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Functional Status (functional + status)
Selected AbstractsFEELING TIRED PREDICTS FUNCTIONAL STATUS, PHYSICAL ACTIVITY, AND MORTALITY IN ELDERLY PEOPLEJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2009Elior Moreh MD No abstract is available for this article. [source] A New Paradigm for Clinical Investigation of Infectious Syndromes in Older Adults: Assessing Functional Status as a Risk Factor and Outcome MeasureJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2005Kevin High Abstract Adults aged 65 and over comprise the fastest growing segment of the U.S. population, and older adults experience greater morbidity and mortality due to infection than young adults. While this factor is well established, most clinical investigation of infectious diseases in the aged focuses on microbiology, and crude endpoints of clinical success such as cure rates or mortality, but often fails to assess functional status, a critical variable in geriatric care. Functional status can be evaluated as a risk factor for infectious disease or an outcome of interest following specific interventions utilizing well-validated instruments. This paper outlines the currently available data suggesting a link between infection, immunity and impaired functional status in the elderly, summarizes commonly employed instruments used to determine specific aspects of functional status, and provides recommendations for a new paradigm in which clinical trials of older adults include functional assessment. [source] Association Between Functional Status and Use and Effectiveness of Beta-Blocker Prophylaxis in Elderly Survivors of Acute Myocardial InfarctionJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2004Gail Vitagliano MD Objectives: To examine whether physical and cognitive impairments explain low use of beta-blockers in elderly patients and whether functionally impaired older adults have improved survival if a beta-blocker is prescribed at hospital discharge. Design: Cross-sectional and retrospective cohort study. Setting: Acute care hospitals in the United States. Participants: National cohort of 45,370 elderly acute myocardial infarction survivors, with no chart-documented contraindications to beta-blocker treatment. Measurements: The main outcome measures were beta-blocker prescription at hospital discharge and 1-year survival. Results: Fifty percent (n=22,683) of eligible patients were prescribed a beta-blocker at discharge. Older age and functional impairments (incontinence, mobility impairment, and cognitive impairment) were independently associated with decreased use of beta-blockers. The odds ratios for prescribing a beta-blocker at hospital discharge were 0.82 (95% confidence interval (CI)=0.77,0.86), 0.63 (95% CI=0.56,0.71), and 0.40 (95% CI=0.32,0.51) for persons with one, two, and three impairments, respectively, compared with those with no impairments. In survival analysis, patients prescribed a beta-blocker were 21% less likely than nonrecipients to die within 1 year of follow-up (relative risk=0.79, P=.0001). Similar survival benefit was observed in patients with and without functional impairments. Conclusion: This study shows a strong association between functional impairment and the use of beta-blockers after acute myocardial infarction in elderly patients. The results suggest that increasing use of beta-blockers in this group provides an opportunity to improve outcomes. [source] Reliability and validity of the Inventory of Functional Status after Childbirth when used in an Australian populationNURSING & HEALTH SCIENCES, Issue 3 2002Carol McVeigh RN Abstract This study presents the results of reliability and validity testing of the Inventory of Functional Status after Childbirth (IFSAC) when used in an Australian sample. Data were obtained from a culturally diverse group of 173 women residing in a regional city in New South Wales, Australia. Participants could read and write English, delivered healthy infants between 37 and 42 weeks gestation and experienced normal pregnancies, labors, and deliveries. The inventory and its five scales were assessed for reliability using Cronbach's coefficient , and construct validity using item-total correlation matrices. While three of the IFSAC scales performed well, two were problematic in this Australian population. With modification and updating, the clinical utility of IFSAC may be more fully realized. [source] Are Ecosystem Composition, Structure, and Functional Status Related to Restoration Success?RESTORATION ECOLOGY, Issue 2 2006A Test from Semiarid Mediterranean Steppes Abstract Theoretical models emphasize the importance of considering the composition, structure, and functioning of an ecosystem when restoring it. However, there is a lack of empirical studies evaluating how these ecosystem attributes are linked, if any, to the success of restoration actions. We conducted experimental plantings of the native late-successional shrub Pistacia lentiscus in 10 semiarid steppes located in southeast Spain and related seedling survival rates to measures of ecosystem structure and composition and to surrogates of ecosystem functioning. Seedling survival widely differed among the studied steppes and 17 months after planting ranged from 0 to 89%. Mortality occurred mostly during the first summer in the field, coinciding with a strong drought lasting 3 months. Survival was lower in the steppes located at the highest altitudes and with the highest values of total plant cover, species richness, shrub cover, and functionality. Seedling survival was mainly controlled by abiotic conditions and showed a negative relationship with some of the surrogates of ecosystem functioning evaluated. Our results suggest, but cannot confirm, that the functional status of the ecosystem may not limit the early stages of establishment of P. lentiscus in semiarid steppes and that abiotic conditions play an overriding role in this process. If true, its introduction in these areas would not necessarily need a previous phase of recovery of ecosystem functions like nutrient cycling and infiltration. [source] Effectiveness of a community-based 