Chronic Obstructive Pulmonary Disease and Association With Mild Cognitive Impairment: The Mayo Clinic Study of Aging

ObjectiveTo investigate the association of chronic obstructive pulmonary disease (COPD) with mild cognitive impairment (MCI) and MCI subtype: amnestic MCI and nonamnestic MCI, in a population-based study of elderly patients.Patients and MethodsParticipants included 1927 individuals aged 70 to 89 years enrolled in the population-based Mayo Clinic Study of Aging. Participants were evaluated by using a nurse assessment, neurological evaluation, and neuropsychological testing, and the diagnosis of MCI was made by a consensus panel according to the standardized criteria. Chronic obstructive pulmonary disease was identified by the review of medical records. The study was conducted from October 1, 2004, through July 31, 2007. The associations of COPD and disease duration with MCI and its subtypes were evaluated by using logistic regression models adjusted for potential covariates.ResultsOf 1927 participants, 288 had COPD (men vs women: 18% vs 12%; P<.001). As compared with patients without COPD, patients with COPD had a higher prevalence of MCI (27% vs 15%; P<.001). The odds ratio (OR) for MCI was almost 2 times higher in patients with COPD than in those without (OR, 1.87; 95% CI, 1.34-2.61), with a similar effect in men and women. The OR for MCI increased from 1.60 (95% CI, 0.97-2.57) in patients with a COPD duration of 5 years or less to 2.10 (95% CI, 1.38-3.14) in patients with a COPD duration of more than 5 years.ConclusionThis population-based study suggests that COPD is associated with increased odds of having MCI and its subtypes. There was a dose-response relationship with the duration of COPD after controlling for the potential covariates.     

The Beneficial Effects of Mind-Body Exercises for People With Mild Cognitive Impairment: a Systematic Review With Meta-analysis

ObjectiveTo objectively evaluate the most common forms of mind-body exercise (MBE) (tai chi, yoga, qigong) on cognitive function among people with mild cognitive impairment (MCI).Data SourcesWe searched 6 electronic databases (Scopus, PubMed, PsycINFO, WanFang, Web of Science, CNKI) from inception until September 2018.Study SelectionNine randomized controlled trials and 3 nonrandomized controlled trials were included for meta-analysis.Data ExtractionTwo researchers independently performed the literature searches, study selection, data extraction, and methodological quality assessment using the revised Physiotherapy Evidence Database (PEDro) scale.Data SynthesisThe pooled effect size (standardized mean difference [SMD]) was calculated while random-effect model was selected. Overall results of the meta-analysis (N=1298 people with MCI) indicated that MBE significantly improved attention (SMD=0.39, 95% confidence interval [CI] 0.07-0.71, P=.02, I²=31.6%, n=245), short-term memory (SMD=0.74, 95% CI 0.57-0.90, P<.001, I²=0%, n=861), executive function (SMD=-0.42, 95% CI -0.63 to -0.21, P<.001, I²=38.54%, n=701), visual-spatial/executive function (SMD=0.35, 95% CI 0.07-0.64, P<.05, I²=0%, n=285), and global cognitive function (SMD=0.36, 95% CI 0.2-0.52, P<.001, I²=15.12%, n=902). However, the significant positive effect on cognitive processing speed was not observed following MBE interventions (SMD=0.31, 95% CI -0.01 to 0.63, P=.054, I²=28.66%, n=233).ConclusionsStudy findings of this meta-analysis suggest that MBE have the potential to improve various cognitive functions in people with MCI.     

Inflammation Is Strongly Associated With Cardiorespiratory Fitness,Sex, BMI,and the Metabolic Syndrome in a Self-reported Healthy Population: HUNT3 Fitness Study

