The Utility of the WHO Intrinsic Capacity Screening Tool to Identify Physical and Mental Function Declines

Background The disease concept is increasingly being replaced by a functional approach to address the healthcare needs of the older people. WHO proposed the Integrated Care for Older People (ICOPE) screening tool to identify older people with priority conditions associated with declines in intrinsic capacity (IC). Very few evidence on the clinical utility of the ICOPE tool is available. Objectives: To determine if the tool can identify adults with poor physical and mental function. Method: 376 participants aged 50–97 years were included. IC was assessed with the WHO ICOPE screening tool, covering the following five domains: cognitive decline, limited mobility, malnutrition, sensory loss, and depressive symptoms. We assessed the activities of daily living, the Fried frailty phenotype, FRAIL scale, SARC-F scale, MMSE, GDS, social frailty, and quality of life. Peak expiratory flow, bones mineral density, body composition were obtained. Results 69.1% of the participants showed declines in IC. Participants with declines in IC were older, had more chronic diseases, worse general health, worse physical function as indicated by lower Barthel index, walk speed, grip strength, and physical fatigue, worse mental function indicated by lower MMSE scores, higher GDS scores, more mental fatigue, and worse social function. After adjusting for age, IC was positively correlated with walking speed, resilience score, and MMSE score and negatively correlated with frailty, SARC-F score, IADL score, GDS score, and physical and mental fatigue. Conclusion The WHO ICOPE screening tool is useful to identify adults with poor physical and mental function in Chinese older adults.

Cancer and Treatment Distress (CTXD) and Confidence in Survivorship Information (CSI) Trends in Older (≥60 Years) Allogeneic Hematopoietic Cell Transplantation (AlloHCT) Survivors

Background: AlloHCT survivors generally report higher rates of cancer- and treatment-related distress compared to the general population, although data on cancer and treatment Distress (CTXD) and Confidence in Survivorship Information (CSI) in older alloHCT recipients are limited. We have reported that older HCT survivors have generally low levels of distress and intermediate-high level of CSI (Al-Mansour et al, abstract submitted to ASH 2021 meeting). In this study, we describe specific distress and CSI concerns reported by older alloHCT survivors and their association with other patient-reported outcomes and transplant-related factors. Methods: This cross-sectional retrospective secondary analysis used baseline data from two randomized controlled trials of survivorship interventions in alloHCT recipients enrolled in 18 US transplant centers (combined dataset from survivorship care plan trial [NCT00799461] and internet based self-management intervention trial [NCT01602211]). A total of 181 enrolled patients transplanted from 2003-2014 were ≥60 years of age at alloHCT and were alive and disease-free at ≥1-year post-transplant. All donor and graft types were included in this analysis. Distress was measured by CTXD scale, in which higher values indicate higher levels of distress. Survivorship confidence was based on the CSI questionnaire, in which higher values indicate greater confidence. Health-related quality of life (HQOL) was assessed with the SF-12, with high scores indicating better physical function (PCS) and mental function (MCS). Clinical and sociodemographic variables were summarized in descriptive statistics. Non-parametric test (Wilcoxon rank sum test / Kruskal-Wallis test) was conducted for comparing two or three groups for CTXD/CSI. Spearman correlation and univariate linear regression model were used to evaluate associations between CTXD/CSI and PCS/MCS. Bonferroni correlation was used to adjust for multiple pairwise comparisons within age group at transplant. Results: The median age of this older sample at alloHCT was 64 (range 60-81), with the largest proportions non-Hispanic (96%), White (97%), and males (57%). The majority received peripheral blood grafts (88%) from an unrelated donor (65%) for their first (96%) transplant. At the time of the survey, survivors were at a median of 3 years (range 1-9) from alloHCT. Mean CTXD overall score was 0.85 (standard deviation [SD] 0.44). Among CTXD items, highest distress was reported for "low energy" (mean 1.42, SD 0.97) followed by "feeling tired and worn out" (mean 1.32, SD 0.93) and "not being able to do what I used to do" (mean 1.28, SD 0.98), while the lowest distress was reported for "communication with medical people"(mean 0.32, SD 0.66) and "getting information when I need it" (mean 0.39, SD 0.70; Figure 1). Similarly, mean CSI overall score was 1.39 (SD 0.44) in this Among CSI items, information on "disease treated" (mean 1.79, SD 0.41) scored the highest in confidence level followed by "treatment received for transplant" (mean 1.75, SD 0.46); meanwhile, information on "community resources for long-term effects of disease" (mean 1.14, SD 0.72) followed by "strategies for treating long-term physical effects of your treatment" (mean 1.15, SD 0.71) scored the lowest in confidence level (Figure 2). There were negative correlations between CTXD and PCS/MCS (P<0.001) and positive correlation between CSI and PCS/MCS (P<0.001). Different age groups at transplant (<65, 65-<70, vs. ≥70), history of chronic graft-versus-host disease, and enrollment time from transplant (≤2 vs. >2 years) showed no apparent effect on CTXD or CSI overall scores. Conclusion: Older alloHCT survivors report low level of cancer- and treatment-related distress and a relatively high level of CSI. Physical and mental function were associated with lower distress and increased CSI. Survivorship intervention needs in older alloHCT recipients include management of fatigue, education on long-term effects, and improving knowledge of and access to resources for long-term recovery and reintegration to society. The CTXD and CSI scales provide opportunities to evaluate and tailor interventions to the needs of older survivors with the potential to improve alloHCT survivorship care for older adults. Figure 1 Figure 1. Disclosures Hong: Adaptive Biotechnology: Other: Current employment of my spouse. Farhadfar: Incyte: Consultancy. Shaw: Orca bio: Consultancy; mallinkrodt: Other: payments. Devine: Sanofi: Consultancy, Research Funding; Johnsonand Johnson: Consultancy, Research Funding; Orca Bio: Consultancy, Research Funding; Be the Match: Current Employment; Vor Bio: Research Funding; Tmunity: Current Employment, Research Funding; Magenta Therapeutics: Current Employment, Research Funding; Kiadis: Consultancy, Research Funding. Wingard: Merck: Consultancy; AlloVir: Consultancy; Celgene: Consultancy; Shire: Consultancy; Janssen: Consultancy; Cidara Therapeutics: Consultancy. Majhail: Anthem, Inc: Consultancy; Incyte Corporation: Consultancy.

