Comparison of Some Postural and Functional Factors in the Elderly With and Without a History of Falling

Introduction: Falling is one of the serious issues of old age that occurs due to many factors. This research aimed to compare static and dynamic balance, walking speed, spinal curvature, and central stability of elderly people with and without a history of falling.Methods: The current research was a causal-comparative research. 60 elderly women aged between 60 and 70 from Tabriz voluntarily participated in the research. The participants were assigned into two groups with and without a history of falling. The fall history of the participants was measured by the Fall Efficacy Scale. The static and dynamic balance were evaluated by Sharpened-Romberg and Timed Up and Go tests, respectively. Walking speed was measured with a 10-meter walk test, core stability was measured with McGill endurance tests, and spinal curvature was measured with a flexible ruler. Independent t-test was used to compare the mean variables in two groups.Results: The results showed a significant difference between the static and dynamic balance indices, lumbar spine curvature, walking speed, and core stability in the elderly with and without a history of falling. However, there was no significant difference between the curvature index of the lumbar spine in the elderly with and without a history of falling.Conclusion: According to the research results, it seems necessary to develop and improve the indices of balance, walking speed, and core stability in people with a history of falling

Parsing cyclothymic disorder and other specified bipolar spectrum disorders in youth

© 2018 Elsevier B.V. Objective: Most studies of pediatric bipolar disorder (BP) combine youth who have manic symptoms, but do not meet criteria for BP I/II, into one “not otherwise specified” (NOS) group. Consequently, little is known about how youth with cyclothymic disorder (CycD) differ from youth with BP NOS. The objective of this study was to determine whether youth with a research diagnosis of CycD (RDCyc) differ from youth with operationalized BP NOS. Method: Participants from the Course and Outcome of Bipolar Youth study were evaluated to determine whether they met RDCyc criteria. Characteristics of RDCyc youth and BP NOS youth were compared at baseline, and over eight-years follow-up. Results: Of 154 youth (average age 11.96 (3.3), 42% female), 29 met RDCyc criteria. RDCyc youth were younger (p =.04) at baseline. Over follow-up, RDCyc youth were more likely to have a disruptive behavior disorder (p =.01), and were more likely to experience irritability (p =.03), mood reactivity (p =.02), and rejection sensitivity (p =.03). BP NOS youth were more likely to develop hypomania (p =.02), or depression (p =.02), and tended to have mood episodes earlier in the eight-year follow-up period. Limitations: RDCyc diagnoses were made retrospectively and followed stringent criteria, which may highlight differences that, under typical clinical conditions and more vague criteria, would not be evident. Conclusion: There were few differences between RDCyc and BP NOS youth. However, the ways in which the groups diverged could have implications; chronic subsyndromal mood symptoms may portend a severe, but ultimately non-bipolar, course. Longer follow-up is necessary to determine the trajectory and outcomes of CycD symptoms

Effects of comorbid anxiety disorders on the longitudinal course of pediatric bipolar disorders

OBJECTIVE: To examine the longitudinal effects of comorbid anxiety disorders in youth with bipolar spectrum disorder (BP). METHOD: As part of the Course and Outcome of Bipolar Youth study, 413 youth, who were 7 through 17 years or age and who met criteria for DSM-IV BP-I (n = 244), BP-II (n = 28), and operationally defined bipolar disorder not otherwise specified (BP-NOS) (n = 141) were included. Subjects were followed on average 5 years using the Longitudinal Interval Follow-up Evaluation. Effects of anxiety on the time to mood recovery and recurrence and percentage of time with syndromal and subsyndromal mood symptomatology during the follow-up period were analyzed. RESULTS: At intake and during the follow-up, 62% of youth with BP met criteria for at least 1 anxiety disorder. About 50% of the BP youth with anxiety had ≥2 anxiety disorders. Compared to BP youth without anxiety, those with anxiety had significantly more depressive recurrences and significantly longer median time to recovery. The effects of anxiety on recovery disappeared when the severity of depression at intake was taken into account. After adjusting for confounding factors, BP youth with anxiety, particularly those with ≥2 anxiety disorders, spent significantly less follow-up time asymptomatic and more time with syndromal mixed/cycling and subsyndromal depressive symptomatology compared to those without anxiety. CONCLUSIONS: Anxiety disorders are common and adversely affect the course of BP in youth, as characterized by more mood recurrences, longer time to recovery, less time euthymic, and more time in mixed/cycling and depressive episodes. Prompt recognition and the development of treatments for BP youth with anxiety are warranted

