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Selected AbstractsPrevalence and patterns of executive impairment in community dwelling Mexican Americans: results from the Hispanic EPESE StudyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2004Donald R. Royall Abstract Introduction Little is known about the prevalence of impaired executive control function (ECF) in community dwelling elderly or minority populations. We have determined the prevalence of cognitive impairment and impaired ECF in a community dwelling Mexican American elderly population, and their associations with functional status. Subjects Subjects were 1165 Mexican Americans age 65 and over who were administered CLOX as part of the third wave of the Hispanic Established Population for Epidemiological Study (HEPESE) conducted from 1998 to 1999. Methods ECF was measured by an executive clock-drawing task (CDT) (i.e. CLOX1). Non-executive cognitive function was assessed by the Mini-Mental State Examination (MMSE) and a non-executive CDT (CLOX2). CLOX scores were combined to estimate the prevalence of global CLOX failure (i.e. ,Type 1' cognitive impairment) vs isolated CLOX1 failure (i.e. Type 2 cognitive impairment). Results 59.3% of subjects failed CLOX1. 31.1% failed both CLOX1 and CLOX2 (Type 1 cognitive impairment). 33.3% failed CLOX1 only (Type 2 cognitive impairment). 35.6% passed both measures [no cognitive impairment (NCI)]. Many subjects with CLOX1 impairment at Wave 3 had normal MMSE scores. This was more likely to occur in the context of Type 2 cognitive impairment. Both CLOX defined cognitive impairment groups were associated with functional impairment. Conclusions A large percentage of community dwelling Mexican American elderly suffer cognitive impairment that can be demonstrated through a CDT. Isolated executive impairments appear to be most common. The ability of a CDT to demonstrate ECF impairments potentially offers a rapid, culturally unbiased and cost-effective means of assessing this domain. In contrast, the MMSE is relatively insensitive to ECF assessed by CLOX1. Copyright © 2004 John Wiley & Sons, Ltd. [source] ORIGINAL RESEARCH,INTERSEX AND GENDER IDENTITY DISORDERS: Gender Assignment and Medical History of Individuals with Different Forms of Intersexuality: Evaluation of Medical Records and the Patients' PerspectiveTHE JOURNAL OF SEXUAL MEDICINE, Issue 4i 2007Lisa Brinkmann PhD ABSTRACT Introduction., Until now, there are only few studies that focus on the specific treatment experiences of people with intersexuality and evaluate their outcome in terms of psychological, physical, and social well-being. Further, the presentation of the patients' perspective is often neglected in research. Aim., Overview of preliminary results of the Hamburg-Intersex-Study on gender assignment and medical history of adult subjects with intersexuality (disorders of sex development), as well as the patients retrospectively stated thoughts and feelings regarding these interventions. Main Outcome Measures., Medical records from participants of the study were analyzed. The subjective attitudes and evaluation of the treatment measures were assessed with a self-constructed questionnaire. Data on psychological well-being were measured with the Brief Symptom Inventory. Methods., In total, 37 adult participants (mean age 30.6 years) with following diagnosis were included: congenital adrenal hyperplasia, complete and partial androgen insensitivity syndrome, gonadal dysgenesis and disturbances of the androgen biosynthesis, such as 5 alpha reductase deficiency and 17 beta hydroxysteroid deficiency. Results., The majority of participants had (often multiple) genital surgery to correct the appearance of their genitalia and/or to enable sexual functioning. The diagnostic groups differ not only in amount and invasiveness of experienced surgical and medical treatment but also in the subjective and retrospective evaluation of the treatment measures and in the amount of reported psychological distress. Conclusion., Many subjects stated to have experienced the medical procedures and care very negatively, whereby the aspects of secrecy, untruthfulness, and concealment were stated as most difficult and burdening. Brinkmann L, Schuetzmann K, and Richter-Appelt H. Gender assignment and medical history of individuals with different forms of intersexuality: Evaluation of medical records and the patients' perspective. J Sex Med 2007;4:964,980. [source] Foot abnormalities in Canadian Aboriginal adolescents with Type 2 diabetesDIABETIC MEDICINE, Issue 7 2007J. Chuback Abstract Aims To determine the profile of foot abnormalities in Canadian Aboriginal adolescents with Type 2 diabetes