Hypothalamic-Pituitary-Adrenal (HPA) Axis and Chronic Fatigue Syndrome in Older Adults: The Rehabilitation Perspectives

Chronic fatigue syndrome (CFS) is a long-term and debilitating condition that regards as a neurological disease. Its symptoms include profound physical and mental fatigue (characteristically made worse by exertion), muscle and joint pain, disturbed sleep, and both concentration and memory problems. CFS is a kind of human stress-related disorders that are characterized by alterations in hypothalamic-pituitary-adrenal (HPA) axis activity. Investigation of abnormal activity of the HPA axis in various neurological and neuropsychiatric disorders can date back at least 60 years, and its relation to CFS had been reported in the early 1990s. This chapter further disseminated updated evidence for disruption of HPA function in CFS, with the explanation on the relationship between cytokines and HPA activities. Moreover, very limited literature had addressed the importance of rehabilitation to them . This chapter addresses this gap by sharing a pilot rehabilitation outcome on a single-blinded randomized control trial with a parallel group experimental design in the application of activity scheduling (AS) program of occupational therapy for a group of community-dwelling older adults with CFS. The primary objective is to study the outcome of physical functioning of individual participants. The second objective is to study the outcome of AS on impact of caring role through assessing individual caregivers’ perceived burden in care. The third objective is to study the time that needed in taking care; individuals’ perception of enjoyment and achievement in their participated activities will be evaluated. There was a significant effect of AS on the physical functioning of participants as measured by Functional Independence Measure (FIM), as the primary outcome measure, in experimental group, with Wilk’s λ = 0.72, F (2,57) = 18.75, p < 0.001. Moreover, in secondary outcome measures, there is a significant decrease in the impact of caring role as reflected by their perceived burden as measured by the Chinese Zarit Burden Interview (CZBI) in caring for experimental group, with Wilk’s λ = 0.72, F (2,97) = 18.75, p < 0.001. Another study set out to examine the effect of time on caring activities for those recruited couples in AS group. There was significant effect of AS on caring activities with Wilk’s λ = 0.71, F (2,97) = 12.47, p < 0.001. With proper coaching and regular facilitation regarding AS, activity participation in older adults with CFS can be greatly enhanced. Behavioral intervention, such as AS, can supplement therapeutic treatment or may lead to decline in CFS symptoms

Pilot Testing of Assessment of Capacity for Myoelectric Control (ACMC) in Evaluating Myoelectric Hand Function in Chinese Population

Upper limb amputations cause marked functional disability and lower the individual’s self-body image, with severepsychological implications. Many rehabilitation parameters are involved in the successful rehabilitation of upper limbamputations. The aim of this study was to examine the validity and reliability of the Chinese version of Assessment ofCapacity for Myoelectric Control (Chinese-ACMC) in upper limb amputated subjects and with a myo-electric-poweredprosthetic hand.To validate the Chinese version of Assessment of Capacity for Myoelectric Control (Chinese-ACMC) in upper limbamputee subjects (children and adults) with a myo-electric-powered prosthetic hand. A sample of convenience samplingof 22 subjects (11 males, 11 females) with upper limb amputation and myoelectric prosthetic hands were recordedduring a regular clinical visit for ACMC. Each subject was evaluated according to four criteria: (a) Upper Limb Amputationincluding all levels of amputation; (b) No specific pain type – no matter phantom or pain in the stump; (c) With intactcognitive function; (d) Age ranged from 12 to 40 years. With instruction, occupational therapists and prosthetic-orthoticswith at least twenty years’ clinical experience of myoelectric prosthesis training would conduct the 30-items ChineseACMC for each subject. A serial of errand tasks of activities of daily living were designed for evaluation. Individuals’ratings were repeated after 4 weeks. Through test-retest reliability, internal consistency testing, factor analysis, intra andinter factor correlation analysis. A four-factor structure, namely, “Gripping”, “Holding”, “Releasing” and “Coordinating”are identified

Semi-structured Interview to Analyse Needs of Family Caregivers for People with Dementia

Background: Globally, our population is aging. The prevalence of dementia increases dramatically with advancing age. Caring for a person living with dementia affects different people in different ways. Objectives: In response, this research study was conducted to explore the role, needs and stress of family caregivers (FCGs) for people with dementia as a means of understanding their experience of caring. The study also targeted to identify coping strategies employed by FCGs and explore positive aspects of the caring relationship in relation to their quality of life, information needs, day care and respite care, and emotional support.Methods: To measure individuals’ uniqueness and their specificity in their care-giving experience, this study employed qualitative research design, through semi-structure interview (SSI) as research methods to explore the grounded theory on role, needs and stress of caregivers. The needs of caregivers were documented under their continuum of care: seeking understanding, stabilization, preparation, implementation and adaptation. Results: Twenty FCG were recruited through purposeful sampling. Results indicated caregiving to dementia is a very demanding task both mentally and physically. Two main categories were formulated from the data: the impact of caring and the need to support their caregivers' role. The need to develop understanding of the effectiveness of specific health and social care interventions showed as highly important. Conclusion: Individuals’ perspectives need to be integrated into future service planning and decision-making processes. Suggested strategies from FCG’ perspectives that can potentially alleviating their care stress would be illustrated

