Nepali Translation, Validity and Reliability Study of the Cohen-Hoberman Inventory of Physical Symptoms for Utilization With Bhutanese Refugees.

BACKGROUND AND OBJECTIVES: Language-appropriate outcome measurements help to improve health equity. The purpose of this study was to translate and validate the Cohen-Hoberman Inventory of Physical Symptoms (CHIPS) in Nepali for Bhutanese refugee utilization. METHODS: English-Nepali forward and back translations of CHIPS were completed by an official translator and evaluated by three content experts. A scaled rubric measured the following constructs: neurogenic stress response (NSR), somatic stress response (SSR), and visceral stress response (VSR). Data were analyzed using SPSS 26.0. RESULTS: The Nepali version of CHIPS reported good content validity, strong internal consistency (Cronbach's α = .94), and inter-rater reliability (ICC = 0.91). Kappa statistic reported 88% to 96% agreement. Constructs of NSR (0.91), SSR (0.94), and VSR (0.94) reported strong internal consistency. CONCLUSIONS: The Nepali translated version of CHIPS showed strong validity and reliability for utilization in the Bhutanese refugee population and improves health access to outcome measurements for a vulnerable population.

Comparison of Structural Diagnosis and Management (SDM) approach and MyoFascial Release (MFR) for improving plantar heel pain, ankle range of motion and disability: A randomized clinical trial.

[Purpose] The purpose of this study was to compare the effectiveness of the Structural Diagnosis and Management (SDM) approach with Myofascial Release (MFR) in improving plantar heel pain, ankle range of motion, and disability. [Subjects] Sixty-four subjects, aged 30-60 years, with a diagnosis of plantar heel pain, plantar fasciitis, or calcaneal spur by a physician according to ICD-10, were equally allocated to the MFR (n = 32) and SDM (n = 32) groups by hospital randomization and concealed allocation. [Methods] In this assessor-blinded randomized clinical trial, the control group performed MFR to the plantar surface of the foot, triceps surae, and deep posterior compartment calf muscles, while the experimental group performed a multimodal approach utilizing the SDM concept for 12 sessions over 4 weeks. Both groups also received strengthening exercises, ice compression, and ultrasound therapy. Pain, activity limitations and disability were assessed as primary outcomes using the Foot Function Index (FFI) and Range of motion (ROM) assessment of the ankle dorsiflexors and plantar flexors using a universal goniometer. Secondary outcomes were measured using the Foot Ankle Disability Index (FADI) and a 10-point manual muscle testing process for the ankle dorsiflexors and plantar flexors. [Results] Both MFR and SDM groups exhibited significant improvements from baseline in all outcome variables, including pain, activity level, disability, range of motion, and function after the 12-week intervention period (p < .05). The SDM group showed more improvements than MFR for FFI pain (p < .01), FFI activity (p < .01), FFI (p < .01) and FADI (p = <.01). [Conclusion] Both MFR and SDM approaches are effective in reducing pain, improving function, ankle range of motion, and reducing disability in plantar heel pain, however, the SDM approach may be a preferred treatment option.

Health-related quality of life and coping strategies adopted by COVID-19 survivors: A nationwide cross-sectional study in Bangladesh.