ObjectiveTo investigate whether C-reactive protein (CRP, a general marker of inflammation), neopterin (activated macrophages), lactoferrin (activated neutrophils), and endothelial function (flow-mediated vasodilation [FMD]) are associated with cardiorespiratory fitness (peak oxygen uptake [VO_2peak]), sex, body mass index (BMI), and the metabolic syndrome (MetSyn) in a healthy adult population.Patients and MethodsThis was a cross-sectional association study based on the population-based HUNT3 Fitness Study performed from May 15, 2007, through June 23, 2008. Seven hundred forty self-reported healthy respondents (327 women) identified as having the MetSyn were age- and sex-matched with 692 controls (307 women) from the same cohort. Associations between the inflammatory biomarkers and VO_2peak, FMD, and the MetSyn were analyzed by multivariate linear regression.ResultsThe CRP level was negatively associated with VO_2peak (P<.001), positively associated with the MetSyn (with a stronger effect in men) (P<.001) and BMI (with a stronger effect in women) (P<.01), but not with FMD (P=.34). Lactoferrin was positively associated with the MetSyn (P<.001), but neither neopterin nor lactoferrin were associated with VO_2peak or FMD.ConclusionThe CRP level was strongly associated with VO_2peak and the MetSyn, but not with FMD. The associations among inflammation, VO_2peak, and the MetSyn were strongly influenced by sex and BMI. These data support that low cardiorespiratory fitness should be considered an etiologic factor contributing to systemic inflammation and that reducing body weight and improving VO_2peak are methods that may positively affect CRP levels.     

Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls

Montero-Odasso M, Muir SW, Speechley M. Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls.ObjectiveTo determine the effect of 2 different dual tasks on gait variability in people with mild cognitive impairment (MCI) compared with control subjects.DesignCross-sectional study.SettingMemory clinic at a university hospital.ParticipantsOlder adults with MCI (n=43) and cognitively normal control subjects (n=25) from the community. Gait was assessed under single (usual walking) and dual tasking (naming animals and subtracting serial 7s), using an electronic walkway.InterventionsNot applicable.Main Outcome MeasuresThe dependent variable was the coefficient of variation of gait variability, a marker of gait stability and an established risk factor for falls. Two-way repeated-measures analysis of variance was used to examine main effects (group, task) and their interaction.ResultsA significant difference was found within and between groups (P=.016) of increasing gait variability as dual-task complexity increased. Gait velocity decreased within groups as dual-task complexity increased. The magnitude of increased gait variability across tasks was greater for the MCI group (2.68%– 9.84%) than for the control group (1.86%–3.74%), showing a significant between-group difference (P=.041).ConclusionsDual-task load significantly increased gait variability in the MCI group compared with the control group, an effect that was larger than the changes in gait velocity. The magnitude of this impairment on gait stability was related to the complexity of the dual task applied. Our findings help to explain the high risk of falls recently described in older adults with MCI, and may help in the identification of fall risk in cognitively impaired persons.     

Falls Efficacy Is Associated With Better Gait and Functional Outcomes After Rehabilitation in Older Patients

ObjectiveTo examine the relationship between falls efficacy and the change in gait speed and functional status in older patients undergoing postacute rehabilitation.DesignProspective cohort study.SettingPostacute rehabilitation facility.ParticipantsPatients (N=180) aged 65 years and older (mean age ± SD, 81.3±7.1y).InterventionsNot applicable.Main Outcome MeasuresData on demographics; functional, cognitive, and affective status; and falls efficacy using a 10-item version of the Falls Efficacy Scale (FES; range, 0-100) were collected upon admission. Data about gait speed and functional status (Barthel Index and Basic Activities of Daily Living [BADL]) were measured at admission and discharge. In addition, BADL performance was self-reported 1 month after discharge.ResultsCompared with admission, all rehabilitation outcomes improved at discharge: gait speed (0.41±0.15 m/s vs 0.50±0.16 m/s; P<.001), Barthel Index score (68.4±16.3 vs 82.5±13.6; P<.001), and BADL (3.5±1.6 vs 4.7±1.3; P<.001). Adjusting for baseline status and other potential confounders, baseline FES independently predicted gait speed (adjusted coefficient: 0.002; 95% confidence interval [CI], 0.000-0.004; P=.025) and Barthel index (adjusted coefficient: 0.225; 95% CI, 0.014-0.435; P=.037) at discharge, with higher confidence at baseline predicting greater improvement. Baseline FES was also independently associated with self-reported BADL performance at the 1-month follow-up (adjusted coefficient: 0.020; 95% CI, 0.010-0.031; P<.001).ConclusionsIn older patients, higher falls efficacy predicted better gait and functional rehabilitation outcomes, independently of baseline performance. These results suggest that interventions aiming at falls efficacy improvement during rehabilitation might also contribute to enhancing gait speed and functional status in patients admitted to this setting.     

