Risk Factors For Disability Research Articles

Social prescribing initiatives connecting general practice patients with community-based physical activity: A scoping review with expert interviews.

The World Health Organization states that physical inactivity is one of the leading behavioural risk factors for disability and mortality in Europe. Social prescribing holds promise as a possible solution by connecting patients from general practice to community-based physical activity. Although research within social prescribing exists, the process of connecting general practice patients to community-based physical activity is not well investigated. This scoping review aimed to summarise and synthesise knowledge on social prescribing provided by health professionals in general practice towards community-based physical activity. A systematic search for literature in PubMed, Embase, Scopus, SportsDiscus and other sources was conducted to identify initiatives connecting general practice to community-based physical activity. Semi-structured interviews were then conducted with subject-specific national experts. Finally, preliminary findings from the literature and the interviews were used in a co-creation process with experts to synthesise and finalise the results of a thematic analysis across data sources. Based on 19 records, five expert interviews and subsequent co-creation, we identified three themes: (a) barriers and facilitators, (b) organisational perspectives and (c) value-based considerations. This review illuminates the complex nature of social prescribing programmes that connect general practice patients to community-based physical activity in Denmark. It also presents practical and fundamental considerations when applying social prescribing across different settings.

Decoding the anti-hypertensive mechanism of α-mangostin based on network pharmacology, molecular docking and experimental validation.

Hypertension is a leading risk factor for disability and deaths worldwide. Evidence indicates that alpha-mangostin(α-MG) can reduce blood pressure and improve target organ damage. Nonetheless, its pharmacological targets and potential mechanisms of action remain inadequately elucidated. We used SwissTargetPrediction to identify α-MG's drug targets and DisGeNET, GeneCards, CTD, and GEO databases for hypertension-related targets, and then determined antihypertensive therapeutic targets of α-MG by intersecting these targets. GO functional enrichment analysis, KEGG pathway analysis, and disease association analysis were conducted using the DAVID database and R package "clusterprofile", visualized with Cytoscape software. The binding affinity of α-MG to identified targets was confirmed through molecular docking using Autodock Vina v.1.2.2 software. The impact of α-MG on target genes was validated using an Angiotensin II-induced hypertensive mouse model and RT-qPCR. A total of 51 potential antihypertensive therapeutic targets for α-MG were identified by intersecting 109 drug targets with 821 disease targets. Furthermore, 10 cellular component terms, 10 disease terms, and the top 20 enriched biological processes, molecular functions, and KEGG pathways related to α-MG's antihypertensive effects were documented. Molecular docking studies indicated a strong binding affinity of α-MG with the HSP90AA1 domain. In Ang II-induced hypertensive mice aorta, treatment with α-MG effectively reversed the aberrant mRNA expression of TNF, HSP90AA1, NFKB1, PPARG, SIRT1, PTGS2, and RELA. Our analyses showed that TNF, HSP90AA1, NFKB1, PPARG, SIRT1, PTGS2, and RELA might be α-MG's potential therapeutic targets for hypertension, laying groundwork for further investigation into its pharmacological mechanisms and clinical uses.

Medical meteorological forecast for ischemic stroke: random forest regression vs long short-term memory model.

Ischemic stroke (IS) is one of the top risk factors for death and disability. Meteorological conditions have an effect on IS attack. In this study, we try to develop models of medical meteorological forecast for IS attack based on machine learning and deep learning algorithms. The medical meteorological forecast would be beneficial to public health in IS events prevention and treatment. We collected data on IS attacks and climatology in each day from 18th September 2016 to 31th December 2020 in Haikou. Data on IS attacks were from the number of hospital admissions due to IS attack among general population. The random forest (RF) regression and long short-term memory (LSTM) algorithms were respectively used to develop the predictive model based on meteorological data. Performance of the model was assessed by mean squared error (MSE) and root mean squared error (RMSE). A total of 42849 IS attacks was included in this study. IS attacks were significantly decreased in winter. The pattern of climatological data was observed the regularity in seasons. For the performance of RF regression model, the MSE is 243, and the RMSE is 15.6. For LSTM model, the MSE is 36, and the RMSE is 6. In conclusion, LSTM model is more accurate than RF regression model to predict IS attacks in general population based on meteorological data. LSTM model showed acceptable accuracy for the prediction and could be used as medical meteorological forecast to predict IS attack among population according to local climate.