3-year advisory program after acquired brain injuryEUROPEAN JOURNAL OF NEUROLOGY, Issue 11 2007E. Grill Objective of this study was to examine the effectiveness of a coordinated, community based 3-year advisory program in 1534 patients with acquired brain injury. Patients and caregivers were offered a coordinated advisory program after discharge from rehabilitation. Patients in the historical control group received standard aftercare. The main outcomes were functional status [Functional Independence Measure (FIM)], and days spent in the acute hospital. The secondary outcome was survival. Patients were comparable for sex (intervention: 41.3% female, control: 38.0%), and younger in the control group (mean age intervention: 55.3, control: 49.6). Functional status at discharge was lower in the intervention group (mean FIM intervention: 66.2, control: 80.3). Patients in the intervention group experienced a moderate gain in FIM. Rate of days in hospital was 15.4 per 1000 person days (intervention) and 15.5 per 1000 person days (control). Patients of the intervention group had an increased rate of days in hospital. A total of 16.0% of patients in the intervention group and 19.3% in the control group died during follow-up. Patients in the intervention had a significant lower mortality risk depending on follow-up period and discharge FIM. The advisory program may be effective for all patients with acquired brain injury. [source] Effect of enhanced external counterpulsation on medically refractory angina patients with erectile dysfunctionINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2007W. E. Lawson Summary Patients with refractory angina often suffer from erectile dysfunction. Enhanced external counterpulsation (EECP) decreases symptoms of angina, and increases nitric oxide release. This study evaluated the effect of EECP on sexual function in men with severe angina. The International Index of Erectile Function (IIEF) was used to assess erectile function of severe angina patients enroled in the International EECP Patient Registry. Their symptom status, medication use, adverse clinical events and quality of life were also recorded before and after completing a course of EECP. A cohort of 120 men (mean age 65.0 ± 9.7) was enroled. The men had severe coronary disease with 69% having a prior myocardial infarction, 90% prior coronary artery bypass graft or percutaneous coronary intervention, 49% with three vessel coronary artery disease, 86% were not candidates for further revascularisation, 71% hypertensive, 83% dyslipidaemia, 42% diabetes mellitus, 75% smoking and 68% using nitrates. Functional status was low with a mean Duke Activity Status Inventory score of 16.6 ± 14.8. After 35 h of EECP anginal status improved in 89%, and functional status in 63%. A comparison of the IIEF scores pre- and post-EECP therapy demonstrated a significant improvement in erectile function from 10.0 ± 1.0 to 11.8 ± 1.0 (p = 0.003), intercourse satisfaction (4.2 ± 0.5 to 5.0 ± 0.5, p = 0.009) and overall satisfaction (4.7 ± 0.3 to 5.3 ± 0.3, p = 0.001). However, there were no significant changes in orgasmic function (4.2 ± 0.4 to 4.6 ± 0.4, p = 0.19) or sexual desire (5.3 ± 0.2 to 5.5 ± 0.2). The findings suggest that EECP therapy is associated with improvement in erectile function in men with refractory angina. [source] Identifying functional impairment with scores from the repeatable battery for the assessment of neuropsychological status (RBANS)INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2010Valerie L. Hobson Abstract Objective To examine the link between RBANS scores and functional impairment. Functional status was evaluated through informant report using the clinical dementia rating (CDR) scale. Methods Archival data were reviewed from records of 99 patients in a memory disorder clinic (MDC) research database. Consensus-based diagnoses were Alzheimer's disease (AD; n,=,48), mild cognitive impairment (MCI; n,=,48), AD with vascular components; (n,=,2) and dementia due to psychiatric conditions (n,=,1). Results The RBANS language index score was significantly related to CDR domain scores of community affairs (p,<,.01), home and hobbies (p,<,.01), personal care (p,<,.05), memory (p,<,0.01), and judgment (p,<,0.01). RBANS immediate memory index scores were significantly related to (p,<,0.05) the CDR Memory and judgment and problem solving domains. Based on these findings, follow-up regressions were conducted. Semantic fluency was significantly related to CDR memory (p,<,0.01), judgment (p,<,0.05), community affairs (p,<,0.05), home/hobbies (p,<,0.05), and personal care (p,<,0.05) functional domains. Picture naming was significantly related to the CDR personal care domain (p,<,0.05). List learning was significantly related to CDR memory functional domain (p,<,0.01) and judgment (p,<,0.05). Lastly, story memory was significantly related to the CDR judgment domain (p,<,0.05). Conclusions The RBANS may be an indicator of functional impairment as well as a neuropsychological testing tool. The use of the RBANS could reduce the amount of testing that is administered to the patient, or can provide a way to compare other measurements of functional impairment to assess accuracy of findings. Copyright © 2009 John Wiley & Sons, Ltd. [source] Influence of social network characteristics on cognition and functional status with agingINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2008Ariel Frank Green Abstract Objective To determine whether more frequent engagement in larger social networks, and more emotional support protect against cognitive and functional decline with aging. Methods We examined the influence of social networks on cognition and instrumental activities of daily living (IADLs) over a median interval of 10.9 years. Data were from the Baltimore follow-up of the Epidemiologic Catchment Area (ECA) study, a community-based sample of adults in eastern Baltimore. Eight hundred and seventy-four participants completed cognitive testing at both the third and fourth study waves (1993,1996 and 2003,2004) on the Mini-Mental State Examination (MMSE) and a delayed word recall task. Functional status at both