Drug Treatment,Postural Control,and Falls: An Observational Cohort Study of 504 Patients With Acute Stroke,the Fall Study of Gothenburg

ObjectiveTo identify whether, and to what extent, treatment with cardiovascular drugs and neurotropic drugs are associated with postural control and falls in patients with acute stroke.DesignObservational cohort study.SettingA stroke unit at a university hospital.ParticipantsA consecutive sample of patients (N=504) with acute stroke.InterventionsNot applicable.Main Outcome MeasuresPostural control was assessed using the modified version of the Postural Assessment Scale for Stroke Patients. Data including baseline characteristics, all drug treatments, and falls were derived from medical records. Univariable and multivariable logistic regression and Cox proportional hazards models were used to analyze the association of drug treatment and baseline characteristics with postural control and with falls.ResultsIn the multivariable logistic regression analysis, factors significantly associated with impaired postural control were treatment with neurotropic drugs (eg, opioids, sedatives, hypnotics, antidepressants) with an odds ratio (OR) of 1.73 (95% confidence interval [CI], 1.01-2.97, P=.046); treatment with opioids (OR 9.23, 95% CI, 1.58-54.00, P=0.014); age (OR 1.09, 95% CI, 1.07-1.12, P<.0001), stroke severity, which had a high National Institutes of Health Stroke Scale-score (OR 1.29, 95% CI, 1.15-1.45, P<.0001), and sedentary life style (OR 4.32, 95% CI, 1.32-14.17, P=.016). No association was found between neurotropic drugs or cardiovascular drugs and falls.ConclusionsTreatment with neurotropic drugs, particularly opioids, in the acute phase after stroke, is associated with impaired postural control. Since impaired postural control is the major cause of falls in patients with acute stroke, these results suggest opioids should be used with caution in these patients.     

Measuring Discharge Outcomes,Length of Stay,and Functional ADL Score During COVID-19 in Inpatient Rehabilitation Hospitals

ObjectiveTo measure discharge disposition, length of stay (LOS), and functional activities of daily living (ADL) scores for patients admitted to acute inpatient rehabilitation hospitals (IRHs) during the coronavirus disease 2019 (COVID-19) pandemic and to compare these parameters with a period prior to the pandemic.DesignRetrospective cohort study via systematic retrospective chart review of consecutive patients admitted to IRHs from January 1-February 19, 2020 (pre–COVID-19T), and COVID-19 time period/patients admitted from April 1, 2020-May 9, 2020 (COVID-19T).SettingSystem of 3 IRHs in the Northeastern United States.ParticipantsPre–COVID-19T, n=739; COVID-19T, n=335, of whom n=139 were positive for COVID-19 (COVID+) and n=196 were negative (COVID−) (N=1074).InterventionsNot applicable.Main Outcome MeasuresDischarge disposition, LOS, and functional ADL scores.ResultsCOVID-19T patients were younger (P=.03) and less likely to be White (P=.03). These patients also had a higher case mix index (CMI; P<.01), longer acute care LOS (P<.01), and longer IRH LOS (P<.01). Patients who were COVID+ (during COVID-19T) were less likely to be White (P<.01), had lower CMI (P<.01), had higher admission and discharge functional ADL scores (P=.02, P<.01), and had longer acute care LOS compared with those who were COVID− (P<.01). There were no differences in discharge outcomes between pre–COVID-19T and COVID-19T cohorts (P=.75), including when stratified for COVID-19 status (P=.74). Functional ADL scores on admission and discharge were lower in COVID-19T than in pre–COVID-19T (P=.01), including when stratified for COVID-19 status though not significant (P=.06).ConclusionsThere were no differences in discharge outcomes for any group. IRH LOS was significantly increased during the pandemic, but there were no statistically significant differences between the COVID+ and COVID− cohorts within COVID-19T. Functional ADL scores were significantly lower during COVID-19T, but COVID status was not a significant predictor. This suggests that COVID+ status was not a barrier to discharge or functional outcomes. This supports the importance of IRHs to restore function and discharge patients to home, even with a more medically complex COVID-19 pandemic population.     

