How Music Intervention Lowered Participants’ Morning Cortisol—Qualitative Case Stories

Non-pharmacological interventions for improved home care of persons with dementia and their family caregiver are and will be increasingly important for society. A music intervention study was performed on persons with persons with dementia and family caregiver. The persons with dementia and family caregiver were instructed to choose a daily routine for joint listening to recorded music. They selected the music they were interested in from a menu. The intervention period lasted for two months. Both persons with dementia and family caregiver provided daily saliva samples for the assessment of stress-related steroid hormones. In previous reports we have reported that the morning cortisol levels decreased significantly among the family caregiver when the intervention group was compared to a control group. In the present study we report narratives from four dyads, two of whom with beneficial effects of the music intervention, one dyad with no clear beneficial effects and one dyad with mixed results. The narratives illustrate the strong cohesive effect that the joint music listening could have, leading to improved social functioning paralleled by decreased morning cortisol levels particularly in the family caregiver. The narratives also illustrate reasons for failed effects.

糖尿病相关的足溃疡预防指南(2023年更新版)——《国际糖尿病足工作组:糖尿病相关的足病预防与管理指南(2023)》的一部分

本章是2023年国际糖尿病足工作组(IWGDF)关于糖尿病相关的足溃疡预防的指南,是在2019年版指南基础上的更新。本指南面向临床医生和其他医务人员。我们遵循推荐、评估、发展和评价分级(GRADE)方法,采用患者-干预-比较-结局(PICO)的方法来设计临床问题和关键结局,并进行了包括必要的Meta分析在内的医学科学文献的系统综述,同时撰写了推荐及其理由。这些推荐基于系统综述中证据质量、在没有足够证据的情况下的专家意见、同时考虑干预措施的有益和不良效果,以及患者的偏好、成本、公平性、可行性和适用性的权衡。我们推荐对足溃疡风险较低的糖尿病患者每年进行一次保护性感觉丧失和周围动脉病变的筛查,并对高危患者进行更高频率的筛查以及其他危险因素的筛查。为了预防足溃疡,要对有危险因素的患者进行健康教育,教育其对足部进行适当地自我护理,在没有适当的足部保护的情况下不要行走,并对溃疡前兆进行有效治疗。指导足溃疡中高危风险的糖尿病患者穿着合适、宽松的治疗性鞋类,并考虑指导他们监测足部皮肤温度。开具处方使用治疗性鞋类,这些鞋类在行走时具有缓解足底压力的效果,能够防止足底溃疡复发。推荐足溃疡中低风险人群最好制定一个有监督的足踝运动计划,以减少溃疡风险;就溃疡的风险而言,每天总共增加1000步的负重活动可能是安全的。对于有溃疡前兆的非僵直锤状趾患者,可考虑屈肌腱切断术。我们建议不要用神经松解减压术来预防足溃疡。要对足溃疡中高危的糖尿病患者给予综合足部护理,以预防溃疡复发。贯彻这些推荐有助于医疗专业人员对有足溃疡风险的糖尿病患者提供更好的护理,增加无溃疡的天数,减少患者糖尿病相关的足病的医疗负担。

