Urinary Incontinence and Its Association with Physical and Psycho-Cognitive Factors: A Cross-Sectional Study in Older People Living in Nursing Homes

Urinary incontinence (UI) is a common geriatric syndrome affecting bladder health and is especially prevalent in nursing homes (NHs). The aim of the study was to determine the prevalence of UI and its associated factors in 5 Spanish NHs. UI (measured with Minimum Data Set 3.0.), sociodemographic and health-related variables were collected. Chi- square (or Fisher’s) or Student’s t-test (or Mann Whitney U) for bivariate analysis were used, with Prevalence Ratio (PR) as an association measure. The prevalence of UI was 66.1% (CI:95%, 53.6–77.2) and was significantly associated with frailty (PR 1.84; 95%CI 0.96–3.53), faecal incontinence (FI) (PR 1.65; 95%CI 1.02–2.65), anxiety (PR 1.64; 95%CI 1.01–2.66), physical performance (PR 1.77; 95%CI 1.00–3.11) and cognitive state (PR 1.95; 95%CI 1.05–3.60). Statistically significant differences between incontinent-continent groups were found for activities of daily living (ADL) limitations, mobility, quality of life, sedentary behaviour (SB) and handgrip strength. It can be concluded that 2/3 of the residents experienced UI, and its significant associated factors were mainly physical (SB, frailty, physical performance, ADL limitations, mobility, FI and handgrip strength) followed by psycho-cognitive factors (cognition, anxiety and quality of life).

Assessment of the Risk of Depression in Residents Staying at Long-Term Care Institutions in Poland During the COVID-19 Pandemic Depending on the Quality of Cognitive Functioning

Background: The development of the COVID-19 pandemic has prompted the implementation of many procedures to safeguard against further increases in illness. Unfortunately, this has drastically reduced residents’ contact with their families, which has increased feelings of loneliness and isolation. This is particularly difficult in long-term care facilities, where the risk of developing depression is higher than in the general population.Objectives: The aim of the study was to assess the risk of depression among the residents of long-term care institutions in Poland during the COVID-19 pandemic and to determine the relationship between the risk of depression and the occurrence of cognitive impairment in the study group.Methods: The study included 273 residents from long-term care institutions in Poland. The risk of depression was determined based on an originally designed questionnaire. The cognitive state of the subjects was assessed using the screening test Mini-Mental State Examination (MMSE). Both the depression risk assessment and the MMSE test were conducted twice: in March and December 2020.Results: In March, severe dementia was present in 28.2% of the residents and normal MMSE scores were observed in 16.1% of the subjects; in December, the prevalence of severe dementia increased to 31.1% and that of normal scores decreased to 10.3%. In March, no participant was found to be at high risk of depression and moderate risk was observed in 14.3% of the subjects; in December, 2.6% of the residents had a high risk score and 45.4% had a moderate risk score. Statistical analysis revealed that higher MMSE scores correspond with a higher risk of depression.Conclusion: A higher risk of depression was observed with the development of the pandemic. Residents with cognitive impairment were characterised by a lower risk of depression compared to individuals with normal MMSE scores. During the study, progression of cognitive impairment was observed in the residents.

Digital phenotyping and the (data) shadow of Alzheimer's disease

In this paper, we examine the practice and promises of digital phenotyping. We build on work on the ‘data self’ to focus on a medical domain in which the value and nature of knowledge and relations with data have been played out with particular persistence, that of Alzheimer's disease research. Drawing on research with researchers and developers, we consider the intersection of hopes and concerns related to both digital tools and Alzheimer's disease using the metaphor of the ‘data shadow’. We suggest that as a tool for engaging with the nature of the data self, the shadow is usefully able to capture both the dynamic and distorted nature of data representations, and the unease and concern associated with encounters between individuals or groups and data about them. We then consider what the data shadow ‘is’ in relation to ageing data subjects, and the nature of the representation of the individual's cognitive state and dementia risk that is produced by digital tools. Second, we consider what the data shadow ‘does’, through researchers and practitioners’ discussions of digital phenotyping practices in the dementia field as alternately empowering, enabling and threatening.

