Does the global activity limitation indicator measure participation restriction? Data from the European Health and Social Integration Survey in Spain

Purpose The global activity limitation indicator (GALI) is the only internationally agreed and harmonised participation restriction measure. We examine if GALI, as intended, is a reflective measure of the domains of participation; furthermore, we determine the relative importance of these domains. Also, we investigated the consistency of response to GALI by age and gender and compared the performance of GALI with that of self-rated health (SRH). Methods We used Spanish data from the European Health and Social Integration Survey and selected adults aged 18 and over (N = 13,568). Data analysis, based on logistic regression models and Shapley value decomposition, were also stratified by age. The predictors of the models were demographic variables and restrictions in participation domains: studies, work, mobility, leisure and social activities, domestic life, and self-care. The GALI and SRH were the response variables. Results GALI was strongly associated with all participation domains (e.g. for domestic life, adjusted OR 24.34 (95% CI 18.53–31.97) in adult under 65) and performed differentially with age (e.g. for domestic life, adjusted OR 13.33 (95% CI 10.42–17.03) in adults over 64), but not with gender. The relative importance of domains varied with age (e.g. work was the most important domain for younger and domestic life for older adults). The results with SRH were parallel to those of GALI, but the association of SRH with participation domains was lowest. Conclusions GALI reflects well restrictions in multiple participation domains and performs differently with age, probably because older people lower their standard of good functioning.

Signals from predators, injured conspecifics, and pesticide modify the swimming behavior of the gregarious tadpole Rhinella dorbignyi (Anura: Bufonidae)

Tadpoles detect chemical signals released from predators and conspecifics, and those present in the environment, and adjust their behavioral responses. This study evaluated the swimming activity of Rhinella dorbignyi (Duméril and Bibron, 1941) tadpoles exposed to chemical signals, including cues from a predator fish Synbranchus marmoratus Bloch, 1975 and an injured conspecific; sublethal concentration of insecticide cypermethrin; and their combination. Swimming behavior (total distance moved, average speed, global activity, number of contacts between tadpoles) was evaluated in an individual (1) and groups of different size (3, 5, 7 and 10 tadpoles) using a video-tracking software tool. Predator exposure modified behavioral parameters, reducing encounters with predators and, therefore, mortality. Total distance moved and average speed increased in trials involving 1 tadpole and 3 interacting tadpoles exposed to injured conspecifics, whereas global activity increased in all group sizes, showing that gregarious tadpoles may be affected by alarm cues and their behavior may be disrupted. The insecticide treatments (alone and combined) increased parameters in all group sizes, causing hyperactivity due to its neurotoxic effect. The different responses observed after exposure to alarm cues and environmental signals in the different group sizes modified the normal behavior and the ecological dynamics of gregarious tadpoles.

Web Archiving as a Task of National and Local History Bibliography

The foreign experience of forming the majority of national web archives (in national libraries) and many accessible local history archives of public and university libraries has been analyzed due to the development of a model and methodology for electronic local history archives for Russian libraries.It is shown that the global activity on preserving network content is divided into national and regional segments and is national and local history in both contents. Its goals and structure fully fit into the classical forms and directions of national/local history bibliography, which turns out to be the key in all processes of selection and bibliographic processing of a new class of sources. For selection, all the criteria of connection with the country/region/territory, the place of production of the resource, its national language and content, characteristic of the national/local history bibliography; the selection itself is carried out by library specialists. The analysis has revealed the reasons why the preparation of the archived online content for use, regardless of the capabilities of automated technologies, in practice also requires the involvement of specialist in bibliography, the use of classical tools and methods of bibliographic description and indexing of content. The issue of choosing objects for archiving (sites, subdirectories, individual documents) is specially considered. The special significance, advantages and problems of treating individual documents are shown. The necessity of forming such web archiving strategies is substantiated, in which “starting points” are separate documents, and sites are evaluated and selected for productivity as their “containers”. Taking into account the global trends and the conditions of Russian libraries, a model of web archiving is proposed, the implementation of which, in the absence of a national repository and modern tools, will allow the beginning of accumulating some necessary experience and valuable network content.