waves was self-reported on the Lawton-Brody IADL scale. Social network characteristics, assessed at the third study wave, included network size, frequency of contact, and emotional support. Results In cross-sectional analyses at wave 3, larger networks were associated with higher MMSE and better delayed recall scores. This association persisted after adjustment for covariates. More emotional support was associated with better functional status, before and after adjustment. By contrast, social networks were not longitudinally associated with cognitive change, with two counter-intuitive exceptions: more frequent contact and more emotional support were associated with worse delayed recall and IADL scores after adjustment. Conclusions There was no evidence of a longitudinal association between social networks and cognition or IADLs, although a clear cross-sectional association exists. Together, these findings suggest the emergence of social isolation in individuals declining in cognition and functioning, rather than a protective effect of social networks. Copyright © 2008 John Wiley & Sons, Ltd. [source] A New Paradigm for Clinical Investigation of Infectious Syndromes in Older Adults: Assessing Functional Status as a Risk Factor and Outcome MeasureJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2005Kevin High Abstract Adults aged 65 and over comprise the fastest growing segment of the U.S. population, and older adults experience greater morbidity and mortality due to infection than young adults. While this factor is well established, most clinical investigation of infectious diseases in the aged focuses on microbiology, and crude endpoints of clinical success such as cure rates or mortality, but often fails to assess functional status, a critical variable in geriatric care. Functional status can be evaluated as a risk factor for infectious disease or an outcome of interest following specific interventions utilizing well-validated instruments. This paper outlines the currently available data suggesting a link between infection, immunity and impaired functional status in the elderly, summarizes commonly employed instruments used to determine specific aspects of functional status, and provides recommendations for a new paradigm in which clinical trials of older adults include functional assessment. [source] Outcome Predictors of Pneumonia in Elderly Patients: Importance of Functional AssessmentJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2004Olga H. Torres MD Objectives: To evaluate the outcome of elderly patients with community-acquired pneumonia (CAP) seen at an acute-care hospital, analyzing the importance of CAP severity, functional status, comorbidity, and frailty. Design: Prospective observational study. Setting: Emergency department and geriatric medical day hospital of a university teaching hospital. Participants: Ninety-nine patients aged 65 and older seen for CAP over a 6-month recruitment period. Measurements: Clinical data were used to calculate Pneumonia Severity Index (PSI), Barthel Index (BI), Charlson Comorbidity Index, and Hospital Admission Risk Profile (HARP). Patients were then assessed 15 days later to determine functional decline and 30 days and 18 months later for mortality and readmission. Multiple logistic regression was used to analyze outcomes. Results: Functional decline was observed in 23% of the 93 survivors. Within the 30-day period, case-fatality rate was 6% and readmission rate 11%; 18-month rates were 24% and 59%, respectively. Higher BI was a protective factor for 30-day and 18-month mortality (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94,0.98 and OR=0.97, 95% CI=0.95,0.99, respectively; P<.01), and PSI was the only predictor for functional decline (OR=1.03, 95% CI=1.01,1.05; P=.01). Indices did not predict readmission. Analyses were repeated for the 74 inpatients and indicated similar results except for 18-month mortality, which HARP predicted (OR=1.73; 95% CI=1.16,2.57; P<.01). Conclusion: Functional status was an independent predictor for short- and long-term mortality in hospitalized patients whereas CAP severity predicted functional decline. Severity indices for CAP should possibly thus be adjusted in the elderly population, taking functional status assessment into account. [source] Risk of Hip Fracture in Disabled Community-Living Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2003Louise C. Walter MD OBJECTIVES: To determine the rate of hip fracture and risk factors associated with hip fractures in disabled older persons who enroll in the Program of All-Inclusive Care for the Elderly (PACE), a program providing comprehensive care to community-living nursing-home-eligible persons. DESIGN: Prospective cohort study between January 1990 and December 1997. SETTING: The twelve PACE demonstration sites: San Francisco, California; Columbia, South Carolina; Detroit, Michigan; Denver, Colorado; East Boston, Massachusetts; El Paso, Texas; Milwaukee, Wisconsin; Oakland, California; Portland, Oregon; Rochester, New York; Sacramento, California; and the Bronx, New York. PARTICIPANTS: Five thousand one hundred eighty-seven individuals in PACE; mean age 79, 71% female, 49% white, 47% with dementia. MEASUREMENTS: Functional status, cognitive status, demographics, and comorbid conditions were recorded on all the participants, who were tracked for occurrence of a hip fracture. The goals were to determine the rate of hip fracture and identify risk factors. RESULTS: Two hundred thirty-eight hip fractures (4.6%) occurred during follow-up. The rate of hip fracture was 2.2% per person-year. Four independent predictors of hip fracture were identified using Cox proportional hazard analysis: age of 75 and older (adjusted hazard ratio (HR) = 2.0, 95% confidence interval (CI) = 1.4,2.8); white ethnicity (HR = 2.1, 95% CI = 1.6,2.8); ability to transfer independently to and from bed, chair, and toilet (HR = 3.0, 95% CI = 1.2,7.2); and five or more Short Portable Mental Status Questionnaire errors (HR = 1.6, 95% CI = 1.3,2.1). The incidence of hip fracture ranged from 0.5% per person-year in persons with zero to one independent risk factors to 4.7% per person-year