Impact of frailty severity and severe pain on cognitive function for community-dwelling older adults with arthritis: a cross-sectional study in Korea.

Pain is a major symptom of arthritis in older adults, often leading to frailty and cognitive decline. However, few studies have investigated the relationship among pain, frailty, and cognitive function in older adults with arthritis. This study aimed to investigate the factors influencing cognitive function and the impact of frailty severity and pain on cognitive function in older adults with arthritis using a Korean population-based dataset. This cross-sectional descriptive study involved the secondary data of 1089 participants from the seventh and eighth waves of the Korean Longitudinal Study on Aging. We examined general characteristics, health behaviors, health conditions (including severe pain and frailty), and cognitive function. Participants were categorized based on the presence or absence of pain severity and frailty status as follows: robust, only severe pain, only prefrail, prefrail with severe pain, only frail, and frail with severe pain. Multiple linear regression analysis was performed to establish correlations between groups and cognitive function. The only-prefrail group was the largest (19.7%) among participants experiencing either pain or frailty. Advanced age, sex, level of education, and visual and hearing impairments were significantly associated with cognitive function. Compared to the robust group, only prefrail (ß = -1.54, confidence interval [CI] = - 2.33; - 0.76), prefrail with severe pain (ß = - 2.69, CI = - 3.52; - 1.87), only frail (ß = - 4.02, CI = - 5.08; - 2.97), and frail with severe pain (ß = - 5.03, CI = - 5.99; - 4.08) groups were associated with lower Mini-Mental State Examination scores. The study confirmed that severe pain alone does not significantly impact cognitive function in older adults with arthritis. To prevent cognitive decline in this group, assessment of both pain and frailty severity is essential to predict high-risk groups and provide appropriate interventions, such as transfer to hospitals or primary clinics according to the severity of pain and frailty.

A Mobile App for Comprehensive Symptom Management in People With Parkinson's Disease: A Pilot Usability Study.

There is an increasing need for highly accessible health management platforms for comprehensive symptoms of Parkinson disease. Mobile apps encompassing nonmotor symptoms have been rarely developed since these symptoms are often subjective and difficult to reflect what individuals actually experience. The study developed an app for comprehensive symptom management and evaluated its usability and feasibility. A single-group repeated measurement experimental design was used. Twenty-two participants used the app for 6 weeks. Monitoring of nonmotor symptoms, games to address motor symptoms, and medication management were incorporated in the app. Quantitative outcomes were self-assessed through an online questionnaire, and one-on-one telephone interviews were conducted to understand the user's point of view. The successful experience of self-monitoring had improved participants' self-efficacy ( Z = -3.634, P < .001) and medication adherence ( Z = -3.371, P = .001). Facilitators included a simple-to-use interface, entertaining content, and medication helps. Barriers included simple forgetfulness and digital literacy, including unfamiliarity with mobile phone manipulation itself. The study suggested insight into the app use related to acceptability of mobile technology. The preliminary effects on self-efficacy and medication adherence will guide future nursing interventions using mobile health. Our approach will contribute to improving the continuum of care for Parkinson disease by promoting self-monitoring of symptoms.

Validity and Reliability of the Korean Version of the Parkinson's Disease Questionnaire-Carer.

BACKGROUND AND PURPOSE: The importance of the quality of life (QOL) of carers has been increasingly recognized as it has a wide range of effects on the psychological, emotional, and social outcomes of patients with Parkinson's disease (PD). Understanding their QOL is important as it reflects their unique characteristics; however, there have been few studies on this in Korea. This study aimed to translate and validate the Korean version of the Parkinson's Disease Questionnaire-Carer (PDQ-Carer). METHODS: This was a methodological study that included a translation process and a cross-sectional investigation. The Korean version of the scale was developed using back translation, semantic adjustment, and pretests. The final version was self-administered by 125 Korean family carers. Cronbach's alpha values were used to assess the internal consistency of the PDQ-Carer. Exploratory and confirmatory factor analyses were used to validate the translated scale. RESULTS: Exploratory factor analysis identified four factors that accounted for 64.51% of the variance. A modified model using modification indices was found to fit the data well in the confirmatory factor analysis. That factor analysis supported the structure of the original four factors with relocation of several items that reflected Korean culture. Cronbach's alpha values were 0.96 for the total scale, 0.93 for personal and social activities, 0.89 for strain, 0.85 for anxiety and depression, and 0.85 for self-care. CONCLUSIONS: This study verified that the Korean version of the PDQ-Carer can be used to acquire important information about the multidimensional aspects of the QOL of Korean carers for patients with PD.

Person-Centered Navigator Program for People with Parkinson's Disease: A Pilot Study.

