatinine [EXP(B): 1.006, 95 % CI: 1.001–1.012] had negative effects on the prognosis of centenarians (all P < 0.05). Gender [EXP(B): 0.606, 95 % CI: 0.391–1.940] and albumin [EXP(B): 0.939, 95 % CI: 0.896–0.985] had positive effects on the prognosis of centenarians (all P < 0.05). Multivariable Cox regression analysis indicated that physical inability [EXP(B): 2.148, 95 % CI: 1.454–3.173] and urea nitrogen [EXP(B): 1.114, 95 % CI: 1.020–1.216] had negative effects on the prognosis of centenarians (all P < 0.05). ConclusionsFor Chinese centenarians, this prospective study demonstrated that physical inability rather than depression and cognitive impairment had negative effect on the long-term mortality rate and survival time. This result suggested that in order to improve the prognosis of older adults, it could be mainly achieved by improving physical ability.

Advances in the pathogenesis of Alzheimer’s disease: A re-evaluation of the Amyloid cascade hypothesis

Alzheimer's disease (AD), the most common cause of dementia in the elderly is a common neurodegenerative disease characterized clinically by progressive memory deterioration. The disease becomes clinically obvious as an insidious higher intellectual function impairment with altered mood and behavior, dramatic personality changes, disorientation, declining physical coordination and inability to care for themselves. Histopathological changes including extracellular deposits of amyloid-beta (A-beta) peptides forming senile plaques (SP) and intracellular neurofibrillary tangles (NFT) of hyperphosphorylated tau in the brain. During final stages, victims are bedridden, urinary and bowel function controls may be lost with epileptic attacks. Death is usually due to pneumonia, bedsores or secondary urinary tract infections. These manifestations may indicate severe cortical dis-function. In 5-10 year time, affected individual becomes profoundly disabled, mute and immobile. Death may ensue within an average of 8 years of diagnosis, the last 3 of which are typically spent in institutions. AD is the number one cause of institutionalization in United States of America. An appraisal of the advances in pathogenesis of Alzheimer’s disease will be helpful in updating our knowledge on possible etiologies and desired advancements in therapies, clinical care and entire management. Secondly, with the rising cases of AD in tropical regions of the world and coupled with the significant scarcity of literature on Alzheimer’s Disease, the need for this compendium becomes obviously necessary, hence we chose to write. This very review derives from focused overview of pathophysiologies and management of AD. Literature searches were sourced from PubMed, Science Direct, Scopus and Google Scholar.

Postmarketing Follow-Up of a Digital Home Exercise Program for Back, Hip, and Knee Pain: Retrospective Observational Study With a Time-Series and Matched-Pair Analysis.

Musculoskeletal conditions are the main drivers of global disease burden and cause significant direct and indirect health care costs. Digital health applications improve the availability of and access to adequate care. The German health care system established a pathway for the approval of "Digitale Gesundheitsanwendungen" (DiGAs; Digital Health Applications) as collectively funded medical services through the "Digitale-Versorgung-Gesetz" (Digital Health Care Act) in 2019. This article presents real-world prescription data collected through the smartphone-based home exercise program "Vivira," a fully approved DiGA, regarding its effect on self-reported pain intensity and physical inability in patients with unspecific and degenerative pain in the back, hip, and knee. This study included 3629 patients (71.8% [2607/3629] female; mean age 47 years, SD 14.2 years). The primary outcome was the self-reported pain score, which was assessed with a verbal numerical rating scale. The secondary outcomes were self-reported function scores. To analyze the primary outcome, we used a 2-sided Skillings-Mack test. For function scores, a time analysis was not feasible; therefore, we calculated matched pairs using the Wilcoxon signed-rank test. Our results showed significant reductions in self-reported pain intensity after 2, 4, 8, and 12 weeks in the Skillings-Mack test (T3628=5308;P<.001). The changes were within the range of a clinically relevant improvement. Function scores showed a generally positive yet more variable response across the pain areas (back, hip, and knee). This study presents postmarketing observational data from one of the first DiGAs for unspecific and degenerative musculoskeletal pain. We noted significant improvements in self-reported pain intensity throughout the observation period of 12 weeks, which reached clinical relevance. Additionally, we identified a complex response pattern of the function scores assessed. Lastly, we highlighted the challenges of relevant attrition at follow-up and the potential opportunities for evaluating digital health applications. Although our findings do not have confirmatory power, they illustrate the potential benefits of digital health applications to improve the availability of and access to medical care. German Clinical Trials Register DRKS00024051; https://drks.de/search/en/trial/DRKS00024051.

