Cardiovascular risk factors among older persons with cognitive frailty in middle income country

BACKGROUND Cognitive frailty,characterized by the coexistence of cognitive impairment and physical frailty,represents a multifaceted challenge in the aging population.The role of cardiovascular risk factors in this complex interplay is not yet fully understood.AIM To investigate the relationships between cardiovascular risk factors and older persons with cognitive frailty by pooling data from two cohorts of studies in Malaysia.METHODS A comprehensive approach was employed,with a total of 512 communitydwelling older persons aged 60 years and above,involving two cohorts of older persons from previous studies.Datasets related to cardiovascular risks,namely sociodemographic factors,and cardiovascular risk factors,including hypertension,diabetes,hypercholesterolemia,anthropometric characteristics and biochemical profiles,were pooled for analysis.Cognitive frailty was defined based on the Clinical Dementia Rating scale and Fried frailty score.Cardiovascular risk was determined using Framingham risk score.Statistical analyses were conducted using SPSS version 21.RESULTS Of the study participants,46.3%exhibited cognitive frailty.Cardiovascular risk factors including hypertension(OR:1.60;95%CI:1.12-2.30),low fat-free mass(OR:0.96;95%CI:0.94-0.98),high percentage body fat(OR:1.04;95%CI:1.02-1.06),high waist circumference(OR:1.02;95%CI:1.01-1.04),high fasting blood glucose(OR:1.64;95%CI:1.11-2.43),high Framingham risk score(OR:1.65;95%CI:1.17-2.31),together with sociodemographic factors,i.e.,being single(OR 3.38;95%CI:2.26-5.05)and low household income(OR 2.18;95%CI:1.44-3.30)were found to be associated with cognitive frailty.CONCLUSION Cardiovascular-risk specific risk factors and sociodemographic factors were associated with risk of cognitive frailty,a prodromal stage of dementia.Early identification and management of cardiovascular risk factors,particularly among specific group of the population might mitigate the risk of cognitive frailty,hence preventing dementia.

On the Rule of Law Path for Inclusive Education to Empower Education Assistance for Persons with Disabilities

Inclusive education is the mainstream of developing education for persons with disabilities worldwide.It advocates the recognition and protection of the right of persons with disabilities to receive inclusive education in mainstream schools.From the perspective of inclusive education,the educational assistance system for persons with disabilities represents a theoretical innovation in traditional educational support methods,playing a crucial role in integrating persons with disabilities into society,reversing their disadvantaged status,and maintaining educational equity.At present,China's legal system for inclusive education assistance for persons with disabilities needs improvement,and faces several obstacles,including conceptual“limited capacity”,“monotonous”subjects,“crowding-out”obstacles and supervision“absence”obstacles.It is urgent to begin with the transformation of the rule of law concept,clarify the legal positioning of multiple responsibility subjects,achieve mutual reinforcement of education law and education aid legislation,establish a supervision system for inclusive education assistance,and improve the legal framework for educational assistance for persons with disabilities.This will ensure that persons with disabilities can successfully realize their right to education,share in the benefits of social development,and ultimately contribute to achieving common prosperity.

Deep Transfer Learning Driven Automated Fall Detection for Quality of Living of Disabled Persons

Mobile communication and the Internet of Things(IoT)technologies have recently been established to collect data from human beings and the environment.The data collected can be leveraged to provide intelligent services through different applications.It is an extreme challenge to monitor disabled people from remote locations.It is because day-to-day events like falls heavily result in accidents.For a person with disabilities,a fall event is an important cause of mortality and post-traumatic complications.Therefore,detecting the fall events of disabled persons in smart homes at early stages is essential to provide the necessary support and increase their survival rate.The current study introduces a Whale Optimization Algorithm Deep Transfer Learning-DrivenAutomated Fall Detection(WOADTL-AFD)technique to improve the Quality of Life for persons with disabilities.The primary aim of the presented WOADTL-AFD technique is to identify and classify the fall events to help disabled individuals.To attain this,the proposed WOADTL-AFDmodel initially uses amodified SqueezeNet feature extractor which proficiently extracts the feature vectors.In addition,the WOADTLAFD technique classifies the fall events using an extreme Gradient Boosting(XGBoost)classifier.In the presented WOADTL-AFD technique,the WOA approach is used to fine-tune the hyperparameters involved in the modified SqueezeNet model.The proposedWOADTL-AFD technique was experimentally validated using the benchmark datasets,and the results confirmed the superior performance of the proposedWOADTL-AFD method compared to other recent approaches.