Coronary Artery Bypass Grafting in Octogenarians—Risks,Outcomes, and Trends in 1283 Consecutive Patients

ObjectiveTo describe the risks, outcomes, and trends in patients older than 80 years undergoing coronary artery bypass grafting (CABG).MethodsWe retrospectively studied 1283 consecutive patients who were older than 80 years and underwent primary isolated CABG from January 1, 1993, to October 31, 2019, in our clinic. Kaplan-Meier survival probability and quartile estimates were used to analyze patients’ survival. Logistic regression models were used for analyzing temporal trends in CABG cases and outcomes. A multivariable Cox proportional hazards regression model was developed to study risk factors for mortality.ResultsOperative mortality was overall 4% (n=51) but showed a significant decrease during the study period (P=.015). Median follow-up was 16.7 (interquartile range, 10.3-21.1) years, and Kaplan-Meier estimated survival rates at 1 year, 5 years, 10 years, and 15 years were 90.2%, 67.9%, 31.1%, and 8.2%, respectively. Median survival time was 7.6 years compared with 6.0 years for age- and sex-matched octogenarians in the general US population (P<.001). Multivariable Cox regression analysis identified older age (P<.001), recent atrial fibrillation or flutter (P<.001), diabetes mellitus (P<.001), smoking history (P=.006), cerebrovascular disease (P=.04), immunosuppressive status (P=.01), extreme levels of creatinine (P<.001), chronic lung disease (P=.02), peripheral vascular disease (P=.02), decreased ejection fraction (P=.03) and increased Society of Thoracic Surgeons predicted risk score (P=.01) as significant risk factors of mortality.ConclusionAlthough CABG in octogenarians carries a higher surgical risk, it may be associated with favorable outcomes and increase in long-term survival. Further studies are warranted to define subgroups benefiting more from surgical revascularization.     

The Moderating Role of Motivation in the Real-Time Associations of Fatigue,Cognitive Complaints,and Pain With Depressed Mood Among Stroke Survivors: An Ecological Momentary Assessment Study

ObjectiveStroke symptoms fluctuate during the day as stroke survivors participate in daily activities. Understanding the real-time associations among stroke symptoms and depressed mood, as well as the role of motivation for daily activities, informs, and post-stroke symptom management in the context of everyday living. This study aimed to (1) investigate the real-time associations of fatigue, cognitive complaints, and pain with depressed mood and (2) examine the role of motivation for daily activity participation as a potential moderator of these associations in stroke survivors.DesignA prospective cohort study involving 7 days of ecological momentary assessment (EMA), during which participants completed 8 EMA surveys per day. Multilevel modeling was used to analyze data.SettingCommunity.ParticipantsForty community-dwelling stroke survivors (N=40).InterventionsNot applicable.Main Outcome MeasuresEMA measures of depressed mood, stroke symptoms (physical and mental fatigue, cognitive complaints, and pain), and motivation (autonomous motivation, controlled motivation).ResultsHigher levels of within- and between-person physical fatigue, mental fatigue, cognitive complaints, and pain were momentarily associated with greater depressed mood (Ps<.001). Within-person autonomous motivation significantly buffered the momentary associations of physical fatigue (B=-0.06, P<.001), mental fatigue (B=-0.04, P=.032), and pain (B=-0.21, P<.001) with depressed mood.ConclusionsFindings indicate the momentary associations of fatigue, cognitive complaints, and pain with depressed mood in stroke survivors. Autonomous motivation underpinning daily activity participation was found to buffer the associations of fatigue and pain with depressed mood. Promoting autonomous motivation for daily activity participation may be viable for preventing and mitigating poststroke depression.     