in those with all four independent risk factors. CONCLUSIONS: The rate of hip fracture in this cohort of disabled community-living older adults was similar to that reported in nursing home cohorts. Older age, white race, ability to transfer independently, and cognitive impairment were independent predictors of hip fracture. Persons with these risk factors should be targeted for preventive interventions, which should include strategies for making transferring safer. [source] Functional status of masticatory system, executive function and episodic memory in older personsJOURNAL OF ORAL REHABILITATION, Issue 5 2008E. SCHERDER Summary, Findings from human experimental studies suggest that mastication positively influences cognitive function. The participants in those studies were relatively young. The goal of this study was to examine the relationship between the functional status of the masticatory system, episodic memory, and executive functions in elderly people. The participants, elderly people living independently at home, were divided into two groups. One group had a full complement of natural teeth (n = 19) and the other group had full dentures (n = 19). The functional status of the masticatory system was assessed by measuring mandibular excursions (i.e. the distances over which the mandible can move in the open, lateral, and forward directions), bite force, number of occluding pairs and complaints of the masticatory system (facial pain, headaches/migraine). Executive functions and episodic memory were assessed by neuropsychological tests. Backward regression analysis showed that only in the group of elderly people with full dentures, 22% of executive functions were predicted by complaints of the masticatory system and 19·4% of episodic memory was predicted by masticatory performance (composed of mandibular excursions and bite force). The conclusion of this study is that only in older persons with full dentures the relationship between mastication, episodic memory, and executive function becomes evident when the functional status of the masticatory system decreases. [source] Clinical presentation and prognosis of childhood Guillain,Barré syndromeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2008Jung Hwan Lee Aim: Guillain,Barré syndrome (GBS) is an acute inflammatory polyneuropathy commonly characterised by rapidly progressive, symmetric weakness and areflexia. This study is to assess the clinical characteristics of paediatric GBS, as well as its long-term functional prognosis. Methods: We retrospectively assessed the clinical manifestations, results of electrodiagnostic tests, functional status and prognosis of 56 children diagnosed with GBS. Based on clinical and electrophysiological findings, the patients were classified as having acute inflammatory demyelinating polyradiculoneuropathy ([AIDP]n = 34), acute motor axonal neuropathy ([AMAN]n = 14), acute motor and sensory axonal neuropathy (n = 1) and Miller Fisher syndrome ([MFS]n = 7). Results: Upper respiratory infection was the most frequent preceding event, and limb weakness was the most frequent symptom at GBS onset. There was no significant difference in the mean time from the onset of illness to nadir between any of these groups. Both the AIDP and AMAN groups showed significantly poorer functional status, measured by the Hughes scale, than the MFS group. Two years after nadir, however, the three groups did not differ significantly. Functional status at nadir, as estimated by the Hughes scale, is a more important factor than electrophysiological types in predicting long-term outcome. Conclusion: The most common symptom at onset in paediatric GBS was limb weakness. Functional status at nadir in AMAN was not significantly different from that of AIDP, and both types achieved good functional outcome for ambulation after 2 years. Functional status at nadir was more important than the electrophysiological type in predicting long-term outcomes. [source] Karnofsky performance score in acute renal failure as a predictor of short-term survivalNEPHROLOGY, Issue 6 2007JOSE RAMON PEREZ VALDIVIESO SUMMARY: Background: Karnofsky Performance Scale Index (KPS) is a measure of functional status that allows patients to be classified according to their functional impairment. We aim to assess if the prior KPS may predict the risk of death among patients with acute renal failure (ARF). Methods: A cohort of 668 consecutive patients who had been admitted in an university-affiliated hospital between June 2000 and June 2006, and had been diagnosed with ARF, were studied. Three hundred and eighty-six patients with ARF who matched at least one of the RIFLE (Risk, Injury, Failure, Loss and End stage) criteria on increased serum creatinine were included for subsequent analysis. The group was divided into four categories, according to different Karnofsky scores measured by a nephrologist (,80, 70, 60 and ,50). We used an adjusted logistic regression model to assess the relationship between the Karnofky score and mortality. Results: A significant risk of in-hospital mortality within 90 days was observed when the other groups were compared with the ,80 Karnofsky group. Adjusted odds ratios were 8.87 (95% confidence interval (CI) 3.03,25.99), 6.78 (95% CI 2.61,17.58) and 2.83 (95% CI 1.04,7.68), for Karnofsky groups of ,50, 60 and 70, respectively. An adjusted odds ratio of 1.75 (95% CI 1.37,2.23) was observed for every 10 point decrease in KPS score. Conclusion: Functional status as indicated by the KPS is an independent predictor of death in this cohort of patients with ARF. Patients who presented lower scores had increased mortality rates. [source] Functional outcome and health-related quality of life 10 years after moderate-to-severe traumatic brain injuryACTA NEUROLOGICA SCANDINAVICA, Issue 1 2009N. Andelic Objectives,,, To describe the functional outcome and health-related quality of life (HRQL) 10 years after moderate-to-severe traumatic brain injury (TBI). Material and methods,,, A retrospective, population-based study of 62 survivors of working-age with moderate-to-severe TBI injured in 1995/1996, and hospitalized at the Trauma Referral Center