A real-world pharmacovigilance analysis of adverse events associated with irbesartan using the FAERS and JADER databases.

Hypertension is a leading global risk factor for disability and death. Irbesartan, a potent angiotensin II receptor blocker, requires continuous safety monitoring. We conducted a disproportionality analysis of irbesartan-related adverse drug events (ADEs) using the FDA's FAERS and Japan's JADER databases. We extracted irbesartan-related ADE reports from FAERS (Q1 2004 to Q1 2024) and JADER (Q2 2008 to Q4 2023). We used Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM) for signal detection. Sensitivity analyses were conducted to exclude comorbid medications, and subgroup analyses by age and gender were performed to explore ADE occurrence in specific populations. Th time to onset (TTO) of ADEs was assessed using Weibull distribution test and Kaplan-Meier curves. A total of 5,816 (FAERS) and 366 (JADER) reports were analyzed, with irbesartan-related preferred terms (PTs) involving 27 System Organ Classes (SOCs) in FAERS and 22 in JADER. Three SOCs met detection thresholds in both databases: "metabolism and nutrition disorders," "cardiac disorders," and "renal and urinary disorders." We identified 219 positive signals in FAERS and 20 in JADER, including known signals like hyperkalemia, hypotension, and acute kidney injury. Notably, newly identified signals such as acute pancreatitis (n = 50, ROR: 7.76 [5.88-10.25]) and rhabdomyolysis (n = 50, ROR: 7.76 [5.88-10.25]) in FAERS and respiratory failure (n = 7, ROR: 6.76 [3.20-14.26]) in JADER could have significant clinical implications, as they may lead to severe outcomes if not recognized and managed promptly. Subgroup analyses revealed both similarities and differences in signal detection across gender and age groups. Sensitivity analyses, excluding concomitant medications, confirmed the persistence of key positive signals, including hyperkalemia, angioedema, acute pancreatitis, and agranulocytosis. ADEs mainly occurred within 1month (34.14%) and after 1year (32.32%) after dosing, with a median onset of 107days. This study provides valuable real-world evidence on the safety profile of irbesartan. The identification of new safety signals underscores the necessity of updating drug labels, particularly for assessing and managing high-risk patients. Additionally, the TTO analysis emphasizes the importance of sustained vigilance for adverse events over time. In conclusion, our findings contribute to a more comprehensive understanding of irbesartan's safety, aiding healthcare professionals in optimizing its use in clinical practice.

Facilitators of medication adherence in patients with hypertension: a qualitative study.

Hypertension has been identified as the most important risk factor for disability and premature death worldwide. This study aimed to explain the factors that facilitate medication adherence from the perspective of patients with hypertension in southeastern Iran. This qualitative study used conventional content analysis and purposive sampling methods to achieve data saturation, involving 25 participants. Facilitating factors were categorized into two main categories: individual and family factors and organizational support. Individual factors included motivational fears, disease acceptance, healthy lifestyle, disease monitoring, and follow-up. Family factors included family support, while organizational support included governmental support to provide inexpensive medicines, comprehensive healthcare team support, health insurance access, and media training. These factors were identified as essential facilitators that significantly influence appropriate adherence to hypertensive drugs. This study revealed that various factors affected medication adherence in these patients, and efforts should be made to improve hypertension treatment and increase medication adherence. Measures taken to control hypertension are cost-effective to reduce the burden associated with this disease. The findings of this study can be valuable in formulating policies for the treatment and care of hypertension.

Disability status investigation and risk prediction model for middle-aged and older adults in Anhui Province: A derivation and validation study.

This study investigated the disability status of middle-aged and older adults in Anhui Province, China, with a primary focus on physical disability, and constructed a nomogram to predict disability risk. Data was collected through a province-wide questionnaire survey conducted in 16 cities and counties from January to December 2021, involving 3386 participants aged 60 years and above. The abilities of daily living (ADL) scale assessed participants' comprehensive ability. Risk factors for disability were identified using least absolute shrinkage and selection operator and logistic regression, highlighting six independent factors: age, poor sleep quality, depression, malnutrition, stroke, and the number of comorbid chronic diseases. A nomogram prediction model was then established and validated internally and externally. The model demonstrated good fit according to the Hosmer-Lemeshow test and provided significant benefits across various thresholds, as shown by decision curve analysis. This nomogram accurately and quickly identifies high-risk groups, aiding in early intervention.

