A comprehensive approach to risk factors for upper arm morbidities following breast cancer treatment: a prospective study

Background Breast cancer surgery frequently causes deficiencies in shoulder functioning. The study pourpode is to identify risk factors for prolonged pain, reduction in function, and decrease in range of motion (ROM) in BC patients. Methods A prospective cohort study was designed in a private hospital; between October 2018 and April 2019 with a follow-up of 6 months. Patients following BC surgery, were divided by arm morbidities, and the different risk facrors were evaluated using univariate analysis and logistic regression. Results A total of 157 patients were included in the study. Risk factors for functional disabilities included; pain levels during hospitalization NPRS 1.2 (±0.8) compared to patients with no disabilities 0.5 ± 0.7 (p = .006), the size of tumors more than 1.4 ± 0.8 cm. compared with no morbidities 0.8 ± 0.9 cm. (p = .046), and breast reconstructions (p = .030). Risk factors for prolonged pain includes mastectomy (p = .006), breast reconstruction (p = .011), more than three dissected lymph nodes (p = .002), the presence of preoperative pain (p < .001), in-hospital pain (p < .001), axillary web syndrome (p < .001) and lymphedema (p < .001). Risk factors for decreased ROM were more than three dissected lymph nodes (p = .027), radiation (p = .018), and the size of dissected tissue (p = .035). Postoperative physical therapy appears to reduce the incidence of prolonged pain (p = .013) and regular physical activity may reduce long term functional disabilities (p = .021). Conclusions Upper arm morbidity following BC treatments affect up to 70% of the patients. Identifying the different risk and beneficial factors may improve awareness among physicians to refer patients to early rehabilitation programs and thus avoid chronic morbidity and improve the course of recovery. Trial registration The study was registered in Clinical trial with the ID number: NCT03389204.

Culturally Congruent Health Activities for the Prevention of Functional Disabilities Among Older Adults in Japan’s Forest Communities

Introduction: In Japan’s forest areas, cultural capital and older adults play key roles in helping to sustain the community. The purpose was to explore cultural values/beliefs related to culturally congruent health activities among older adults in forest communities. Method: The qualitative ethnonursing research method was used. Data were collected through fieldwork and key informants’ interviews ( n = 14) over 1 year. The setting was a traditional village with 80% forest cover. Results: Findings included two universal cultural values/beliefs, which were “community identity as a community member” and “our cohesion and connection as community members.” Additionally, two diverse cultural values/beliefs were found: “gender-based differences” and “differences between those having experience working outside the forest community and those without this experience.” These were related to community-based health activities. Discussion: These values/beliefs were suggested to develop a multilayered network around health activities in order to prevent functional disabilities among older adults.

Sex disparities in the prevalence of physical function disabilities: a population-based study in a low-income community

Background Functional disability continues to be a significant public health problem that increases older adults’ vulnerability to experience a diminished quality of life, loss of independence, higher healthcare costs and health services utilization, and increased risks of mortality. Thus, we aimed to study the prevalence of functional disabilities by sex according to the types of daily living activities, controlling for specific sociodemographic variables among older Hispanics from low-income communities. Methods We used a cross-sectional epidemiological research design, considering a complex sampling design of households to interview adults ≥65 years living in low-income communities in Puerto Rico. Functional disability was measured by the PROMIS® Physical Function Short Form-20 T-score. The selected community was reported to have 5980 adult residents ≥65 years, according to the USA Census. The prevalence of functional disability was estimated using the logistic regression model, weighting by the effect of the sampling. Our estimated prevalence was compared between sexes using the prevalence ratio (PR), which was estimated with logistic regression models, controlling for age, income, number of chronic conditions, high and low impact of chronic conditions in functional disabilities, marital status, and sampling design. Results We recruited 211 older Hispanics from a randomly selected sample. Their mean age was 74.4 ± 7.1 years, with female predominance (57.3%). The overall estimated prevalence of physical function disability using T-score among females was 2.70 (95% CI: 1.4, 5.1) times the estimated prevalence of physical function disability among males. Women were more likely to report functional disabilities in instrumental activities of daily living, self-care activities, and functional mobility compared to males. However, sex differences were largely explained by the presence of musculoskeletal conditions of high impact in functional disability. Conclusions The females in our study bear the greater burden of physical function disability in their adult age. Health policies, as well as future studies, should be targeted at reducing the burden of physical function disabilities in different types of daily activities through gender-sensitive disability self-management programs.