Cognitive flexibility and performance in children and adolescents with threshold and sub-threshold bipolar disorder

Greater understanding of cognitive function in children and adolescents with bipolar disorder (BD) is of critical importance to improve our ability to design targeted treatments to help with real-world impairment, including academic performance. We sought to evaluate cognitive performance among children with either BD type I, II, or “not otherwise specified” (NOS) participating in multi-site Course and Outcome of Bipolar Youth study compared to typically developing controls (TDC) without psycho-pathology. In particular, we sought to test the hypothesis that BD-I and BD-II youths with full threshold episodes of mania or hypomania would have cognitive deficits, including in reversal learning, vs. those BD-NOS participants with sub-threshold episodes and TDCs. N = 175 participants (BD-I = 81, BD-II = 11, BD-NOS = 28, TDC = 55) completed Cambridge Neuropsychological Automated Testing Battery (CANTAB) tasks. A priori analyses of the simple reversal stage of the CANTAB intra-/extra-dimensional shift task showed that aggregated BD-I/II participants required significantly more trials to complete the task than either BD-NOS participants with sub-syndromal manic/hypomanic symptoms or than TDCs. BD participants across sub-types had impairments in sustained attention and information processing for emotionally valenced words. Our results align with prior findings showing that BD-I/II youths with distinct episodes have specific alterations in reversal learning. More broadly, our study suggests that further work is necessary to see the interaction between neurocognitive performance and longitudinal illness course. Additional work is required to identify the neural underpinnings of these differences as targets for potential novel treatments, such as cognitive remediation

Longitudinal Associations Between Interpersonal Relationship Functioning and Mood Episode Severity in Youth With Bipolar Disorder

This study examined the longitudinal association between mood episode severity and relationships in BP youth. Participants were 413 Course and Outcome of Bipolar Youth study youth, aged 12.6 ± 3.3 years. Monthly ratings of relationships (parents, siblings, and friends) and mood episode severity were assessed by the Adolescent Longitudinal Interval Follow-Up Evaluation (ALIFE) Psychosocial Functioning Schedule (PFS) and Psychiatric Rating Scales (PSR) on average every 8.2 months over 5.1 years. Correlations examined whether participants with increased episode severity also reported poorer relationships, and also examined whether fluctuations in episode severity predicted fluctuations in relationships, and vice versa. Results indicated that participants with greater mood episode severity also had worse relationships. Longitudinally, participants had largely stable relationships. To the extent that there were associations, changes in parental relationships may precede changes in episode severity, although the magnitude of this finding was small. Findings have implications for relationship interventions in BP youth

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Associations between physical activity, mental health concerns, eating disorder symptoms, and emotional intelligence in adolescent athletes transitioning from COVID-19