Expert Opinion on the Role of Sacubitril/Valsartan in the Management of Hypertension in India.

Hypertension, a key modifiable risk factor for cardiovascular diseases (CVD), significantly contributes to premature death and morbidity worldwide. Despite stabilization in age-adjusted global prevalence, the absolute number of hypertensive individuals doubled from 2000 to 2010, largely due to increases in low- and middle-income countries. In 2021, only 21% of hypertensive individuals globally had effective blood pressure (BP) control. In India, hypertension is the leading risk factor for death and disability, with prevalence rates of 24% in men and 21% in women, as reported by the 2019-2020 National Family Health Survey (NFHS-5). Alarmingly, just 25% of rural and 38% of urban hypertensive Indians are undergoing treatment, with only 10% and 20% achieving BP control, respectively. This highlights the hypertension paradox, where clinical inertia and hesitancy in intensifying BP-lowering therapy persist despite the availability of antihypertensive drugs. This expert opinion paper aims to provide a comprehensive evaluation of sacubitril/valsartan in hypertension management, leveraging insights from its approved use in heart failure and examining its benefits and challenges across diverse hypertensive populations. The formulation of this expert opinion involved employing evidence-based methodologies and utilizing all available data. The document underwent scrutiny by expert cardiologists, whose clinical experiences and examination of the evidence and guidelines informed the formation of the expert opinion. This expert opinion paper provides a thorough and informed evaluation of sacubitril/valsartan, highlighting its potential to address unmet needs in BP control, particularly in challenging cases such as resistant hypertension and chronic kidney disease.

An alcohol-related liver disease multi-stakeholder hub (ARMS-Hub) to enhance research activity in underserved communities in the UK.

Alcohol use is the third leading risk factor of death and disability in the UK and costs the NHS £3.5 billion per year. Despite the high prevalence and healthcare burden of Alcohol-related Liver Disease (ArLD), there has been minimal research addressing prevention, morbidity and mortality. Reasons for this include stigma and lack of interest from public, charitable and commercial funding bodies. The objectives of this project were to identify and develop interdisciplinary partnerships, to explore stigma in ArLD, to develop a representative Patient and Public Involvement and Engagement (PPIE) group, to build research capacity, and to develop interdisciplinary research proposals targeting key research priorities. ArLD networks were identified by members of the Project Steering Group. Health Care Professionals (HCPs) from different backgrounds were invited to join the ARMS-Hub. PPIE representatives were invited through charities and support groups. Research areas were identified, discussed, prioritised and ranked. Research questions were refined during an in-person symposium. A mentorship programme was created to encourage and facilitate networking and knowledge exchange for early career researchers. We established the ARMS-Hub with 31 HCPs and 40 PPIE members. There were five stakeholder meetings, which included PPIE representation. Three virtual and three in-person PPIE meetings took place. Topics relevant to stigma in ARLD identified during the meetings were education and awareness, language, and access. Priorities identified were the disconnect between mental health and liver services, education around the wider harms of alcohol, and education of HCPs regarding stigma. We established a mentorship network that regularly meets to support development of new research ideas. Stigma is central to lack of research engagement from professionals and PPIE. The main priority identified relates to the disconnect between mental health and liver services. This collaborative study has allowed development of a research agenda to address this priority.

The Association Between Overweight Obesity Status and Hypertension in a Rural Community in Dang District, Gujarat, India: A Cross-Sectional Study.