Trunk Muscle Composition 2 Months After Hip Fracture: Findings From the Baltimore Hip Studies

ObjectiveTo determine if hip fracture patients would have smaller cross-sectional area (CSA) and lower radiological attenuation (suggesting greater fat infiltration) in all trunk muscles as compared to older adults without hip fractures.DesignCross-sectional analysis of computed tomography (CT) scans.SettingClinical imaging facility.ParticipantsForty-one white participants (19 men, 22 women) from the Baltimore Hip Studies seventh cohort at 2 months postfracture were compared to 693 white participants (424 men, 269 women) from the Health, Aging and Body Composition (Health ABC) study at the year 6 visit (N=734).InterventionNot applicable.Main Outcome MeasuresTrunk muscle CSA and attenuation values were obtained from a single 10-mm, axial CT scan completed at the L4-L5 disc space in each participant.ResultsThe hip fracture cohort had significantly smaller CSA for all trunk muscles (range: 12.1%-38% smaller) compared to the Health ABC cohort (P<.01), with the exception of the rectus abdominus muscle in men (P=.12). But, hip fracture patients, particularly female patients, had higher attenuation levels (lower intramuscular fat) in all trunk muscles (P<.0001).ConclusionsFindings are consistent with atrophy of the trunk muscles in the hip fracture population without a high level of intramuscular fat. Future work should evaluate the role of trunk muscle composition in the functional recovery of older adults after hip fracture.     

Patient- and Physical Therapist–Level Predictors of Patient-Reported Therapeutic Alliance: An Observational,Exploratory Study of Cohorts With Knee and Low Back Pain

ObjectiveTo identify patient- and physical therapist–level predictors for therapeutic alliance at the end of an episode of physical therapy for knee or low back pain (LBP).DesignSecondary analysis of observational cohort.SettingOutpatient physical therapy clinics.ParticipantsPatients receiving physical therapy for knee (n=189) or LBP (n=252) and physical therapists (n=19). Candidate predictor variables included demographics, patient clinical characteristics, and physical therapist attitudes and beliefs (Pain Attitudes and Beliefs Scale for Physical Therapists) and confidence in providing patient-centered care (Self-Efficacy in Patient-Centeredness Questionnaire).InterventionsNot applicable.Main Outcome MeasuresPatient-reported therapeutic alliance was measured using the 12-item Work Alliance Inventory–Short Revised (WAI-SR).ResultsFinal linear mixed models indicated different patient- and physical therapist–level factor contributions in predicting final WAI-SR scores across cohorts with knee and LBP. Female sex was a consistent patient-level predictor for both knee (estimated β=1.57, P<.05) and LBP (β=1.42, P<.05), with age (β=−0.07, P<.01) and baseline function (β=0.06, P<.01) contributing to cohorts with knee and LBP, respectively. Physical therapist–level predictors included female sex (β=6.04, P<.05), Pain Attitudes and Beliefs Scale for Physiotherapists behavioral (β=0.65, P<.01), and Self-Efficacy in Patient-Centeredness Questionnaire (SEPCQ) Exploring Patient Perspective (β=−0.75, P<.01) subscale scores for LBP, with SEPCQ Sharing Information and Power subscale scores (β=0.56, P<.05) contributing to both cohorts with knee (β=0.56, P<.05) and LBP (β=0.74, P<.01). Random effects for patients nested within physical therapists were observed for both cohorts.ConclusionsThese findings provide preliminary evidence for inconsistent relationships among patient- and physical therapist–level factors and therapeutic alliance across cohorts with knee and LBP.     

The effectiveness of physical exercise on cognitive and psychological outcomes in individuals with mild cognitive impairment: A systematic review and meta-analysis