Plasma exchange therapy in refractory inflammatory myopathy with anti-signal recognition particle antibody: a case series

Objectives To explore the efficacy of plasma exchange (PE) therapy in refractory idiopathic inflammatory myopathy (IIM) patients with positive anti-signal recognition particle (SRP) antibody. Methods Nine refractory IIM patients with positive anti-SRP antibody were enrolled, who received PE therapy at Ruijin Hospital from Octobor 2017 to December 2020. The clinical manifestations, laboratory tests, chest CT and lower extremity MRI images before and after PE therapy were compared. The treatment response was evaluated by the 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) myositis response criteria. Results 88.9% (8/9) subjects had achieved improvement by 3 weeks after PE therapy, with 55.6% (5/9) minimal improvement and 33.3% (3/9) moderate improvement. There were statistically significant improvements between baseline and after PE therapy at 3 weeks on the core set measures: physician global activity, patient global activity, Health Assessment Questionnaire (HAQ), manual muscle testing (MMT), extramuscular disease activity, and muscle enzymes activity including creatine kinase (CK), lactate dehydrogenase (LDH), aspartate transaminase (AST), except for alanine transaminase (ALT). Moreover, the chest CT showed regression of ground glass opacities and irregular linear opacities after PE therapy in four patients with interstitial lung disease. The MRI images of lower extremity in four patients showed reduction of muscle oedema after the therapy. Conclusion PE therapy is effective for refractory IIM patients with positive anti-SRP antibody. It should be considered as an alternative treatment for those patients who are resistant to the combined therapy of glucocorticoids and immunosuppressive agents.

Az élettartammal és az időskori betegségteherrel kapcsolatos szubjektív várakozások

Összefoglaló. Bevezetés: A lakosság idősödésével növekvő betegségteher egyéni és társadalmi szinten is fokozódó nyomást jelent. Célkitűzés: Felmérni a hazai általános felnőtt lakosságnak a korlátozottsággal, a gondozási igényekkel és a munkavégzéssel kapcsolatos időskori szubjektív várakozásait. Módszer: Online keresztmetszeti felmérést végeztünk. A korlátozottsággal kapcsolatos várakozásokat a hivatalos szakstatisztikákban alkalmazott globális tevékenységkorlátozottsági mutató (Global Activity Limitation Indicator, GALI) segítségével elsőként vizsgáltuk. A jelen és szubjektíve várt munkavégzést, gondozási igényt, gondozói tevékenységet, valamint a jelen egészségi állapotot és szociodemográfiai helyzetet vizsgáló kérdéseket is feltettünk. Statisztikai analízis: A mintában mért adatokat lokális polinom segítségével simítottuk, és a 60/70/80/90 éves korra adott szubjektív várakozásokkal hasonlítottuk össze. A szubjektív várakozásokat meghatározó tényezőket intervallumregresszióval becsültük. Eredmények: 1000 kitöltőtől 914 érvényes választ kaptunk. Az átlagéletkor (± szórás) 51,2 (± 15,2) év, a minta 55,8%-a nő volt. A férfiak között a fizetett munkát végzők (p<0,001), a nők között az informális gondozók aránya volt magasabb (p = 0,010). Az átlagos (± szórás) szubjektíve várható élettartam (81,0 ± 11,1 év) a minta statisztikailag várható élettartamánál (79,6 ± 3,7 év) 1,3 évvel volt hosszabb (p<0,001), azonban az átlagos, szubjektíve várható egészséges élettartam (64,6 ± 15,2 év) 5,3 évvel volt rövidebb a statisztikailag várható értéknél (70,0 ± 4,2 év; p<0,001). A szubjektíve várható egészséges élettartamot és gondozási igényt elsősorban a válaszadók jelenlegi egészségi állapota befolyásolta. Az életmód és a szubjektíve várható egészséges élettartam között nőknél nem találtunk összefüggés, míg a túlzott gyakorisággal alkoholt fogyasztó vagy elhízott férfiak hosszabb egészséges élettartamra számítottak. A szubjektív várakozások meghatározó tényezői jelentős nemi különbségeket mutattak. Következtetés: Az egészséggel, munkával és gondozással kapcsolatos szubjektív várakozások eltérőek a populációban mért valós adatoktól, és különböznek a nemek között. Orv Hetil. 2021; 162(23): 911–923. Summary. Introduction: The growing disease burden due to ageing populations poses a challenge on both individuals and societies. Objective: To explore the general population’s subjective expectations concerning disability, care needs and employment at older ages. Method: We conducted an online cross-sectional survey. We were the first to measure subjective health expectations using the Global Activity Limitation Indicator (GALI) of official health statistics. Respondents’ actual status and subjective expectations concerning employment, care needs and informal caregiver status, self-perceived health and sociodemographic factors were queried. Statistical analysis: We estimated sample characteristics by local polynomial smoothing and compared with subjective expectations at ages of 60/70/80/90 years. Determinants of subjective expectations were analyzed via interval regression. Results: From 1000 subjects, 914 provided valid responses. Mean (± SD) age was 51.2 (± 15.2) years, and 55.8% of respondents were women. Paid employment was more frequent among men (p<0.001), while informal caregiver status among women (p = 0.010). Mean (± SD) subjective life expectancy (81.0 ± 11.1 years) was 1.3 years longer (p<0.001) than actuarial life-expectancy (79.6 ± 3.7 years), while mean subjective healthy life expectancy (sHLE) (64.6 ± 15.2 years) was 5.3 years shorter than actuarial healthy life expectancy (70.0 ± 4.2 years; p<0.001). sHLE and care needs were mainly determined by respondents’ self-perceived health. Lifestyle risks were not associated with sHLE in women, while pervasive drinker or obese men expected longer healthy life span. Determinants of sHLE showed considerable gender differences. Conclusion: Subjective expectations concerning health, employment and care needs differ from actual values of the general population, with considerable gender differences. Orv Hetil. 2021; 162(23): 911–923.