INTRODUCTION: This study aims to investigate the health-related quality of life and coping strategies among COVID-19 survivors in Bangladesh. METHODS: This is a cross-sectional study of 2198 adult, COVID-19 survivors living in Bangladesh. Data were collected from previously diagnosed COVID-19 participants (confirmed by an RT-PCR test) via door-to-door interviews in the eight different divisions in Bangladesh. For data collection, Bengali-translated Brief COPE inventory and WHO Brief Quality of Life (WHO-QoLBREF) questionnaires were used. The data collection period was from October 2020 to March 2021. RESULTS: Males 72.38% (1591) were more affected by COVID-19 than females 27.62% (607). Age showed significant correlations (p<0.005) with physical, psychological and social relationships, whereas gender showed only a significant correlation with physical health (p<0.001). Marital status, occupation, living area, and co-morbidities showed significant co-relation with all four domains of QoL (p<0.001). Education and affected family members showed significant correlation with physical and social relationship (p<0.001). However, smoking habit showed a significant correlation with both social relationship and environment (p<0.001). Age and marital status showed a significant correlation with avoidant coping strategies (p<0.001); whereas gender and co-morbidities showed a significant correlation with problem-focused coping strategies (p<0.001). Educational qualification, occupation and living area showed significant correlation with all three coping strategies(p<0.001). CONCLUSION: Survivors of COVID-19 showed mixed types of coping strategies; however, the predominant coping strategy was avoidant coping, followed by problem-focused coping, with emotion-focused coping reported as the least prevalent. Marital status, occupation, living area and co-morbidities showed a greater effect on QoL in all participants. This study represents the real scenario of nationwide health-associated quality of life and coping strategies during and beyond the Delta pandemic.

Sensorimotor integration, cervical sensorimotor control, and cost of cognitive-motor dual tasking: Are there differences in patients with chronic whiplash-associated disorders and chronic idiopathic neck pain compared to healthy controls?

PURPOSE: The current investigation aimed to compare the sensorimotor integration, sensorimotor control, and cost of cognitive-motor dual task during walking, in persons with chronic WAD as compared to matched chronic idiopathic neck pain and normal healthy controls. METHODS: A cross-sectional, case control design comparing 30 participants in each of two study groups (chronic WAD and chronic idiopathic neck pain) to a matched control group was conducted. Measurements included: (1) the cranio-vertebral angle (CVA), (2) left and right rotation head repositioning accuracy (HRA), (3) frontal N30 amplitudes to assess sensorimotor integration, (4) dual cognitive gait cost (DCGC). RESULTS: A statistically significant difference for the CVA was found between groups: WAD 36.8° ± 3.4, chronic pain 44.5° ± 1.5, and controls 47.1° ± 4; p < 0.05. MANOVA revealed significant group differences for the N30 amplitude (p < 0.05), where the WAD group had the greatest amplitude. Statistically significant differences among the three groups were found for HRA left and right where the WAD group had the greatest error, (p < 0.05). Post hoc tests revealed that the WAD group had the highest dual-task cost during walking, (p < 0.05). Significant linear correlations between the CVA and N30 amplitude, HRA, and DCGC were identified in all 3 groups, (p < 0.05). CONCLUSIONS: Compared to both a matched control group and chronic neck pain group, whiplash-injured persons have greater forward head posture, greater error in sensorimotor control, and an altered ability to perform a motor task with a simultaneous cognitive task.

Reduction of Thoracic Hyper-Kyphosis Improves Short and Long Term Outcomes in Patients with Chronic Nonspecific Neck Pain: A Randomized Controlled Trial.

This study investigates thoracic hyper kyphosis (THK) rehabilitation using the Denneroll™ thoracic traction orthosis (DTTO). Eighty participants, with chronic non-specific neck pain (CNSNP) and THK were randomly assigned to the control or intervention group (IG). Both groups received the multimodal program; IG received the DTTO. Outcomes included formetric thoracic kyphotic angle ICT­ITL, neck pain and disability (NDI), head repositioning accuracy (HRA), smooth pursuit neck torsion test (SPNT) and overall stability index (OSI). Measures were assessed at baseline, after 30 treatment sessions over the course of 10 weeks, and 1-year after cessation of treatment. After 10 weeks, the IG improved more in neck pain intensity (p < 0.0001) and NDI (p < 0.001). No differences were found for SPNT (p = 0.48) and left-sided HRA (p = 0.3). IG improved greater for OSI (p = 0.047) and right sided HRA (p = 0.02). Only the IG improved in THK (p < 0.001). At 1-year follow-up, a regression back to baseline values for the control group was found for pain and disability such that all outcomes favored improvement in the IG receiving the DTTO; all outcomes (p < 0.001). The addition of the DTTO to a multimodal program positively affected CNSNP outcomes at both the short and 1-year follow-up.