Background The relationship betweenoverweight obesity status and hypertension is well-known throughout the world, especially in low socioeconomic communities and developing countries. Both high blood pressure and obesity are preventable risk factors for noncommunicable disease, death, and disability. The prevalence of obesity-overweight status in India is increasing faster than the global average, and diabetes in Southeast Asia has surged over the past few decades. There have been few systematic studies focusing onpublic health development in rural communities of India, like the Dang District.This study explores the association between overweight-obesity status and hypertension prevalence in a rural community in Dang district, Gujarat, India. Methods A cross-sectional design was utilized for this study, involving 1012 adult patient charts collected from medical camps in December 2018 and 2019. Patients with incomplete information for measurements of blood pressure, height, weight, age, and sex were omitted from the analysis (n=953).Data on BMI and blood pressure were analyzed to examine the relationship between overweight-obesity status and hypertension. Hypertension was defined by the American Heart Association (AHA) cut-offs for measured blood pressure. Both World Health Organization (WHO) and South Asian cut-offs were used for BMI. Binary logistic regression was used to assess the association between hypertension and overweight-obesity status, adjusted for age and sex. Results Most patients were hypertensive, with males having a higher prevalence (63.3%) than females (55.1%). The prevalence of hypertension among participants increased with age. This was true for both sexes, except for males 45-54 years of age. The average BMI for both sexes was 22.4.Results indicated that overweight and obese individuals had a significantly higher prevalence of hypertension compared to their normal-weight counterparts, suggesting a strong association between the two conditions. A binary logistic regression found that males were 1.35 times more likely to have hypertension than females (95% CI 1.03 - 1.79), and increasing age and BMI were associated with an increased likelihood of hypertension. Conclusion The association between hypertension and BMI is positive and is stronger when using South Asian cut-offs. Using these cut-offs will include a wider range of people at risk for hypertension. With males and older adults especially at risk, targeting public health awareness campaigns to reduce BMI and help lower the burden of hypertension can improve the health and quality of life in this community.

Private provider practices and incentives for hypertension management in rural and peri-urban Telangana, India– a qualitative study

Hypertension poses a critical threat to health in India, being the predominant risk factor for mortality and disability. With over 70% of outpatient care being provided by the private sector, our study investigated the practices and incentives of private health providers in screening, diagnosing, treating, monitoring, and counseling hypertension patients in rural and peri-urban India. Conducted from April 2020 to February 2021, the qualitative study involved 46 participants, including various healthcare professionals and patients in three Telangana state districts. Analysis revealed a lack of recognition of hypertension’s gravity among private providers in these areas, leading to inconsistent screening practices and varied diagnostic thresholds, particularly among rural medical practitioners. Both formal and informal providers lacked standardized protocols and follow-up mechanisms, with limited technical knowledge about hypertension observed, especially among rural practitioners who were often the first point of contact. Drug effectiveness, and incentives from pharmaceutical sales representatives influenced prescribing practices. Diagnostic labs also offered financial incentives for patient referrals. Thus, aligning providers’ objectives with patient preferences and public health goals is crucial. To encourage evidence-based hypertension care, the government and NGOs could implement strategies such as tailored incentives, financial rewards, tax benefits, accreditation, and recognition for private healthcare providers. Professional bodies in the private sector should establish programs emphasizing quality assurance and certifications. Future research should focus on designing and testing new models for private sector hypertension service delivery, coupled with targeted interventions to enhance care in rural and peri-urban settings.

Trends in case detection rate for leprosy and factors associated with disability among registered patients in Zanzibar, 2018–2021

BackgroundLeprosy is still a disease of public health concern. Globally, 2–3 million people are thought to be affected by leprosy’s disease-related disabilities. Regarding leprosy status in Zanzibar, limited information is available. Determining changes in detection rates and factors associated with disability is crucial for treatment and preventative strategies for this debilitating disease. This study aimed to determine trends in case detection rate for leprosy and risk factors for disability among registered patients in Zanzibar, from 2018 to 2021. The study included all leprosy patients who received treatment in Zanzibar's 11 districts between 2018 and 2021. The study design used was an analytical cross-sectional. Prevalence and new case detection rate (NCDR) were calculated. Multivariable Poisson regression analyses were used to identify factors associated with leprosy disability. Crude and adjusted prevalence ratios (APR) and their respective 95% confidence intervals (CI) were reported. P-values ≤ 0.05 were considered significant.ResultsOf the 490 leprosy cases reported between 2018 and 2021, 469 (95.7%) were new patients, and 349 (71.2%) were multi-bacillary. The disease was found to be more common in males 296 (60.4%). The average prevalence was 7/100,000 population, while the average NCDR was 7/100,000 from 2018 to 2021. There was a significant decrease in disability grades from diagnosis to the end of treatment over 4 years (P < 0.001). Male sex (APR 1.55; 95% CI 1.18–2.04), advanced age (APR 5.01; 95% CI 1.91–13.17), multi-bacillary (APR 6.99; 95% CI 3.16–15.44) and HIV negative patients (APR 1.51; 95% CI 1.11–2.06) were more likely to develop physical disability.ConclusionThis study found that leprosy disability grades at diagnosis compared to the end of treatment declined during 4 years. There was no significant change in point prevalence and NCDR during the 4-year study period. Disability was associated with male sex, advanced age, multi-bacillary, and HIV-negative patients. To prevent leprosy-related disability and transmission, health education, early case detection, and adequate multidrug therapy should be prioritized.

