Greater and More Natural Use of the Upper Limbs During Everyday Life by Former Amputees Versus Prosthesis Users

Hand loss profoundly impacts daily functioning. Reversal of amputation through hand replantation or transplantation offers an alternative to prosthetics for some. Whether recipients exhibit more extensive and natural limb use during everyday life than prosthesis users is, however, unknown. We asked unilateral, below-elbow amputees (N = 22), hand graft recipients (transplants N = 4; replants N = 2), and healthy matched controls (N = 20) to wear wireless accelerometers distally on their forearms/prostheses and proximally on their upper arms. These units captured limb activity over 3 days within participants’ natural environments. Graft recipients exhibited heavier reliance on their affected hands compared to amputees’ reliance on their prostheses, P < .001. Likewise, reliance on the injured side upper arm was also greater for hand graft recipients than amputees, regardless of whether they were wearing their prostheses, P < .05 in both cases. Hand graft recipients, like healthy controls, also relied more on forearm vs upper arm movements when controlling their limbs, P < .001. Compared with conventional prosthesis users, graft recipients exhibited more extensive and natural functioning of the upper limbs during everyday activities. This information is an important addition to other considerations when evaluating risk-benefit of these treatment alternatives.

Developing a Reablement Program Aimed at Preventing Unnecessary Care Transitions After Geriatric Rehabilitation

Patients returning home after geriatric rehabilitation may encounter several challenges related to daily functioning, which only manifest after returned home due to the large difference in environment and amount of support provided in both settings. This study aimed to develop an intervention preventing transitional care. A co-creation design was used, including literature research, observations, interviews, and working groups including a variety of stakeholders (n=13), including care professionals, policymakers of the municipality, client representatives, and an expert in the field of geriatric rehabilitation. Results indicated four main causes for transitional care problems: lack of communication between patients and professionals, coordination and continuity of care, patients’ limited self-management skills, and insufficient preparation. To solve these problems, an intervention was developed consisting of six intervention components aiming to increase self-management during meaningful daily activities, narrow the gap between the rehabilitation and home setting, and enhance communication and coordination.

The Effectiveness and Common Features of Reablement Services on Clients’ Daily Functioning: A Systematic Review

This systematic review, guided by the ReAble-definition, (1) provides an overview of reablement interventions and their effect on Activities of Daily Living (ADL), and (2) identifies common features of effective interventions. A systematic search was conducted from 2002 to 2020, identifying nineteen studies from eight countries with a total of 6,534 participants. Ten studies (with moderate to high quality) revealed improvements in ADL functioning. Three common intervention features were identified within effective interventions: use of multidisciplinary teams; a protocoled or standardized assessment; and using multiple components such as ADL-training, education and exercise programs. This review emphasizes that future studies should provide a more consistent and detailed reporting on the intervention and its components. Furthermore, a uniform approach regarding components, follow-up times and outcome measures can contribute to the comparison of reablement interventions and better determine their effectiveness, independent of the healthcare system or country in which it is used.

Exploring the impact of ineligibility on individuals expressing interest in a trial aimed at improving daily functioning regarding perceptions of self, research and likelihood of future participation

Background Eligibility guidelines in research trials are necessary to minimise confounds and reduce bias in the interpretation of potential treatment effects. There is limited extant research investigating how being deemed ineligible for such trials might impact patients’ perceptions of themselves and of research. Better understanding of the impact of patient ineligibility could enhance design and implementation of future research studies. Methods Eight semi-structured telephone interviews were conducted to explore the impact of ineligibility on self-perceptions; perceptions regarding the nature of research; and the likelihood of expressing interest in future research. Data were collected and analysed thematically through inductive, interpretive phenomenological analysis (IPA). Results Five themes emerged regarding the experience of being deemed ineligible: (1) Being deemed ineligible is emotion and reaction evoking; (2) ‘Doing your bit’: Helping others and increasing the value of research; (3) Communication of ineligibility; (4) Appreciation for those who express interest; and (5) Subsequent perceptions and attitudes towards research. Conclusions The results suggest that being deemed ineligible can elicit negative emotional outcomes but is not likely to change perceptions of or attitudes towards research, possibly due to a desire to help similar others. Ineligibility can impact future participation in some cases, thus reducing the recruitment pool for subsequent research studies. Recommendations are provided to help minimise this risk. Advising of ineligibility in a personal way is recommended: with enhanced clarity regarding the reasoning behind the decision; providing opportunities to ask questions; and ensuring that appreciation for the patient’s time and interest are communicated.