ObjectiveIndividuals with mild cognitive impairment (MCI) are at high risk for developing dementia. Physical exercise is a promising intervention for cognitive decline. Systematic reviews regarding the effects of physical exercise on cognitive and psychological outcomes among MCI patients are limited, and a systematic review exploring the effects of exercise modalities on the results has not been conducted. This study evaluated the effects of physical exercise on cognitive and psychological outcomes for MCI patients and attempted to identify which specific modality of exercise is more effective.DesignSystematic review and meta-analysis.Data sourcesA systematic search of Medline, CINAHL, EMBASE, PsycINFO, SPORTDiscus, and the China National Knowledge Infrastructure was performed.Review methodsTwo reviewers independently assessed the study quality using the Effective Public Health Practice Project Quality Assessment Tool. Meta-analysis was conducted when data were available, with further subgroup analyses for exercise types. A series of sensitivity analyses were conducted to explore the influence of study quality and control types on the primary outcome. A narrative analysis was performed when statistical synthesis was inappropriate.ResultsEleven studies met the inclusion criteria. The exercise interventions can be classified into three types: (a) aerobic exercise, (b) resistance exercise, and (c) multi-modal exercise. Results showed that physical exercise had beneficial effects for global cognition [standard mean difference (SMD) = 0.30, 95% confidence interval (CI): 0.10–0.49, p = 0.002]. Further subgroup analysis demonstrated that aerobic exercise programmes are consistently associated with medium effect size (SMD: 0.54–0.58). However, the effects of physical exercise on domain-specific cognitive function and psychological outcomes in MCI patients remain inconclusive. Results of sensitivity analysis indicated that types of control exert influence on the outcomes.ConclusionsPhysical exercise, aerobic exercise in particular, benefits global cognition in MCI patients. The evidence of physical exercise on domain-specific cognitive function and psychological outcomes remains unclear, more trials with rigorous study design are necessary to provide the evidence.     

Out-of-hospital characteristics and care of patients with severe sepsis: A cohort study

PurposeEarly recognition and treatment in severe sepsis improve outcomes. However, out-of-hospital patient characteristics and emergency medical services (EMS) care in severe sepsis is understudied. Our goals were to describe out-of-hospital characteristics and EMS care in patients with severe sepsis and to evaluate associations between out-of-hospital characteristics and severity of organ dysfunction in the emergency department (ED).Materials and MethodsWe performed a secondary data analysis of existing data from patients with severe sepsis transported by EMS to an academic medical center. We constructed multivariable linear regression models to determine if out-of-hospital factors are associated with serum lactate and sequential organ failure assessment (SOFA) in the ED.ResultsTwo hundred sixteen patients with severe sepsis arrived by EMS. Median serum lactate in the ED was 3.0 mmol/L (interquartile range, 2.0-5.0) and median SOFA score was 4 (interquartile range, 2-6). Sixty-three percent (135) of patients were transported by advanced life support providers and 30% (62) received intravenous fluid. Lower out-of-hospital Glasgow Coma Scale score was independently associated with elevated serum lactate (P < .01). Out-of-hospital hypotension, greater respiratory rate, and lower Glasgow Coma Scale score were associated with greater SOFA (P < .01).ConclusionsOut-of-hospital fluid resuscitation occurred in less than one third of patients with severe sepsis, and routinely measured out-of-hospital variables were associated with greater serum lactate and SOFA in the ED.     

A pilot study examining the use of ultrasound to measure sarcopenia,frailty and fall in older patients

IntroductionThe importance of this study is to devise an efficient tool for assessing frailty in the ED. The goals of this study are 1) to correlate ultrasonographic (US) measurements of muscle thickness in older ED patients with frailty and 2) to correlate US-measured sarcopenia with falls, subsequent hospitalizations and ED revisits.MethodsParticipants were conveniently sampled from a single ED in this prospective cohort pilot study of patients aged 65 or older. Participants completed a Fatigue, Resistance, Ambulation, Illness and Loss of Weight (FRAIL) scale assessment and US measurements of their upper arm muscles, quadricep muscles, and abdominal wall muscles thickness. We conducted one-month follow-up phone calls to assess for falls, ED revisits, and subsequent hospital visits.ResultsWe enrolled 43 patients (mean age of 78.5). Ultrasound measurements of the three muscle groups were not significantly different between frail and non-frail groups. Frail participants had greater bicep asymmetry (a difference of 0.47 cm vs 0.24 cm, p < .01). A predictive logistic regression model using average quadriceps thickness and biceps asymmetry was found to identify frail patients (AUC of 0.816). Participants with subsequent falls had smaller quadriceps (1.18 cm smaller, p < .01). Subsequently hospitalized patients were found to have smaller quadriceps muscles (0.54 cm smaller, p = .03) and abdominal wall muscles (0.25 cm smaller, p = .01).ConclusionUS measurements of sarcopenia in older patients had mild to moderate associations with frailty, falls and subsequent hospitalizations. Further investigation is needed to confirm these findings.     