Prevalence of Long COVID symptoms in Bangladesh: a prospective Inception Cohort Study of COVID-19 survivors.

BACKGROUND: The objective of this study was to identify the prevalence of long COVID symptoms in a large cohort of people living with and affected by long COVID and identify any potential associated risk factors. METHODS: A prospective survey was undertaken of an inception cohort of confirmed people living with and affected by long COVID (aged 18-87 years). 14392 participants were recruited from 24 testing facilities across Bangladesh between June and November 2020. All participants had a previously confirmed positive COVID-19 diagnosis, and reported persistent symptoms and difficulties in performing daily activities. Participants who consented were contacted by face-to-face interview, and were interviewed regarding long COVID, and restriction of activities of daily living using post COVID-19 functional status scale. Cardiorespiratory parameters measured at rest (heart rate, systolic blood pressure, diastolic blood pressure, oxygen saturation levels, maximal oxygen consumption, inspiratory and expiratory lung volume) were also measured. RESULTS: Among 2198 participants, the prevalence of long COVID symptoms at 12 weeks was 16.1%. Overall, eight long COVID symptoms were identified and in descending order of prominence are: fatigue, pain, dyspnoea, cough, anosmia, appetite loss, headache and chest pain. People living with and affected by long COVID experienced between 1 and 8 long COVID symptoms with an overall duration period of 21.8±5.2 weeks. Structural equation modelling predicted the length of long COVID to be related to younger age, female gender, rural residence, prior functional limitation and smoking. CONCLUSION: In this cohort, at 31 weeks post diagnosis, the prevalence of long COVID symptoms was 16.1%. The risk factors identified for presence and longer length of long COVID symptoms warrant further research and consideration to support public health initiatives.

A national survey in United Arab Emirates on practice of passive range of motion by physiotherapists in intensive care unit.

BACKGROUND: Patients admitted to intensive care units (ICU) are at an increased risk of developing immobility related complications. Physiotherapists are challenged to employ preventive and rehabilitative strategies to combat these effects. Passive limb range of motion (PROM) exercises- a part of early mobilization-aid in maintaining joint range of motion and functional muscle strength and forms a part of treatment for patients in ICU. However, there is a lack of evidence on practice of PROM exercises on patients admitted to ICU in the United Arab Emirates (UAE). This study aimed at exploring practices regarding the same in UAE. METHODS: This survey, conducted from January 2021 to February 2021 in College of Physiotherapy, Sharjah University studied practice of physiotherapists in the intensive care units. Physiotherapists currently working in ICU completed an online questionnaire composed of forty-two questions about physiotherapy service provision, assessment and intervention in the intensive care units. RESULTS: 33 physiotherapists completed the survey. 66.6% of respondents routinely assessed PROM for all the patients in ICU referred for physiotherapy. 84.8% of them assessed all the joints. More than half of the respondents (57.8%) reported that they administered PROM regularly to all the patients. According to 63.6% respondents, maintaining joint range of motion was the main reason for performing PROM. Responses pertaining to sets and repetitions of PROM were variable ranging from 1-6 sets and from 3 to 30 repetitions. Personal experience, resources/financial consideration and research findings were found to have influence on the practice. CONCLUSIONS: PROM was found to be one of the frequently used mobilization techniques administered by physiotherapists in the intensive care units and was mostly performed after assessment. Maintaining joint range of motion was the main aim for performing PROM. Variability was found in the sets and repetitions of PROM administered. Various factors influenced the practice of PROM.

A Cross-Sectional Study on University Students' Knowledge, Attitudes, and Practices Toward COVID-19 in the United Arab Emirates.

