Occupational Therapy Interventions for Activities of Daily Living in Adults with Osteoarthritis

Primary Focus: Productive Aging Learning Objectives: At the end of this presentation, participants will be able to: Describe the clinical presentation of osteoarthritis and three ways it impacts Activities of Daily Living (ADL) performance Recognize the value of an Occupational Therapy intervention in addition to surgical and pharmacological interventions for osteoarthritis Identify at least three current evidence based practice interventions for improving ADL performance for people with osteoarthritis Abstract: Currently, 30.8 million Americans have diagnoses of osteoarthritis (OA) and the number of individuals with arthritis is projected to increase to 78 million by 2040 (CDC, 2016). Health care costs for individuals with OA are estimated at $18,345 per year, which is more than two times higher than patients without OA (Le, Montejano, Cao, Zhao, & Ang, 2012). OA symptoms greatly impact an individual’s ability to perform life roles with independence (AOTA, 2014). Occupational therapists (OT) implement interventions to preserve and increase mobility necessary to perform activities of daily living (ADLs) (Frost, 2011). A systematic review was conducted using PubMed, CINAHL, and Scopus databases to search existing literature from 2010-2016 to answer the clinical question: What is the current evidence that OT intervention is effective in improving ADL performance in adults with OA? Thirteen articles that addressed adults over age 18, written in the English language, measured ADL outcomes and used interventions within the scope of OT were identified for review. Articles were critiqued using Law & MacDermid’s Critical Review Forms (Law & MacDermid, 2014). Themes that emerged from the evidence include orthotics, exercise-based interventions, preparatory methods, patient education, and pain. This session will present findings from this review. Results show there is moderate evidence supporting the use of orthoses, moderate evidence for exercise-based interventions, mixed evidence for preparatory methods, and insufficient evidence for patient education for improving ADL performance in adults with OA. Pain was a common outcome measure reported in the studies. Findings suggest that interventions that improved pain did not always impact ADL performance. In clinical practice, the strongest evidence suggests exercise-based and orthotic interventions result in improved performance of ADLs in adults with OA. References: American Occupational Therapy Association [AOTA]. (2014). Occupational therapy practice framework: Domain and process. American Occupational Therapy Association, 68(Supplement 1), S1-S48. doi: 10.5014/ajot.2014.682006. Centers for Disease Control and Prevention (CDC) (2016). Arthritis-Related Statistics. Retrieved from http://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm Frost, L., (2011). Occupational Therapy’s Role in Managing Arthritis. Retrieved July 15, 2016, from http://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/PA/Facts/Arthritis fact sheet.pdf?la=en Law, M. & MacDermid, J.C. (2014). Evidence Based Rehabilitation: A Guide to Practice, 3rd Ed. Thorofare, NJ: Slack Inc. Le, T. K., Montejano, L. B., Cao, Z., Zhao, Y., & Ang, D. (2012). Health care costs in US patients with and without a diagnosis of osteoarthritis. Journal of Pain Research, 5, 23–30. http://doi.org/10.2147/JPR.S27275 Other: Level of Material: Introductory and Intermediate Level Target Audience: Occupational therapists, Occupational therapist assistants Presentation: 47:2

Cortisol Secretion in Patients With Type 2 Diabetes: Relationship With Chronic Complications

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Type I/II interferon in HIV-1-infected patients: expression in gut mucosa and in peripheral blood mononuclear cells and its modification upon probiotic supplementation

Expression of type I and II interferon (IFN) was evaluated in gut-associated lymphoid tissue (GALT) and peripheral blood mononuclear cells (PBMCs) of HIV-1-positive patients on long-term, suppressive, antiretroviral therapy before and after probiotic supplementation. IFNα subtypes and IFNβ were expressed at higher levels in GALT compared to PBMC, whereas an opposite trend of expression was recorded for IFNγ. An increase of IFNα6, IFNα10, IFNα14, IFNα17, and IFNα21 and a decrease of IFNγ were observed in both anatomical sites after probiotic supplementation