and the risk factors associated with these abnormalities. Methods Aboriginal adolescents with Type 2 diabetes underwent an interview, medical record review and foot examination in a tertiary care, paediatric hospital diabetes clinic and two geographically remote outreach clinics. The notes of 110 subjects were reviewed [mean age 15 ± 3 years; mean duration of diabetes, 30 ± 20 months; 71 (66%) female and 39 (34%) male] and 77 (70%) of the subjects were examined. Results Foot abnormalities were identified by either interview or notes review, and included poor toenail condition in 85 (77%), paronychia in 29 (26%), ingrowing toenails in 16 (15%) and neuropathic symptoms in 13 (12%) subjects. Foot abnormalities were identified by examination in many subjects, including poor toenail condition in 38 (49%), calluses in 34 (44%) and paronychia in 13 (17%) subjects. Eighteen (24%) of 75 subjects did not have running water in the home. Factors that significantly increased the presence of foot abnormalities included: foot care provided by a person other than self; absence of running water in the home; decreased frequency of bathing; and decreased frequency of nail clipping. A greater percentage of subjects living on a reservation or rural community had specialized consultations for retinal examination, footwear, or both than of those living in an urban or unknown residence. Conclusions A high prevalence of foot abnormalities was noted in Aboriginal adolescents with Type 2 diabetes. These findings highlight the associated comorbidities in this population, emphasizing the need for early detection and intervention. [source] Validity of Revised Doppler Echocardiographic Algorithms and Composite Clinical and Angiographic Data in Diagnosis of Diastolic DysfunctionECHOCARDIOGRAPHY, Issue 10 2006Kofo O. Ogunyankin M.D. Background: Commonly used echocardiographic indices for grading diastolic function predicated on mitral inflow Doppler analysis have a poor diagnostic concordance and discriminatory value. Even when combined with other indices, significant overlap prevents a single group assignment for many subjects. We tested the relative validity of echocardiographic and clinical algorithms for grading diastolic function in patients undergoing cardiac catheterization. Method: Patients (n = 115), had echocardiograms immediately prior to measuring left ventricular (LV) diastolic (pre-A, mean, end-diastolic) pressures. Diastolic function was classified into the traditional four stages, and into three stages using a new classification that obviates the pseudonormal class. Summative clinical and angiographic data were used in a standardized fashion to classify each patient according to the probability for abnormal diastolic function. Measured LV diastolic pressure in each patient was compared with expected diastolic pressures based on the clinical and echocardiographic classifications. Result: The group means of the diastolic pressures were identical in patients stratified by four-stage or three-stage echocardiographic classifications, indicating that both classifications schemes are interchangeable. When severe diastolic dysfunction is diagnosed by the three-stage classification, 88% and 12%, respectively, were clinically classified as high and intermediate probability, and the mean LV pre-A pressures was >12 mmHg (P < 0.005). Conversely, the mean LV pre-A pressure in the clinical low probability or echocardiographic normal groups was <11 mmHg. Conclusion: Use of a standardized clinical algorithm to define the probability of diastolic function identifies patients with elevated LV filing pressure to the same extent as echocardiographic methods. [source] Nonmetric multidimensional scaling with clustering of subjectsJAPANESE PSYCHOLOGICAL RESEARCH, Issue 2 2000Kohei Adachi A new nonmetric multidimensional scaling method is devised to analyze three-way data concerning inter-stimulus similarities obtained from many subjects. It is assumed that subjects are classified into a small number of clusters and that the stimulus configuration is specific to each cluster. Under this assumption, the classification of subjects and the scaling used to derive the configurations for clusters are simultaneously performed using an alternating least-squares algorithm. The monotone regression of ordinal similarity data, the scaling of stimuli and the K -means clustering of subjects are iterated in the algorithm. The method is assessed using a simulation and its practical use is illustrated with the analysis of real data. Finally, some extensions are considered. [source] Neutral theory: a historical perspectiveJOURNAL OF EVOLUTIONARY BIOLOGY, Issue 6 2007E. G. LEIGH JR Abstract