The Influence of Socioeconomic Factors on Fear of Falling and Mobility Outcomes after Lower Limb Loss: a Preliminary Study

Background and Purpose: Current research has revealed that as much as 52.4% of individuals with lower limb loss report falling at least once in the past year. Previous research has also indicated that rehabilitation, including physical therapy (PT), generally improves patient outcomes after definitive amputation. Socioeconomic status has been shown to be an important factor in accessing healthcare but has yet to be investigated in this population. The purpose of this study was to investigate the effects of socioeconomic status and access to PT, and how limb loss affects mobility and fear of falling perception. We hypothesized: [1] individuals with socioeconomic difficulty would have reduced access to PT after amputation, and [2] individuals with limb loss will have increased fear of falling and decreased mobility performance when compared to non-amputee, age-matched controls. Subjects: 23 participants (7 females,16 males) mean age 51.30 years old (+ 13.17 SD, range 22-70) with lower limb loss ambulating with a definitive prosthesis. Materials/Methods: Participants completed a survey that included the Fear of Falling Avoidance Behavior Questionnaire (FFABQ), questions to determine their socioeconomic status, and whether they received PT after amputation. Mobility outcomes were measured using the standardized Timed Up and Go test (TUG) and the Six Minute Walk Test (6MWT). Results: There was no statistically significant difference in access to PT after amputation between those with and without financial difficulty (p=.354). However, 75% of participants who had no socioeconomic difficulty reported receiving PT, in comparison to only 25% in those who had socioeconomic difficulty. Additionally, 34.8% of our participants reported socioeconomic difficulties. When comparing the participants with amputation to the non-amputee, age-matched controls, there was a significant difference in the TUG (p\u3c.001), 6MWT (p\u3c.001), and FFABQ (p=.008). On average, participants with limb loss were 4.4 seconds slower on the TUG, walked 136.4m less on the 6MWT, and had an increased FFABQ score of 6.6 points out of 56 points. Discussion: Access to physical therapy and socioeconomic status have been overlooked in current literature for individuals after amputation. While the effect of socioeconomic status on PT access did not reach statistical significance in this preliminary study, only 25% of those who reported socioeconomic difficulty received physical therapy after amputation, compared to 75% in those who reported no difficulty. Further research is needed to determine whether low socioeconomic status is predictive of receiving rehabilitation services post-amputation and long-term outcomes. Our findings also showed that when compared to age-matched non-amputees, amputees tend to have impaired mobility and higher degree of fear of falling. These findings agree with current literature. Conclusion: Although not statistically significant, our preliminary findings showed that socioeconomic difficulty may affect access to physical therapy after amputation. Furthermore, our data demonstrated that individuals with lower limb loss exhibit reduced mobility performance and increased fear of falling when compared to the age-matched controls

Motivating Factors, Barriers, and Success Factors among Agri-based Micro- and Small-scale Women Entrepreneurs in Isabela, Philippines

In recent years, a number of women have started agribusiness enterprises in Isabela, Philippines, such as the production and retailing of dominant agricultural products like rice and corn, livestock and poultry raising, and the processing of root crops into native delicacies. This study aims to examine the motivating factors, start-up barriers, and success factors among micro- and small-scale women entrepreneurs in selected areas in Isabela, Philippines. A survey was conducted among 46 women entrepreneurs whose businesses were based in the cities of Ilagan and Cauayan and the town of Roxas. Descriptive statistics, factor analysis, and chi-square analysis were employed to analyze the data. In terms of their personal entrepreneurial competency (PEC) profile, the women entrepreneurs were found to be moderate (i.e., scoring 16–18 out of a possible 25) in terms of opportunity-seeking, demand for quality and efficiency, systematic planning and monitoring, persuasion and networking and self-confidence and weak in the area of goal-setting. Women entrepreneurs were motivated to establish a business by the following factors: achievement, competence, affiliation factor, and job/financial security. On the other hand, the women entrepreneurs faced common start-up problems like lack of training education, unavailability of low-interest loans for capital, and career-family conflict. Meanwhile, two success factors were found to be associated to performance (i.e., micro vs. small-scale): if the entrepreneur had finished a business degree and if their business was the only source of family income. The study recommended that organizations should conduct action-oriented trainings to develop the PECs of Isabela women entrepreneurs. Future studies should consider having a larger sample size