Improving Oral Hygiene Maintenance Through Teacher Empowerment to Reduce the Debris Index of Children with Disabilities

The prevalence of disability continues to increase. In 2003 there were 0.9% of all children in Indonesia with disabilities, in 2006 there were 1.38% of all children in Indonesia with disabilities and the peak in 2012 was 2.45% of all children in Indonesia. Children with disabilities are vulnerable and prone to exposure to diseases and threats. According to the 2011 Social Protection Programme (PPLS), there were 32,990 children with disabilities from poor families. Disability is defined as the physical inability of the body to perform normal bodily functions. Teacher empowerment is very important because through teacher empowerment, teachers will gain new knowledge, new ideas in achieving the learning process. Through teacher empowerment activities on the importance of maintaining oral hygiene in students with disabilities will motivate teachers to further increase the importance of maintaining oral hygiene in students with disabilities. This study is to analyse the effect of improving oral hygiene maintenance through teacher empowerment on reducing the debris index of children with disabilities. The type of research used is Analytical Quasi Experiment. The targets in the study were all SLB D/YPAC teachers. Data collection methods using questionnaires and observation. Data analysis technique using chi square statistical test. The results of the study showed that there was an effect of knowledge and attitude of maintaining oral hygiene through teacher empowerment on reducing the debris index of children in SLB-D YPAC Surabaya.

Describing epilepsy-related anxiety to inform the design of a virtual reality exposure therapy: Results from Phase 1 of the AnxEpiVR clinical trial.

People with epilepsy (PwE) are at a greater risk of comorbid anxiety, which is often related to the fear of having another seizure for safety or social reasons. While virtual reality (VR) exposure therapy (ET) has been successfully used to treat several anxiety disorders, no studies to date have investigated its use in this population. This paper discusses Phase 1 of the three-phase AnxEpiVR pilot study. In Phase 1, we aimed to explore and validate scenarios that provoke epilepsy/seizure-specific (ES) interictal anxiety and provide recommendations that lay the foundation for designing VR-ET scenarios to treat this condition in PwE. An anonymous online questionnaire (including open- and closed-ended questions) that targeted PwE and those affected by it (e.g., through a family member, friend, or as a healthcare professional) was promoted by a major epilepsy foundation in Toronto, Canada. Responses from n=18 participants were analyzed using grounded theory and the constant comparison method. Participants described anxiety-provoking scenes, which were categorized under the following themes: location, social setting, situational, activity, physiological, and previous seizure. While scenes tied to previous seizures were typically highly personalized and idiosyncratic, public settings and social situations were commonly reported fears. Factors consistently found to increase ES-interictal anxiety included the potential for danger (physical injury or inability to get help), social factors (increased number of unfamiliar people, social pressures), and specific triggers (stress, sensory, physiological, and medication-related). We make recommendations for incorporating different combinations of anxiety-related factors to achieve a customizable selection of graded exposure scenarios suitable for VR-ET. Subsequent phases of this study will include creating a set of VR-ET hierarchies (Phase 2) and rigorously evaluating their feasibility and effectiveness (Phase 3).

Effects of Tourniquet Features on Application Processes.