Laughter as a Semiotic Problem

Purpose. The article is aimed to substantiate the view on the phenomenon of laughter as a subject of semiotic analysis, which leads to the following tasks: to reveal the possibilities of semiotics application in the study of laughter nature; to analyze the phenomenon of laughter as a cultural and natural phenomenon, as a sign and as an attribute; to consider the place of laughter in culture, which is understood as a sign system. Theoretical basis. The semiotic approach proceeds from the fact that human lives in the world of signs, all the surrounding reality can be interpreted as a sign system. The basic concept of semiotics is the concept of a sign. The theoretical basis of the article is understanding the culture as a sign-symbolic system. Laughter is considered as a phenomenon ontologically rooted in human culture. At the same time, laughter is on the edge of culture. The research is based on the work of semiotic authors, cultural researchers, and the researchers of laughter. Originality. The originality lies in the application of the semiotic method to the research of laughter phenomenon, consideration of the dialectics of natural and cultural, signedness and non-signedness, manifested in the phenomenon of laughter. Conclusions. Laughter is considered as a psychophysiological phenomenon (attribute) and as a cultural phenomenon (sign). Laughter acts as an emotional manifestation, a physiological reaction, but socially and culturally mediated. In any case, laughter indicates an emotional or cognitive state of a human. Laughter acts as a process and result of the interpretation of a sign, a reaction to a sign. Laughter is a form and a means of communication. Being a natural phenomenon, in the process of social evolution, laughter acquires signedness, is integrated by culture as a sign system, and, at the same time, maintains a connection with nature. Thus, laughter occupies an ambivalent position between nature and culture. In the phenomenon of laughter, the dual state of human is revealed. In laughter, boundaries are blurred, the unity and opposition of natural and cultural, biological and social, soul and body, thought and feeling, sign and attribute are manifested.

Theta Neurofeedback Training Supports Motor Performance and Flow Experience

Flow is defined as a cognitive state that is associated with a feeling of automatic and effortless control, enabling peak performance in highly challenging situations. In sports, flow can be enhanced by mindfulness training, which has been associated with frontal theta activity (4-8 Hz). Moreover, frontal-midline theta oscillations were shown to subserve control processes in a large variety of cognitive tasks. Based on previous theta neurofeedback training studies, which revealed that one training session is sufficient to enhance motor performance, the present study investigated whether one 30-minute session of frontal-midline theta neurofeedback training (1) enhances flow experience additionally to motor performance in a finger tapping task, and (2) transfers to cognitive control processes in an n-back task. Participants, who were able to successfully upregulate their theta activity during neurofeedback training (responders), showed better motor performance and flow experience after training than participants, who did not enhance their theta activity (non-responders). Across all participants, increase of theta activity during training was associated with motor performance enhancement from pretest to posttest irrespective of pre-training performance. Interestingly, theta training gains were also linked to the increase of flow experience, even when corresponding increases in motor performance were controlled for. Results for the n-back task were not significant. Even though these findings are mainly correlational in nature and additional flow-promoting influences need to be investigated, the present findings suggest that frontal-midline theta neurofeedback training is a promising tool to support flow experience with additional relevance for performance enhancement.

Functional Profile of Older Adults Hospitalized in Convalescence Units of the National Network of Integrated Continuous Care of Portugal: A Longitudinal Study

Aim: To evaluate the evolution of the functional profile of older adults admitted to a health unit in Portugal; to relate the functional profile of these individuals with age, sex, education level and emotional state; and to evaluate the probability of the degree of dependence as a function of age and sex. Methods: longitudinal, retrospective study with a sample of 59,013 older adults admitted to convalescence units of the National Network of Integrated Continuous Care of Portugal. Results: In the first 75 days of hospitalization, activities of daily living, mobility and cognitive state improved, but there was a decline after 75 days of hospitalization. The ability to perform instrumental activities of daily living improved in the first 15 days of hospitalization, stabilized until 45 days and then began to worsen. Women had a higher probability of having a severe/complete dependence three years earlier than men (88 years to 91 years). A higher education level and stable emotional state were protective factors against functional decline. Conclusions: The functional profile of older adults improved during the length of stay recommended for hospitalization in convalescence units (30 days). It is critical for health systems to adopt strategies to prevent declines in the emotional state of frail individuals.

Single-trial detection of EEG error-related potentials in serial visual presentation paradigm

When the outcome of an event is not the same as expected, the cognitive state that monitors performance elicits a time-locked brain response termed as Error-Related Potential (ErrP). Objective – In the existing work, ErrP is not recorded when there is a disassociation between an object and its description. The objective of this work is to propose a Serial Visual Presentation (SVP) experimental paradigm to record ErrP when an image and its label are disassociated. Additionally, this work aims to propose a novel method for detecting ErrP on a single-trial basis. Method – The method followed in this work includes designing of SVP paradigm in which labeled images from six categories (bike, car, flower, fruit, cat, and dog) are presented serially. In this work, a text (visual) or an audio clip describing the image in one word is presented as the label. Further, the ErrP is detected on a single-trial basis using novel electrode-averaged features. Results - The ErrP data recorded from 11 subjects’ have consistent characteristics compared to existing ErrP literature. Detection of ErrP on a single-trial basis is carried out using a novel feature extraction method on two type labeling types separately. The best average classification accuracy achieved is 69.09±4.70% and 63.33±4.56% for the audio and visual type of labeling the image, respectively. The proposed feature extraction method achieved higher classification accuracy when compared with two existing feature extraction methods. Significance - The significance of this work is that it can be used as a Brain-Computer Interface (BCI) system for quantitative evaluation and treatment of mild cognitive impairment. This work can also find non-clinical BCI applications such as image annotation.