国际糖尿病足工作组:糖尿病足溃疡预防指南——《国际糖尿病足工作组:糖尿病足防治国际指南(2019)》的一部分

国际糖尿病足工作组(IWGDF)1999年发布了关于预防和管理糖尿病足病的循证指南。该指南旨在预防糖尿病患者的足部溃疡,并在2015年,IWGDF对预防指南进行了更新。我们遵循GRADE(grading of recommendations assessment development and evaluation)的评分方法,采用以患者为观察对象、有干预措施、与对照组进行比较、观察结局(patient-intervention-comparison-outcome,PICO)的方法来设计临床问题和关键成果,对医学科学文献进行系统评价,并撰写推荐意见及其理由。这些推荐基于系统评价中发现的证据质量、专家意见,以及益处及危害的权重、患者偏好、可行性和适用性以及与干预相关成本的权衡。我们建议对处于极低溃疡风险的患者每年做一次筛查,了解其是否有周围神经病变和外周血管病变,对高风险人群检查的频率要更高,以筛查其他危险因素。为了预防足溃疡,要对有危险因素的患者进行健康教育,教育患者适当地对足部进行自我护理以及对溃疡前症状进行有效治疗。指导中高危患者穿着合适的治疗鞋,并对其足部皮肤温度进行监测。处方治疗鞋在行走过程中具有明显的减轻足底压力的效果,能够防止足底溃疡复发。急性足溃疡或即将发生的足溃疡保守治疗失败,应考虑手术干预。我们不建议使用神经松解减压术。对高危患者给予综合足部医疗护理,以防溃疡复发。贯彻这些推荐将有助于医疗专业人员对有足溃疡风险的糖尿病患者提供更好的护理,降低糖尿病足溃疡的发生率,使足部健康维持更长的时间即增加无足病的天数,显著减少糖尿病患者和医疗机构的负担。

Can the International Classification of Functioning, Disability and Health (ICF) be used to understand risk factors for falls in older Australian women?

Purpose: To evaluate the relevance and accuracy of determining and predicting risk factors for falls in older women using the International Classification of Functioning, Disability and Health (ICF). Methods: We tested the accuracy of the ICF against risk of falls amongst 568 community dwelling participants of the Australian Longitudinal Survey on Women’s Health (ALSWH). We linked health-related variables to the ICF using ten linking rules. The logistic regression analysis evaluated the relationship between the variables and the outcome of falls. Self-report surveys measured daily functioning, health service use, medications, housing and social support. Results: Variables aligned with the ICF components of body function, health conditions, environment, activity and participation (ADL/IADL), and general health were significantly associated with falls. Discussion and conclusion: Mapping ALSWH health-related data to ICF components identified significant risk factors for falls are related to health conditions, functional limitations and home hazards. Biopsycho-social approaches guided by the ICF framework are crucial for fall prevention.

Nintendo®Wii&#8482 and a Physical Activity Routine: Effective Therapeutic Interventions in the Older Adult Population?

Occupational therapists work with individuals across the lifespan to promote health and wellness. “Occupational therapy promotes health and wellbeing through active involvement in meaningful occupations. By helping clients eliminate barriers, enhance their self-management skills, improve their performance of daily activities and adopt healthy habits and routines, occupational therapy unlocks the door to participation across the lifespan” (AOTA, 2010). In today’s world, health and wellness-related services are in demand for those aged 65 and older. As life expectancy rates continue to rise, there is an increase in concern for the field of occupational therapy to find a successful and efficient way to meet the needs of the growing number of older adults (National Center for Health Statistics, 2006). The idea that physical activity can be a beneficial occupation in the elderly has been examined and proved effective as a means of enhancing the quality of life in this population. “Although functional impairments due to the aging process seem to be inevitable, functional limitations due to an inactive lifestyle might be reversed. Indeed, it has been suggested that physically active lifestyles may contribute to improving or maintaining health and wellness” (Fletcher, Gulanick, & Braun, 2005). The purpose of this study was to investigate the effects of two different physical activity programs on individuals aged 65 and older. The variables that were examined were functional skills (activities of daily living), balance skills, and overall upper extremity function. This study looked at two forms of physical activity to determine their individual effects on functional skills, balance, and overall upper extremity function in this population. The two physical activity interventions were the Nintendo&#8482 Wii gaming system and a videotaped exercise routine.