There are limited Parkinson's disease (PD)-specific navigator programs, although PD is chronic and requires life-long comprehensive care. As most patient navigation literature focuses on oncology and is based in the West, this study aimed to develop a person-centered navigator program for PD and evaluate its preliminary outcomes and feasibility in the Korean context. The program was developed using the "analysis, design, development, implementation, and evaluation" model, and "professional navigation framework." Initially, 28 participants were recruited to participate in an 8-week navigator program. The retention rate was 82%. Social function was significantly improved 12 weeks after baseline. Participants reported high satisfaction with the program, suggesting that it was well-accepted. This study systematically developed a navigator program based on PD-specific needs and the Korean context. Future models should focus on personal and participatory attributes. Navigator programs for people with PD represent appropriate and evolving healthcare interventions.

Systematic review and meta-analysis of randomization controlled and nonrandomized controlled studies on nurse-led nonpharmacological interventions to improve cognition in people with dementia.

AIMS AND OBJECTIVES: To evaluate nurse-led nonpharmacological interventions for improving cognition in people with dementia. BACKGROUND: Starting in 2006, donepezil was administered worldwide to improve cognition; however, its side effects limited its therapeutic value for long-term use, prompting a need for nonpharmacological interventions to improve cognition. Nurse-led nonpharmacological interventions are especially important because they are effective in terms of resources and costs, reduce patient latency and improve patient safety and satisfaction. METHODS: A systematic review was identified by searching 10 electronic databases. The search period was between 1 January 2007, and 30 September 2021. Languages were limited to English and Korean. The inclusion criteria were studies of nurse-led interventions that evaluated cognition using validated instruments. The exclusion criteria were qualitative research, scale development studies, abstracts and grey literature. Quality appraisal of research was conducted using the Risk of Bias in Nonrandomized Studies of Interventions for quasi-experimental studies and the Risk of Bias 2.0 for randomised controlled studies. This study was conducted in accordance with PRISMA reporting guideline (Appendix S1). The search protocol was registered in the PROSPERO (CRD 42021229358). RESULTS: A total of 24 studies were included in the systematic review, and 15 studies were included in the meta-analysis. Meta-analysis included 8 RCT and 7 quasi-experimental studies. The studies (11 quasi-experimental studies and 9 randomised controlled studies) demonstrated low to moderate quality of evidence for improving the cognition of people with dementia. The meta-analysis showed that nurse-led single nonpharmacological interventions more effectively improved cognition than complex interventions in people with dementia. CONCLUSION: Nurse-led nonpharmacological interventions were effective for improving cognition in people with dementia. RELEVANCE TO CLINICAL PRACTICE: Nurses are qualified professionals with expertise in providing nonpharmacological interventions to improve cognition in people with dementia. Nurse-led nonpharmacological interventions for this purpose should be developed in future research.

Combined effects of handgrip strength and sensory impairment on the prevalence of cognitive impairment among older adults in Korea.

Older adults commonly experience concurrent lower handgrip strength and sensory impairment. However, previous studies have analyzed the individual effects of either handgrip strength or sensory impairment on cognitive impairment. To address this gap, this study investigated the combined effects of handgrip strength and sensory impairment on cognitive impairment among older adults. In total, 2930 participants aged 65 and older were analyzed using 2014-2018 data from the Korean Longitudinal Study of Aging. Participants underwent assessments of handgrip strength (grip dynamometer), sensory impairment (self-reported responses), and cognitive impairment (Korean version of the Mini-Mental State Examination). Low handgrip strength, compared to normal handgrip strength, was associated with cognitive impairment. In participants with low handgrip strength, vision and hearing impairment were associated with cognitive impairment (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.06-1.75; OR 2.58, 95% CI 1.77-3.78, respectively) compared to those with normal handgrip strength. Participants with low handgrip strength and dual sensory impairment had the highest OR for cognitive impairment (OR 3.73, 95% CI 2.65-5.25). Due to the strong association of low handgrip strength and dual sensory impairment with cognitive impairment, people living with low handgrip strength and dual sensory impairment should be classified as a high-risk group for cognitive impairment and should be prioritized for interventions.

Multidimensional factors affecting homebound older adults: A systematic review.

PURPOSE: To systematically identify the multidimensional factors affecting homebound older adults. DESIGN: Systematic review. METHODS: We searched PubMed, MEDLINE, Cochrane Library, CINAHL, EMBASE, and PsycINFO from inception to November 15, 2020. This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used for quality assessment. FINDINGS: Nineteen studies met the review criteria; the studies were either cross-sectional or longitudinal. Most studies have focused on personal factors affecting homebound older adults. The individual construct consisted of demographic, biological, psychological, functional, and health-related factors. The structural construct included architectural, environmental, community, and social factors. Based on the different definitions of homebound used in the studies, the prevalence of homebound status ranged from 3.5% to 39.8%. CONCLUSIONS: The prevalence of homebound status among older adults varied depending on how homebound was defined. Homebound status is the interaction between the individual and structural constructs. Variations in cultural, political, and economic conditions could influence homebound status across countries over time. Comprehensive assessment and interventions for homebound older adults based on multidisciplinary approaches are recommended for nurses. CLINICAL RELEVANCE: This research will impact the development of nursing strategies to screen homebound older adults and provide targeted preventive interventions so that older adults with many risk factors do not become homebound.