To resolve a panselectionist paradox, the population geneticist Kimura invented a neutral theory, where each gene is equally likely to enter the next generation whatever its allelic type. To learn what could be explained without invoking Darwinian adaptive divergence, Hubbell devised a similar neutral theory for forest ecology, assuming each tree is equally likely to reproduce whatever its species. In both theories, some predictions worked; neither theory proved universally true. Simple assumptions allow neutral theorists to treat many subjects still immune to more realistic theory. Ecologists exploit far fewer of these possibilities than population geneticists, focussing instead on species abundance distributions, where their predictions work best, but most closely match non-neutral predictions. Neutral theory cannot explain adaptive divergence or ecosystem function, which ecologists must understand. By addressing new topics and predicting changes in time, however, ecological neutral theory can provide probing null hypotheses and stimulate more realistic theory. [source] Increased oxidative damage in nuclear and mitochondrial DNA in mild cognitive impairmentJOURNAL OF NEUROCHEMISTRY, Issue 3 2006Jianquan Wang Abstract Increasing evidence suggests that oxidative damage is associated with normal aging and several neurodegenerative diseases. Mild cognitive impairment (MCI), the phase between normal aging and early dementia, is a common problem in the elderly with many subjects going on to develop Alzheimer's disease (AD). Although increased DNA oxidation is observed in the AD brain, it is unclear when the oxidative damage begins. To determine if DNA oxidation occurs in the brain of subjects with MCI, we quantified multiple oxidized bases in nuclear and mitochondrial DNA isolated from frontal, parietal and temporal lobes and cerebellum of short post-mortem interval autopsies of eight amnestic patients with MCI and six age-matched control subjects using gas chromatography/mass spectrometry with selective ion monitoring. We found statistically significant elevations (p < 0.05) of 8-hydroxyguanine, a widely studied biomarker of DNA damage, in MCI nuclear DNA from frontal and temporal lobe and in mitochondrial DNA from the temporal lobe compared with age-matched control subjects. Levels of 8-hydroxyadenine and 4,6-diamino-5-formamidopyrimidine were significantly elevated in nuclear DNA from all three neocortical regions in MCI. Statistically significant elevations of 4,6-diamino-5-formamidopyrimidine were also observed in mitochondrial DNA of MCI temporal, frontal and parietal lobes. These results suggest that oxidative damage to nuclear and mitochondrial DNA occurs in the earliest detectable phase of AD and may play a meaningful role in the pathogenesis of this disease. [source] Prolonged use of continuous glucose monitors in children with type 1 diabetes on continuous subcutaneous insulin infusion or intensive multiple-daily injection therapyPEDIATRIC DIABETES, Issue 2 2009Diabetes Research in Children Network (DirecNet) Study Group Objective:, For continuous glucose sensors to improve the treatment of children with type 1 diabetes (T1D), they must be accurate, comfortable to wear, and easy to use. We conducted a pilot study of the FreeStyle NavigatorÔ Continuous Glucose Monitoring System (Abbott Diabetes Care) to examine the feasibility of daily use of a continuous glucose monitor (CGM) in an extended ambulatory setting. Methods:, Following a 13-wk trial of daily Navigator use, 45 children with T1D [10.7 ± 3.7 yr, range 4.6,17.6, 24 using insulin pumps; continuous subcutaneous insulin infusion (CSII) and 21 using glargine-based multiple daily injections (MDI)] used the Navigator for an additional 13 wk. Results:, Navigator use was initially slightly higher in the CSII users than in the MDI users but declined similarly in both groups by 22,26 wk. After 26 wk, 11 (46%) of 24 CSII users and 7 (33%) of 21 MDI users were using the CGM at least 5 d a week. No baseline demographic or clinical factors were predictive of the amount of sensor use at 26 wk. However, Navigator use during weeks 1,13 and scores on a CGM satisfaction survey at 13 wk were predictive of use in weeks 22,26. Conclusions:, CGM was generally well-tolerated in children with T1D for more than 6 months, and early acceptance of CGM was predictive of extended use of the device. Although many subjects and parents found CGM valuable, the declining usage over time underscores the need to develop new technologies and strategies to increase acceptance, effectiveness, and long-term use of these devices in youth with T1D. [source] Parkinson's Disease and Low Frequency Alleles Found