in Eastern Norway. Functional status was measured by the Glasgow Outcome Scale-Extended (GOS-E). HRQL was assessed by the SF-36 questionnaire. Results,,, The mean current-age was 40.8 years. The frequency of epilepsy was 19% and the depression rate 31%. A majority had good recovery (48%) or moderate disability (44%). Employment rate was 58%. Functional and employment status were associated with initial injury severity in contrast to HRQL. Study patients had significantly lower scores in all SF-36 dimensions when compared with the general Norwegian population. Conclusion,,, At 10-years follow-up, our study population is still in their most productive years and affected domains should be considered in long-term follow-up and intervention programs. [source] Practical Assessment of Maternal Cardiovascular Risk in PregnancyCONGENITAL HEART DISEASE, Issue 5 2008Nazanin Moghbeli MD ABSTRACT Cardiovascular disease in pregnancy is the most common cause of maternal mortality in the developed world and an important cause of heart failure, stroke, and arrhythmia. As more children with congenital heart disease survive into adulthood, there is a more pressing need to understand the risks that pregnancy poses for these women. Pregnancy, labor, and delivery increase the hemodynamic stress on the cardiovascular system and place women with heart disease at increased risk of cardiovascular complications, which include heart failure and death. Systematic assessment of pregnancy risk in these women, ideally before conception, is essential in optimizing maternal and fetal outcomes. This article describes the process of assessing risk of pregnancy-associated cardiovascular complications in women with structural heart disease. We review the current literature on pregnancy risk in women with complex congenital lesions, valvular heart disease, cardiomyopathy, and aortopathy, and suggest an approach to risk stratification. Based on a review of the literature, we report features that pose an increased risk of adverse maternal and fetal outcomes, which include poor maternal functional status; prior history of heart failure, arrhythmia, or cerebral vascular events; cyanosis; poor systemic ventricular function; and severe aortic or mitral stenosis. Pulmonary hypertension and Eisenmenger syndrome place women at exceedingly high risk for cardiovascular complications in pregnancy, including maternal and fetal death. [source] Extended Mechanical Circulatory Support With a Continuous-Flow Rotary Left Ventricular Assist DeviceCONGESTIVE HEART FAILURE, Issue 2 2010Scott Harris DO Background LVAD therapy is an established treatment modality for patients with advanced heart failure. Pulsatile LVADs have limitations in design precluding their use for extended support. Continuous-flow rotary LVADs represent an innovative design with potential for small size and greater reliability by simplification of the pumping mechanism. Methods In a prospective multicenter study, 281 patients urgently listed (United Network for Organ Sharing status 1A or 1B) for heart transplant underwent implant of a continuous-flow LVAD. Survival and transplant rates were assessed at 18 months. Patients were assessed for adverse events throughout the study and for quality of life, functional status, and organ function for 6 months. Results Of 281 patients, 222 (79%) underwent transplant or LVAD removal for cardiac recovery or had ongoing LVAD support at 18-month follow-up. Actuarial survival on support was 72% (95% confidence interval, 65%,79%) at 18 months. At 6 months, there were significant improvements in functional status and 6-minute walk test results (from 0% to 83% of patients in New York Heart Association functional class I or II and from 13% to 89% of patients completing a 6-minute walk test) and in quality of life (mean values improved 41% with Minnesota Living With Heart Failure and 75% with Kansas City Cardiomyopathy questionnaires). Major adverse events included bleeding, stroke, right heart failure, and percutaneous lead infection. Pump thrombosis occurred in 4 patients. Conclusions A continuous-flow LVAD provides effective hemodynamic support for at least 18 months in patients awaiting transplant, with improved functional status and quality of life. [source] Effect of storage media on human periodontal ligament cell apoptosisDENTAL TRAUMATOLOGY, Issue 1 2008Mónica M. Chamorro However, the mechanisms by which different storage conditions alter the functional status of PDL cells have not been determined. The purpose of the present study was to investigate, in vitro, the level of programed cell death or apoptosis in a population of PDL cells following storage under different conditions. Primary human PDL cells were plated into 24-well-culture plates and allowed to attach for 24 h. Cells were then exposed for 1 h to milk, Hank's balanced salt solution (HBSS), Soft Wear contact lens solution or Gatorade at room temperature or on ice. Culture medium was used as a negative control. Apoptosis was evaluated at 24, 48, and 72 h after treatment on quadruplicate samples by using the ST 160 ApopTag Fluorescein Direct In Situ Detection Kit. The total number of cells and the total number of apoptotic cells were counted. The results indicated that at 24 and 72 h, PDL treated with Gatorade and the contact lens solution displayed the highest percentages of apoptotic cells when compared with the other treatment groups at room temperature. Overall, cells treated on ice showed significantly lower levels of apoptosis when compared with treatments at room temperature. In conclusion, the results indicated that apoptosis plays a major role in cell death in cells treated with Gatorade and contact lens solutions in comparison to other storage solutions and that storage on ice can inhibit programed cell death. [source] Complementary and alternative medicine use in families of children with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2003Edward A Hurvitz MD In order to assess patterns of usage of complementary and alternative medicine (CAM) in families of children with cerebral palsy (CP), 213 families with a child (0 to 18 years) with CP were recruited at the