Global Communications and Changing Perspectives:The World as a World Society

In this paper we will analyze the world as a world society.Our assumption is that,thanks to global communications,the world has become a unique social field.Therefore,it is necessary to make an analysis of the changes that have occurred in the society-state relationship.In the contemporary understanding,societies are constituted as relatively closed,self-referential systems,in which the world of life is framed by the borders of national states.Intensifying and extending the communication process has relativized the boundaries of such closed systems,creating an opportunity for the establishment of a world society.However,the practical political(infra)structure is still fixed on old patterns and,objectively,lags behind this change,creating a legitimacy deficit in the political field.So it is necessary to look at the world from a new perspective.

An fNIRS-Based Study on Prefrontal Cortex Activity during a Virtual Shopping Test with Different Task Difficulties in Brain-Damaged Patients

We developed a Virtual Shopping Test with three different task levels for assessment of daily cognitive function using virtual reality technology. The objective of present study was to investigate the difference on task performance, brain activation and subjective assessment in relation to the difficulty levels of the tasks. Subjects were asked to buy specific 2 items in Task 1, 4 items in Task 2, and 6 items in Task 3 at a virtual mall. The tasks and questionnaires were conducted on 10 convalescent brain-damaged patients and 6 healthy young adults. Hemodynamic changes in the prefrontal cortex (PFC) during activation due to the tasks were examined using functional near-infrared spectroscopy. As the result, the mean total time was significantly longer for the patients than for healthy subjects. PFC showed a greater response for related Task 2 than Task 1 in shopping and moving phase in patient group. The patients evaluated Tasks 1 and 2 are more difficult and bring more psychological load than healthy adults subjectively. That is, although the healthy adults did not show large difference in their task performances as well as PFC responses, they can evaluate the differences between three task levels, subjectively, while which could not be for the patients means that patients could not distinguish the difference of the tasks, subjectively. The results suggest that 4-item shopping task might be enough difficulty level that causes brain activation for the brain-damaged patients.

Exploring Cross Generational COVID-19 Attitudes and Behaviors

Objective: The COVID-19 pandemic has presented extraordinary challenges that have tested the resolve of the world and transformed our daily lives. We sought to capture COVID-related attitudes and behaviors of older adults and relate these to views of adolescents from a national study in the USA. Methods: This mixed-methods online survey accepted responses from adult volunteers, age 55+, from April to July 2020 (N = 223). We used a snowball approach to recruitment initiated in the state of Maine (USA). Results: Older respondents tended to report congruent attitudes concerning COVID-19 risks and associated preventative behaviors. Most reported taking Centers for Disease Control and Prevention guidance seriously. In contrast, adolescents surveyed in a prior study reported similar adherence, but less concern. Thematic review of open-ended responses highlights key intergenerational similarities and differences. Discussion: COVID-19 has changed day-to-day life in myriad ways. Attitudes vary within and between age groups. Further research could focus on intergenerational differences in motivations underlying behaviors as well as differing needs for public health education and support.

Co-Creation of a Working Model to Improve Sexual Health for Persons Living with Rheumatological Diseases

Background: Sexual health needs are insufficiently met for persons living with rheumatological diseases and it is necessary to create better ways to meet these needs. Objective: To co-create a working model to improve sexual health for persons living with rheumatological diseases, that can be used by rheumatological teams in regular rheumatology practice. Design: This study applied a co-creation design with three key features: 1) it took a systems perspective with emergent multiple interactive entities;2) the research process was viewed as a creative endeavour with strong links to design, while human imagination and the individual experience of patient and staff were at the core of the creative design effort;3) the process of the co-creative efforts was as important as the generated product. Results: A model defining the role of the patient, the professionals, and the team in optimizing sexual health for persons living with rheumatological diseases was co-created. The model can be seen as a practice guideline, which includes the support needed from and to each participant in the process of promoting sexual health, while being within the professional scope of the professionals’ knowledge and capacity, and in line with the needs of the persons living with rheumatological diseases. Discussion and Conclusions: The co-creative work process identified crucial factors in promoting sexual health, resulting in a useful model for patients, professionals and teams. Co-creation was experienced to be a useful research design to improve rheumatological care, through valuing and using the competence of all research members equally.