Improved diastolic function in type 2 diabetes after a six month liraglutide treatment

AbstractAimsTo investigate whether liraglutide improves diastolic function in type 2 diabetes.MethodsThirty-seven patients with type 2 diabetes who began liraglutide therapy between June 2013 and May 2014 were enrolled in this observational, prospective study. 26 patients received liraglutide therapy for at least 6months. The remaining 11 patients withdrew from liraglutide therapy during the first month, were started on other hypoglycaemic therapies and formed the control group. Anthropometric, metabolic and echocardiographic parameters including pulsed wave tissue Doppler imaging were evaluated at baseline and at 6months.ResultsIn the liraglutide group the early diastolic mitral annulus velocity on the lateral (e-lat) and medial (e-med) sides of the mitral annulus increased from 9.2±3.4 to 11.6±4.7cm/s (p<0.001) and from 6.9±1.7 to 8.4±2.6cm/s (p<0.003), respectively. The ratio of early-to-late velocities on the lateral and medial sides of the mitral annulus increased from 0.7±0.3 to 0.9±0.4 (p<0.001) and from 0.5±0.1 to 0.6±0.1 (p<0.02), respectively. The ratio of early diastolic mitral inflow velocity to early diastolic myocardial relaxation velocity decreased from 10.7±4.3 to 8.5±2.5 (p<0.005). No improvements in diastolic function was detected in the control group. Glucose control improved similarly in both groups: HA1bc −1.5% (−17mmol/mol) vs −1.3% (−14mmol/mol), p=0.67.ConclusionsIn patients with type 2 diabetes, 6months liraglutide treatment was associated with a significant improvement in diastolic function

Receptor-Receptor Interactions as a Widespread Phenomenon: Novel Targets for Drug Development?

open5The discovery of receptor-receptor interactions (RRI) has expanded our understanding of the role that G protein-coupled receptors (GPCRs) play in intercellular communication. The finding that GPCRs can operate as receptor complexes, and not only as monomers, suggests that several different incoming signals could already be integrated at the plasma membrane level via direct allosteric interactions between the protomers that form the complex. Most research in this field has focused on neuronal populations and has led to the identification of a large number of RRI. However, RRI have been seen to occur not only in neurons but also in astrocytes and, outside the central nervous system, in cells of the cardiovascular and endocrine systems and in cancer cells. Furthermore, RRI involving the formation of macromolecular complexes are not limited to GPCRs, being also observed in other families of receptors. Thus, RRI appear as a widespread phenomenon and oligomerization as a common mechanism for receptor function and regulation. The discovery of these macromolecular assemblies may well have a major impact on pharmacology. Indeed, the formation of receptor complexes significantly broadens the spectrum of mechanisms available to receptors for recognition and signaling, which may be implemented through modulation of the binding sites of the adjacent protomers and of their signal transduction features. In this context, the possible appearance of novel allosteric sites in the receptor complex structure may be of particular relevance. Thus, the existence of RRI offers the possibility of new therapeutic approaches, and novel pharmacological strategies for disease treatment have already been proposed. Several challenges, however, remain. These include the accurate characterization of the role that the receptor complexes identified so far play in pathological conditions and the development of ligands specific to given receptor complexes, in order to efficiently exploit the pharmacological properties of these complexes.openGuidolin, Diego; Marcoli, Manuela; Tortorella, Cinzia; Maura, Guido; Agnati, Luigi FGuidolin, Diego; Marcoli, Manuela; Tortorella, Cinzia; Maura, Guido; Agnati, Luigi

Incidental ameloblastoma diagnosed after treatment for childhood tumor

Abstract Ameloblastoma is a rare odontogenic neoplasm accounting for 1% of all tumors of the jaws. It is rarely diagnosed in pediatric and adolescent age. Cancer treatment is a well-known risk factor for the onset of secondary malignancies among childhood cancer survivors, but any link between ameloblastoma and prior cancer treatments has yet to be explored. Here we report on two cases of ameloblastoma diagnosed in patients previously treated for tumors in pediatric age