We investigated emergency-use limb tourniquet design features effects on application processes (this paper) and times to complete those processes (companion paper). Sixty-four appliers watched training videos and then each applied all eight tourniquets: Combat Application Tourniquet Generation 7 (CAT7), SOF™ Tactical Tourniquet-Wide Generation 3 (SOFTTW3), SOF™ Tactical Tourniquet-Wide Generation 5 (SOFTTW5), Tactical Mechanical Tourniquet (TMT), OMNA Marine Tourniquet (OMT), X8T tourniquet (X8T), Tactical Ratcheting Medical Tourniquet (Tac RMT), and RapidStop™ Tourniquet (RST). Application processes were scored from videos. Thirty-three appliers had no prior tourniquet experience. All 512 applications were placed proximal to the recipient's simulated distal thigh injury. Thirty-one appliers (13 with no experience) had 66 problem-free applications (18 by no experience appliers). Tightening-system mechanical problems were more frequent with windlass rod systems (26 losing hold of the rod, 27 redoing rod turns, and 58 struggling to secure the rod) versus ratchet systems (3 tooth skips and 16 advance failures). Thirty-five appliers (21 with no experience) had 68 applications (45 by no experience appliers) with an audible Doppler pulse when stating "Done"; causes involved premature stopping (53), inadequate strap pull (1 SOFTTW3, 1 RST), strap/redirect understanding problem (1 SOFTTW5, 1 X8T, 4 Tac RMT, 1 RST), tightening-system understanding problem (2 CAT7, 1 SOFTTW3, 1 TMT, 1 RST), and physical inability to secure (1 SOFTTW3). Fifty-three appliers (32 no experience) had 109 applications (64 by no experience appliers) not correctly secured. Six involved strap/redirect understanding problems: 4 Tac RMT, 1 X8T, 1 SOFTTW5; 103 involved improper securing of non-self-securing design features: 47 CAT7 (8 strap, 45 rod), 31 TMT (17 strap, 19 rod), 22 OMT (strap), and 3 SOFTTW3 (rod). Self-securing systems have process advantages. Because most emergent tourniquet recipients require transport, we believe tourniquet security is a critical design aspect. Decisions regarding tourniquet choices may become very different when both occlusion and tourniquet security are considered.

Economic and social inclusion of person with disability and transgender through skills development program of BRAC: A qualitative study

AbstractThis article is based on the Skills Training for Advancing Resources (STAR) project for the youth initiative of the Bangladesh Rural Advancement Committee (BRAC) in Bangladesh. The objective was to explore the consequences of social and economic inclusion of this project for the persons with disability (PWDs) and transgender (TG) youth people. The research focused on how inclusive programmatic interventions created multidimensional impacts among the “marginalized” and “excluded” PWD and TG youths at the grassroots level. This study adopted a qualitative approach where in‐depth case interviews and observation were applied for data collection. PWD and TG graduates, master craft persons (MCPs), employers, and program staff members were the participants in this study. Results found that PWD and TG youths faced vulnerabilities and social stigma in their lives and livelihood trajectories due to their physical inability and low level of social dignity. The STAR project has a certain level of contribution to the livelihoods of PWD and TG people, where these helped them to gain their social, cultural, and economic capital. Findings would be an important guideline for policymakers, NGO managers, and human rights workers.

Artificial Neural Networks and Its Applications in Chemical Industry

Artificial neural networks, as an important part of artificial intelligence, have a wide scope of development to improve the traditional production technology of chemical processes with its inherent advantages of parallel structure and parallel processing, fault tolerance, full approximation of any complex nonlinear relationships, learnability and self-adaptability, etc. Thus, it has a wide scope of development to improve the problems of lagging diagnosis, difficult to optimize control, large errors in physical property estimation and inability to deal with nonlinear complex situations. This paper summarizes the theory of artificial neural network, including its structure and characteristics, and introduces its applications in different fields, especially in chemical industry.

Clinical Validation of a Smartphone-based Handheld ECG Device: A Validation Study.