The unprecedented coronavirus pandemic is hitting the whole world, including the United Arab Emirates. Public awareness and adherence to the recommendations play a major role in managing a crisis of this magnitude which is largely affected by knowledge, attitudes, and practices (KAP). Hence, the aim of this study was to assess COVID-19-related KAP of the University of Sharjah (UOS) students and compare between health-related (HR) and non-HR (NHR) majors. A cross-sectional study was conducted in May 2020 in which 1,012 (481 health-related and 531 NHR) students participated via an online KAP questionnaire. The students' sociodemographic characteristics and sources of information were also recorded, and data were analyzed. Students were aged 20-25 years, with an overall knowledge score of 72.4%, and the main source of their information was the Internet and social media (85.2%). Those in HR majors had a higher knowledge score (76%) than those in NHR students (69%). Regarding attitudes, both HR and NHR students demonstrated comparable and positive attitudes to curb the spread. With respect to practices, more NHR students used masks (92.3%), almost all the time than HR students (88.4%). HR students (99.4%) avoided crowded places and practiced social distancing more than NHR students (99.4% versus 97.4% and 97.7% versus 93.2%, respectively). In conclusion, UOS students demonstrated adequate knowledge, and possessed good attitudes and low-risk practices toward prevention of COVID-19. It is recommended that universities including UOS continue to use digital university communication platforms to regularly disseminate vital information in such emergencies.

Waist circumference is a major determinant of oxidative stress in subjects with and without metabolic syndrome.

AIM: Oxidative stress (OS) plays a major role in pathogenic mechanisms associated with metabolic syndrome (Mets) yet the main component of Mets contributing most to OS is not well elucidated. Hence, the aim of this study was to investigate the oxidative-antioxidative status in Mets subjects and to determine the main predicting component of OS. METHODS: Anthropometric measures, fasting blood glucose, lipid profile, antioxidant enzymes [catalase, superoxide dismutase (SOD) and glutathione peroxidase (GPx)], reduced glutathione (GSH), malondialdehyde (MDA) and protein carbonyl were assessed in 172 adult UAE residents. International Diabetes Federation criteria were used for Mets diagnosis. Mets Scores (0-5) were calculated and assigned per subject based on number of components. RESULTS: Of all participants, 22.1% had Mets and 49.4% had large waist circumference (WC). Significant lower levels of catalase, SOD, GPx and GSH, and higher levels of MDA and protein carbonyl were observed in subjects with Mets. In addition, catalase, SOD, GPx, and GSH correlated negatively, while MDA and protein carbonyl correlated positively with almost all Mets components. Similar trend of correlations was noticed with Mets Scores. When adjusted for age and gender, linear regression analysis revealed that subjects with large WC demonstrated significantly lower levels of antioxidative enzymes and GSH, and higher levels of MDA and protein carbonyl. Consequently, WC emerged as the best predictor of OS. CONCLUSIONS: The degree of OS is dependent on the Mets Scores, and WC contributes independently to increased OS among adults in UAE.

Effects of an 8-week pelvic core stability and nutrition community programme on maternal health outcomes.

INTRODUCTION: Women, during the antenatal and post-partum period, report pelvic, low back pain, stress and urge urinary incontinence, colorectal dysfunction, and other co-morbidities that negatively affect health-related quality of life. Exercise and nutrition are important considerations for improving maternal health in this period. PURPOSE: The purpose of this study was to examine the effects of a community-driven nutrition and exercise programme focused on pelvic floor and core stability, healthy nutrition, and breastfeeding counselling over an 8-week period on pelvic floor and urinary distress (UDI), prolapse and colorectal distress for antenatal and post-partum women with limited access to health care, and low socio-economic resources from a Midwestern Region of the United States. MATERIALS AND METHODS: Purposive sample of 35 females, ages 18-44, were recruited for this prospective, preintervention to postintervention study, following ethical approval from Institutional Review Board and voluntary written consent from participants. The Health History Questionnaire, SF-36, Food Frequency Questionnaire, report of pelvic organ prolapse dysfunction (POPDI), colorectal-anal dysfunction (CRADI), and UDI as measured by the Pelvic Floor Distress Inventory (PFDI) were completed before and after intervention. RESULTS: Thirty-five women (n = 35) 18 to 44 years old (mean age of 22.72 ± 3.45 years) completed the study. A significant difference was found from preintervention to postintervention scores means for PFDI total scores, CRADI individual scores, and UDI individual scores (p < .05). POPDI scores decreased preintervention to postintervention but were not significant. A significant improvement in healthy nutrition and breastfeeding postintervention was also found (z = 3.21, p = .001). Further analysis showed significant, but weak, correlation between parity and POPDI (r = .366, p = .033); between parity and UDI (r = .384, p = .03); and between parity and PFDI (r = .419, p = .014). DISCUSSION: Our study found a significant reduction in pelvic floor dysfunction, urinary, and colorectal-anal distress symptoms and improvement in breastfeeding and healthy nutrition following an 8-week community-driven nutrition and exercise programme focused on pelvic floor and core stability, healthy nutrition, and breastfeeding counselling.