P150 Hand-held dynamometry may provide a valid and objective method of muscle strength quantification in adult inflammatory myopathy: results from clinical practice in a tertiary centre

Background/Aims Accurate methods of muscle strength assessment are vital in the care of patients with idiopathic inflammatory myopathy (IIM). Manual muscle testing (MMT) is limited in quantification of strength and has a demonstrated 'ceiling effect'. Recent research has indicated that hand-held dynamometry (HHD) may provide a user-friendly and patient-acceptable method to quantify muscle strength without a ceiling effect. This study aims to demonstrate routine clinical application of HHD and explore the ability to predict physical function and patient-rated impact in a tertiary IIM cohort. Methods Data was collected from adult IIM patients attending a UK tertiary centre between 2016 and 2019. Bilateral HHD of knee extension, shoulder abduction and grip strength were measured by a single specialist physiotherapist. Data was also collected on function (Health Assessment Questionnaire [HAQ]), muscle strength (MMT-8) and global activity (patient global visual analogue scale [VAS]). Generalised linear modelling, adjusted for age and sex was used to quantify associations between HHD values of each movement and HAQ score, MMT-8 score and patient global activity VAS. Results Data was collected on 57 patients (60% female) with a mean age of 56 years (SD 13), mean HAQ of 1 (SD 0.85), and mean MMT-8 of 75 (SD 6) out of a maximum score of 80. Summary values of each collected measurement and modelling results are displayed in Table 1. All HHD measurements significantly correlated with HAQ, MMT-8 and patient global VAS scores. The greatest magnitude of association was seen with shoulder abduction. The collection of strength measures by the HHD method was tolerable and time-efficient for patient and clinician. Patient feedback on being able to see their objective strength measures on the HHD was also encouragingly positive, boosting their intrinsic motivation to take part in rehabilitation. P150 Table 1:Summary HHD strength values and modelling resultsMeasurement using HHDMean (SD) (kg)Association with HAQ - Coef (p-value)Association with MMT-8 - Coef (p-value)Association with patient global VAS - Coef (p-value)Grip strength22.98 (12.41)-0.04 (&lt;0.01)0.26 (&lt;0.01)-1.53 (&lt;0.01)Shoulder abduction10.39 (5.51)-0.11 (&lt;0.01)0.60 (&lt;0.01)-2.74 (&lt;0.01)Knee extension13.03 (7.17)-0.06 (&lt;0.01)0.51 (&lt;0.01)-1.53 (&lt;0.01)SD = standard deviation, HAQ = Health Assessment Questionnaire, MMT-8 = manual muscle testing, VAS = visual analogue scale, Coef = coefficient, HHD = hand held dynamometry. Conclusion This study indicates that HHD may provide an inexpensive, user-friendly method of strength assessment in IIM patients, providing accurate insights into function, strength and global activity. Undertaking HHD in clinic and by a specialist physiotherapist allows for stratified, personalised rehabilitation intervention. Following future validation, HHD could form a method of objective muscle strength assessment, thus focusing IIM clinical care and research. Disclosure W.J. Gregory: Honoraria; W.G. has received honoraria from Abbvie, Pfizer and UCB. A. Oldroyd: None. H. Chinoy: None.