The IRYSS-COPD appropriateness study: objectives, methodology, and description of the prospective cohort

<p>Abstract</p> <p>Background</p> <p>Patients with chronic obstructive pulmonary disease (COPD) often experience exacerbations of the disease that require hospitalization. Current guidelines offer little guidance for identifying patients whose clinical situation is appropriate for admission to the hospital, and properly developed and validated severity scores for COPD exacerbations are lacking. To address these important gaps in clinical care, we created the IRYSS-COPD Appropriateness Study.</p> <p>Methods/Design</p> <p>The RAND/UCLA Appropriateness Methodology was used to identify appropriate and inappropriate scenarios for hospital admission for patients experiencing COPD exacerbations. These scenarios were then applied to a prospective cohort of patients attending the emergency departments (ED) of 16 participating hospitals. Information was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up after admission or discharge home. While complete data were generally available at the time of ED admission, data were often missing at the time of decision making. Predefined assumptions were used to impute much of the missing data.</p> <p>Discussion</p> <p>The IRYSS-COPD Appropriateness Study will validate the appropriateness criteria developed by the RAND/UCLA Appropriateness Methodology and thus better delineate the requirements for admission or discharge of patients experiencing exacerbations of COPD. The study will also provide a better understanding of the determinants of outcomes of COPD exacerbations, and evaluate the equity and variability in access and outcomes in these patients.</p

Analysis of Dehydration and Strength in Elite Badminton Players

Background: The negative effects of dehydration on aerobic activities are well established. However, it is unknown how dehydration affects intermittent sports performance. The purpose of this study was to identify the level of dehydration in elite badminton players and its relation to muscle strength and power production. Methodology: Seventy matches from the National Spanish badminton championship were analyzed (46 men?s singles and 24 women?s singles). Before and after each match, jump height and power production were determined during a countermovement jump on a force platform. Participants? body weight and a urine sample were also obtained before and after each match. The amount of liquid that the players drank during the match was also calculated by weighing their individual drinking bottles. Results and Discussion: Sweat rate during the game was 1.1460.46 l/h in men and 1.0260.64 l/h in women. The players rehydrated at a rate of 1.1060.55 l/h and 1.0160.44 l/h in the male and female groups respectively. Thus, the dehydration attained during the game was only 0.3760.50% in men and 0.3260.83% in women. No differences were found in any of the parameters analyzed during the vertical jump (men: from 31.8265.29 to 32.9064.49 W/kg; p.0.05, women: from 26.3664.73 to 27.2564.44 W/kg; p.0.05). Post-exercise urine samples revealed proteinuria (60.9% of cases in men and 66.7% in women), leukocyturia (men = 43.5% and women = 50.0%) and erythrocyturia (men = 50.0% and women = 21.7%). Conclusions: Despite a moderate sweat rate, badminton players adequately hydrated during a game and thus the dehydration attained was low. The badminton match did not cause muscle fatigue but it significantly increased the prevalence of proteinuria, leukocyturia and erythrocyturia

Protective Human Leucocyte Antigen Haplotype, HLA-DRB1*01-B*14, against Chronic Chagas Disease in Bolivia

Chronic Chagas disease consists of four different forms categorized on the basis of their clinical manifestations, namely; cardiac, digestive, cardiodigestive and indeterminate. In Latin America, there are 8–10 million seropositive persons who are at risk of, or have already developed serious clinical complications and who have limited access to effective treatment. The cardiac and digestive forms are characterized by tissue damage caused by persistent infection of Trypanosoma cruzi and are thought to be modulated by host immunity. In our large scale screening for chronic Chagas disease in Santa Cruz, Bolivia, hearts and colons of 229 seropositive patients were examined. We found 31.4% of patients had abnormal electrocardiograms (ECGs), 15.7% presented with megacolon, 5.2% had a combination of abnormal ECG and megacolon, and 58.1% were of indeterminate status. Previously, we attempted to ascertain whether parasite genetic polymorphism might account for the differences in clinical manefestations, by analyzing parasite DNA taken from the same study group (with the addition of a further 62 megacolon post-operational patients). We found no relationships between parasite lineages and clinical disease form. The present study reveals that host HLA polymorphisms associate with clinical manifestations of Chagas