Relationship of salivary adipocytokines, diet quality, physical activity, and nutrition status in adult Emirati females in United Arab Emirates.

AIMS: The United Arab Emirates (UAE) ranks as the fifth most obese country with increasing cardio-metabolic risks. In this paper, relationships of salivary adipocytokines (markers of cardio-metabolic syndrome), diet quality and physical activity in 90 normal-weight, overweight and obese (30 subjects in each group) Emirati adult females were investigated. METHODS: A cross-sectional research design was adopted. Anthropometric measurements, diet quality and physical activity questionnaires were administered. Overnight fasting saliva was collected to determine levels of adiponectin, interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α). RESULTS: Salivary adiponectin was significantly lower, while TNF-α was higher in obese than normal-weight subjects. IL-10 displayed a lower trend in obese subjects. Though diet quality and physical activity did not exhibit significant differences among the three groups, better diet quality and higher physical activity level were reported among normal-weight subjects. Salivary TNF-α correlated positively with body mass index (BMI) (r = 0.37; p < 0.001) and waist circumference (r = 0.31; p < 0.001), while adiponectin correlated negatively with BMI (r = -0.28; p < 0.05). IL-10 showed negative trend in correlation with obesity measures. Correlations were not observed between diet quality and physical activity with salivary adipocytokines. Interestingly, a significant negative correlation emerged between diet quality and neck circumference (r = -0.24; p < 0.05). CONCLUSION: Our findings demonstrate that salivary adipocytokines correlate with obesity measures and can serve as convenient adjunct method in predicting cardio-metabolic risks in the population.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) and metabolic syndrome components among young adult females.

AIMS: Occurrence of metabolic syndrome (MetS) in the United Arab Emirates (UAE) is rising steadily, with subsequent increase in the prevalence of type 2 diabetes and cardiovascular disease (CVD). Recent studies have shown that PCSK9 plays a substantial role in atherogenic dyslipidemia. Hence, the aim of this study was to assess level of PCSK9 and its relationship with MetS components among young adult females. METHODS: This study was carried out on 137 adult females over 18 years of age residing in the UAE. Subjects were categorized into two groups according to waist circumferences (WC): normal (<80cm; n=41) and large (≥80cm; n=96). Anthropometric and biochemical parameters in the fasting state (glucose, insulin, lipid profile, and PCSK9) were determined using conventional techniques. Homeostasis model assessment of insulin resistance (HOMA-IR) and MetS scores were calculated as appropriate. RESULTS: PCSK9 was lower in subjects with large WC compared to normal WC (p=0.016). PCSK9 correlated negatively with measures of obesity (p<0.05), and positively with IR (r=0.425, p<0.001). Multiple linear regression analysis revealed that the strongest predictor of PCSK9 was IR (B=6.213; p<0.001), followed by WC (B=-2.488; p<0.001) and triglycerides (B=0.897; p=0.013). CONCLUSION: Results from this study demonstrate that PCSK9 correlates with some components of metabolic syndrome and central obesity in young females. Such findings support the suggestion of using PCSK9 inhibitors in the management of MetS to modify risk for development of CVD.

Qualitative interviewing: methodological challenges in Arab settings.