Yoga Sebagai Sarana Menuju Tuhan Yang Advaita

<p><em>Yoga is becoming an increasingly global activity. This worldwide yoga is only for hatha yoga, not accompanied by the well-known advanced stages of hatha yoga, namely Raja yoga. The actually, Yoga teach to connect ātman and paramātman . This goal can be achieved if humans undergo the stages of yoga as a whole so that the atman who is affected by virtual nature can be purified again.Maha Rsi Pātañjali was the first people to give an explanation of the yoga system in the Yoga Sutras and there are eight stages which are called astangga yoga. Furthermore, yoga teachings are also contained in tattwa texts, including: Lontar Text of Tattwa Jñāna (prayogasaṅdhi);The lontar text of Wrhaspati Tattwa (ṣaḍanga yoga); Lontar text of Jñānasiddhânta (ṣaḍ-aṅga-yoga). Tattwa texts contain teachings about yoga because in the tattwa teachings there are the concepts of cetana and acetana. Putting off acetana leads to cetana with yoga as the path. The teachings of yoga whose aim is to connect and purify the ātman to paramātman are related to the advaita or monistic concept of divinity, because the paramātman that the ātman will aim at in yoga is of course the monistic paramātman which believes that everything is God and all the differences that exist are mere delusion.</em></p>

Determinants of Disability in Minority Populations in Spain: A Nationwide Study

Some population groups could be especially vulnerable to the effects of population ageing. The Global Activity Limitation Indicator (GALI) has been proposed as a measure of disability, but it has not been used in minority groups. The aim of this study is to estimate the prevalence of disability using the GALI and to analyse its determinants in immigrant and Roma populations. Data from the Spanish National Health Survey 2017 and the National Health Survey of the Roma Population 2014 were used, including adults aged 50 and above. Prevalence of disability was estimated, and odds ratios were calculated using logistic regression models to assess the association between disability and demographic, socioeconomic, and health variables. The prevalence of disability was estimated at 39.4%, 30.6%, and 58.7% in the native, immigrant, and Roma populations, respectively. Gender was a common determinant for the native and Roma populations. On the other hand, among immigrants, the risk of disability increased over the time residing in Spain. There were significant interactions with age and gender in the native population. Disability has different determinants in the three population groups. Public health measures to protect the Roma population and immigrants’ health should be considered.

Activity of docetaxel, carboplatin, and doxorubicin in patient-derived triple-negative breast cancer xenografts

Triple-negative breast cancer (TNBC) is highly responsive to neoadjuvant polychemotherapy regimens including anthracyclines, taxanes, and, more recently, carboplatin. However, there is inadequate information on the individual contribution of each of these agents to the global activity of the combinations, and the use of combinations of up to four of these drugs is associated with relevant toxicity. Identifying single-drug activity in the clinical neoadjuvant setting is challenging. We developed patient-derived xenografts (PDXs) from several chemotherapy-naïve TNBC samples to assess the antitumor activity of single drugs and combinations of drugs. PDXs were established from chemotherapy-naïve TNBC samples. Nine TNBC PDX models (all of which corresponded to a basal-like phenotype according to the PAM50 classifier) were treated with carboplatin, docetaxel, and doxorubicin and the combination of docetaxel and carboplatin. Only one of nine PDX models showed sensitivity to doxorubicin, while eight of nine PDX models showed sensitivity to docetaxel and carboplatin as single agents. The 3 PDX models derived from patients with gBRCA-1 or gPALB2 mutations were very sensitive to carboplatin single agent. All 6 PDX models from patients without hereditary germ-line mutations showed increased sensitivity to the combination of docetaxel and carboplatin. In the present study, docetaxel and carboplatin single agents were active drugs against basal-like TNBC, while doxorubicin monotherapy showed low activity. The combination of docetaxel and carboplatin was more effective than the drugs used as single agents, except in the PDX from patients with gBRCA1/PALB2 mutations.