Advanced e-Call Support Based on Non-Intrusive Driver Condition Monitoring for Connected and Autonomous Vehicles

Background: The growth of the number of vehicles in traffic has led to an exponential increase in the number of road accidents with many negative consequences, such as loss of lives and pollution. Methods: This article focuses on using a new technology in automotive electronics by equipping a semi-autonomous vehicle with a complex sensor structure that is able to provide centralized information regarding the physiological signals (Electro encephalogram—EEG, electrocardiogram—ECG) of the driver/passengers and their location along with indoor temperature changes, employing the Internet of Things (IoT) technology. Thus, transforming the vehicle into a mobile sensor connected to the internet will help highlight and create a new perspective on the cognitive and physiological conditions of passengers, which is useful for specific applications, such as health management and a more effective intervention in case of road accidents. These sensor structures mounted in vehicles will allow for a higher detection rate of potential dangers in real time. The approach uses detection, recording, and transmission of relevant health information in the event of an incident as support for e-Call or other emergency services, including telemedicine. Results: The novelty of the research is based on the design of specialized non-invasive sensors for the acquisition of EEG and ECG signals installed in the headrest and backrest of car seats, on the algorithms used for data analysis and fusion, but also on the implementation of an IoT temperature measurement system in several points that simultaneously uses sensors based on MEMS technology. The solution can also be integrated with an e-Call system for telemedicine emergency assistance. Conclusion: The research presents both positive and negative results of field experiments, with possible further developments. In this context, the solution has been developed based on state-of-the-art technical devices, methods, and technologies for monitoring vital functions of the driver/passengers (degree of fatigue, cognitive state, heart rate, blood pressure). The purpose is to reduce the risk of accidents for semi-autonomous vehicles and to also monitor the condition of passengers in the case of autonomous vehicles for providing first aid in a timely manner. Reported abnormal values of vital parameters (critical situations) will allow interveneing in a timely manner, saving the patient’s life, with the support of the e-Call system.

PP231 Safety, Effectiveness And Economic Analysis Of Exercise Intervention For Prevention Of Cognitive And Functional Deterioration In Hospitalized Patients

IntroductionCognitive and functional deterioration is common in hospital setting and occurs in 40 percent of admitted older patients. One of its main causes is physical inactivity. The objective of our health technology assessment was to assess the safety and clinical effectiveness of a structured multicomponent intervention of physical exercise (Vivifrail) for the prevention of the cognitive and functional deterioration in hospitalized patients aged 70 years or older and to estimate costs and the budgetary impact for the Spanish National Health Service.MethodsA systematic review of available scientific literature (including experimental and observational designs) on the safety and effectiveness of Vivifrail was performed. A costing study and budgetary impact analysis of the incorporation of Vivifrail as a therapeutic alternative to standard care with a time horizon of 5 years was performed.ResultsOne randomized controlled trial (RCT) (n = 370) showed positive effects of Vivifrail compared to usual care in functional capacity (mean difference (MD) = 2.20, 95% confidence interval (CI) 1.78 to 2.62), cognitive state (MD = 1.80, 95% CI 1.24 to 2.36), and quality of life (MD = 13.20, 95% CI 12.70 to 13.70). Regarding other variables, the Vivifrail increased the grip strength of the dominant hand (MD = 2.30; 95% CI = 1.79 to 2.81), verbal fluency (MD = 2.15; 95% CI = 1.56 to 2.74), performance of double tasks (MD = 0.10; 95% CI = 0.07 to 0.13), executive function (MD = −31.07; 95% CI = −49.23 to −12.91) and emotional state (MD = −2.00; 95% CI = −2.50 to −1.50).The total cost of implementing Vivifrail in a 1,000-bed general hospital would be EUR18,000 per year (adjusted to 2020 currency), with approximately 150 patients older than 75 years benefited. This represents a cost of EUR120 per patient.ConclusionsThe Vivifrail could improve functional and cognitive capacity, although available evidence on the Vivifrail is very scarce. More well designed and executed RCT and cost-effectiveness study confirming or refuting the promising findings are needed for a new assessment.