Liver function in transgender persons:Challenges in the COVID-19 era

Transgender persons constitute a non-negligible percentage of the general population.Physical gender-transitioning in trans persons is mainly achieved with hormonal cross-sex therapy and sex reassignment surgeries that aim to align bodily appearance with gender identity.Hormonal treatment acts via suppressing the secretion of the endogenous sex hormones and replacing them with the hormones of the desired sex.The administration of testosterone is the typical masculinizing treatment in trans men,whilst trans women are routinely treated with estradiol agents in combination with anti-androgens or gonadotrophinreleasing hormone agonists if testes are present.Exogenous androgenic steroids,estradiol agents,and anti-androgens have been implicated in a series of hepatotoxic effects.Thus,liver integrity is a major concern with the long-term administration of cross-sex therapy.Hepatic tissue is susceptible to coronavirus disease 19(COVID-19)through various pathophysiological mechanisms.Special consideration should be paid to minimize the risk of hepatic damage from the potential cumulative effect of COVID-19 and gender-affirming treatment in transgender patients.Appropriate care is significant,with continuous laboratory monitoring,clinical observation and,if needed,specific treatment,especially in severe cases of infection and in persons with additional liver pathologies.The pandemic can be an opportunity to provide equal access to care for all and increase the resilience of the transgender population.

Impact of community-based rehabilitation on quality of life and self-esteem of persons with physical disabilities and their family members

Objective:Community-based rehabilitation(CBR)is a strategy by which persons living with disability(PWDs)access comprehensive rehabilitation services with limited evidence regarding its impact on the quality of life(QOL)and self-esteem(SE)of PWDs and their family members.This study compared the QOL and SE of Nigerian PWDs in communities with and without a CBR programme(CBR and non-CBR respectively),and the family quality of life(FQOL)of their family members.Methods:Cross-sectional study involving 2604 PWDs(1302 in CBR and 1302 in non-CBR);5208 family members of PWDs(2604 in CBR and 2604 non-CBR),recruited from four randomly selected geo-political zones in Nigeria,purposive/consecutive selection of eight CBR programmes,PWDs and their family members(CBR and non-CBR).Outcomes assessed using Rosenberg Self-Esteem Scale(RSES),World Health Organization Quality of Life Instrument-short form(WHOQOL-BREF)and Beach Centre Family Quality of Life Instrument(BCFQOL).Mann-Whitney U test and Spearman's rank order correlation were used to analyse data at P<0.05.Results:PWDs in CBR scored higher in all domains of WHOQOL-BREF(P<0.0001 in all cases)and RSES than non-CBR group(P<0.0001).The CBR families scored significantly higher than non-CBR families in all domains(P<0.05)except Emotional Well-Being of the BCFQOL.The CBR group scores on Psychological and Social Health domains of the WHOQOL-BREF showed significant positive correlation with CBR families'Family Interaction(P=0.06)and Parenting(P=0.07)domains and total FQOL(P=0.07).Conclusion:Community-based rehabilitation positively impacted on SE and QOL of PWDs and their family members.