Heart Rate Variability Dynamics for the Prognosis of Cardiovascular Risk

Statistical, spectral, multi-resolution and non-linear methods were applied to heart rate variability (HRV) series linked with classification schemes for the prognosis of cardiovascular risk. A total of 90 HRV records were analyzed: 45 from healthy subjects and 45 from cardiovascular risk patients. A total of 52 features from all the analysis methods were evaluated using standard two-sample Kolmogorov-Smirnov test (KS-test). The results of the statistical procedure provided input to multi-layer perceptron (MLP) neural networks, radial basis function (RBF) neural networks and support vector machines (SVM) for data classification. These schemes showed high performances with both training and test sets and many combinations of features (with a maximum accuracy of 96.67%). Additionally, there was a strong consideration for breathing frequency as a relevant feature in the HRV analysis

Heart Rate Variability Dynamics for the Prognosis of Cardiovascular Risk

Statistical, spectral, multi-resolution and non-linear methods were applied to heart rate variability (HRV) series linked with classification schemes for the prognosis of cardiovascular risk. A total of 90 HRV records were analyzed: 45 from healthy subjects and 45 from cardiovascular risk patients. A total of 52 features from all the analysis methods were evaluated using standard two-sample Kolmogorov-Smirnov test (KS-test). The results of the statistical procedure provided input to multi-layer perceptron (MLP) neural networks, radial basis function (RBF) neural networks and support vector machines (SVM) for data classification. These schemes showed high performances with both training and test sets and many combinations of features (with a maximum accuracy of 96.67%). Additionally, there was a strong consideration for breathing frequency as a relevant feature in the HRV analysis

Impact of COVID-19 Pandemic on TAVR Activity: A Worldwide Registry

Background: The COVID-19 pandemic had a considerable impact on the provision of structural heart intervention worldwide. Our objectives were: 1) to assess the impact of the COVID-19 pandemic on transcatheter aortic valve replacement (TAVR) activity globally; and 2) to determine the differences in the impact according to geographic region and the demographic, development, and economic status of diverse international health care systems. Methods: We developed a multinational registry of global TAVR activity and invited individual TAVR sites to submit TAVR implant data before and during the COVID-19 pandemic. Specifically, the number of TAVR procedures performed monthly from January 2019 to December 2021 was collected. The adaptive measures to maintain TAVR activity by each site were recorded, as was a variety of indices relating to type of health care system and national economic indices. The primary subject of interest was the impact on TAVR activity during each of the pandemic waves (2020 and 2021) compared with the same period pre–COVID-19 (2019). Results: Data were received from 130 centers from 61 countries, with 14 subcontinents and 5 continents participating in the study. Overall, TAVR activity increased by 16.7% (2,337 procedures) between 2018 and 2019 (ie, before the pandemic), but between 2019 and 2020 (ie, first year of the pandemic), there was no significant growth (–0.1%; –10 procedures). In contrast, activity again increased by 18.9% (3,085 procedures) between 2020 and 2021 (ie, second year of the pandemic). During the first pandemic wave, there was a reduction of 18.9% (945 procedures) in TAVR activity among participating sites, while during the second and third waves, there was an increase of 6.7% (489 procedures) and 15.9% (1,042 procedures), respectively. Further analysis and results of this study are ongoing and will be available at the time of the congress. Conclusion: The COVID-19 pandemic initially led to a reduction in the number of patients undergoing TAVR worldwide, although health care systems subsequently adapted, and the number of TAVR recipients continued to grow in subsequent COVID-19 pandemic waves. Categories: STRUCTURAL: Valvular Disease: Aorti

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials.

Funder: laura and john arnold foundationBACKGROUND: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care