Association between transient acute kidney injury and morbidity and mortality after lung transplantation: A retrospective cohort study

Purpose

Acute kidney injury (AKI) is a common occurrence after lung transplantation (LTx). Whether transient AKI or early recovery is associated with improved outcome is uncertain. Our aim was to describe the incidence, factors, and outcomes associated with transient AKI after LTx.

Materials and Methods

We performed a retrospective cohort study of all adult recipients of LTx at the University of Alberta between 1990 and 2011. Our primary outcome transient AKI was defined as return of serum creatinine below Kidney Disease–Improving Global Outcome AKI stage I within 7 days after LTx. Secondary outcomes included occurrence of postoperative complications, mortality, and long-term kidney function.

Results

Of 445 LTx patients enrolled, AKI occurred in 306 (68.8%) within the first week after LTx. Of these, transient AKI (or early recovery) occurred in 157 (51.3%). Transient AKI was associated with fewer complications including tracheostomy (17.2% vs 38.3%; P < .001), reintubation (16.4% vs 41.9%; P < .001), decreased duration of mechanical ventilation (median [interquartile range], 69 [41-142] vs 189 [63-403] hours; P < .001), and lower rates of chronic kidney disease at 3 months (28.5% vs 51.1%, P < .001) and 1 year (49.6% vs 66.7%, P = .01) compared with persistent AKI. Factors independently associated with persistent AKI were higher body mass index (per unit; odds ratio [OR], 0.91; 95% confidence interval, 0.85-0.98; P = .01), cyclosporine use (OR, 0.29; 0.12-0.67; P = .01), longer duration of mechanical ventilation (per hour [log transformed]; OR, 0.42; 0.21-0.81; P = .01), and AKI stages II to III (OR, 0.16; 0.08-0.29; P < .001). Persistent AKI was associated with higher adjusted hazard of death (hazard ratio, 1.77 [1.08-2.93]; P = .02) when compared with transient AKI (1.44 [0.93-2.19], P = .09) and no AKI (reference category), respectively.

Conclusions

Transient AKI after LTx is associated with fewer complications and improved survival. Among survivors, persistent AKI portends an increased risk for long-term chronic kidney disease.     

Relationship Between Hip Extensor Strength and Back Extensor Length in Patients With Low Back Pain: A Cross-Sectional Study

ObjectiveThe purpose of this study was to examine the relationship between hip extensor strength and back extensor length in patients with low back pain (LBP) and healthy controls.MethodsIn 266 patients with LBP and 215 matched controls, back extensor length and hip extensor strength were measured and compared in the 2 groups using an independent t test. The Pearson correlation coefficient was used to determine correlation between these 2 variables. Multivariate logistic regression was used to test the risk of sustaining LBP with having these muscle insufficiencies.ResultsA significant difference in hip extensor strength was found between patients with LBP and controls (P < .001). Back extensor length was different in healthy men compared with the patients with LBP (P < .001) but was not significant between women with and without LBP (P = .34). The results showed a significant relationship between back extensor length and hip extensor strength in men with LBP (r = 0.6, P = .01). Multivariate logistic regression revealed that having a weak hip extensor (P = .001) or shortened back extensor (P = .01) could increase the risk of LBP occurrence.ConclusionThe findings support the assumptions of the presence of muscle imbalance of hip extensor weakness and back extensor tightness in male patients with LBP and that each muscle impairment may contribute to LBP.     

Natural Disasters and Myocardial Infarction: The Six Years After Hurricane Katrina

ObjectiveTo determine the prolonged effect of Hurricane Katrina on the incidence and timing of acute myocardial infarction (AMI) in the city of New Orleans.Patients and MethodsOur study population consisted of 1476 patients with AMI before (August 29, 1999, to August 28, 2005) and after (February 14, 2006, to February 13, 2012) Hurricane Katrina at Tulane University Health Sciences Center to determine post-Katrina alterations in the occurrence and timing of AMI.ResultsCompared with pre-Katrina values, there was a more than 3-fold increase in the percentage of admissions for AMI during the 6 years after Hurricane Katrina (P<.001). The percentage of admissions for AMI after Hurricane Katrina increased significantly on nights (P<.001) and weekends (P<.001) and decreased significantly on mornings (P<.001), Mondays (P<.001), and weekdays (P<.001). Patients with AMI after Hurricane Katrina also had significantly higher rates of psychiatric comorbidities (P=.01), smoking (P<.001), lack of health insurance (P<.05), and unemployment (P<.001).ConclusionThese results indicate that the effect of natural disasters on the occurrence of AMI may persist for at least a 6-year period and may be related to various factors including population shifts, alterations in the health care system, and the effects of chronic stress and associated behaviors.     