Gut Bacteria and Nutritional Status of Nigerian Children at an Internally Displaced Persons’ Camp in Benue State, Nigeria: A Pilot Study

This study was conducted to determine the gut bacteria and nutritional status of children (n = 30) aged 2 - 11 in Benue’s largest internally displaced persons (IDP) camp since information on this is lacking. Gut bacteria were identified using culture techniques, while Body Mass Index (Kg/m2), Weight-for-Height (WHZ), and Weight-for-Age (WAZ) z scores were computed from anthropometric measurements. Socio-demographic and economic variables were collected via structured questionnaires. IBM SPSS v25 was used to analyze the data, with p Salmonella spp., Shigella spp., and Escherichia coli compared to children from a nearby private school (n = 10), except for E. coli, where the prevalence was equal. The results for BMI revealed that 23 (57.5%) of the children had a healthy weight while 17 (42.5%) were underweight.WAZ z-scores were between (-0.02 - 2.51) with evidence of mildly underweight (20%) and mildly overweight (5%) children. WHZ z-scores were between -0.03 - 2.37, with moderately wasted (30%) and severely wasted (5%) found. To ensure better health outcomes for residents, conditions in the camp must be improved.

Depression and Suicidal Ideations among Older Persons Living with HIV/AIDS in Mbarara City, Southwest Uganda

Background: Due to the increase in longevity and use of antiretroviral treatment, Uganda has had a growing population of older persons living with HIV/AIDS. However, there is a paucity of information on the mental health of the elderly living with HIV/AIDS. In this cross-sectional study, we determined the prevalence of, and associated factors for depression and suicidal ideation among older persons living with HIV/AIDS in Mbarara city, southwest Uganda. Methods: Older persons (150 females, 115 males), with mean age = 64.2 (±5.1) years, accessing health services from three purposively selected HIV/AIDS care centers in Mbarara city, southwest Uganda were recruited. Data on depression and suicidal ideation were collected using a Patient Health Questionnaire (PHQ-9) validated in Uganda, and a structured questionnaire was used to collect data on clinical and socio-demographic characteristics. Data were analysed using logistic regression. Results: Approximately 8.3% and 12.1% had depression and suicidal ideation, respectively. The factors associated with lowering the likelihood of depression were: an increase in the number of family members they stayed with and having no having any problems with their ARVs. On the other hand, earning more than 100,000 Uganda shillings was associated with reducing the risk of suicidal ideations among the participants. Conclusion: Approximately 8 to 12 in 100 older persons living with HIV/AIDS in Uganda have experienced depression or suicidal ideation. Family support and financial control were instrumental factors associated with depression and suicidal ideations, respectively. We recommended strengthening family structures and creating more avenues for financial independence among older persons living with HIV/AIDS to reduce the burden of depression, and suicidal behaviours among this vulnerable population.

Challenges and Demands for College English Teachers Raised by Training All-round Qualified Persons

The latest issue of College English Curriculum Requirements has posed challenges and demands for teachers in terms of linguistic competence, academic knowledge, language skills, professional morality, emotional and attitudinal qualifications, etc., which requires teachers to embrace and handle with active and open-minded responses. Hence, teachers ought to strive to develop and improve their own overall qualifications in collaboration with the long-term development of the subject and of the national higher education, with the need of qualified persons demanded by social development and the students＇ learning. Teachers also ought to form a notion of scientific development by keeping pace with the time, so as to discern the trend of subject development, to form appropriate judgments concerning the social development and to properly regulate their own development.

Challenges and New Directions of Information Accessibility for Persons with Disabilities in China: From the Perspective of the Convention on the Rights of Persons with Disabilities

Accessibility is the basis and prerequisite for persons with disabilities to enjoy and exercise all human rights and fundamental freedoms With the rapid development of the internet, providing and promoting information accessibility is considered an important obligation for the State In the process of transforming international human rights law into domestic law, how to deal with the human rights protection of persons with disabilities and the obligations of the private sector to ensure persons with disabilities receive services and products that meet the requirements and principles of information accessibility has become a development issue in the new era Against the backdrop of the Convention on the Rights of Persons with Disabilities and in the context of the booming development of the cause of persons with disabilities in China, legal scholars, persons with disabilities, and organizations have jointly proposed the Beijing Initiative on the Principles of Information Accessibility for Science and Technology Products It clarifies that the private sector should embrace the human rights model advocated by the Convention in terms of information accessibility, and provide equal participation for persons with disabilities in the process of designing, producing and selling scientific and technological products The Initiative also states that the private sector should keep pace with the United Nation’s sustainable development goals and the basic national policy of building a well-to-do society in an all round way, ensuring persons with disabilities are included within a moderately well-off society It also provides civil opinions on the formulation and clarification of relevant laws in the future.