university medical center in Ann Arbor, MI, USA as part of a descriptive survey. Two hundred and thirty-five surveys were distributed. Mean age of the child was 8 years 6 months (SD 4y: 9mo) and 56% of the sample was male with 35% full-time independent ambulators, while the rest used an assistive device or a wheelchair. Fifty-four percent were in special education classrooms. Families were given a survey on functional status of the child with CP, CAM usage of the child and the parent, factors influencing the decision to use CAM, demographics, and clinical information. Of the families, 56%, used one or more CAM techniques. Massage therapy (25%) and aquatherapy (25%) were the most common. Children of families that used CAM were significantly younger (7y: 9mo, SD 4y: 7mo) than non-users (9y: 6mo, SD 4y: 6mo: t -test p < 0.01 two-tailed). Children with quadriplegic CP, with spasticity, and those who could not walk independently were more commonly exposed to CAM (Pearson's X2 [PX2] p=0.01 two-tailed; for mobility, odds ratio [OR] of 2.5 with regression). Mothers with a college degree had a greater tendency to use CAM for their child than those without (PX2p=0.01 two-tailed). Fathers of children who used CAM were older than fathers of those who did not (37y: 9mo versus 33y: 2mo, p=0.04 two-tailed). There was no significant difference between groups for mother's age, father's education, income, or for population of home town. Parents who used CAM for themselves were more likely to try CAM for their child (70% versus 47%, OR 2.1), and were much more likely to be pleased with the outcome (71% versus 42%, OR 3.5). Child's age (younger), lack of independent mobility, and parental use of CAM were the most significant predictive factors identified via logistic regression. [source] The Canadian National Outcomes Measurement Study in Schizophrenia: overview of the patient sample and methodologyACTA PSYCHIATRICA SCANDINAVICA, Issue 2006G. Smith Objective:, The Canadian National Outcomes Measurement Study in Schizophrenia (CNOMSS) is a prospective survey of routine clinical practice. Method:, Patients with schizophrenia or a related disorder were consecutively enrolled from all regions of Canada. Both academic and community psychiatric clinics were included and patients were followed up for 2 years. Clinical and functional status, quality of life, medication and economic costs were assessed at enrollment and monitored throughout the follow-up period. Results:, Patients attending an academic clinic tended to be younger and more severely ill than those from community clinics. Both types of sites prescribed atypical neuroleptics to more than three-quarters of the patients. The majority of those enrolled were unemployed and living in poverty. Poor clinical status was associated with poverty. Conclusion:, The CNOMSS provides demographic, clinical and treatment-related information about a large Canada-wide sample of psychiatric patients. The following three articles in this issue of Acta Psychiatrica Scandinavica explore issues related to medication, quality of life and resource utilization. [source] Transcriptional activity of paddy soil bacterial communitiesENVIRONMENTAL MICROBIOLOGY, Issue 4 2009Pravin Malla Shrestha Summary Bulk mRNA was used to explore the transcriptional activity of bacterial communities in oxic versus anoxic paddy soil. Two microbial cDNA libraries were constructed from composite samples using semi-randomly primed RT-PCR. cDNAs averaged 500,600 bp in length and were treated as expressed sequence tags (ESTs). Clustering analysis of 805 random cDNAs resulted in 179 and 155 different ESTs for the oxic and anoxic zones respectively. Using an E -value threshold of e,10, a total of 218 different ESTs could be assigned by blastx, while 116 ESTs were predicted novel. Both the proportion and significance of the EST assignments increased with cDNA length. Taxonomic assignment was more powerful in discriminating between the aerobic and anaerobic bacterial communities than functional inference, as most ESTs in both oxygen zones were putative indicators of similar housekeeping functions, in particular ABC-type transporters. A few ESTs were putative indicators for community function in a biogeochemical context, such as ,-oxidation of long-chain fatty acids specifically in the oxic zone. Expressed sequence tags assigned to Alpha- and Betaproteobacteria were predominantly found in the oxic zone, while those affiliated with Deltaproteobacteria were more frequently detected in the anoxic zone. At the genus level, multiple assignments to Bradyrhizobium and Geobacter were unique to the oxic and anoxic zones respectively. The phylum-level affiliations of 93 16S rRNA sequences corresponded well with two taxonomically distinct EST patterns. Expressed sequence tags affiliated with Acidobacteria and Chloroflexi were frequently detected in both oxygen zones. In summary, the soil metatranscriptome is accessible for global analysis and such studies have great potential in elucidating the taxonomic and functional status of soil bacterial communities, but study significance depends on the number and length of cDNAs being randomly analysed. [source] Older patients' experiences of treatment for colorectal cancer: an analysis of functional status and service useEUROPEAN JOURNAL OF CANCER CARE, Issue 5 2004C. BAILEY msc, rgn Age and ageing are an important part of the context within which the care and treatment of people with cancer is provided. More information is needed about the effects of cancer treatment on the lives of older people following inpatient care. We conducted a 3-year study in which older people with colorectal cancer completed a detailed questionnaire on multidimensional function and service use before and after elective treatment. Here we present an analysis of changes in functional status and service use over the pre- to post-treatment period, and set out a detailed picture of older people's experiences before and after treatment. In total, 337 patients with colorectal adenocarcinoma aged 58,95 years were interviewed before treatment using the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), Rotterdam