Risk factor of disability as new certification of long-term care needs in older Japanese adults with diabetes mellitus: A longitudinal study.

This observational longitudinal study aimed to explore the risk factors for disabilities in older Japanese individuals with diabetes at a frailty clinic, an outpatient clinic specializing in comprehensive geriatric assessments for older patients. The outcome was the onset of disability as a new certification of long-term care needs in outpatients aged ≥65 years. Multivariable Cox regression analyses examined the independent associations between the onset of disability and the variables that reached significance in the bivariate analysis, after adjusting for age and sex, years of education, and certification of need for support. A total of 182 participants (mean age 77.8 years, 59.9% female) were included in the study. During a mean follow-up period of 1070 days, 28 patients (15.4%) developed disabilities. Multivariable analysis showed that poor glycemic control (higher levels of glycosylated albumin and HbA1c), frailty as measured by the Clinical Frailty Scale (CFS), cognitive decline as assessed by the revised Hasegawa Dementia Scale (especially "5 object recall" and verbal fluency as assessed by the number of "vegetable names"), poor adherence to medications, and reduced muscle mass were significantly associated with the development of disability. Multivariable Cox regression analyses revealed independent and significant associations between the development of disability and HbA1c ≥7.5%, CFS ≥4, and generating vegetable names≤9. In identifying older patients with diabetes who are at risk of developing disabilities, it may be useful to evaluate glycemic control, CFS, cognition, and medication adherence. Verbal fluency tests using vegetable names may serve as simple tools for assessing the risk of disability. Geriatr Gerontol Int 2024; 24: 1030-1038.

Role of Ultrasound in the Evaluation of Skeletal Muscle Changes in Patients with Type 2 Diabetes Mellitus

Abstract Background Diabetes is a global public health problem, with type 2 diabetes mellitus (T2DM) accounting for more than 90% of the diabetic population and it has been consistently reported as one of the strongest correlates of mobility limitation, especially in older people, and a potential risk factor for future mobility disability and loss of independence. Long-term complications and diabetes-related comorbidities only partially explain the excess risk of disability associated with diabetes. Changes in body composition, in particular progressive loss of muscle mass and increase in fat mass, with decline in muscle strength and quality have been proposed as additional potential mediators of the association between diabetes and disability. Aim of the Work to investigate the differences in Skeletal muscle ultrasound features in people with and without type 2 diabetes mellitus. Patients and Methods This was a Case control study conducted at the Ultrasound Radiology Unit, Radiology Department, Ain Shams University Hospitals from July, 2023 to January 2024. The study was performed on simple random sample consists of 36 T2DM patients on regular follow up in the endocrinology clinics in Ain Shams University Hospitals. And 36 Healthy controls came for routine checkup in Ain Shams University Hospitals clinics and meeting the study inclusion criteria. A signed informed consent was obtained from all patients and controls prior to inclusion in the study after explaining the procedure details. The approval of research ethical committee of faculty of Medicine - Ain Shams University was obtained before starting the study. The privacy of participants and confidentiality of data was guaranteed during the various phases of the study. Results we measured three ultrasonic parameters. MT, FL and PA. The FL and PA are measured in both relaxed and contracted states. the DPN group had the lowest MT, FL at both rest and contracted states and PA at contracted state as well as the lowest ΔFL and ΔPA. The control group had the highest MT, FL at both rest and contracted states and PA at contracted state as well as the highest ΔFL and ΔPA. The non-DPN group had intermediate values for the same variables. The differences among the groups were statistically significant for all the variables except for the pennation angle at rest. It showed that the ΔFL of the DPN group was significantly lower than that of the non-DPN group (p &amp;lt; 0.001), which was similar to a previous conclusion that the gastrocnemius fascicles undergo the smallest length changes in a DPN group. Conclusion The combination of MT,ΔFL and ΔPA of the MG showed high-diagnostic accuracy (sensitivity &amp;gt;80%; specificity &amp;gt;95%) for predicting DPN, which could be used for rapid screening in the future. Early muscle ultrasound screening should be timely carried out in patients with T2DM, especially those with a long disease course and poor long-term blood glucose levels, and there is no difference between men and women.

