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BMJ Neurology Open 2024A critical first step in managing functional neurological disorder (FND) is a positive diagnosis and clear explanation using an understandable illness model....
BACKGROUND
A critical first step in managing functional neurological disorder (FND) is a positive diagnosis and clear explanation using an understandable illness model. Multidisciplinary group education sessions are one way to achieve this, with some evidence they improve understanding, confidence in diagnosis and outcomes with further treatment. In many conditions, illness perceptions and stigma affect distress, functioning, quality of life and engagement. Exploring relationships between these factors could lead to deeper understanding of the impact of education.
METHODS
Questionnaires assessing illness perceptions, quality of life, mood, anxiety, comorbidities, treatment engagement and stigma (both experienced and anticipated) were completed before, immediately and 1 month after a multidisciplinary online group education session for FND at a regional neurosciences centre. Free-text data on causal attributions and needs were also collected.
RESULTS
166 patients attended online education sessions from January 2022 to July 2023; 61 (37%) completed presession surveys, 42 (25%) completed postsession and 35 (21%) completed 1 month postsession surveys. Patients reported multiple comorbidities, poor quality of life, functioning and high levels of stigma. Illness perception scores indicated FND as threatening, mysterious and unpredictable, with low personal or treatment control over symptoms. Illness coherence/understanding (mean difference 2.27, p<0.01, 95% CI 1.22 to 4.23) and engagement (mean difference 2.42, p<0.01, 95% CI 0.46 to 4.36) increased after the session. There were no significant changes in stigma, distress, sense of control or anticipated discrimination. Free-text analysis revealed stress and trauma as the most common causal attributions, followed by physical illnesses. Patients requested personalised formulations, practical disability advice, help with explaining the condition to others (eg, employers), peer support and treatment.
CONCLUSION
Multidisciplinary group FND education sessions potentially improve patient understanding and engagement. Clinicians should consider the possible benefits of personalised formulations and linking to practical and peer support. Further work assessing illness perceptions is needed, such as adapting measures for FND.
PubMed: 38860228
DOI: 10.1136/bmjno-2024-000633 -
Frontiers in Public Health 2024To analyse whether the accumulation of early adverse experiences among individuals of different generations has an impact on disabilities and evaluate the cumulative...
OBJECTIVE
To analyse whether the accumulation of early adverse experiences among individuals of different generations has an impact on disabilities and evaluate the cumulative effects of disadvantages in rural older adults in China.
METHODS
A Binary Logit Model was used to analyse the life course effects of the disability dilemma among rural older adults.
RESULTS
Regarding Activities of Daily Life (ADLs), there was no significant difference between older adults that experienced 1 adverse events and the control group. The probability of older adults experiencing difficulties in 2, 3, 4, or more types of ADLs was 1.486 times, 2.173 times, and 3.048 times higher than that of the control group, respectively. Regarding Instrumental Activities of Daily Life (IADLs), there was no significant difference between the population that experienced 1 or 2 adverse events and the control group. The probability of experiencing difficulties in 3, 4, or more types of IADLs was 1.527 times and 1.937 times higher than that of the control group, respectively. Early adverse events had a cumulative disadvantageous effect on disability in older adults. The longer the duration of adverse experiences, the higher the risk of disability in old age. Education had a significant mitigating effect on health risks.
CONCLUSION
Pay attention to early factors in the life course, strengthen the promotion of health prevention concepts, and pay attention to the moderating and relieving effects of education on health. We should also gradually improve the rural disability care system and family health security capabilities in China's rural areas.
Topics: Humans; China; Aged; Rural Population; Disabled Persons; Female; Male; Activities of Daily Living; Aged, 80 and over; Middle Aged
PubMed: 38859896
DOI: 10.3389/fpubh.2024.1358106 -
BMC Psychiatry Jun 2024Depressive symptoms and sarcopenia, often observed among middle-aged and elderly individuals, are significant health concerns in China, particularly given the country's...
Association between depressive symptoms and sarcopenia among middle-aged and elderly individuals in China: the mediation effect of activities of daily living (ADL) disability.
BACKGROUND
Depressive symptoms and sarcopenia, often observed among middle-aged and elderly individuals, are significant health concerns in China, particularly given the country's rapidly aging population. Depressive symptoms, characterized by persistent feelings of sadness and loss of interest, can significantly impact quality of life. Little is known about the underlying pathway connecting these two conditions.