Dissimilarities in Social Support as Described by Swedish- and Foreign-Born Persons Diagnosed with Type 2 Diabetes and Living in Sweden

Diabetes (DM) requires self-care that is demanding and may cause stress. Social support can buffer effects of stress. No previous study has been found comparing perceptions of foreign-born persons with DM, concerning the content of and need for social support with a population of origin. The aim was to compare the meaning of support and its impact on the life situation in Swedish- and foreign-born persons diagnosed with type 2 DM living in Sweden. A purposive sample of 74 persons;34 foreign- and 40 Swedish-born, aged 32-80 years, diagnosed with type 2 DM, was included. The foreign-born persons were mostly Middle Eastern and Ex-Yugoslavian refugees. Mixed methods were used and data were collected by qualitative interviews and quantitative data collected by the Norbeck Social Support Questionnaire (NSSQ). Studying the figures measured by NSSQ, no significant differences were found according to gender but foreign-born men scored lower than Swedish, especially in emotional support and aid. The main findings showed that respondents, irrespective of origin, described the meaning of the concept of support mainly as information support in learning to manage DM. However, foreign-born persons also focused on medical support with regular follow-ups while Swedes emphasized the need for emotional support. Foreign- and Swedish-born persons are in general more similar than dissimilar in describing the meaning, need and impact of support. Irrespective of origin they want to learn to manage their disease and thus desire and need regular follow-up and information immediately from being diagnosed. Further studies are needed as the study is based on a limited sample.

Social Participation of Older Persons Based on Human Rights:Conception Renewal and Action Plan

Equal participation and the promotion of social integration are essential parts of human rights protection. The theory of the right to social participation of older persons from the perspective of age stratification hardly explains the real difficulties older persons face in participating in social life. Life course theory reveals that social participation is an intermediate link between individuals and the social environment, so it is a means for individuals to achieve specific objectives as they age. In this light, there are three main interpretations for expressions of social participation of older persons throughout history, namely participation in health-oriented toward treatment of physiological aging, participation in production oriented toward human resources development of older persons, and full participation based on human rights. In the context of mainstreaming human rights and active aging, full participation based on human rights should become the main concept of relevant academic exploration and policy practice. To this end, we should establish the principle of protecting the rights of the elderly to social participation and integration, examine the participation process from the perspective of dynamic development, and construct the participation protection mechanism in light of China’s conditions.

Persons With Disabilities in China——An interview with Mr. Deng Pufang, President of the China Disabled Persons' Federation

In December 2003, Mr. Deng Pufang, President of the China Disabled Persons' Federation, was awarded the 2003 United Nations Prize in the field of Human Rights in recognition of his 'outstanding contributions to the promotion and protection of human rights and fundamental freedom.' The following is an interview with Mr. Deng on the development of the cause of disabled persons in China.

The UN Convention on the Rights of Persons with Disabilities and China's Protection of the Right to Education of the Persons with Disabilities

The UN Convention on the Rights of Persons with Disabilities effective in 2008 explicitly stipulates that Member States shall guarantee that people with disabilities enjoy the right to education free from discrimination and without prejudice to equal opportunities.The Chinese government made amendments to the Law of the People s Republic of China on the Protection of Persons with disabilities and the Regulation on the Education of the Persons with Disabilities and issued a series of rules on the Education of the Persons with Disabilities so as to actively implement the Convention. In recent years,the number and proportion of children with disabilities who receive education in China and the number of students with disabilities receiving high school and higher education have been on the rise annually.However, there is still a gap in the level of education on all stages between persons with disabilities and persons without, presenting a huge challenge for the achievement of the right to education of persons with disabilities. We should continue to actively fulfill the obligations prescribed by the Convention to protect the right to education, explore the construction of integrated education, support the maintenance system,strive to improve the quality of special education,allocate resources for the education of persons with disabilities, and emphasize the appraisal of the education of persons with disabilities.