Genome-wide association study for genetic variants related with maximal voluntary ventilation reveals two novel genomic signals associated with lung function.

Genome-wide association studies (GWAS) for spirometry parameters have been limited to forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and their ratio. This study examined to identify genetic variants associated with maximal voluntary ventilation (MVV), an important spirometry parameter presenting inspiratory muscle strength.A total of 8842 Korean subjects participated in the Korean Association REsource Consortium were used to identify nucleotide variants associated with MVV and other spirometry parameters through a GWAS. Genetic associations were determined by employing a mixed model that can control background polygenic effects.The analysis revealed 3 nucleotide variants associated with MVV (P < 5 × 10). One (rs1496255) was also associated with FVC and FEV1. The other 2 variants were identified only for MVV and located in the genes of LOC102724340 (rs41434646) and FHIT (rs9833533). In particular, FHIT represses transcriptional activity of ß-catenin, a critical protein for growth of skeletal muscle, and thus might have influenced the level of MVV.The current study revealed 2 novel nucleotide variants as genetic association signals for MVV. The association signals were suggested specific for neuromuscular diseases with a restrictive ventilatory impairment. Further studies are required to understand underlying mechanisms for their influence to restrictive lung diseases.

Common Expression Quantitative Trait Loci Shared by Histone Genes.

A genome-wide association study (GWAS) was conducted to examine expression quantitative trait loci (eQTLs) for histone genes. We examined common eQTLs for multiple histone genes in 373 European lymphoblastoid cell lines (LCLs). A linear regression model was employed to identify single-nucleotide polymorphisms (SNPs) associated with expression of the histone genes, and the number of eQTLs was determined by linkage disequilibrium analysis. Additional associations of the identified eQTLs with other genes were also examined. We identified 31 eQTLs for 29 histone genes through genome-wide analysis using 29 histone genes (P < 2.97 × 10-10). Among them, 12 eQTLs were associated with the expression of multiple histone genes. Transcriptome-wide association analysis using the identified eQTLs showed their associations with additional 80 genes (P < 4.75 × 10-6). In particular, expression of RPPH1, SCARNA2, and SCARNA7 genes was associated with 26, 25, and 23 eQTLs, respectively. This study suggests that histone genes shared 12 common eQTLs that might regulate cell cycle-dependent transcription of histone and other genes. Further investigations are needed to elucidate the transcriptional mechanisms of these genes.

Pure red cell aplasia and adult-onset Still's disease.

Pure red cell aplasia (PRCA) associated with adult-onset Still's disease (AOSD) is very rare. In this report a 28-year-old woman was admitted with fever, skin rash, jaundice and anemia. She was diagnosed as having AOSD with PRCA by bone marrow examination. Treatment with high-dose prednisolone and intravenous immunoglobulin resulted in remission of the PRCA and a good response of the AOSD.

Acute and chronic changes of vascular endothelial growth factor (VEGF) in induced sputum of toluene diisocyanate (TDI)-induced asthma patients.

Vascular endothelial growth factor (VEGF) is a multi-functional cytokine involved in inflammation, repair and angiogenesis in asthmatic airway. This study aimed to evaluate the role of VEGF in immediate bronchoconstriction induced by TDI inhalation, and in chronic TDI-asthma patients. 11 newly diagnosed TDI-asthma patients (group I), 12 chronic TDI-asthma patients with persistent asthma symptoms followed for >4 yr and 15 unexposed healthy controls were enrolled. In group I, induced sputum and serum were collected before and 7 hr after placebo- and TDI-bronchoprovocation test (BPT). In group II, induced sputum and serum were collected every 2 yr. VEGF levels were measured by ELISA. There were no significant differences in sputum and serum VEGF levels between patients and controls. Before and after placebo and TDI-BPT, no significant changes were noted in sputum and serum VEGF levels of group I. In group II patients, sputum VEGF showed variable changes at 1-yr, then decreased significantly at 2-yr (p<0.05), while serum VEGF showed variable changes at 2-yr, which decreased significantly at 4-yr (p<0.05). These results suggest that VEGF may play a minor role in immediate bronchoconstriction after TDI-BPT. In chronic TDI-asthma, VEGF may be involved to 2 yr after the diagnosis and the contribution may decrease after then.

Leukotriene-related gene polymorphisms in ASA-intolerant asthma: an association with a haplotype of 5-lipoxygenase.