Effect of 12-Month Supervised,Home-Based Physical Exercise on Functioning Among Persons With Signs of Frailty: A Randomized Controlled Trial

ObjectivesTo investigate the effects of a 12-month home-based exercise program on functioning and falls among persons with signs of frailty.DesignA randomized controlled trial with a 1:1 allocation.SettingHome-based.ParticipantsHome-dwelling persons aged 65 years or older meeting at least 1 frailty phenotype criteria (N=300). The mean age of the participants was 82.2±6.3 years, 75% were women, 61% met 1-2 frailty criteria, and 39% met ≥3 criteria.InterventionsA 12-month, individually tailored, progressive, and physiotherapist-supervised physical exercise twice a week (n=150) vs usual care (n=149).Main Outcome MeasuresFIM, Short Physical Performance Battery (SPPB), handgrip strength, instrumental activities of daily living (IADL), and self-reported falls and physical activity (other than intervention). Assessed 4 times at home over 12 months.ResultsFIM deteriorated in both groups over 12 months, −4.1 points (95% confidence interval [CI], −5.6 to −2.5) in the exercise group and −6.9 (95% CI, −8.4 to −2.3) in the usual care group (group P=.014, time P<.001, interaction P=.56). The mean improvement in SPPB was significantly greater in the exercise group (1.6 [95% CI, 1.3-2.0]) than in the usual care group (0.01 [95% CI, −0.3 to 0.3]) (group P<.001, time P=.11, interaction P=.027). The exercise group reported significantly fewer falls per person-year than the usual care group (incidence rate ratio, 0.47 [95% CI, 0.40-0.55]; P<.001). There was no significant difference between the groups over 12 months in terms of handgrip strength, IADL function, or self-reported physical activity.ConclusionsOne year of physical exercise improved physical performance and decreased the number of falls among people with signs of frailty. FIM differed between the groups at 12 months, but exercise did not prevent deterioration of FIM, IADL, or handgrip strength.     

Acceptability and feasibility of public square dancing for community senior citizens with mild cognitive impairment and depressive symptoms: A pilot study

ObjectivesTo explore the acceptability and feasibility of public square dancing among community residents with mild cognitive impairment (MCI) and depressive symptoms.MethodsThis mixed-method study consisted of a quantitative and a qualitative phase. From January to July 2018, a total of 241 community-dwelling senior citizens who complained of memory loss in one community in the Haidian District in Beijing were approached and screened, and 41 qualified for the study. Among them, 35 senior citizens participated in the public square dancing intervention. By the end of the three-month follow-up, 31 senior citizens completed the whole study. The Subjective Exercise Experience Scale (SEES) was used to survey senior citizens at the end of the three-month public square dancing intervention and follow-up to measure the participants’ subjective exercise experience. Then 15 senior citizens were interviewed to collect attitudes, opinions, and suggestions related to the intervention.ResultsDuring the intervention, 90.6% of senior citizens met the requirement for defined hours. All senior citizens continued to dance at the three-month follow-up, and 32.3% met the requirement for defined hours. The scores of psychological well-being (11.03 ± 2.82 vs. 14.87 ± 3.93, P < 0.001) and fatigue (11.00 [8.00, 12.00] vs. 14.00 [9.00, 18.00], P < 0.001) increased at the end of the three-month follow-up. Qualitative research results extracted four major themes: increased confidence and a sense of accomplishment; easy to learn, close to real life, and sense of belonging; promotes physical and mental health; future expectations include music selection, reduced weather disruption, and self-organizing workouts.ConclusionPublic square dancing proved to be an acceptable, viable, and valuable intervention for MCI residents with depressive symptoms, which could be carried out by nursing staff in the community. Future studies should consider the appropriate population, intensity, and frequency of public square dancing and its effect on specific cognitive functions.