Self-rated health in old age, related factors and survival: A 20-Year longitudinal study within the Silver-MONICA cohort

INTRODUCTION

Self-rated health (SRH) offers insights into the evolving health demographics of an ageing population.

AIM

To assess change in SRH from old age to very old age and their associations with health and well-being factors, and to investigate the association between SRH and survival.

METHODS

All participants in the MONICA 1999 re-examination born before 1940 (n = 1595) were included in the Silver-MONICA baseline cohort. The Silver-MONICA follow-up started in 2016 included participants in the Silver-MONICA baseline cohort aged 80 years or older. Data on SRH was available for 1561 participants at baseline with 446 of them also participating in the follow-up. The follow-up examination included a wide variety of measurements and tests.

FINDINGS

Most participants rated their health as "Quite good" (54.5 %) at baseline. Over the study period, 42.6 % had stable SRH, 40.6 % had declined, and 16.8 % had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p < 0.05).

CONCLUSION

This study demonstrates associations between changes in SRH and a multitude of health- and wellbeing-related factors, as well as a relation between survival and SRH, accentuating their relevance within the ageing population.

Self-perception of health and physical activity among adults before and amidst the COVID-19 pandemic: United States, 2019-2020

The compounded impact of the COVID-19 lockdowns on self-perception of health (SPoH) and physical activity (PA) levels among U.S. adults remains to be explored. We sought to: (1) describe the SPoH and PA levels among U.S. adults; (2) explore the relationship between SPoH and PA before and amidst the COVID-19 pandemic. We analyzed data from the 2019 and 2020 Health Information National Trends Survey (HINTS). COVID-19 was declared a pandemic by the World Health Organization on March 11th, 2020. This date was chosen to demarcate the responses as before and amidst the COVID-19 pandemic. Weighted prevalence estimates were presented alongside adjusted odds ratios from multivariable logistic regression of general SPoH and PA levels for U.S. adults before and amidst COVID-19 pandemic. We analyzed data for 9328 participants. Over half of the U.S. adult population reported performing no muscle strengthening exercise in 2019. The number of inactive people has slightly increased in 2020 (27.8%), compared to 2019 (26.5%). Overall, levels of PA for active people were comparable in 2020 pre and post the WHO pandemic declaration date (36.4% and 39.8%; respectively). Higher odds of negative SPoH were observed among black individuals, current cigarettes smokers, with annual income less than $35,000, physically inactive individuals, people who do not perform muscle-strengthening exercise, and who were very obese. Negative SPoH were associated with lack of moderate exercise, and lack of muscle-strengthening training among U.S. adults before and amidst the pandemic. Pandemic policies and recommendations should include and facilitate PA, specifically among vulnerable populations.

Assessment of a digital game as a neuropsychological test for postoperative cognitive dysfunction

OBJECTIVE

Postoperative cognitive dysfunction may result from worsening in a condition of previous impairment. It causes greater difficulty in recovery, longer hospital stays, and consequent delay in returning to work activities. Digital games have a potential neuromodulatory and rehabilitation effect. In this study, a digital game was used as a neuropsychological test to assess postoperative cognitive dysfunction, with preoperative patient performance as control.

METHODS

It was a non-controlled study, with patients selected among candidates for elective non-cardiac surgery, evaluated in the pre- and postoperative periods. The digital game used has six phases developed to evaluate selective attention, alternating attention, visuoperception, inhibitory control, short-term memory, and long-term memory. The digital game takes about 25 minutes. Scores are the sum of correct answers in each cognitive domain. Statistical analysis compared these cognitive functions pre- and post-surgery using a generalized linear mixed model (ANCOVA).

RESULTS

Sixty patients were evaluated, 40% male and 60% female, with a mean age of 52.7 ± 13.5 years. Except for visuoperception, a reduction in post-surgery scores was found in all phases of the digital game.

CONCLUSION

The digital game was able to detect decline in several cognitive functions postoperatively. As its completion is faster than in conventional tests on paper, this digital game may be a potentially recommended tool for assessing patients, especially the elderly and in the early postoperative period.

Is accreditation in medical education in Korea an opportunity or a burden?