Application of explanatory sequential design of mixed methods research in conciliating qualitative and quantitative findings on social stressors and to examine the social problem solving orientation in substance abuse population

Substance abuse has been a problem with every society and across every generation. The increasing number of substance abusers in Hong Kong causes a huge impact to our healthcare system. With the consideration in the complexity of psychosocial nature of this population, the utility of both qualitative and quantitative research methods have been becoming increasingly accepted in health sciences. This is a pioneer project in Hong Kong that employed mixed methods research for substance abuse populations which incorporates evidence of pre-treatment individual characteristics and other specific-tailored treatment factors in promoting changes over time. This study aimed at developing a comprehensive understanding of how individual factors, different social stressors and social problem solving orientation in shaping their behavior. This study covered two phases. The first one was to collect quantitative data in subjects’ ability in problem recognition, treatment readiness, social values and their orientation in social problem solving. A regression model of relapse prediction was constructed, in which, social problem solving was the most prominent factor, followed by treatment readiness, problem recognition and emotional problem. In the second phase of the study, individual semi-structure interview, and qualitative focus group activities of free-listing and pile-sorting were employed to collect qualitative data on the impact of various social stressors like stress from peers, from family, and from work or study. In the final step, we interpreted findings from these two subsets of quantitative and qualitative data. Results indicated stress from peers was the most prominent single stressor of substance abusers, which yielded similar impact as the combination of cross-product of stress from family and from work or study. Moreover, most subjects adopted negative orientation in their social problem solving, in which, stress from work or study noted with the highest response rate in negative orientation in their social problem solving

Adoption and Handling Information Communication Technology as Instrumental Activities of Daily Living for Aging-in-Place in Chinese Older Adults

(Background) The use of information communication technology and smartphone application are crucial to individuals’ functional independence of community living. Previous studies did not reveal how older adults’ in applying the information communication technology will affect their aging-in-place in our contemporary community. (Methods) This study aimed at developing the psychometric properties of the instrument named Advanced Instrumental Activities of Daily Living (AIADL), and to explore the adoption and handling information communication technology in instrumental activities of daily living for aging-in-place of older adults. 100 home-living participants who are functionally and socially independent, 100 hostel-living participants who are functionally independent but need social assistance, and 100 care-and-attention home living participants who need environment support and assistance in daily functioning were recruited for this study. (Results) AIADL showed good test-retest reliability and good-to-excellent internal consistency. Exploratory factor analysis revealed a two-factor structure with “home living and management” and “community living”. Validity analysis with the known-groups method showed a high overall accuracy of prediction of individuals’ capability of independent living in the community. (Conclusions) AIADL is a valid and reliable instrument to assess older adults’ ability in handling contemporary instrumental activities in their daily life. This instrument can serve as a reference in measuring individuals’ ability of aging-in-place

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis

BackgroundHistologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD.MethodsThis was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0–4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0–2 vs F3 vs F4; LSM: 2·67; NFS: 0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226.FindingsOf 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44–63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33–91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62–0·81) for histology, 0·76 (0·70–0·83) for LSM-VCTE, 0·74 (0·64–0·82) for FIB-4, and 0·70 (0·63–0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression.InterpretationSimple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases

Risks and Mitigating Factors in Psychosocial Adjustment of Spousal Caregivers of People with Dementia

By applying the Stress Process Model to examine the characteristics of people with dementia and their spousal caregivers, this study aims to identify the potential risk and mitigating factors of psychosocial adjustment among the spousal caregivers. We recruited 80 care recipient-caregiver couples in Hong Kong and examined the relationships of socio-economic, care recipient’s, and caregiver’s factors with spousal caregivers’ psychosocial adjustment. It was found that care recipients’ cognitive functions were associated with caregivers’ reported frequencies of their behavioral and psychological symptoms of dementia (BPSD) (r = .30, p = .008), and caregivers’ perceived burden of caregiving (r = -.54, p = .008). Caregivers’ quality of life was associated with their perceived caregiving burden (r = -.82, p = .001) and self-efficacy (r = .32, p = .001). Upon further examining the caregiving model with these parameters, a significant multivariate general linear model was found with (F (1, 12) = 13.06, p = .001, partial eta square = .70, observed power = .99). Moreover, female caregivers reported higher sense of caregiving stress and poorer quality of life than male caregivers. This study found that the cognitive functions and BPSD of care recipients with dementia and perceived level of caregiving burden are strongly associated with degrees of psychosocial adjustment among their spousal caregivers. The self-perceived caregiving role in a family is also a possible confounding factor contributing to the perceived caregiving burden. To support in-home caregiving of people with dementia, strategies to empower spousal caregivers to execute their caregiving roles are recommended