Remote cardiac monitoring and screening have already become an integral telemedicine component. The wide usage of several different wireless electrocardiography (ECG) devices warrants a validation study on their accuracy and reliability. Totally, 300 inpatients with the Nabz Hooshmand-1 handheld ECG device and the GE MAC 1200 ECG system (as the reference) were studied to check the accuracy of the devices in 1 and 6-limb lead performance. Simultaneous 10-second resting ECGs were assessed for the most common ECG parameters in lead I. Afterward, 6-lead ECGs (limb leads), were performed immediately and studied for their morphologies. Of the 300 patients, 297 had acceptable ECG quality in both devices for simultaneous lead I ECGs. The ECGs were inspected on-screen by a cardiologist for their rhythms, rates, axes, numbers, morphologies of premature atrial and ventricular beats, morphologies and amplitudes of PQRST waves, P-wave durations, QRS-wave durations, P-R intervals, and QT intervals. No significant differences were detected between the devices, and no major abnormalities were missed. Six-limb lead ECGs were obtained in 284 patients, of whom 281 had acceptable quality in ECGs by both devices. The morphology matching evaluation of the ECGs demonstrated an overall 98% compatibility rate, with the highest compatibility in lead I and the lowest in lead augmented vector foot. The diagnosis of critical pathological rhythms, including atrial fibrillation and high-grade atrioventricular node block, was not missed by the Nabz Hooshmand-1 and GE MAC 1200 ECG devices. Accordingly, rhythm detection as the primary purpose of handheld ECG devices was highly accurate. Both devices had acceptable sensitivity to diagnose long P-R and long and short QT intervals. Although the modern technology of smartphones and the physical inability for the 6-limb mode might cause old patients difficulty in utilizing such devices, their use for screening and follow-up is safe.

Value of diastolic stress echocardiography combined with speckle tracking imaging in assessment of patients with exertional dyspnea and normal resting left ventricular functions

Abstract Background A group of patients presenting with exertional dyspnea and a preserved left ventricular ejection fraction (LVEF) have a normal resting left ventricular (LV) filling pressure which increases with exercise or stress due to diastolic dysfunction. Objectives We aimed to study the value of diastolic stress echocardiography combined with speckle tracking imaging in assessment of patients with exertional dyspnea and normal resting LV functions. Patients We prospectively studied 200 patients their age ≤60years who had unexplained exertional dyspnea and unable to do exercise test including those with (severe physical or mental inability, morbid obesity, recent stroke, etc) all patients included in the study had a normal both LV systolic function (LVEF≥50%), and diastolic function by conventional echocardiography. Methods All patients were subjected to a standard DSE protocol with incremental dobutamine infusion rates of 5, 10, 20, 30, and 40 mg/kg/min each stage lasts for 3 minutes, and the following LV echo parameters were recorded at baseline and at peak dose of the DSE; LVEF, (E/e') it is the ratio between early mitral inflow velocity and mitral annular early diastolic velocity, also two-dimensional speckle tracking imaging(2D-STI) was done to measure LV global longitudinal systolic strain (GLS), global longitudinal diastolic strain rate (DSr) during early filling (DSrE), late diastole (DSrA). Results The study included 200 patients their mean age 45.7 ± 8.4 years(60% were males). The LVEF, and the GLS showed non-significant difference at baseline compared to peak dose DSE (P=0.81, 0.73 respectively), the E/e', DSrA and E/DSrE were significantly increased from baseline to peak study(p &amp;lt;0.001, 0.003,and 0.006 respectively), while DSrE was significantly decreased at peak stress(p &amp;lt; 0.001), and the E/DSrE, and DSrE were significantly correlated to E/e'(p &amp;lt; 0.001) Conclusions DSE combined with global diastolic strain rate parameters are valuable methods to evaluate diastolic dysfunction in patients with exertional dyspnea and normal resting myocardial functions. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.