Symptom Checklist (RSCL) and a severity of morbidity score. Study end points were defined as post-treatment functional status, symptom distress, severity of morbidity and frequency of service use. Pre- and post-treatment data were compared using matched analyses. Logistic regression was used to assess associations between age and the main outcome measures, and frequency of service use after treatment was compared between age groups using the ,2 test. Overall, patients experienced both positive and negative outcomes following treatment. It was notable that patients aged ,,75 years showed improvement in only one of the principal outcome measures. Patterns of service use following treatment suggest that support at home is a key issue for patients. With the exception of nursing care, however, help at home is provided on a majority of occasions by families themselves. This raises important questions about how much preparation patients and families receive or would like before they leave hospital after treatment for cancer. A collaborative, family-centred approach to meeting people's needs is called for in the months following inpatient care. [source] Chemotherapy-related nausea and vomiting , past reflections, present practice and future managementEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2004M. MILLER ba (hons), msc (cancer nursing), rgn research fellow Although much progress has occurred in the last decade regarding the management of chemotherapy-induced nausea and vomiting, these remain among the most intolerable side-effects of treatment and patients continue to report the negative impact such symptoms have on their ability to enjoy life. Inadequate control of nausea and vomiting reduces patients' quality of life and functional status and jeopardizes the delivery of optimal treatment, so making its management a priority for oncology health care workers. This article will reflect on past and present evidence regarding the management of chemotherapy-induced nausea and vomiting while highlighting some of the most recent scientific advances before drawing conclusions about the future management of this troublesome symptom for patients receiving chemotherapy. [source] Health-related quality of life, symptom distress and sense of coherence in adult survivors of allogeneic stem-cell transplantationEUROPEAN JOURNAL OF CANCER CARE, Issue 2 2001L. Edman This is the first Swedish study to evaluate the health-related quality of life and sense of coherence in adult survivors of allogeneic, haematopoietic stem cell transplantation (HSCT). Twenty-five recipients completed three questionnaires 2,4 years after the transplantation. The questionnaires used were the Sickness Impact Profile (SIP), the Symptom Frequency Intensity and Distress (SFID-BMT) scale and the Sense of Coherence (SOC) scale measuring subjective functional status, symptom distress and coping ability. Impairments in functional status were found, as compared with a population norm. The most common impairments were found in the areas of social interaction and sleep and rest. Eye problems, dry mouth, cough, sexual problems, tiredness, anxiety and changes of taste were symptoms reported by more than half of the patients. Despite impaired functioning and a high incidence of symptoms, the general health was described as quite good or excellent by 80% (n = 20) of the patients. The majority (20/22) had also been able to return to work or to attend school. No difference in the sense of coherence was seen, as compared with the population norm. Functional impairments were significantly correlated to a lower degree of sense of coherence. [source] Medium-term results of percutaneous vertebroplasty in multiple myelomaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 1 2006Luis Ramos Abstract:, Vertebral compression fractures (VCFs) are common in multiple myeloma (MM). Percutaneous vertebroplasty (PVP) is used to stabilize vertebral collapse and treat the pain. Few studies have been carried out on PVP in MM and follow-up has tended to be short. We have prospectively evaluated the safety and efficacy of PVP in the VCFs resulting from MM or plasmacytomas. Nineteen PVP were performed in 12 consecutive patients. We monitored their pain and functional status using visual analog (VAS) and Eastern Cooperative Oncology Group (ECOG) scale, respectively. For a subjective assessment, every patient was asked about his/her degree of satisfaction. The mean age of the participants was 66 yr. Significant improvement occurred 1 d after PVP according to the VAS score (7.5 pre-PVP to 3.7, P < 0.0001) and ECOG assessment (3.1 to 2.5, P = 0.002). This significant improvement was maintained after 3.2 yr of follow-up. Sixty-three percent of patients were highly satisfied with the result of the PVP and 37% were satisfied. The peri-operative mortality was 0%. Leakage of the cement outside of the vertebral body was noted in 16 of 19 injected vertebrae (84%) but none of the patients developed any clinical or neurological symptoms. At the last follow-up, no further collapse in the treated or neighboring vertebrae was noted. VCFs caused by MM or plasmacytomas can be effectively treated by vertebroplasty. PVP is associated with early clinical improvement of pain and function and can be maintained after a long follow-up without major procedure-related complications. [source] Effectiveness of a community-based 3-year advisory program after acquired brain injuryEUROPEAN JOURNAL OF NEUROLOGY, Issue 11 2007E. Grill Objective of this study was to examine the effectiveness of a coordinated, community based 3-year advisory program in 1534 patients with acquired brain injury. Patients and caregivers were offered a coordinated advisory program after discharge from rehabilitation. Patients in the historical control group received standard aftercare. The main outcomes were functional status [Functional Independence Measure (FIM)], and days spent in the acute hospital. The secondary outcome was survival. Patients were comparable for sex (intervention: 41.3% female, control: 38.0%), and younger in the control group (mean age intervention: 55.3, control: 49.6). Functional status at discharge