Impact of a transformative health literacy model for Thai older adults with hypertension

BackgroundHypertension is the important risk factor for cause disability and death, particularly if there is a loss of self-care knowledge. Health literacy encompasses the comprehension and awareness of health-related information, which is beneficial for managing the health of older adults with hypertension. Therefore, the objective of this study was to examine the impact of a transformative health literacy model to develop the health literacy levels among Thai senior citizen with hypertension.MethodThis research employed an experiment. Thirty-six participants engaged in the transformative health literacy model. The instrument is the health literacy in hypertension scale, which had acceptable reliability and validity.ResultsThe study revealed that the level of health literacy in the post-test and follow-up phases of the experimental group who received the health literacy promotion model was significantly higher than the pre-test level of health literacy at a significance level of 0.05.ConclusionThe study outcomes create a new pathway to enhancements of health literacy in Thai older adults with hypertension.

Association Between Restricting Symptoms and Disability After Critical Illness Among Older Adults.

Older adults who survive critical illness are at risk for increased disability, limiting their independence and quality of life. We sought to evaluate whether the occurrence of symptoms that restrict activity, that is, restricting symptoms, is associated with increased disability following an ICU hospitalization. Prospective longitudinal study of community-living adults 70 years old or older who were interviewed monthly between 1998 and 2018. South Central Connecticut, United States. Two hundred fifty-one ICU admissions from 202 participants who were discharged alive from the hospital. None. Occurrence of 15 restricting symptoms (operationalized as number of symptoms and presence of ≥ 2 symptoms) and disability in activities of daily living, instrumental activities of daily living, and mobility was ascertained during monthly interviews throughout the study period. We constructed multivariable Poisson regression models to evaluate the association between post-ICU restricting symptoms and subsequent disability over the 6 months following ICU hospitalization, adjusting for known risk factors for post-ICU disability including pre-ICU disability, frailty, cognitive impairment, mechanical ventilation, and ICU length of stay. The mean age of participants was 83.5 years ( sd , 5.6 yr); 57% were female. Over the 6 months following ICU hospitalization, each unit increase in the number of restricting symptoms was associated with a 5% increase in the number of disabilities (adjusted rate ratio, 1.05; 95% CI, 1.04-1.06). The presence of greater than or equal to 2 restricting symptoms was associated with a 29% greater number of disabilities over the 6 months following ICU hospitalization as compared with less than 2 symptoms (adjusted rate ratio, 1.29; 95% CI, 1.22-1.36). In this longitudinal cohort of community-living older adults, symptoms restricting activity were independently associated with increased disability after ICU hospitalization. These findings suggest that management of restricting symptoms may enhance functional recovery among older ICU survivors.

Interdisciplinary pain program participants with high catastrophizing scores improve function utilizing enriched therapeutic encounters and integrative health techniques: a retrospective study.

Pain catastrophizing describes helplessness, rumination, and magnification of a pain experience. High pain catastrophizing is an independent risk factor for disability, pain severity, inadequate treatment response, chronicity, and opioid misuse. Interdisciplinary pain programs (IPPs) are beneficial and cost-effective for individuals with chronic pain, but their functional impact on individuals with high pain catastrophizing is not well established. The emerging field of placebo studies suggests that patient-provider relationships, positive treatment expectations, and sociobiologically informed care trigger physiological responses that may enhance therapeutic interventions. In this retrospective observational cohort study, we compared admission and discharge data for 428 adults with high-impact chronic pain (mean 8.5 years) who completed the Spaulding-Medford Functional Restoration Program (FRP). The interdisciplinary FRP team of physiatrists, behavioral health clinicians, physical therapists, and occupational therapists specializes in evidenced-based conventional rehabilitation, integrative health, and pain psychoeducation via enriched therapeutic encounters, fostering collaboration, validation, trust, self-efficacy, and positive expectations. Clinical outcome measures included the Canadian Occupational Performance Measure (COPM) assessing functional performance (COPM-PS) and satisfaction with function (COPM-SS), the Pain Numeric Rating Scale (NRS), the Pain Catastrophizing Scale (PCS), and the Patient Health Questionnaire-9 (PHQ-9). FRP participants with clinically elevated catastrophizing at baseline (PCS ≥30, mean PCS 39) achieved statistically significant improvements in function (mean delta -2.09, CHI2 = 15.56, p < 0.001), satisfaction with function (COPM-SS mean delta -2.50, CHI2 = 7.42, p = 0.007), pain (NRS mean delta 2.7), mood (PHQ-9 mean delta 1.87, p = 0.002), and catastrophizing (PCS mean delta 4.16, p < 0.001). Subgroup analysis revealed racial disparities in pain scores, and exploratory analysis showed a trend toward reducing opiate consumption. Despite the known association of adverse outcomes with high catastrophizing, FRP participation was associated with increased productive engagement, reduced pain, reduced maladaptive thought processes, and improved mood. Although causation and efficacy cannot be established from a retrospective design, this is the first study to identify functional improvement in patients with high-impact chronic pain and clinically relevant high pain catastrophizing who participate in an IPP combining conventional and complementary rehabilitation with psychoeducation. These enriched therapeutic encounters may enhance the treatment process by promoting trust, empathy, collaboration, and beneficial reframing of patients' experiences, expectations, and goals.