METHODS
The data for this study were derived from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were evaluated using the Centre for Epidemiological Studies Depression (CSED) scale. Logistic regression analyses were employed to investigate the association between depressive symptoms, activities of daily living (ADL) disability, and sarcopenia, while adjusting for potential confounding factors. The selection of predictor variables, including social activity, chronic diseases, demographic factors, and lifestyle habits, was based on their known associations with mental health, physical functioning and sarcopenia. These variables were included to ensure a comprehensive adjustment for potential confounding factors and to provide a more accurate estimation of the relationship between depressive symptoms and sarcopenia. Additionally, mediation analysis was conducted to assess the mediating role of ADL disability in the relationship between depressive symptoms and sarcopenia.
RESULTS
A comprehensive study was conducted on a total of 8,238 participants aged 45 years and older, comprising 3,358 men and 4,880 women. Logistic regression analyses were conducted to identify significant associations between depressive symptoms (OR = 1.30, P = 0.0269,95%CI = 1.03-1.63), ADL disability (OR = 1.94, P < 0.001,95%CI = 1.37-2.75) and sarcopenia. The results revealed significant relationships among these variables. Furthermore, mediation effect analyses demonstrated that ADL disability partially mediated the association between depressive symptoms and sarcopenia (estimated indirect effect: 0.006, 95% CI: 0.003, 0.008, proportion of mediation effect: 20.00%).
CONCLUSIONS
The study underscores a significant association between depressive symptoms and sarcopenia among middle-aged and elderly individuals in China, with ADL disability acting as a mediator. These findings offer novel insights for targeted health interventions. Future interventions should effectively combat sarcopenia by integrating psychological support with muscle-strengthening exercise programs. By addressing both depressive symptoms and ADL disability, clinicians and public health professionals can enhance outcomes for this demographic. Collaborative efforts across disciplines are essential for providing comprehensive health management tailored to the needs of middle-aged and elderly individuals. Future research should longitudinally assess the impact of such integrated interventions on sarcopenia prevention and depressive symptom alleviation. Additionally, investigating the role of social and environmental factors in mediating this relationship is crucial for developing more effective health strategies for this vulnerable population.
Topics: Humans; Activities of Daily Living; China; Male; Female; Aged; Depression; Sarcopenia; Middle Aged; Longitudinal Studies; Aged, 80 and over; Mediation Analysis; Disabled Persons
PubMed: 38858698
DOI: 10.1186/s12888-024-05885-y -
BMC Public Health Jun 2024People living with HIV (PLWH) live longer and face new health challenges resulting from the confluence of chronic HIV infection and the natural effect of aging and... (Clinical Trial)
Clinical Trial
The association between HIV infection, disability and lifestyle activity among middle-aged and older adults: an analytical cross-sectional study in Ivory Coast (the VIRAGE study).
INTRODUCTION
People living with HIV (PLWH) live longer and face new health challenges resulting from the confluence of chronic HIV infection and the natural effect of aging and comorbidities. However, there is a dearth of information on the long-term impact of HIV infection on the health and wellbeing of PLWH in sub-Saharan Africa. This research aimed to fill this gap by reporting on physical, functional and social outcomes among PLWH treated at a referral center in Abidjan, Ivory Coast, and comparing them with those of a control group.
METHODS
Body composition, functional capacity, sarcopenia, limitations in daily activities and social participation were assessed among 300 PLWH (aged ≥ 30 years) and 200 uninfected adults of similar age and sex. The associations between these outcomes and participants' socioeconomic characteristics, HIV history and physical activity level were assessed using generalized additive models adjusted for age and sex.
RESULTS
The median age was 51 years, and the median antiretroviral therapy duration was 15 years. Compared to controls, PLWH reported higher levels of physical activity (p < 0.0001). They had a lower muscle index (adjusted p < 0.0001) and grip strength (adjusted p < 0.0001) but achieved similar performance on the 6-min walk test (6MWT, p = 0.2). Among PLWH, physical activity level was positively associated with better performance in the 6MWT (p = 0.006) and greater hand grip strength (p = 0.04). The difference in physical performance according to the level of physical activity appeared mainly after the age of 60. PLWH reported similar rates of activity limitations (p = 0.8), lower depression levels and greater scores for social functioning (p = 0.02).
CONCLUSION
In this study, PLWH achieved high levels of physical activity, which may explain why they maintained good physical performance and social functioning despite having a higher risk of sarcopenia. These results have important implications for resource-limited health systems and show avenues for chronic care models.
TRIAL REGISTRATION
This study was registered on the ClinicalTrials.gov website (NCT05199831, first registration the 20/01/2022).