Self-Efficacy for Symptom Management in Long-Term Adult Hematopoietic Stem Cell Survivors

Background: Hematopoietic cell transplantation (HCT) survivors have a complex and multiphase recovery period. Health care delivery and psychosocial interventions for HCT survivors are challenging as many HCT recipients live great distances from the facility where they had their HCT. Therefore, identifying factors associated with a patient's capability to self-manage symptoms is an important focus of survivorship research. A patient's self-efficacy may be important for the successful management of major stressors associated with treatments and recovery. Here, we aimed to evaluate the impact of perceived self-efficacy on distress, quality of life (QoL), depression, and fatigue, and identify the factors associated with lower self-efficacy. Methods: This cross-sectional study analyzed baseline data from a randomized controlled internet based self-management intervention trial (INSPIRE, NCT01602211) in adult (age 18 and older) survivors 2-10 years post HCT. Patients with recurrence or subsequent malignancy requiring cancer treatment during the two years prior to enrollment, inability to read and understand English and lack of access to email and the Internet were excluded. Data included medical records and patient-reported outcomes (PROs) including Cancer and Treatment Distress (CTXD) with 6 subscales, Patient Health Questionnaire depression scale (PHQ-8), Short Form 12 Health Survey (SF-12) physical function (PCS) and mental function (MCS) scores, Brief Fatigue Inventory (BFI) and Health Self-Efficacy. Pearson correlations were used to test bivariate associations for self-efficacy with CTXD, SF-12, BFI, and PHQ8. General linear models were used to test the independent association for CTXD and SF-12 outcomes with self-efficacy, controlling for selected sociodemographic and treatment covariates. Tenability of statistical model assumptions were examined, and no remediation was necessary. Results: Total of 1078 HCT survivors were included in the analysis. Participants were 18 to 76 years (mean age 51), 53% male, and over 90% white and non-Hispanic. Only 16% reported living in a rural area. A majority received an autologous HCT (55%) and were less than 5 years from their first HCT (54%). Among the allogeneic HCT recipients, more than half (60%) had active chronic Graft-versus-Host (cGVHD) and nearly 40% were on active systemic treatment. The mean self-efficacy score was 3.01 (SD 0.49). Female gender (p=0.014), younger age at HCT, younger age at cGVHD presentation, moderate to severe currently active cGVHD (p=0.003) and household income less than $40,000 (p < 0.001) were associated with lower self-efficacy. In bivariate analyses, self-efficacy was negatively correlated with mean total CTXD (r -0.5, p <0.001) and each of the CTXD subscales including family strain (r -0.41, p<0.0001), identity (r -0.37, p<0.0001), uncertainty (r -0.5, p<0.0001), interference (r -0.47, p<0.0001), medical (r -0.36, p<0.0001) and health burden (r -0.42, p<0.0001). HCT survivors with higher self-efficacy also reported better physical (r 0.48, p<0.001) and mental function on the SF-12 (r 0.57, p<0.001). Moreover, self-efficacy was negatively correlated with symptoms such as fatigue (r -0.44, p<0.001) and depression (r -0.48, p<0.001). In a regression model investigating the impact of self-efficacy on CTXD controlled for demographics and disease characteristics , lower self-efficacy was independently associated with higher CTXD (beta -0.232; 95% CI (-0.294, -0.169), p< 0.001) (Table 1). Moreover, there was a significant positive relationship between self-efficacy and both mental (beta 4.68; 95% CI (3.82, 5.54); p <0.001) (Table 2) and physical (beta 2.69; 95% CI (1.74, 3.64); p<0.001) (Table 3) components of QoL. Conclusion: Our study demonstrates that lower levels of self-efficacy reported by HCT survivors was independently associated with higher levels of symptoms such as fatigue and depression, lower QoL, and more cancer -related distress. Furthermore, self-efficacy is more likely to be impaired in females, younger adults, those with lower incomes, and survivors with active cGVHD. These findings support the value of self-management interventions focused on improving self-efficacy as having the potential to improve multiple symptoms and QoL in HCT survivors. Figure 1 Figure 1. Disclosures Farhadfar: Incyte: Consultancy. Jim: RedHill Biopharma: Consultancy; Janssen Scientific Affairs: Consultancy; Merck: Consultancy; Kite pharma: Research Funding. Majhail: Anthem, Inc: Consultancy; Incyte Corporation: Consultancy. Wingard: Merck: Consultancy; AlloVir: Consultancy; Celgene: Consultancy; Shire: Consultancy; Janssen: Consultancy; Cidara Therapeutics: Consultancy.