The accreditation process is both an opportunity and a burden for medical schools in Korea. The line that separates the two is based on how medical schools recognize and utilize the accreditation process. In other words, accreditation is a burden for medical schools if they view the accreditation process as merely a formal procedure or a means to maintain accreditation status for medical education. However, if medical schools acknowledge the positive value of the accreditation process, accreditation can be both an opportunity and a tool for developing medical education. The accreditation process has educational value by catalyzing improvements in the quality, equity, and efficiency of medical education and by increasing the available options. For the accreditation process to contribute to medical education development, accrediting agencies and medical schools must first be recognized as partners of an educational alliance working together towards common goals. Secondly, clear guidelines on accreditation standards should be periodically reviewed and shared. Finally, a formative self-evaluation process must be introduced for institutions to utilize the accreditation process as an opportunity to develop medical education. This evaluation system could be developed through collaboration among medical schools, academic societies for medical education, and the accrediting authority.

Self-rated joint hypermobility: the five-part questionnaire evaluated in a Swedish non-clinical adult population

Background

The conventional way to identify generalised joint hypermobility is by a physical examination according to the Beighton Score. However, a physical examination is time-consuming in clinical practise and may be unfeasible in population-based studies. The self-assessment five-part questionnaire on hypermobility (5PQ) offers a more practicable way to identify GJH. The aim of this study was to test validity and reliability of the five-part questionnaire on hypermobility (5PQ) translated into Swedish on a non-clinical adult population.

Methods

A structured procedure was used for the translation of the 5PQ into Swedish. The Beighton Score was used as reference standard for generalised joint hypermobility. Test-retest reliability was tested in a separate group who filled in the questionnaire twice with a ten-week interval. Participants consisted of a convenience sample recruited in Stockholm, Sweden (2017).

Results

A total of 328 participants were included in the study, 297 participants in the validity group and 31 participants in the reliability group. When evaluated against a present Beighton Score with an age-dependent cut-off, the Swedish 5PQ attained a sensitivity of 91%, a specificity of 75% and an area under the curve of 0.87. The Swedish 5PQ showed substantial to almost perfect test-retest reliability.

Conclusions

The Swedish 5PQ is a valid and reliable instrument to screen for or to identify generalised joint hypermobility.

Symptom perception in heart failure - Interventions and outcomes: A scoping review

BACKGROUND

Symptom perception in heart failure has recently been described as essential in the self-care process bridging self-care maintenance and self-care management. Accordingly, symptom perception appears to be critical for improving patient outcomes such as decreased hospital readmission and increased survival.

OBJECTIVES

To explore what interventions have been reported on heart failure symptom perception and to describe outcomes responsive to symptom perception.

DESIGN

We conducted a scoping review using PRISMA Extension for Scoping Reviews.

DATA SOURCES

Structured searches of Medline, PubMed, Embase, CINAHL, PsychINFO, Web of Science, Cochrane, Joanna Briggs Institute and Grey literature databases.

REVIEW METHODS

Two authors independently screened references for eligibility. Eligible articles were written in English, French, German, Swedish, Italian or Spanish and concerned symptom perception in adults with heart failure. Data were extracted and charted in tables by three reviewers. Results were narratively summarized.

RESULTS

We identified 99 eligible studies from 3055 references. Seven interventional studies targeted symptom perception as the single intervention component. Mixed results have been found: while some reported decreased symptom frequency, intensity and distress, enhanced health-related quality of life, improved heart failure self-care maintenance and management as well as a greater ability to mention heart failure symptoms, others found more contacts with healthcare providers or no impact on anxiety, heart failure self-care nor a number of diary reported symptoms. Additional interventional studies included symptom perception as one component of a multi-faceted intervention. Outcomes responsive to symptom perception were improved general and physical health, decreased mortality, heart failure decompensation, as hospital/emergency visits, shorter delays in seeking care, more consistent weight monitoring, improved symptom recognition as well as self-care management, decreased hospital length of stay and decreased costs.

CONCLUSIONS

While many studies allowed to map a comprehensive overview of interventions supporting symptom perception in heart failure as well as responsiveness to outcomes, only a few single component intervention studies targeting symptom perception have been reported and study designs preclude assessing intervention effectiveness. With regard to multiple component interventions, the specific impact of symptom perception interventions on outcomes remains uncertain to date. Well-designed studies are needed to test the effectiveness of symptom perception interventions and to elucidate relationships with outcomes.