Rural–Urban Inequalities in Poor Self-Rated Health, Self-Reported Functional Disabilities, and Depression among Chinese Older Adults: Evidence from the China Health and Retirement Longitudinal Study 2011 and 2015

The household registration system (Hukou) in China classifies persons into rural or urban citizens and determines eligibility for state-provided services and welfare. Not taking actual residence into account may underestimate rural–urban differences. This study investigates rural–urban inequalities in self-reported health outcomes among older adults aged 60+, taking into account both Hukou and actual residence, adjusting for sociodemographic determinants, based on the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015. Self-Rated Health (SRH) was assessed with a single question, functional abilities were assessed with the Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) scales, and depression was assessed with the 10-item version of the Center for Epidemiologic Studies Depression Scale. Rural respondents had poorer socioeconomic status and higher prevalence of poor SRH, functional disabilities, and depression than urban respondents in both years, which were closely related to rural–urban differences in educational level and income. Impairments appeared at a younger age among rural respondents. Analyses using only Hukou registration and not actual residence resulted in underestimation of rural–urban differences. This study may serve as a basis for interventions to address rural–urban differences in health and social services and reduce health inequalities among Chinese older adults.

Playing your pain away: designing a virtual reality physical therapy for children with upper limb motor impairment

Children with upper limb motor impairment often undergo repetitive therapeutic physiotherapy sessions to minimize functional disabilities of the affected area. Even though therapeutic processes can improve functional outcomes and minimize persistent disabilities, patients often neglect to participate fully in physical therapies due to the associated procedural pain. Over recent decades, there has been a growing interest in designing non-pharmacological interventions which aim to minimize pain during physical therapies and improve functional outcomes. Via two interrelated studies, we explored the use of virtual reality (VR) as a tool to provide therapeutic physiotherapy for child patients in an out-patient hospital department. We found that VR is an effective solution for children with upper limb motor impairment undergoing painful therapeutic process within a hospital environment. VR can improve functional disabilities, alleviate perceived pain, reduce the perceived difficulty of rehabilitation exercises, increase exercise duration and produce positive emotions towards the therapy.Trial registration number and date of registration Protocol ID NCT03998995. Release Date: June 25, 2019.

Title: Sex disparities in the prevalence of disabilities: A population-based study in a low-income community

Background: Functional disability continues to be a significant public health problem that increases older adults’ vulnerability to experience a diminished quality of life, loss of independence, higher healthcare costs and health services utilization, and increased risks of mortality. Thus, we aimed to study the prevalence of disabilities by sex according to the types of daily living activities, controlling for specific sociodemographic variables among older Hispanics from low-income communities.Methods: We used a cross-sectional epidemiological research design, considering a complex sampling design of households to interview adults ≥65 years living in low-income communities in Puerto Rico. Functional disability was measured by the PROMIS ® Physical Function Short Form-20 T-score. The prevalences of disability were estimated using the logistic regression model, weighting by the effect of the sampling. Our estimated prevalences were compared between sexes using the prevalence ratio (PR), which was estimated with logistic regression models, controlling for age, income, number of chronic conditions, high and low impact of chronic conditions in functional disabilities, marital status, and sampling design.Results: We recruited 211 older Hispanics from randomly selected sample. Their mean age was 74.4 ± 7.1 years, with female predominance (57.3%). The estimated prevalence of physical function disability using T-score among females was 2.70 (95% CI: 1.4, 5.1) times the estimated prevalence of physical function disability among males. Women were more likely to report functional disabilities in instrumental activities of daily living, self-care activities, and functional mobility compared to males. These sex differences were largely explained by differences in disability-related chronic conditions.Conclusions: The females in our study bear the greater burden of physical function disability in their adult age. Health policies as well as future studies should be targeted at reducing the burden of physical function disabilities in different types of daily activities through gender sensitive disability self-management programs.

Is Cannabidiol During Neurodevelopment a Promising Therapy for Schizophrenia and Autism Spectrum Disorders?

Schizophrenia and autism spectrum disorders (ASD) are psychiatric neurodevelopmental disorders that cause high levels of functional disabilities. Also, the currently available therapies for these disorders are limited. Therefore, the search for treatments that could be beneficial for the altered course of the neurodevelopment associated with these disorders is paramount. Preclinical and clinical evidence points to cannabidiol (CBD) as a promising strategy. In this review, we discuss clinical and preclinical studies on schizophrenia and ASD investigating the behavioral, molecular, and functional effects of chronic treatment with CBD (and with cannabidivarin for ASD) during neurodevelopment. In summary, the results point to CBD's beneficial potential for the progression of these disorders supporting further investigations to strengthen its use.