Mortality Predictors and Neurological Outcomes Following Extracorporeal Cardiopulmonary Resuscitation (eCPR): A Single-Center Retrospective Study.

Extracorporeal cardiopulmonary resuscitation (eCPR) offers cardiorespiratory support to patients experiencing cardiac arrest. However, this technology is not yet considered a standard treatment, and the evidence on eCPR criteria and its association with survival and good neurological outcomes remains scarce. Therefore, we aimed to investigate the overall mortality and risk factors for mortality. Moreover, we provide a comparison of demographic, clinical, and laboratory characteristics of patients, including neurological outcomes and adverse events during support. This retrospective analysis included in-hospital and out-of-hospital cardiac arrest patients who received eCPR and were admitted between January 2008 and June 2022 at a tertiary and trauma one-level university hospital in Austria. In total, 90 patients fulfilled inclusion criteria, 41 (46%) patients survived until intensive care unit discharge, and 39 (43%) survived until hospital discharge. The most common cause of cardiac arrest was myocardial infarction (42, 47%), and non-shockable initial rhythm was reported in 50 patients (56%). Of 33 survivors with documented outcomes, 30 had a good recovery as measured with Cerebral Performance Category score, 2 suffered severe disability, and 1 remained in a persistent vegetative state. Finally, multivariate analysis identified asystole as initial rhythm (HR 2.88, p = 0.049), prolonged CPR (HR 1.02, p = 0.043), and CPR on the weekend (HR 2.57, p = 0.032) as factors with a higher risk of mortality. eCPR-related decision-making could be additionally supported by the comprehension of the reported risk factors for mortality and severe disability. Further studies are needed to elucidate the impact of peri-arrest variables on outcomes, aiming to improve patient selection.

An 'alcohol health champions' intervention to reduce alcohol harm in local communities: a mixed-methods evaluation of a natural experiment.