AIM: To explore some of the main methodological challenges faced by interviewers in Arab settings, particularly during interviews with psychiatric nurses. BACKGROUND: Interviews are a tool used commonly in qualitative research. However, the cultural norms and practices of interviewees must be considered to ensure that an appropriate interviewing style is used, a good interviewee-interviewer relationship formed and consent for participation obtained sensitively. DATA SOURCES: A study to explore the nature of psychiatric nurses' practices that used unstructured interviews. REVIEW METHODS: This is a methodology paper that discusses a personal experience of addressing many challenges that are specific to qualitative interviewing in Arab settings, supported by literature on the topic. DISCUSSION: Suggestions for improving the interview process to make it more culturally sensitive are provided and recommendations for future research are made. CONCLUSION: Openness, flexibility and a reflexive approach by the researcher can help manage challenges in Arab settings. IMPLICATIONS FOR RESEARCH/PRACTICE: Researchers should allow themselves to understand the cultural elements of a population to adapt interviewing methods with the aim of generating high quality qualitative research.

Prevalence and risk factors for incontinence among Emirati women with diabetes.

PURPOSE: To estimate the prevalence and risk factors for urinary incontinence among a sample of Emirati women with diabetes. DESIGN: A cross-sectional survey design using probability sampling was employed to evaluate incontinence among 350 Emirati diabetic women. Age, body mass index, history of urinary tract infections, parity, diabetes duration, and type of diabetes management were evaluated as potential risk factors for incontinence. To assess type and frequency of incontinence, items from the National Health and Nutrition Examination Survey-Kidney Condition-Urology were used. FINDINGS: A total of 225 (64.3%) participants reported incontinence, with 110 (31.4%) expressed having an episode once a week or more. Both stress (n = 197, 56.3%) and urge incontinence (n = 208, 59.4%) were seen; 96 (48.7%) reported at least weekly stress incontinence episodes, and 109 (52.4%) reported weekly or more urge episodes. Results of logistic regression indicated that diabetes duration was the most significant risk factor for incontinence. CONCLUSION: Prevalence of incontinence in Emirati women was higher than that reported by diabetic women in other cultures. PRACTICE IMPLICATIONS: Clinicians working with Emirati diabetic women should endeavor to enhance screening for incontinence and design culturally appropriate strategies for teaching and treating this complication of diabetes.

Analysis of the relationship of leptin, high-sensitivity C-reactive protein, adiponectin, insulin, and uric acid to metabolic syndrome in lean, overweight, and obese young females.

OBJECTIVE: Over the last decade there has been a steady rise in obesity and co-morbidity, but little is known about the rate of metabolic dysfunction among young adults in the United Arab Emirates. Various factors have been implicated as biomarkers of metabolic syndrome. The objective of this study was to analyze the relationships of leptin, C-reactive protein (CRP), adiponectin, insulin, and uric acid to the metabolic syndrome components in lean, overweight, and obese young females. METHODS: This was a cross-sectional study of 69 apparently healthy young females, who were classified according to their body mass index (BMI) (kg/m(2)) into three groups: lean (25 and <30), and obese (>or=30). Estimated biomarkers were: leptin, insulin, adiponectin, high-sensitivity [hs]-CRP, uric acid, blood sugar, high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and triglycerides (TG). Anthropometric measures, blood pressure, and homeostasis model assessment-insulin resistance (HOMA-IR) were also measured. RESULTS: Serum leptin, hs-CRP, insulin, and uric acid increased significantly (p < 0.01) with increased BMI. Only one significant correlation (p < 0.05) between the biomarkers and the metabolic syndrome components was found in lean subjects (leptin vs. waist circumference r = 0.48) as opposed to six in the obese group (hs-CRP vs. waist circumference and systolic blood pressure [SBP], r = 0.45 and r = -0.41, respectively; insulin vs. diastolic blood pressure [DBP], r = 0.47; adiponectin vs. blood sugar, r = -0.44; and uric acid vs. waist circumference and TG, r = 0.5 and r = 0.51, respectively). CONCLUSION: Estimation of the levels of studied biomarkers could be an important tool for early detection of metabolic syndrome before the appearance of its frank components. Uric acid seems to be the most reliable biomarker to identify obese subjects with metabolic syndrome.