CHARACTERIZATION OF THE ORAL HEALTH OF INDIVIDUALS WITH SPECIAL NEEDS AT CERCI PORTALEGRE

Introduction: At the present time, progress has been made between the relation in oral health and general health. Therefore, deepen knowledge of the oral health status of a population is essential for the establishment of health promotion measures. Since populations with special needs require a multidisciplinary approach, it is even more important to define these measures. The first step will be to establish the baseline values of a population, and thus to better understand their oral health needs. Objectives: This work aims to characterize the oral health status of a population with special needs at Cerci Portalegre. Methods: After obtaining the informed consent of the heads of the institution and the individuals’ legal guardians, as well as the consent of the individuals, the observation of the oral cavity was carried out to collect the present and past history of dental caries using the DMFT index (index of decayed, missing and filled teeth) and the evaluation of bacterial plaque accumulation on the dental surface by the DI’S index (bacterial plaque index). Results: Forty individuals were observed, 29 men and 11 women, with a mean age of 35 years. It was observed that these individuals had a mean value of DMFT of 4.7 decayed, missing and filled teeth, with no statistically significant difference between men and women (p=0.952). The mean value of DI’S was 2.02 which represents a high value of bacterial plaque accumulation which, being an etiological factor of oral diseases, indicates a risk of developing oral health problems. Conclusions: Patients with disabilities in most cases require more care at the level of oral health, due to their physical and mental inability to perform correct oral hygiene habits. Therefore, promoting oral health and educational measures may play a relevant role in the study population for the prevention of oral health problems and consequently other health problems.

Measuring Food Insecurity in Older Adults Using Both Physical and Economic Food Access, NHANES 2013–18

BackgroundEconomic food insecurity tools are used to detect need for assistance in the general population. However, in older adults, food insecurity can also be due to factors other than economic, such as physical inability to shop or cook. ObjectivesWe determined: 1) the proportion of older adults in the United States who experience physical and/or economic food insecurity; 2) differences in characteristics, diet quality, chronic conditions, and depression by economic and/or physical food insecurity; and 3) the relation of physical and economic food insecurity with diet quality and with depression. MethodsData from adults aged ≥60 y of the NHANES (2013–2018) were used. Groups were created based on economic food security [measured using the USDA's Household Food Security Survey Module (HFSSM)] and physical food security (measured using questions evaluating ability to shop and cook). Depression, Healthy Eating Index (HEI-2015) score, and socioeconomic characteristics were compared by food security group. Rao–Scott χ2 tests were used to test for significant differences between categorical variables, and t tests for continuous variables. Associations between food security status, HEI-2015, and depression score were examined using linear regression analysis. ResultsOne-quarter (25.0%) of older adults had physical difficulty accessing food but were not living in economically food insecure households. Those who lived in economically food insecure households and also had physical difficulties accessing food had the lowest mean HEI-2015 score (51.7) and highest mean depression score (6.9); both were significantly lower than the mean scores of those who lived in food secure households (HEI-2015 = 57.3; depression = 2.1; P < 0.01). ConclusionsConsidering physical ability to shop for and prepare food when measuring food insecurity in older adults can help identify those who might need dietary and mental health support the most, and those who need food assistance but would otherwise be missed if only measuring economic access.

Movement disorders in COVID-19 times: impact on care in movement disorders and Parkinson disease.

The purpose of this review is to outline the impact of the COVID-19 pandemic on movement disorder holistic care, particularly in the care of people with Parkinson disease (PWP). As the pandemic unfolds, a flurry of literature was published regarding the impact of COVID-19 on people with Parkinson disease including the direct impact of infection, availability of ambulatory care, loss of community-based team care, and acceptability of telemedicine. COVID-19 has impacted the care of PWP in numerous ways. Recognizing infection in PWP poses challenges. Specific long-term complications, including emerging reports of long COVID syndrome is a growing concern. Caregivers and PWP have also been impacted by COVID-19 social isolation restrictions, with radical changes to the structure of social networks and support systems globally. In a matter of weeks, the global community saw an incredible uptake in telemedicine, which brought benefits and pitfalls. As PWP adapted to virtual platforms and the changing architecture of care delivery, the pandemic amplified many preexisting inequities amongst populations and countries, exposing a new 'digital divide'.