Modulating brain integrative actions as a new perspective on pharmacological approaches to neuropsychiatric diseases

: A critical aspect of drug development in the therapy of neuropsychiatric diseases is the "Target Problem", that is, the selection of a proper target after not simply the etiopathological classification but rather the detection of the supposed structural and/or functional alterations in the brain networks. There are novel ways of approaching the development of drugs capable of overcoming or at least reducing the deficits without triggering deleterious side effects. For this purpose, a model of brain network organization is needed, and the main aspects of its integrative actions must also be established. Thus, to this aim we here propose an updated model of the brain as a hyper-network in which i) the penta-partite synapses are suggested as key nodes of the brain hyper-network and ii) interacting cell surface receptors appear as both decoders of signals arriving to the network and targets of central nervous system diseases. The integrative actions of the brain networks follow the "Russian Doll organization" including the micro (i.e., synaptic) and nano (i.e., molecular) levels. In this scenario, integrative actions result primarily from protein-protein interactions. Importantly, the macromolecular complexes arising from these interactions often have novel structural binding sites of allosteric nature. Taking G protein-coupled receptors (GPCRs) as potential targets, GPCRs heteromers offer a way to increase the selectivity of pharmacological treatments if proper allosteric drugs are designed. This assumption is founded on the possible selectivity of allosteric interventions on G protein-coupled receptors especially when organized as "Receptor Mosaics" at penta-partite synapse level

Physical activity recommendations for early childhood: an international analysis of ten different countries’ current national physical activity policies and practices for those under the age of 5

During the last two decades there have been growing interests on recommendations for children’s physical activity. The World Health Organization (WHO) launched the first global international recommendations for children in 2010, focusing on children and youth aged 5-17 year olds. The recommendations were based on the dose-response relationship between the frequency, duration, intensity, type and amount of physical activity needed for prevention of non-communicable diseases. There remains however, at time of writing, (2019) a gap in the recommendations, as the WHO did not offer global recommendations for those children under the age of 5 (early years). An international policy and practice analysis, (not previously undertaken), of ten sample countries, was completed of current national physical activity practices. Also an international comparison of early years’ education settings were examined, specifically for those under the age of 5, to investigate current curricula, as well as the qualifications, knowledge and understanding of those supporting children’s learning in different cultural contexts. The sample of ten countries (Belgium, China, Denmark, Finland, Germany, Ireland, Italy, Norway, United Kingdom and United States of America) questioned whether the global daily physical activity recommendations (WHO, 2010) are costumed and used for to the early years’ age group on a national level or if they need to be adjusted. The analysis revealed that eight countries have developed their own national recommendations for children below the age of 5, while only two countries do not have any early years’ specific physical activity recommendations. National authorities seem to be the most common executive sources behind the recommendations. The content of physical activity for children under the age of 5, mostly included the total amount and intensity of physical activity. The total daily amount of physical activity in these ten countries varies between 60 minutes moderate to vigorous intensity physical activity up to 180 min total light to moderate intensity physical activity and for some countries the daily recommendations are only from age 1 year, not between birth and 1 year, this age range remains unsupported. The conclusions from the analysis of national recommendations, underlined the need to see the global recommendations be developed for the younger age group, to support all countries. It is proposed a need for universally new recommendations to go beyond just physical activity intensity levels and to consider how young children’s development can be supported in a versatile way by physically active play. Also age specific recommendations are offered for appropriate and purposeful physical activity to support early years and school aged children’s overall development. The findings also suggest educational recommendations for staff members of early childhood education and care settings to know appropriate and age specific recommendations to ensure they are able to support young children to reach the national and global recommendations. Research recommendations are also proposed