was lower in the intervention group (mean FIM intervention: 66.2, control: 80.3). Patients in the intervention group experienced a moderate gain in FIM. Rate of days in hospital was 15.4 per 1000 person days (intervention) and 15.5 per 1000 person days (control). Patients of the intervention group had an increased rate of days in hospital. A total of 16.0% of patients in the intervention group and 19.3% in the control group died during follow-up. Patients in the intervention had a significant lower mortality risk depending on follow-up period and discharge FIM. The advisory program may be effective for all patients with acquired brain injury. [source] Clinical features and assessment of severe dementia.EUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2002A review Sound understanding of the dementia syndrome requires adequate acquaintance with its entire spectrum, from the lightest to the most advanced stages. Most studies of dementia deal with light to moderate stages of the condition, while relatively little attention has been paid to its most severe stages. This review presents a clinical description of patients with severe dementia and of the tests currently available to evaluate their cognitive, behavioural, and functional status. Available instruments such as the Hierarchic Dementia Scale or the Severe Impairment Battery now allow quantification of the cognitive and behavioural status of patients with severe dementia. Experience with severe dementia shows that, far from being in a `vegetative state', as is commonly thought, late-stage patients are in fact quite different from one another and in most cases continue to have an interaction with their environment. This ability to better define the characteristics of patients with severe dementia provides the basis for correlations between clinical data and data derived from neuroimaging, neurochemistry, or neuropathology. It also sets the stage for possible therapeutic trials involving these patients. [source] Sex hormone-dependent desensitization of 5-HT1A autoreceptors in knockout mice deficient in the 5-HT transporterEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 8 2003Saoussen Bouali Abstract The serotonin transporter (5-HTT) is the target of most antidepressant drugs, whose therapeutic action is related to their facilitatory influence on 5-HT neurotransmission. In this study, we investigated the functional adaptive properties of 5-HT1A autoreceptors, which regulate serotonergic neuronal firing, in knockout mice deficient in 5-HTT. Neurons of the dorsal raphe nucleus (DRN) were recorded extracellularly under chloral hydrate anaesthesia in male and female knockout 5-HTT mice and their wild-type counterparts. The inhibitory response of DRN neurons to intravenous injection of the 5-HT1A agonist 8-OH-DPAT was dramatically reduced in knockout 5-HTT compared with wild-type mice, especially in females. Changes in 8-OH-DPAT-induced hypothermia and autoradiographic labelling of 5-HT1A sites in the DRN confirmed a greater level of desensitization/down-regulation of 5-HT1A autoreceptors in female than in male knockout 5-HTT mice. After gonadectomy, the functional status of 5-HT1A autoreceptors was unchanged in wild-type mice, whereas in knockout 5-HTT, castrated males exhibited a down-regulation, and ovariectomized females an up-regulation of these receptors, as shown by electrophysiological recording and autoradiographic labelling in the DRN, as well as by changes in 8-OH-DPAT-induced hypothermia. Finally, in gonadectomized knockout 5-HTT mice, treatment with testosterone or estradiol restored the DRN neuronal firing sensitivity to 8-OH-DPAT back to sham control level in males or females, respectively. These data indicate that sexual hormones participate in the mechanisms responsible for the desensitization of 5-HT1A autoreceptors in knockout 5-HTT mice. The differential effects of testosterone and estradiol on 5-HT1A -mediated control of 5-HT neurotransmission might be related to the well-established gender differences in the vulnerability to depression. [source] Two new potent and convenient predictors of mortality in older nursing home residents in JapanGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2004Orie Tajima Background: Malnourishment is closely connected with poor health outcomes in frail elderly. However, the relative importance of specific nutritional predictors of mortality remains unclear in the Japanese population. We investigated the potent nutritional factors associated with mortality from nutritional assessments of three parameters in Japanese frail elderly. Methods: Ninety residents in a nursing home in Japan, aged 65 and over (18 men, 72 women; mean age 82.2 ± 8.0 years) were enrolled in a 38-month follow-up study. The eligibility condition for analysis was having lived at the nursing home for more than 30 days, so three participants were excluded. Three nutritional parameters, which included: anthropometric measurements (body mass index, mid-arm circumference, triceps skinfold thickness and calf circumference); serum markers (albumin, total protein, prealbumin, retinol binding protein and total cholesterol); and food intake, were assessed. After categorizing each putative factor according to tertile distribution, risk of mortality was analyzed using Cox proportional hazard models. Results: At the end of the 38-month follow-up period, 29 participants had died. After adjustment for gender, age, clinical status, and functional status, three indicators (i.e. mid-arm circumference, triceps skinfold thickness and lipid intake) showed a significant relationship with mortality. When all of the putative factors were included in a stepwise procedure, mid-arm circumference and lipid intake were significantly associated with adjusted mortality. Conclusion: Among institutionalized Japanese frail elderly, lower levels of mid-arm circumference and lipid intake could potently predict an increased risk of mortality. These two indicators may be useful for many kinds of assessments and intervention for the improvement of health conditions in Japanese frail elderly. [source] | |||||||||||||||||||||||||||||||||||||||||||