Globally alcohol consumption is a leading risk factor for premature death and disability and is associated with crime, social and economic consequences. Local communities may be able to play a role in addressing alcohol-related issues in their area. To evaluate the effectiveness and cost-benefit of an asset-based community development approach to reducing alcohol-related harm and understand the context and factors that enable or hinder its implementation. A mixed-methods evaluation. Area-level quasi-experimental trial analysed using four different evaluation methods (a stepped-wedge design where each area was a control until it entered the intervention, comparison to matched local/national controls and comparison to synthetic controls), alongside process and economic evaluations. Ten local authorities in Greater Manchester, England. The outcomes evaluation was analysed at an area level. Ninety-three lay persons representing nineareas completed questionnaires, with 12 follow-up interviews in five areas; 20 stakeholders representing ten areas were interviewed at baseline, with 17 follow-up interviews in eight areas and 26 members of the public from two areas attended focus groups. Professionals in a co-ordinator role recruited and supported lay volunteers who were trained to become alcohol health champions. The champion's role was to provide informal, brief alcohol advice to the local population and take action to strengthen restrictions on alcohol availability. Numbers of alcohol-related hospital admissions, accident and emergency attendances, ambulance call-outs, street-level crime and antisocial behaviour in the intervention areas (area size: 1600-5500 residents). Set-up and running costs were collected alongside process evaluation data exploring barriers and facilitators. Routinely collected quantitative data on outcome measures aggregated at the intervention area and matched control and synthetic control areas. Data from policy documents, licensing registers, meeting notes, invoices, time/cost diaries, training registers, questionnaires, interviews, reflective diaries and focus groups. The intervention rolled out in nine out of ten areas, seven of which ran for a full 12 months. Areas with better-established infrastructure at baseline were able to train more champions. In total, 123 alcohol health champions were trained (95 lay volunteers and 28 professionals): lay volunteers self-reported positive impact. Champions engaged in brief advice conversations more readily than taking action on alcohol availability. There were no consistent differences in the health and crime area-level indicators between intervention areas and controls, as confirmed by using three different analysis methods for evaluating natural experiments. The intervention was not found to be cost-beneficial. Although the sequential roll-out order of the intervention was randomised, the selection of the intervention areas was not. Self-reported impact may have been subject to social desirability bias due to the project's high profile. There was no measurable impact on health and crime outcomes. Possible explanations include too few volunteers trained, volunteers being unwilling to get involved in licensing decisions, or that the intervention has no direct impact on the selected outcomes. Future similar interventions should use a coproduced community outcomes framework. Other natural experiment evaluations should use methodological triangulation to strengthen inferences about effectiveness. This trial is registered as ISRCTN81942890. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 15/129/03) and is published in full in Public Health Research; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.

Study of Migraine in Headache Patients and its Association with Anxiety, Depression, and Insomnia: A Hospital-based Study

Background: Migraine is a common disabling disease with a higher global prevalence among the adult population. Moreover, there is a frequent coexistence of affective disorders, especially depression, anxiety, and sleep disturbances. This association may cause aggravation of migraine symptoms resulting in the persistence of headache and poor quality of life. This study is designed to investigate the prevalence of migraine in patients with headache. The study has also assessed the prevalence of anxiety, depression, and insomnia and their association with migraine. Disability caused by migraine has also been explored in this study. Materials and Methods: This cross-sectional study included 250 patients of headache. Participants were screened for migraine using ID Migraine. Assessment was made using sociodemographic details, Migraine Disability Assessment Questionnaire, Patient health questionnaire-9, Generalized anxiety disorder-7, and Insomnia Severity Index. Results: Nearly 71.2% of patients had migraine and 28.8% had other types of headache. Depression, anxiety, and insomnia were reported in 33.15%, 37.64%, and 23.03% of participants with migraine, respectively. Patients with migraine had 48% and 85% more chances of developing depression and insomnia, respectively, and more than twice the chance of having anxiety. Moderate and severe disability was reported by 32% and 30.9% of participants, respectively. Depression, anxiety, and insomnia were predisposing risk factors for disability. Conclusion: The association of insomnia, anxiety, and depression is common with migraine and may cause disability in these patients. Hence, their timely assessment may reduce the risk of developing disability in migraine patients.

Correlation of Clinical Factors with Hypertensive Patient Medication Adherence

Hypertension is the primary risk factor for both disability and death worldwide, mainly due to two significant complications: strokes (cerebrovascular accidents) and ischemic heart disease. Hypertension is a condition when systolic blood pressure ≥140mmHg and or diastolic blood pressure ≥90mmHg. Patient adherence is an indicator of the efficacy of therapy. Patient adherence measurement could be done by indirect methods such as self-report and pill count methods. The study aims to determine the correlation between clinical factors and medication adherence in hypertensive patients at Rajabasa Indah Community Health Center. This is a descriptive-analytic study with a cross-sectional approach. Purposive sampling was used in the sampling technique. There are 100 respondents in this study, patients diagnosed with hypertension at Rajabasa Indah Community Health Center who met the inclusion and exclusion criteria. A total of 45 patients were included in the category of non-adherent patients taking medication, and 55 patients were included in the category of patients who adhered to taking medication. This study showed that factors that influenced drug adherence in hypertensive patients were comorbidities (p=0.004), duration of treatment (p=0.007), the number of medications (p=0.002), and history of side effects (p=0.002). Medication adherence has been linked with some clinical factors such as comorbidities, duration of treatment, number of medications, and history of side effects. Incorporating adherence evaluation into the overall assessment of patients undergoing hypertension treatment should be essential.