PubMed · 8715528
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S Brown, A Zamprogna. 1996. Balancing act.. https://pubmed.ncbi.nlm.nih.gov/8715528/
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BACKGROUND: Psychotic symptoms have been found to be more common in demented elderly persons. Genetic variation in the apolipoprotein E (APOE) gene is reported to be associated with variation in the risk of Alzheimer's dementia. This study reports on variables associated with psychotic symptoms including APOE, in demented and nondemented elderly persons. METHODS: A population of 668 elderly persons was examined. APOE genotype was available in 309 individuals. RESULTS: Psychotic symptoms were found to be associated with dementia, a previous psychiatric history, female gender, being less educated, disability in daily living and institutionalisation. In the nondemented group, psychotic symptoms were equally common in subjects with or without the epsilon 4 present. In the demented subjects, psychotic symptoms were slightly more common, although not significant, in subjects without the epsilon 4 genotype. CONCLUSIONS: There was no statistical significant difference in APOE genotype between subjects with and without psychotic symptoms, stratified by dementic diagnosis.
STUDY DESIGN: A prospective cohort study of patients with subacute occupational back pain. OBJECTIVES: To study the relation between a marketed opto-electric device measuring trunk kinematics, a widely used specific functional capacity questionnaire, and work status in back pain patients, and to assess the responsiveness to change in work status of the opto-electric device and the questionnaire. SUMMARY OF BACKGROUND DATA: Several instruments have been developed to evaluate the functional capacities of patients with back pain, but the relation between these instruments and work status has rarely been studied. METHODS: The relation between the opto-electric device, the questionnaire, and work status in patients with back pain was evaluated. The study population was a prospective cohort of patients with subacute back pain who were absent from regular work for more than 4 weeks. All data were compiled blindly on the same day, at study entry (4 weeks after work accident), and at 12, 24, and 52 weeks after the work accident. The validity of the questionnaire and opto-electric device scores was assessed with partial correlation analyses, standardized response mean, logistic regression analyses, and receiver operating characteristics curves. RESULTS: The correlation between the questionnaire and opto-electric device scores was low. The questionnaire scores were significantly related to work status, but the opto-electric device scores were not. The questionnaire was responsive to change in work status, whereas the opto-electric device was not. CONCLUSIONS: The opto-electric device scores were not related to either functional capacity scores (questionnaire) or work status in patients with low back pain, and the opto-electric device was not responsive to change in work status. Conversely, the questionnaire was related to work status and was responsive to change in work status.
OBJECTIVE: To compare tension-free open mesh hernioplasty under local anaesthetic with transabdominal preperitoneal laparoscopic hernia repair under general anaesthetic. DESIGN: A randomised controlled trial of 403 patients with inguinal hernias. SETTING: Two acute general hospitals in London between May 1995 and December 1996. SUBJECTS: 400 patients with a diagnosis of groin hernia, 200 in each group. MAIN OUTCOME MEASURES: Time until discharge, postoperative pain, and complications; patients' perceived health (SF-36), duration of convalescence, and patients' satisfaction with surgery; and health service costs. RESULTS: More patients in the open group (96%) than in the laparoscopic group (89%) were discharged on the same day as the operation (chi2 = 6.7; 1 df; P=0.01). Although pain scores were lower in the open group while the effect of the local anaesthetic persisted (proportional odds ratio at 2 hours 3.5 (2.3 to 5.1)), scores after open repair were significantly higher for each day of the first week (0.5 (0.3 to 0.7) on day 7) and during the second week (0.7 (0.5 to 0.9)). At 1 month there was a greater improvement (or less deterioration) in mean SF-36 scores over baseline in the laparoscopic group compared with the open group on seven of eight dimensions, reaching significance on five. For every activity considered the median time until return to normal was significantly shorter for the laparoscopic group. Patients randomised to laparoscopic repair were more satisfied with surgery at 1 month and 3 months after surgery. The mean cost per patient of laparoscopic repair was 335 pounds (95% confidence interval 228 pounds to 441 pounds) more than the cost of open repair. CONCLUSION: This study confirms that laparoscopic hernia repair has considerable short term clinical advantages after discharge compared with open mesh hernioplasty, although it was more expensive.