Together Throughout LRRK2ANNALS OF HUMAN GENETICS, Issue 4 2009Coro Paisán-Ruiz Summary Mutations within LRRK2, most notably p.G2019S, cause Parkinson's disease (PD) in rare monogenic families, and sporadic occurrences in diverse populations. We investigated variation throughout LRRK2 (84 SNPs; genotype or diplotype found for 49 LD blocks) for 275 cases (European ancestry, onset at age 60 or older) and 275 neurologically healthy control subjects (NINDS Neurogenetics Repository). Three grade-of-membership groups, i.e. genetic risk sets, were identified that exactly matched many subjects (cases: 46, 4, 137; controls: 0, 178, 0), and distinguished 94% of the subjects (i.e. >50% likeness to one set). Set I, affected, carried certain low frequency alleles located in multiple functional domains. Set II was unaffected. Set III, also affected, resembled set II except for slightly elevated frequencies of minor alleles not defining set I. We conclude that certain low frequency alleles distributed throughout LRRK2 are a genetic background to a third of cases, defining a distinct subset. [source] Differential effects of ageing on foveal and peripheral colour visionACTA OPHTHALMOLOGICA, Issue 2009F RAUSCHER Purpose Colour sensitivity was assessed to establish aging effects both at the fovea and 6 deg away from fixation, in each of the four quadrants. Methods 65 normal healthy subjects (from 20 to 80 years of age) took part in the study. All subjects had Visual Acuity (VA) of 6/6 or better. Fixation accuracy was monitored using infrared imaging of the pupil and the tests were carried out on the P_SCAN system. Target size was adjusted for parafoveal locations to account for retinal and cortical magnification. Yellow-blue (YB) and red-green (RG) colour discrimination was assessed using the CAD (colour assessment and diagnosis) test (http://www.caa.co.uk/docs/33/200904.pdf). Results RG and YB colour thresholds were analysed separately for all five locations tested and showed no significant effect with ageing below the age of 60 years. Two age bands were formed based on statistical analysis (20-59.9 and 60-79.9). The decline in performance with age was more rapid at the fovea and exhibited a steeper gradient when compared with results in the periphery for both RG and YB discrimination. Foveal YB discrimination showed the largest ageing effect. No significant difference was found between the four parafoveal locations. YB discrimination at the fovea also exhibited the largest inter-subject variability. Conclusion These findings may have clinical significance in the very early detection of disease processes that remain subclinical in many subjects. Differences between foveal and peripheral locations help to differentiate between the normal effects of ageing and disease. For example, higher foveal and normal peripheral YB thresholds in normal subjects from high peripheral thresholds in early glaucomatous subjects. [source] Inotropes in the beta-blocker eraCLINICAL CARDIOLOGY, Issue S3 2000B. D. Lowes M.D. Abstract Beta-adrenergic blocking agents are now standard treatment for mild to moderate chronic heart failure (CHF). However, although many subjects improve on beta blockade, others do not, and some may even deteriorate. Even when subjects improve on beta blockade, they may subsequently decompensate and need acute treatment with a positive inotropic agent. In the presence of full beta blockade, a beta agonist such as dobutamine may have to be administered at very high (> 10 ,g/kg/min) doses to increase cardiac output, and these doses may increase afterload. In contrast, phosphodiesterase inhibitors (PDEIs) such as milrinone or enoximone retain their full hemodynamic effects in the face of beta blockade. This is because the site of PDEI action is beyond the beta-adrenergic receptor, and because beta blockade reverses receptor pathway desensitization changes, which are detrimental to PDEI response. Moreover, when the combination of a PDEI and a beta-blocking agent is administered long term in CHF, their respective efficacies are additive and their adverse effects subtractive. The PDEI is administered first to increase the tolerability of beta-blocker initiation by counteracting the myocardial depressant effect of adrenergic withdrawal. With this combination, the signature effects of beta blockade (a substantial decrease in heart rate and an increase in left ventricular ejection fraction) are observed, the hemodynamic support conferred by the PDEI appears to be sustained, and clinical results are promising. However, large-scale placebo-controlled studies with PDEIs and beta blockers are needed to confirm these results. [source] | ||||||||||||||||||||||