The Formulation of Convention on the Rights of Older Persons:The Process and Prospects

Since its establishment,the United nations open-ended Working group on aging has shouldered the historical mission of exploring the“possibilities”and even laying the“foundation”for a Convention on the Rights of older Persons.Although the formulation of a convention on the protection of the rights of older persons has been widely supported by the general public and many countries,it still faces many problems.China should adhere to the combination of“human rights”and“development”and adjust its policies to adapt to the new changes in related fields.With successful case studies,concise expression of rights,and regional contracting practice,China could participate more fully in the reform of the international mechanism for the protection of the rights of older persons to improve the voice in future international human rights governance and make greater contributions to the protection of the rights of older persons worldwide.

Revision of Regulations on Education for Persons with Disabilities:Concept Innovation and System Improvement

In January 2017, the State Council of the People’s Republic of China revised and adopted the Regulations on Education for Persons with Disabilities The revision, which adapts to the new situation brought by the education reform and development in China, highlights the basic and key role of education for persons with disabilities in helping them to integrate into the society and participate in social life It updates the concept of education for persons with disabilities and improves various systems which ensure the right of persons with disabilities to education The revision and implementation of the Regulations is important for the promotion of education for persons with disabilities, the improvement of the entire education law system and the innovation of concepts of educational development.

Hepatitis C virus control among persons who inject drugs requires overcoming barriers to care

Despite a high prevalence of hepatitis C virus(HCV)infection,the vast majority of persons who inject drugs(PWID)have not engaged in HCV care due to a large number of obstacles.Education about the infection among both PWID and providers remains an important challenge as does discrimination faced by PWID in conventional health care settings.Many providers also remain hesitant to prescribe antiviral therapy due to concerns about adherence and relapse to drug use resulting in reinfection.Presently,however,as a result of improvements in treatment efficacy combined with professional society and government endorsement of HCV treatment for PWID,a pressing need exists to develop strategies to engage these individuals into HCV care.In this article,we propose several strategies that can be pursued in an attempt to engage PWID into HCV management.We advocate that multidisciplinary approaches that utilize health care practitioners from a wide range of specialties,as well as co-localization of medical services,are strategies likely to result in increased numbers of PWID entering into HCV management.Pursuit of HCV therapy after stabilization through drug treatment is an additional strategy likely to increase PWID engagement into HCV care.The full impact of direct acting antivirals for HCV will only be realized if innovative approaches are pursued to engage all HCV infected individuals into treatment.

Eligibility of persons who inject drugs for treatment of hepatitis C virus infection

In this decade, an increase is expected in end-stageliver disease and hepatocellular carcinoma, most commonly caused by hepatitis C virus(HCV) infection.Although people who inject drugs(PWID) are the ma-jor source for HCV infection, they were excluded fromantiviral treatments until recently. Nowadays there isincontrovertible evidence in favor of treating these patients, and substitution therapy and active substanceuse are no longer contraindications for antiviral treatment. The viral clearance in PWID after HCV antiviraltreatment with interferon or pegylated interferon combined with ribavirin is comparable to the viral clearancein non-substance users. Furthermore, multidisciplinary approaches to delivering treatment to PWID are advised, and their treatment should be considered on anindividualized basis. To prevent the spread of HCV inthe PWID community, recent active PWID are eligiblefor treatment in combination with needle exchange programs and substitution therapy. As the rate of HCV reinfection is low after HCV antiviral treatment, there is no need to withhold HCV treatment due to concerns about reinfection alone. Despite the advances in treatment efficacies and data supporting their success, HCV assessment of PWID and initiation of antiviral treatment remains low. However, the proportion of PWID assessed and treated for HCV is increasing, which can be further enhanced by understanding the barriers to and facilitators of HCV care. Removing stigmatization and implementing peer support and group treatment strategies, in conjunction with greater involvement by nurse educators/practitioners, will promote greater treatment seeking and adherence by PWID. Moreover, screening can be facilitated by noninvasive methods for detecting HCV antibodies and assessing liver fibrosis stages. Recently, HCV clearance has become a major endpoint in the war against drugs for the Global Commission on Drug Policy. This review highlights the most recent evidence concerning HCV infection and treatment strategies in PWID.