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Activities of Daily Living; Body Composition; Cote d'Ivoire; Cross-Sectional Studies; Disabled Persons; Exercise; HIV Infections; Life Style; Sarcopenia; Social Participation
PubMed: 38851706
DOI: 10.1186/s12889-024-19020-9 -
Brazilian Journal of Physical Therapy 2024Sports participation for people with disabilities exists at the intersection of health, sport, and education sectors. However, no common framework and language exist to... (Review)
Review
BACKGROUND
Sports participation for people with disabilities exists at the intersection of health, sport, and education sectors. However, no common framework and language exist to describe the stages of sports participation.
OBJECTIVE
To present the background to the SPORTS Participation Framework, and how it can be used to illuminate the path that people with disability may travel to enter into, participate in, and enjoy and excel at all levels of sport.
METHOD
The SPORTS Participation Framework includes six stages drawn from mainstream sports pathways and models used to classify barriers to sports participation for people with disabilities: (S) Screening, goal setting and individual preparation, (P) Practitioner led, peer-group sports interventions, (O) Organised junior entry-point sports programs, (R) Recreational sport (non-competitive), (T) Team competition (school/club representation), and (S) State, National, and International competition.
RESULTS
For each stage, this paper describes the content of sports activities, the context in which they are performed, key stakeholders, barriers to participation, available evidence, and case studies.
CONCLUSIONS
The SPORTS Participation Framework presents a structure to navigate the stages of introducing and promoting lifelong sports participation for people with disabilities. It scaffolds clear communication, governance, and policy across health, sport, and education sectors, and supports clinicians and researchers to address barriers to participation at each stage to improve individual and population-wide participation in sport for people with disabilities.
Topics: Humans; Disabled Persons; Sports
PubMed: 38851054
DOI: 10.1016/j.bjpt.2024.101081 -
BMC Public Health Jun 2024Choosing a suitable job and leading a fulfilling professional life is vital for individuals, regardless of disability. Governments provide rehabilitation services to... (Observational Study)
Observational Study
BACKGROUND
Choosing a suitable job and leading a fulfilling professional life is vital for individuals, regardless of disability. Governments provide rehabilitation services to promote employment for individuals with disabilities, but research on their effects is limited. This study aimed to examine the impact of rehabilitation services on employment among people with physical disabilities in South Korea using propensity score matching.
METHODS
This study utilized an observational research design. Data were obtained from the 2020 National Survey of Disabled Persons, including 1,757 individuals aged 20 or older with physical disabilities. Descriptive statistics, chi-square and independent t-tests, logistic regression, and propensity score matching were employed.
RESULTS
The results for employment of individuals with physical disabilities showed no difference between the with rehabilitation services and the without rehabilitation services group. Based on subgroup analysis, when individuals with physical disabilities who rated their subjective health status low received rehabilitation services, it had a positive effect on employment.
CONCLUSIONS
The results of this study could serve as foundational data for future policies and educational directions concerning rehabilitation services for persons with disabilities.
Topics: Humans; Propensity Score; Disabled Persons; Female; Male; Republic of Korea; Adult; Employment; Middle Aged; Young Adult; Surveys and Questionnaires; Aged
PubMed: 38849810
DOI: 10.1186/s12889-024-19015-6 -
International Journal For Equity in... Jun 2024Involvement in healthcare decisions is associated with better health outcomes for patients. For children and adolescents with intellectual disability, parents and... (Review)
Review
BACKGROUND
Involvement in healthcare decisions is associated with better health outcomes for patients. For children and adolescents with intellectual disability, parents and healthcare professionals need to balance listening to a child's wishes with the responsibility of keeping them safe. However, there is a scarcity of literature evaluating how to effectively involve them in decision making. In this context, we review the concept of health literacy, focusing on the skills of healthcare decision making for children and adolescents with intellectual disability.
METHODS
We describe the concept of health literacy and models explaining shared decision making (individuals and healthcare professionals collaborate in decision making process) and supported decision making (when a trusted person supports the individual to collaborate with the healthcare professional in the decision-making process), and a rapid review of the literature evaluating their efficacy. We discuss healthcare decision making for children and adolescents with intellectual disability in the context of relevant recommendations from the recent Disability Royal Commission into Violence, Abuse, Neglect, and Exploitation of People with Disability in Australia.
RESULTS
Health literacy skills enable individuals to access, understand, appraise, remember and use health information and services. Shared decision making has been described for children with chronic conditions and supported decision making for adults with intellectual disability. Decision-making contributes to how individuals appraise and use healthcare. The rapid review found very limited evidence of outcomes where children and adolescents with intellectual disability have been supported to contribute to their healthcare decisions. Recommendations from the Disability Royal Commission highlight current needs for greater efforts to support and build the capacity of individuals with disability to be involved in the decisions that affect their life, including healthcare decision making.