Patient reported experience and adherence to remote patient management in chronic heart failure patients: a posthoc analysis of the TIM-HF2 trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research Background Remote Patient Management (RPM) enables early detection and prevention of cardiac deterioration in heart failure (HF) patients by measuring vital signs. Clinical trials reported inconsistent results. Patient adherence was suggested to be one of the main reasons for inconsistent results in previous trials (2-4). The "Telemedical interventional management in heart failure II (TIM-HF2)" study showed the superiority of non-invasive RPM compared to usual care (UC) in terms of mortality and unplanned cardiovascular (CV) hospitalisation (1). Purpose The objective of the analysis is to assess the patient experience with RPM, the adherence to daily measurements and outline factors affecting both aspects. Methods TIM-HF2 was conducted 2013-2018 with 1,538 HF patients in a 12-month follow-up (5). Inclusion criteria were HF in NYHA class II or III with either LVEF ≤45% or, if LVEF &amp;gt;45%, patients had been treated with oral diuretics; and HF hospitalisation within the last 12 months. Patients with major depression were excluded. Patients were randomly assigned (1:1) to RPM or UC. RPM-Patients had to measure daily weight, blood pressure, ECG and self-rated health status. Data were sent automatically to the telemedical centre (TMC). In case of conspicuous findings, the TMC contacted the patient or GP for therapy adjustment. At the study end, RPM-patients were asked to evaluate the program through a 9-question survey. Adherence was distinguished between measurement of at least one (incomplete adherence- IA) and all vital parameters (complete adherence- CA) and defined as ratio of the number of days of measurements taken divided by the number of days of possible measurements. All data were analysed descriptively (mean ± standard deviation). Differences between groups were analysed by ANOVA and T-Test. Results The survey was answered by n=564 patients (response rate: 79.7%). The patients were satisfied with the program and device usability. CA was 89.1±14.1% and consistently high over the study course (table 1). Reasons for dropouts (n=37) were e.g. frustration with the devices and physical inability to complete the measurement protocol. Patients &amp;lt;70 years and living in rural areas had lower IA rates. The mean adherence was independent of severe of disease (LVEF, NTproBNP, NYHA). Patients (n=244) had significantly lower IA the week prior to an unplanned CV hospitalisation (difference by -5.2±20.5%) compared to the entire study period. IA was significantly lower by -12.8±24.7% in the week after an unplanned CV hospitalisation compared to the entire study period. Conclusions In a setting with user-friendly devices, pre-interventional patient training, regular TMC-patient contact and close cooperation between primary physicians and TMC a long-lasting and high adherence and satisfaction regarding RPM could be achieved. A change in adherence might detect deterioration in health status and indicate the need to intensify telemedical care.

Paper 20: Clinical Outcomes and Return to Sport in Patients Undergoing Osteochondral Allograft

Objectives:The purpose of the current study was to evaluate the clinical outcomes and rates of return to play in patients who underwent an osteochondral allograft (OCA) procedure for a symptomatic osteochondral defect in the knee.Methods:A retrospective review of patients who underwent an OCA for an osteochondral defect of the knee, between June 2011 and March 2019 was performed. Return to play, the level of return and the timing of return were assessed. Additionally, the reasons for being unable to return were evaluated. A p-value of < 0.05 was considered to be statistically significant.Results:Overall, there were 103 patients who underwent OCA at our institution and met our inclusion and exclusion criteria. The mean age was 31.8 ± 11 years, and 63.9% were male, with a mean of 44.2 ± 23.3 month follow-up. The overall rate of return to play was found to be 63.1% (N=65), while the rate of RTP at the same or higher level was 32.0% (N = 33). With respect to the patients who were unable to return to their desired sport, reasons cited included pain in the operative knee (N = 18, 47.3%), physical inability to perform in the desired sport (N = 8, 21.1%), and fear of re-injury (N = 6, 15.8%).Conclusions:Overall, there was a poor rate of return to play following OCA. Additionally, the majority of patients were unable to return to play at their pre-injury level.

