Persistent Disability Six Months after Initial Disability Less Likely in Older Women

Many community-dwelling older adults develop activity of daily living (ADL) disability and subsequently regain function. Using data from the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial, we examined the relationship of gender, incident disability, and persistent disability 6 months after the incident disability. Walking, bathing, dressing, transferring, toileting, and eating were assessed as ADLs, at bi-annual interviews. ADL disability was defined as requiring help with or inability to do or severe difficulty with ≥1 ADL; persistent disability was an ADL loss at 6 months after a first (incident) ADL disability. Discrete time, multivariable Cox proportional hazards regression was utilized to estimate associations with developing incident ADL disability described as cause-specific hazard ratios, with death as a competing outcome. For persons with incident ADL disability, odds of developing persistent disability at 6 months as compared to recovery was determined using multivariable logistic regression. These analyses included 18,414 (51.6% women) ASPREE participants in the United States and Australia aged 70+ years (65+ years if U.S. ethnic minority) without ADL disability at trial entry. During a median follow-up of 4.7 years, 1,485 participants (63.2% women) developed an incident ADL disability, and, of those, 272 (57.0% women) met criteria for persistent disability at 6 months. Women had an increased risk (HR=1.17, 95% CI=1.05 to 1.32) of developing incident ADL disability; however, women were less likely to have persistent disability versus recovery 6 months later (OR=0.66, 95% CI=0.49 to 0.89). Why persistent disability development is lower in older women needs further exploration.

Features of diseases of the musculoskeletal and peripheral nervous systems in workers of metallurgical production in modern conditions

Manufacturing industries, including metallurgy, are the backbone of the country’s economy. A number of technological operations involve the impact of physical overload, heating microclimate, static load, and often entails the development of diseases of the musculoskeletal and peripheral nervous systems. The clinical picture of such patients is dominated by pain in various parts of the spinal column, in some cases, combined localization. The analysis of the results of the examination of the connection of diseases of the musculoskeletal and peripheral nervous systems with the profession, carried out by employees of a large metallurgical enterprise of the Republic of Bashkortostan (RB), using the archival material of the FBUN clinic «Ufa Research Institute of Occupational Medicine and Human Ecology» was carried out. The group of the main professions of the enterprise includes: wire drawing machine, wire rewinder, caliper, pyrometrist, laboratory assistant for physical and mechanical tests, automatic machine for cold landing machines, mechanic-repairman, sorter-delivery of metal. During the analyzed period, in 117 cases, the workers of the enterprise confirmed the professional etiology of the disease. The nosological structure in 60 % of cases of the first established occupational diseases is represented by diseases of the musculoskeletal system and connective tissue. A significant part of diseases of occupational etiology was detected in persons aged 50 to 59 years. Workers of the studied professional groups are at the highest risk of developing diseases of the musculoskeletal and peripheral nervous systems of professional etiology, which is due to the specific conditions of their professional activity. Establishing a connection between the disease and the profession is characterized by late detection, at the stage of pronounced clinical symptoms with the formation of persistent disability.

Silicoarthritis: issues of early diagnosis, prevention

Background. The severity of the course of silicosis is aggravated by the addition of complications; one of the serious and rare complication of silicosis is silicoarthritis or Kaplan’s syndrome (KS), which accounts for 0.1-0.6% of all cases of silicosis. Silicoarthritis significantly reduces the quality of the life of patients and leads to early and persistent disability.Aim. To establish the most significant methods of diagnosing silicoarthritis for early detection of the disease and prevention of complications.Materials and methods. The article presents clinical cases of silicosis and its rare complication - SC. The basis for the diagnosis of this pathology is X-ray, immunological and functional methods.Results. In patients with more than 5 years of experience exposed to aerosols of fibrogenic action, crystalline silicon dioxide, with an excess of the MPC level from 2.3 to 4 times on the basis of MSCT of the lungs, during which multiple polymorphic foci with a diameter of 2 up to 10 mm, partly merging with each other into peribronchovascular couplings, as well as perifocal areas of reduced airiness like ground glass and thickening of the axial interstitium, a diagnosis of late silicosis, stage 2 nodular form was established, the diagnosis was confirmed by biopsy data. In dynamics, after 5 years, arthralgic complaints joined. On the basis of immunological (increased TNF-alpha, IL-1b), X-ray examination (osteoarthritis of the distal and proximal interphalangeal, wrist, metatarsophalangeal joints), the diagnosis was clarified as Silicoarthritis: Kaplan’s syndrome.Conclusion. Diagnosis of silicosis and its complications at the preclinical stage in workers who have been in contact with silica dust for 5 years or more should include: MSCT of the lungs, determination of TNF-alpha, IL-1b, rheumatoid factor, and a study of respiratory function.