Yoga Module to Improve Health and Wellbeing During COVID 19 Pandemic

After the initial outbreak of coronavirus disease 2019 (COVID-19) in China, the disease spreads rapidly across the whole world. It is observed that there is a rampant rise in the rate of infection in spite of best possible precautionary measures taken into consideration against Corona. As there is no scientifically validated full proofed medicine against COVID-19 till date, the only possible way is prevention against this infection by improving self-immunity, mass immunisation and controlling non-communicable diseases, if suffered from. Another possible way from the prevention from this deadly virus is development of herd immunity, but the process takes time and can be fatal for people with higher age groups and with co-morbidities. Yoga, an Indian way of mind-body purification, has been reported to improve functionality of human physiological systems and to prevent diseases. It is also observed that yoga, being a low to moderate intensity physical activity, breathing maneuvers and meditation, can also be performed by any person irrespective of age, with maximum benefit and having less stress in the vital organs during the practice. Therefore, a yoga package for improving immunity and other physical and physiological capacities and mental function to prevent Corona like disease has been formulated on the basis of knowledge from traditional yogic literature and evidence from available research publications on yoga. The yoga package might be beneficial across all age groups for improving health and wellbeing in this pandemic situation.

IMPACT OF PRAKRITI ON COGNITION AND WORKING MEMORY: A REVIEW

State of body and mind depends upon individual Prakriti (type of body constitution). Medha is grasping power, for which proper functioning of memory and mind is essential. Medha includes Dhee (wisdom), Dhriti (retaining power of mind) and Smriti (memory) which are the component of higher mental function. Cognition involves different kind of information processing, recollection and overall process involved in the formation of memory. Working memory is a mental workspace for processing of both new input and retrieved memories. Dosha decide the Sharirik (bodily constitution) and Mansik Prakriti (psychological constitution) of individual. It helps to understand and describe individual health status and intelligence like characteristics. Prakriti have an effect on the working of higher mental function, every individual has its own constitution type and hence mental function works differently according to its constitution.

From Altered Function to Restriction of Life

This chapter traces the development of children and young people with neurodevelopmental disorders through their later childhood and teenage years. The pattern and severity of impairments in mental function influence their course over time. In addition, the courses fluctuate in response to a series of encounters with potentially harmful influences. Stigma is widespread in many cultures. Physical illness and injury and premature mortality are consequences of several psychiatric syndromes. Economic disadvantage is more frequent for families of disabled people and interacts with other family stresses. Transitions into school, peer cultures, puberty, work, and the virtual world of the internet all tend to take different forms for those whose brain functions are altered by comparison with the rest of the population. All these can be responsible for adverse outcomes of children and young people.

Od małego „Dyzia” do dorosłego „rycerza z La Manchy”. Analiza problemu marzycielstwa u dzieci i młodzieży z perspektywy kulturowo-historycznej teorii rozwoju

This study describes the issue of maladaptive daydreaming. This phenomenon is becoming a contemporary educational problem because it limits the development potential of children and adolescents as well as their interpersonal relations. The field of possible understanding of maladaptive daydreamingin relation to terms related in meaning was outlined, as well as the current attempts at its scientific conceptualization. In my analysis, I go beyond the dualistic understanding of the children’s real and imaginary world, referring to the cultural-historical theory of the development of creative imagination as a higher mental function as an internalized system of social relations. From this perspective, the phenomenon of daydreaming in children and adolescents, in relation to reality, is not treated in a dichotomous way, but as a social development situation.

Multiple superficial mucoceles on the lower lip of a patient with phenylketonuria: A case report

This article reports a 13-year-old boy with phenylketonuria and multiple superficial mucoceles on his lower lip. Phenylketonuria (PKU) is a serious and rare genetic disorder that affects the levels of amino acids such as phenylalanine in the body. If left untreated, PKU can negatively affect mental function and cause retardation. Patients with PKU receive less oral examination compared to the normal population. Mucoceles are lesions formed by the accumulation of mucous of salivary glands in soft tissue by blockage or extravasation. Local trauma has been identified as the main cause of mucoceles development. Superficial mucoceles are rare in the lower lip. These patients need close oral and maxillofacial examination to find problems, which may be related to their systemic problem. Micro-marsupialization is a conservative therapeutic approach for management of pediatric oral mucoceles. Management of trauma in patients with mental retardation is an important issue.