Antioxidant Status in Persons With and Without Senile Lens Changes

Biochemical evidence on lens culture suggests that antioxidant nutrients can protect lens against peroxidation caused by radiation. A case-control study was carried out on 262 middle aged (45-54) and aged (55-64) subjects. The relationship between biochemical markers of antioxidant status and senile lens changes (including cataract) was examined in 131 subjects with senile lens changes and 131 control subjects with clear lens. Antioxidant status was measured using plasma and erythrocyte glutathione peroxidase, erythrocyte superoxide dismutase and catalase activity and plasma levels of vitamine E and vitamin A. Subjects were grouped by age and sex. The results were as follows: (1) The subjects with lens changes tended to have lower plasma levels of vitamin E and vitamin A, lower activity of several antioxidant enzymes and higher level of MDA. (2) The subjects with senile lens changes had significantly lower erythrocyte glutathione peroxidase level.(3) In the middle-aged group, subjects with senile lens changes were observed to have lower erythrocyte and plasma glutathione peroxidase level than those without senile lens changes.The results suggest that appropriate amount of antoxidant nutrients might be expected to prevent or retard the process of lens changes

An Exploratory Study on the Meaning of Using Community Psychiatric Rehabilitation among Persons with Psychiatric Disabilities

This study explores the meaning of the use of community psychiatric rehabilitation(CPR)services to gain knowledge to improve services and shed more light on how to facilitate recovery.The topics explored included:the motivation for participation,perception and expectation towards CPR,the interactions with professionals in the CPR Center,and the feelings towards activities.A qualitative approach was adopted,and 30 consumers were interviewed face-to-face by using semi-structured interview guide.Data were analyzed using the open coding method of grounded theory.The consumer accounts provided information on the eight aspects of CPR services.The findings revealed that the CPR Center created a lifeworld,a friendly place similar to home with structure and activities.Professional relationship was the key change agent for rehabilitation.Most professionals adopted recovery-oriented approach to empower participants by giving opportunities and choices.The essential ingredients of this lifeworld covered rehabilitation goals,physical exercises,psychological impact,social interactions,learning,and economic gains.The services were venues for interpersonal interactions and provided structure for daily life,which helped consumers reach their rehabilitation goals and brought existential meaning to their lives.Yet,the accounts also revealed negative phenomena in the CPR center.Suggestions were made to improve services.

Basic studies on life circumstances and stress in persons with congenital physical disabilities using always wheelchairs

Many studies about the health problems of persons with physical disabilities have been performed, however few studies have focused on the life circumstances of persons with physical disabilities. This study aimed to clarify the relationship between stress and the life circumstances of persons with congenital physical disabilities who must use wheelchairs. The participants were 70 individuals who used the services of care workers employed by welfare service business offices. Participants used wheelchairs. In addition, those participants who used a standard manual wheelchair were not able to operate it alone. Participants were required to answer a two-part questionnaire with questions about factors related to basic lifestyle and stress, and about life factors related to the stress of individuals with physical disabilities. No significant relationship between lifestyle and stress was found in either males or females. Most persons with congenital physical disabilities using wheelchairs had some kind of stress in daily life. In particular, significantly more level of stress was found in females (90%) than that in males (65%). Levels of stress according to life factor differed between males and females. The most dramatic gender difference was that the level of stress caused by the mental or mind factor in females was significantly higher than that in males (p < 0.05). Most persons who must use wheelchairs have stress resulting from daily life, and in particular, females experience more mental stress than males.