CONCLUSIONS
Existing rights frameworks and healthcare standards confirm the importance of providing all people with the opportunities to learn and practise health literacy skills including decision making. There is little literature examining interventions for healthcare decision making for children with intellectual disability. Childhood is a critical time for the development of skills and autonomy. Evidence for how children and adolescents with intellectual disability can learn and practice healthcare decision-making skills in preparation for adulthood is needed to reduce inequities in their autonomy.
Topics: Humans; Intellectual Disability; Adolescent; Child; Health Literacy; Decision Making; Australia; Patient Participation; Decision Making, Shared
PubMed: 38849806
DOI: 10.1186/s12939-024-02204-5 -
Aging Clinical and Experimental Research Jun 2024We aimed to explore the association combined nutritional status and activities of daily living disability with all-cause mortality of older adults with hip fracture in...
Combined nutritional status and activities of daily living disability is associated with one-year mortality after hip fracture surgery for geriatric patients: a retrospective cohort study.
OBJECTIVE
We aimed to explore the association combined nutritional status and activities of daily living disability with all-cause mortality of older adults with hip fracture in the first year after hospitalization.
METHODS
This is a single-center retrospective cohort study in older adults with hip fracture patients. Clinical data and laboratory results were collected from electronic medical record system of our hospital (2014-2021). The endpoint of this study was all-cause mortality in the first year after hospitalization.
RESULTS
A total of 303 older adults were enrolled and all-cause mortality was 21.8%. The study population was categorized by CONUT score. Patients in CONUT score 5-12 had a higher age, ASA status, CRP and creatinine level, more patients with history of fracture, pneumonia and delirium, meanwhile, lower BMI and ADL score, lower hemoglobin, lymphocyte, total protein, albumin, triglyceride, total cholesterol and one year survival than those in CONUT score 0-4 (all P < 0.05). Multivariable Cox analysis showed that BMI, ADL score and CONUT score were independent risk factors for all-cause mortality of hip fracture in older adults (HR (95% CI):2.808(1.638, 4.814), P < 0.001; 2.862(1.637, 5.003), P < 0.001; 2.322(1.236, 4.359), P = 0.009, respectively). More importantly, the combined index of CONUT and ADL score had the best predictive performance based on ROC curve (AUC 0.785, 95% CI: 0.734-0.830, P < 0.0001). Kaplan-Meier survival curves for all-cause mortality showed that patients with CONUT score increase and ADL score impairment had a higher mortality rate at 1 year compared to CONUT score decrease and ADL score well (Log Rank χ2 = 45.717, P < 0.0001).
CONCLUSIONS
Combined CONUT and ADL score is associated with one-year mortality after hip fracture surgery for geriatric patients.
Topics: Humans; Hip Fractures; Activities of Daily Living; Male; Female; Retrospective Studies; Aged; Nutritional Status; Aged, 80 and over; Risk Factors; Disabled Persons; Geriatric Assessment
PubMed: 38849714
DOI: 10.1007/s40520-024-02786-8 -
The Primary Care Companion For CNS... Jun 2024The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During...
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. .
Topics: Humans; Mental Disorders; Disabled Persons
PubMed: 38848461
DOI: 10.4088/PCC.23f03684 -
PeerJ 2024Attentional processing of pain has been theorized to play a key role in the severity of pain and associated disability. In particular attentional bias towards pain...
BACKGROUND
Attentional processing of pain has been theorized to play a key role in the severity of pain and associated disability. In particular attentional bias towards pain information, resulting in poor pain outcomes, has been extensively researched. Recently, the idea was put forward that attention bias malleability (AM), , the readiness to acquire an attentional bias irrespective of its direction, may be key in predicting poor pain outcomes. We tested this hypothesis in two studies.
METHODS
In Study 1, 55 healthy participants completed an AM paradigm, followed by an experimental heat pain paradigm probing pain experience and pain-related task interference. In Study 2, 71 people with chronic pain completed an AM paradigm and questionnaires probing pain experience and associated disability.
RESULTS
In Study 1, including healthy participants, no relationship was found between AM indices and experimental pain outcomes. In Study 2, including chronic pain patients, results indicated that higher levels of overall AM were related to higher levels of pain experience and disability.
CONCLUSION
This study partially supports the hypotheses that the degree to which individuals can adapt their attentional preference in line with changing environmental conditions is associated with poor pain outcomes. However, future research is needed to clarify inconsistent findings between healthy volunteers and chronic pain patients as well as to determine the causal status of AM in poor pain outcomes.
Topics: Humans; Female; Male; Adult; Attentional Bias; Chronic Pain; Middle Aged; Pain Measurement; Surveys and Questionnaires; Young Adult; Disabled Persons; Attention
PubMed: 38846749
DOI: 10.7717/peerj.17430