Clinical and functional characteristics of disabled people due to diseases of the peripheral nervous system at working age

The dominant position among the reasons of working-age population’s health deterioration belongs to diseases of the peripheral nervous system (PNS), the peak prevalence of which occurs at the age of 35–40. PNS diseases are diagnosed in about 76.0% of industrial workers, and account for more than half of all occupational diseases. They are the main cause of incapacitation and long-term disability. Publications on disability due to PNS diseases are isolated.The aim of the work. Clinical and functional characteristics of PNS disorders that cause disability in the working-age population.Material and methods. Among 91 496 first recognized as disabled in the Republic of Bashkortostan in 2014–2018, all disabled people of working age were selected due to PNS diseases, in which the main independent diagnosis was radiculopathy, polyneuropathy, neuropathy and vibratory disease with indication to lumbar-sacral radiculopathy with polyneuropathy of the upper extremities. 107 people were identified to constitute a closed cohort for a comprehensive study of the clinical-functional state and patterns of disability formation in them. The clinical-functional characteristic is given on the basis of the results of studies set forth in the directional medical documents and the assessment by an expert neurologist of the Main Bureau of Medical and Social Expertise. Statistical analysis was performed in Microsoft Excel.Results. The prevalence of PNS diseases has been found to be increasing. Three of the newly diagnosed neurological patients have been the carriers of PNS disease. PNS diseases are formed and reach peak in working age. Characterized by a chronic, progressive course, they often cause temporary and persistent disability. On average, there are 0.1 ± 0.028 persons with disabilities per 10 thousand of the able-bodied population due to PNS diseases, the level of which in dynamics for 2014–2018 increased by 1.7 times. Persons with disabilities (69.0%) are mainly represented by men, every second (50.6%) is over 50 years old, with an average age of 48.7 ± 5.7 years. The clinical-functional state is characterized by constant pain, numbness, seizures, restriction of movements in the limbs, sensory disorders, vegetative-vascular disorders.Conclusion. The quantitative evaluation of the main types of the body functions and main categories of vital activity persistent disorders made it possible to detect that 69.3 ± 4.4% persons with disabilities have persistent moderate abnormalities of functions in the range 40–60% (II degree), another 24.4 ± 3.8 — persistent pronounced abnormalities in the range 70–80% (III degree) and 6.3 ± 6.0% — persistent significant abnormalities in the range 90–100% (IV degree). The severity of impaired functioning of the body is the basis for the level of persistent disability determination.

MODERN CRITERIA FOR THE SELECTION OF HEAD AND NECK CANCER PATIENTS FOR RECONSTRUCTION OF THE UPPER AERODIGESTIVE TRACT BY THE VISCERAL FLAPS

Introduction. The high incidence of cancer of the upper aerodigestive tract, impairment of breathing, speech, and swallowing functions accompanied by prolonged and often persistent disability put the rehabilitation and the quality of life of patients among the most important social problems.Material and methods. We have gained experience in reconstructing the pharynx and esophagus with various fragments of the gastrointestinal tract in 121 cancer patients. Based on our own clinical experience, the most important criteria of selecting patients after laryngectomy for reconstruction of the upper aerodigestive tract with visceral flaps were identified. Visceral autografts formed from different parts of the patient’s gastrointestinal tract were full-layer fragments of the abdominal organs, which included the mucous membrane of the stomach, small intestine, or large intestine. In some patients, the choice of flap was limited by a large omentum.Results. In 9.9 % of cases, flap necrosis was observed. Oral nutrition was restored in 93.9 % of patients. In 90.5 % of cases, speech function was restored after the installation of avoice prosthesis. The method of autologous transplantation of the ileo-colonic flap made it possible not only to remove the organs affected by the tumor, but also to simultaneously restore the lost nutrition and vocal functions without resorting to artificial prostheses, but using only their own tissues. The 5-year survival rates were 36.4 % and 67.3 % in patients with simultaneous reconstruction and in patients with delayed reconstruction, respectively.Conclusion. The use of visceral flaps in the reconstruction of the upper aerodigestive tract allows patients to restore both the nutrition and voice functions after laryngectomy.

Metabolic syndrome in individuals suffering from multiple sclerosis: Why we should not blame the patients

Multiple sclerosis (MS) is a progressive inflammatory disease of the central nervous system that normally leads to impairment and persistent disability at a rather early age. The observation that physical stress can lead to the onset of reversible neurological symptoms has in the past led to patients being discouraged from doing sports. We investigated the current status of research and conclude that this advice may be as incorrect for a majority of MS patients as recent recommendation which encourage individuals with MS to engage in all kinds of physical activity.

Major aspects of working-age population disability caused by mental disorders

The scientific review reveals the relevance of the problem of persistent disability in patients with mental disorders as one of the most important indicators of public health. It has been shown that organic pathology plays an important role in increasing of incidence of disability due to mental disorders in people of working age. In addition, the clinical and epidemiological data of recent years, confirming the large scatter of disability rates across regions and the poorly understood clinical factors that determine disability in organic mental disorders, are presented. The need for further study of predictors of health deterioration as well as risk factors for persistent disability in order to solve the problems of preventing disability and to develop personalized programs of medical and social rehabilitation is discussed.