Evaluating Self-Refraction and Ready-Made Spectacles for Treatment of Uncorrected Refractive Error

PURPOSE

Uncorrected refractive error is the leading cause of visual impairment worldwide and has significant quality of life and economic implications. Treatment with subjective refraction and custom-made spectacles requires expensive equipment and highly trained personnel. We examine several alternatives.

METHODS

Patients were taught to self-refract using two devices: AdSpecs and the I-test Vision Screener. Ready-made spectacles were fit to the self-refraction and visual acuity (VA) was measured. Donated-spectacles were fit to subjective refraction and VA was measured. Self-refraction and donated spectacles spherical equivalent (SE) and VA were compared to subjective refraction SE and VA.

RESULTS

About 57 patients (102 eyes) were enrolled in the study. Patients accurately determined refractive power with self-refraction by both AdSpecs and the I-test (compared to subjective refraction SE, r² = 0.97 and r² = 0.94, respectively). SE of donated spectacles fit well with self-refraction SE (r² = 0.91). There was no significant difference between best-corrected VA by subjective refraction and VA treated by ready-made spectacles fit to self-refraction by either device (analysis of variance (ANOVA), p non-significant). Patients fit with donated spectacles had significantly worse VA than best-corrected VA by subjective refraction (ANOVA, p < 0.01), although 80% improved to >20/40.

CONCLUSION

Patients accurately self-refract using both devices and ready-made spectacles fit to self-refraction have excellent visual outcomes. Donated spectacles have worse visual outcomes but might be useful in a subset of patients. Ready-made spectacles fit to self-refraction may provide a treatment alternative to uncorrected refractive error.

Lack of agreement between objective and subjective measures in the evaluation of masticatory function: A preliminary study

The evaluation of mastication is important to understand the masticatory behavior and diagnose feeding difficulties. The objective of this preliminary study was to verify if there is agreement between objective and subjective validated methods of chewing evaluation in a convenience sample which consisted of 32 adolescents (mean 15.5years), complete permanent dentition and free of tooth decay. The Quality of Masticatory Function Questionnaire with the Food-Mastication, Habits, Meat, Fruit and Vegetables domains was used in the subjective evaluation. The objective aspects consisted of maximum bite force (BF) and masticatory performance (MP) by mastication of cubes of test-material and sieving to determine the median particle size (X₅₀) and distribution in the sieves ("b"), and by the colorimetric method using colorchangeable chewing gum. Data were submitted to exploratory analysis, normality test and correlation tests (Pearson/Spearman). The correlation between BF and X₅₀ (r=-0.43; p=0.02) and between BF and MP chewing gum (r=0.53; p=0.002) was significant with large effect size. The MP evaluated by chewing gum correlated with X₅₀ (r=-0.34; p=0.055), but not with "b" (r=-0.06; p=0.73), while "b" correlated only with X₅₀ (r=0.52, p=0.002). No significant correlation was observed between the objective measures and the total score of the subjective evaluation; only a negative correlation was observed between "b" and Meat domain (r=-0.40; p=0.023). The objective methods showed moderate correlation with each other and no agreement between the objective and subjective methods was observed in this sample of healthy adolescents, emphasizing the importance of both aspects in the evaluation of masticatory function.

Falls and self-assessment of eyesight among elderly people: a population-based study in a south Brazilian municipality

This paper seeks to verify the association between falls and self-assessment of visual acuity in elderly people by means of a cross-sectional population-based study involving 1593 elderly people (aged 60 or over) from the urban zone of the municipality of Bagé-RS. Poisson regression was used for association analysis. Fall prevalence in the last year was 28.0% (95%CI: 25.8; 30.2), with 45.0% of these having suffered two or more falls in the same period. Elderly people self-assessing their eyesight as bad/very poor (10.0%) or regular (33.3%) showed a linear increase in fall occurrence when compared to individuals who considered their eyesight to be good/excellent. Self-assessment of eyesight showed itself to be an important factor associated with the occurrence of falls. This results entails the need to make progress with tracing elderly people with eyesight difficulties and its possible impact on actions to prevent the occurrence of falls.