Case Report: Propranolol Therapy for Infantile Tremor Syndrome in a Child With Vitamin B12 Deficiency

Vitamin B12 deficiency in childhood presents with a wide variety of symptoms including anemia, failure to thrive and developmental delays. It is a diagnostic consideration in children who are exclusively breastfed or have minimal solid intake, especially if their mother is vegetarian or has underlying vitamin B12 deficiency. Infantile tremor syndrome (ITS) has been associated with vitamin B12 deficiency. ITS presents with neurological symptoms such as developmental delays and tremors. The tremors seen in ITS can be profound and interfere with daily functioning. Different therapies have been tried for those tremors without much evidence or information regarding their efficacy and dosing regimens. We present the case of a 13-month-old girl with vitamin B12 deficiency who developed ITS with significant tremors after initiation of vitamin B12 therapy. She was treated with propranolol which resulted in significant improvement in her tremors. This case highlights the efficacy and safety of propranolol for the treatment of ITS in the context of vitamin B12 deficiency.

Community-level Mental Health and Psychosocial Support During Armed Conflict: A Cohort Study from the Democratic Republic of Congo, Mali and Nigeria

Introduction: Community-level mental health and psychosocial support (MHPSS) was the first type of MHPSS program launched by the International Committee of the Red Cross (ICRC) back in 2004. Standardized beneficiary-level monitoring was put in place in late 2018. This is the first study to explore whether this type of program correlates, as intended, with reduced psychological distress and increased daily functioning.Methods: Between December 2018 and June 2020, 6,413 victims of violence received MHPSS through 32 community-level projects in the Democratic Republic of Congo, Mali and Nigeria. Symptoms of psychological distress (IES-R or DASS21) and daily functioning (ICRC scale) were assessed before and after the intervention and logistical regression models were used to identify predictors of these symptoms. Results: The most predominant perpetrators were weapon-bearers (76%) and the most common type of violence was rape (46%). Victims of violence committed by weapon-bearers were more likely to show high levels of anxiety prior to MHPSS (aOR 3.51; p<0.0001). Also, victims of physical violence were more likely to show high levels of stress (aOR 1.49; p<0.0001) whereas victims who had witnessed physical violence were more like to report high levels of depression (aOR 2.54; <0.0001). Lack of social support stood out as a predictor of both high anxiety (aOR 2.10; p<0.0001) and post-traumatic stress (aOR 2.04; p<0.0001) prior to MHPSS. Following MHPSS, the vast majority of beneficiaries reported a reduction in distress on the DASS21 (96.58%) and the IES-R scales (92.70%) as well as an increase of functioning (82.26%). Adherence to group therapy (7 sessions on average) was stronger than individual therapy (4 sessions on average). A linear trend was found between length of treatment and likelihood of reporting reduced symptoms of depression. Having suffered destruction or loss of property or income was predicted less improvement of functioning following MHPSS (aOR 0.90; p=0.044). Conclusion: Community-level MHPSS is associated with increased well-being among the vast majority of beneficiaries. To further increase intended health outcomes, it is recommended to increase the number of sessions per beneficiary and address, where relevant, the financial consequences of violence. Also, a longitudinal study is recommended to assess the longer-term changes in symptoms.

Diabetes mellitus

Diabetes is an increasingly common, progressive metabolic disorder that results in a range of distressing symptoms, altered daily functioning, social and psychological impacts on individuals and their families, high healthcare expenditures, lost productivity, and premature mortality. Prevalence and absolute numbers of people with diabetes has grown worldwide, with no country or region spared. In this chapter, we review the data regarding diabetes burdens, describing patterns observed in low- and middle-income countries, and in high-income countries. We describe the major gaps that must be addressed, both in research and in implementation, to better detect, prevent, and treat diabetes. We describe what is known and yet unknown about vulnerable populations and describe efforts to address disparities in diabetes.