A recent study has demonstrated the possible involvement of a leukotriene C4 synthase (LTC4S) gene polymorphism in ASA-intolerant asthma (AIA) in a Polish population, whereas no significant association was noted in other populations. To investigate the role of genetic polymorphism in AIA development, we screened single nucleotide polymorphisms (SNPs) of the key enzymes involved in arachidonate metabolism, and the cysteinyl leukotriene receptor 1 (CYSLTR1) in a large Korean population with AIA: 93 AIA and 181 ASA-tolerant asthma (ATA) patients, and 123 normal controls. The single-base extension method was used to genotype SNPs in 5-lipoxygenase (ALOX5, -1708G-->A, 21C-->T, 270G-->A, 1728G-->A), ALOX5-activating protein (ALOX5AP, 218A-->G), prostaglandin-endoperoxide synthase 2 (PTGS2, COX2, -162C-->G, 10T-->G, R228H, V511A), LTC4S (-444A-->C), and CYSLTR1 (927T-->C). Haplotype analyses were undertaken for the SNPs in ALOX5. No significant differences in allele and genotype frequencies of single SNPs were observed between the patient groups ( P>0.05). However, the frequency of the ALOX5-ht1[G-C-G-A] haplotype in the AIA group was significantly higher than its frequency in the ATA group with a probability ( P) of 0.01, odds ratio (OR) of 5.0, and 95% confidence interval (95%CI) of 1.54-17.9, and in the normal controls ( P=0.03, OR=4.5, 95%CI=1.1-18.4), by using a dominant model. These results suggest a lack of association between the ALOX5AP, PTGS2, LTC4S, and CYSLTR1 gene polymorphisms and the AIA phenotype in the Korean population. However, the possible involvement of ALOX5-ht1[G-C-G-A] in AIA development is suggested.

Serum cytokine profiles in patients with adult onset Still's disease.

OBJECTIVE: Adult onset Still's disease (AOSD) is a systemic inflammatory disorder characterized by fever, arthritis, and rash. Although the pathogenesis is not known, immunologically mediated inflammation occurs in active AOSD. To evaluate the pathogenesis and disease activity of AOSD, we measured serial serum concentrations of several cytokines in patients with active and inactive disease. METHODS: Seventeen patients diagnosed as having AOSD were enrolled. We analyzed clinical and laboratory findings retrospectively. Serial serum samples were obtained from 14 patients with active and inactive AOSD. Interleukin 18 (IL-18), soluble IL-2 receptor (sIL-2R), IL-6, interferon-g (IFN-g), and IL-8 were determined by ELISA. RESULTS: Serum levels of IL-18, IFN-g, and IL-8 were significantly higher in patients with AOSD than in healthy controls (p < 0.01), but there were no significant differences between patients with active and inactive AOSD. Serum sIL-2R levels tended to be higher in the active state than in healthy controls, but there was no statistically significant difference between the 2 groups. Serum sIL-2R levels decreased significantly with antiinflammatory therapy (p < 0.05). Serum IL-18 and sIL-2R levels correlated significantly with serum ferritin levels in the active AOSD group (p < 0.05). CONCLUSION: Overproduction of IL-18 may contribute to the pathogenic mechanism of AOSD, and serum sIL-2R levels may be used as a marker for monitoring disease activity in AOSD.

Eosinophil inflammation of nasal polyp tissue: relationships with matrix metalloproteinases, tissue inhibitor of metalloproteinase-1, and transforming growth factor-beta1.

Eosinophil and mast cell infiltrations are consistent findings in nasal polyp tissue. Previous studies have shown that matrix metalloproteinases (MMPs) may be involved in eosinophil infiltration in airway mucosa of asthmatic patients, and that transforming growth factor-beta1 (TGF-beta1) induces extracellular matrix deposition in nasal polyp tissue. The aim of this study was to evaluate the role of MMPs and tissue-inhibitor of metalloproteinase-1 (TIMP-1) in association with TGF-beta1, eosinophils and mast cell activation in nasal polyp tissue. Nasal polyp tissues from 20 patients who underwent polypectomies were collected and prepared into tissue homogenate. Eosinophil cationic protein (ECP) and tryptase levels were measured by CAP system (Pharmacia, Sweden). MMP-2, MMP-9, TIMP-1 and TGF-beta1 levels were measured by enzyme-liked immunosorbent assay. MMP-2 was the predominant form of MMPs, followed by MMP-9 and TIMP-1. There were significant correlations between ECP, and MMP-9, MMP-2, TGF-beta1 and tryptase, but not with TIMP-1. Significant correlations were noted between tryptase, and MMP-2, MMP-9, and TGF-beta1, but not with TIMP-1. Close correlations were noted between TGF-beta1, and MMP-9 and MMP-2, but not with TIMP-1. MMP-2, MMP-9, and TGF-beta1 may contribute to eosinophil and mast cell migrations into nasal polyp tissue.