The Role of Music Therapy with Infants with Perinatal Brain Injury.

Perinatal brain injury occurs in 5.14/1000 live births in England. A significant proportion of these injuries result from hypoxic ischaemic encephalopathy (HIE) in term infants and intracranial haemorrhage (IVH) or periventricular leukomalacia (PVL) in preterm infants. Standardised care necessitates minimal handling from parents and professionals to reduce the progression of injury. This can potentially increase parental stress through the physical inability to bond with their baby. Recent research highlights the ability of music therapy (MT) to empower parental bonding without handling, through sharing culturally informed personal music with their infant. This review therefore aimed to systematically evaluate the use of MT with infants diagnosed with perinatal brain injury in a neonatal intensive care unit (NICU). Search terms were combined into three categories (audio stimulation (MT), population (neonates) and condition (brain injury), and eight electronic databases were used to identify relevant studies following PRISMA guidelines. Eleven studies using music or vocal stimulation with infants diagnosed with perinatal brain injury were identified and quality assessed using Cochrane ROB2, the ROBINSI Tool and the Newcastle Ottawa Scale. Studies used either voice as live (n = 6) or pre-recorded (n = 3) interventions or pre-recorded instrumental music (n = 2). Studies had two primary areas of focus: developmental outcomes and physiological effects. Results suggested the use of music interventions led to a reduction of infants’ pain scores during procedures and cardiorespiratory events, improved feeding ability (increase oral feeding rate, volume intake and feeds per day) and resulted in larger amygdala volumes than control groups. Additionally, MT intervention on the unit supported long-term hospitalised infants in the acquisition of developmental milestones. Vocal soothing was perceived to be an accessible intervention for parents. However, infants with PVL showed signs of stress in complex interventions, which also potentially resulted in an increase in maternal anxiety in one study. MT with infants diagnosed with perinatal brain injury can have positive effects on infants’ behavioural and neurological parameters and support parental involvement in their infants’ developmental care. Further feasibility studies are required using MT to determine appropriate outcome measures for infants and the support required for parents to allow future comparison in large-scale randomised control trials.

Approaching Addiction

AbstractThis essay seeks to illuminate the shifting definitions of addiction over time by providing a brief, anecdotal history of addiction as well as a review of how it has been conceptualized by the American Psychiatric Association’s DSM classification system. While all addictions have in common the attempt to experience an appetitive effect (satiety), preoccupation, loss of control, and negative or undesired consequences, including physical danger, social complaints, or inability to carry on one’s life roles, the meaning of addiction has not always been consistent. By approaching addiction from the historical/anecdotal and the official/medical perspectives, this essay provides a framework for working toward a common understanding of this complex phenomenon.

The Evaluation of body dysmorphic disorder in adult orthodontic patients

Introduction: The present study aimed to evaluate body dysmorphic disorder (BDD) in orthodontic patients. Also, the relation between demographic factors and BDD was investigated. Materials and Methods: This descriptive-analytical cross-sectional study was performed on 320 patients referred to the dental clinic. Participants were excluded if they had craniofacial syndromes, visible physical inabilities, mental diseases such as depression and OCD, and required orthognathic surgery. The YBOCS-BDD was used to assess BDD. Fisher’s exact test was performed using SPSS Version 24 at the significance level of P=0.05. Results: 47.5% of patients were normal and 34.4% had mild BDD and 17.2% had moderate BDD, and only 0.9% of the patients had severe BDD. A significant relation was found between gender and BDD, and between marital status and BDD. (P=0.004 and P&amp;lt;0.001, respectively). The relation of age and severity of BDD was not statistically significant. Conclusion: BDD disorder in orthodontic patients is more common in women and single people. In this regard, it is recommended that cosmetic clinicians be careful in accepting patients with a history of mental and personality problems, multiple and frequent esthetic surgeries, and if necessary, persuade and refer the patient to a psychiatrist and counselor to prevent the consequences.