BackgroundIt is well known that COVID-19 significantly disrupted the routines of school sports for adolescent athletes. In transitioning from this "change event," athletes may need support with resuming their pre-pandemic level of activities, and addressing their ongoing mental health concerns, including exacerbated eating disorder symptoms. Emotional intelligence (the ability to understand emotions, influencing decisions and motivation) is a factor that has not yet been studied during this transition, but may serve as a coping mechanism for altered physical activity, mental health, and eating disorder symptoms.MethodsParticipants of the study included 315 Iranian adolescent athletes who transitioned back to 1 of 10 sports post quarantine restrictions (January 2022-January 2023). Physical activity and related stages of motivation for behavioral change were assessed by the Physical Activity Stages of Change Questionnaire, mental health concerns were assessed by the General Health Questionnaire-28, eating disorder symptoms were assessed by the Eating Attitudes Test-26, and emotional intelligence was assessed by the Schutte Self-Report Emotional Intelligence Test.ResultsA three-way Multivariate Analysis of Variance (MANOVA) was conducted in order to test the overall differences between the 5 physical activity and behavioral change motivation groups (Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance) on each of the 3 health measures (mental health concerns, eating disorder symptoms, and emotional intelligence); significant main effects were found for each measure. Fischer's Least Significant Difference Post-Hoc Test indicated that there were significant differences between the Pre-Contemplation and Preparation groups, as well as the Preparation and Action groups, on all of the health measure mean variable scores, which contributed to the MANOVA significant main effects.ConclusionsParticipants in the Pre-Contemplation group (not intending to make behavioral changes within the next 6 months) had less mental health, higher eating pathology, and lower emotional intelligence, compared to participants who were in the Preparation group (intending to make behavioral changes within the next 1 month). Similarly, participants in the Preparation group had less mental health, higher eating pathology, and lower emotional intelligence, compared to participants who were in the Action group (has made specific, overt behavioral changes within the preceding 6 months). Overall, the findings from the current study highlight the need for sports professionals working with adolescent athletes transitioning from COVID-19 to monitor these aspects of mental, eating, and emotional health. Given that those in earlier motivation stages had more health concerns compared to those in later stages, professionals should encourage progression from the Pre-Contemplation to Action/Maintenance stage in order to improve health outcomes

Comparison of eating disorders symptoms and body image between individual and team sport adolescent athletes during the COVID-19 pandemic

BackgroundCOVID-19 has significantly disrupted the routines of school sports for adolescent athletes, which can affect their usual eating behaviors and body image. Specific pressures of individual sports (which tend to emphasize "leanness" as a means to improving performance), versus team sports (which tend to not require "leanness" for an athlete to be competitive), may further increase the risk of disordered eating (DE), eating disorders (ED), and distorted body image. An additional factor to consider is the gender of the athletes, with participation in "lean" sports associated with increased DE and body dissatisfaction for male, but not female, athletes.MethodsParticipants of the study included 124 Iranian male adolescent athletes residing in Mazandaran province (one of the most affected areas of Iran during COVID-19), who played in 1 of 6 sports (3 individual, 3 team). ED symptoms were assessed by the Eating Attitudes Test-26 (EAT-26), and body image was assessed by the Body-Esteem Scale for Adolescents and Adults (BESAA).ResultsThe individual athlete group (n = 62) had significantly higher EAT-26 subscale scores for Bulimia and Food Preoccupation (p = 0.019), as well as significantly higher BESAA subscale scores for Appearance (p = 0.001), Weight (p = 0.001), and Attribution (p = 0.001), compared to the team athlete group (n = 62). However, there were no significant differences between the two athlete groups on the EAT-26 Dieting and Oral Control subscales.ConclusionsCOVID-19 presents specialized issues for adolescent athletes, particularly those at risk for, or experiencing, DE, ED, and distorted body image. While individual athletes had significantly higher scores than team athletes on most subscales, there were no differences between groups on subscales of dieting and oral control. Overall, the findings highlight the need for sport psychologists, coaches, and other sports professionals working with male adolescent athletes (individual and team) to monitor DE, ED, and distorted body image during COVID-19, in order to provide early intervention, and mitigate the risk of long-term consequences. COVID-19 has significantly disrupted the routines of school sports for adolescent athletes, which can affect their usual eating behaviors and body image. Specific pressures of individual sports (which tend to emphasize "leanness" as a means to improving performance), versus team sports (which tend to not require "leanness" for an athlete to be competitive), may further increase the risk of disordered eating (DE), eating disorders (ED), and distorted body image. An additional factor to consider is the gender of the athletes, with participation in "lean" sports associated with increased DE and body dissatisfaction for male, but not female, athletes. Participants of the study included 124 Iranian male adolescent athletes in Mazandaran province (one of the most affected areas of Iran during COVID-19), who played in 1 of 6 sports (3 individual, 3 team). The individual athlete group (62 participants) had significantly higher scores on measures of ED (Bulimia, Food Preoccupation), and body image (Appearance, Weight, Attribution), versus the team athlete group (62 participants). However, there were no significant differences between groups on other measures of ED (Dieting, Oral Control). Findings highlight the need for sport professionals working with adolescent athletes to monitor DE and body image during COVID-19 for early intervention