SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Preventing or minimizing functional dependency in older adults rests, in part, upon the ability to predict who is at risk. The purpose of this study was to compare the ability of five tests of hand function to discriminate the degree of dependency in older adults. Seven hundred sixty four subjects were assessed for hand function on performance-based (Williams Test of Hand Function, a test of Williams Board items only, Jebsen Test of Hand Function, grip strength), and self-reported (Dexterity Scale of the Geriatrics-Arthritis Impact Measurement Scale (GERI-AIMS] measures of hand function, and self-reported multidimensional functional status (GERI-AIMS). A trichotomous variable representing a continuum of dependency based upon living site (independent living, home-bound, institutional) was used as the measure of dependency. Sixty-two cases were dropped for incomplete data. Discriminant function analyses of the 702 subjects (age X = 76.78 years, SD = 8.79) showed that basic demographic variables explain 40.8% of the variance in dependency; all hand function tests significantly correlated with dependency; the Williams Board correlated best (additional 12.5% variance explained). However, a multidimensional functional status measure explains substantially more variance in dependency (16.9%) after controlling for demographic variables and performance on the Williams Board. This comparison of methods and tests available for measuring hand function was made to provide criteria for selecting an instrument for a given setting.
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) is associated with profound alterations in body composition, skeletal muscle dysfunction, and impaired exercise capacity. Exerkines representing exercise-responsive signaling molecules released by skeletal muscle, adipose tissue, and other organs may mediate systemic metabolic communication between tissues. However, their role in advanced HFrEF and their relationship with adiposity and skeletal muscle characteristics remain poorly understood. METHODS: We studied 73 patients with end-stage HFrEF and 16 healthy controls. Body composition was assessed using computed tomography, including visceral (VAT), subcutaneous (SAT), and epicardial adipose tissue (EAT), as well as skeletal muscle quantity (psoas muscle index, PMI) and quality (psoas muscle density, PMD). Functional performance was evaluated using handgrip strength (HGT) and the 6-min walk test (6MWT). Circulating exerkines were quantified using the Olink technology. Associations between proteins and clinical variables were assessed using age- and creatinine-adjusted linear models with false discovery rate correction. RESULTS: Among patients with HFrEF, 36% were obese and 38% exhibited central obesity independent of BMI. Muscle strength and muscle quality were strongly associated with functional capacity. VAT correlated with muscle mass but not with muscle quality or performance. Compared with controls, HFrEF patients demonstrated elevated inflammatory and metabolic stress-related exerkines including CXCL8, CCL2, IL-6, TNF, IL-15, GDF15, FGF21, ANGPTL4, CTSB, DCN, and resistin. In contrast, proteins associated with muscle integrity and regenerative signaling (myostatin, BDNF, IL-7, SPARC) were significantly reduced. In HFrEF patients leptin strongly correlated with adiposity measures. Metabolic stress mediators (GDF15, IL-15, FGF21, CTSB) were inversely associated with muscle quality and functional performance, whereas myostatin positively correlated with muscle quality, strength, and exercise capacity. BDNF was inversely associated with frailty. CONCLUSIONS: Advanced HFrEF is characterized by a dysregulated exerkine network linking adiposity, skeletal muscle quality, and functional performance. Four biologically coherent axes were identified: a leptin-driven adiposity axis, a metabolic stress-muscle quality axis, a myostatin-related muscle function axis, and a neurotrophic frailty axis. These findings support the presence of a systemic cardio-adipose-muscle signaling network in end-stage HFrEF and identify candidate molecular mediators of sarcopenia and functional decline.
We performed a functional respiratory examination which consisted of arterial gasometry, spirometry, diffusion capacity to CO2, alveolo-arterial gradient of O2 and pulmonary volumes to 8 patients with cirrhosis diagnosed by clinical history, laboratory exams, abdominal ultrasound and histology. Our results showed a slight obstructive pattern of peripheric airways (FMM: 88.87 +/- 8.7%) in the spirometry, no difference in arterial gases at upright and recumbent position was observed, with low values of apO2 (75.51 +/- 1.16 upright and 75.87 +/- 2.16 mmHg recumbent) without statistic significance. The gradient G(Aa) O2 increased to (30.89 +/- 1.06 mmHg). Besides there was a diffusion abnormality with a DLCO2/VA of (71.87 +/- 6.05%). Breathing 100% O2, did not change the gradient which allows us to postulate the existence of an abnormality of gaseous interchange due to shunts. We found no relationship between albumin levels and DLCO2/VO neither with pO2 in upright position; there was a relationship at recumbent position between the hepatic disorder and the arterial desaturation. We concluded that there is no significant hypoxia even with position changes, there is increase of G (Aa) O2 by shunt type disorders and that this is probably related with albumin levels.
If aged patients who have been wearing their full dentures without complications so far, need further prothetic treatment, the dentist must not replace the old denture by a completely new one. It is better to rebuild it step by step. This demand is based on the following theses: --Nobody but the patient himself is able to perform functional movements. --Unless bite and occlusion are correct, patients are not able to perform accurate functional movements. --When bite and occlusion have been checked and, if necessary, improved, bases and alveolar ridges must be congruent.
The high incidence of poor social adjustment in long-term follow-up studies of depressed children seems to relate to the inadequacy of the pharmacotherapy necessary to sustain long-lasting remission or possibly to repetitive inappropriate stresses. Insufficient antidepressant therapy with resultant intermittent depression-induced dysfunction of the socialization functions performed by the right cerebral hemisphere would not permit the child to develop appropriate interpersonal skills (causing failure in most social situations), and associated cognitive difficulties would complicate academic performance. Repeated school failure and chronic social ineptitude preclude development of the skills necessary for successful independent living in society. Thus, if symptoms of depression are found, it is imperative that the learning-disabled or behaviorally disturbed child or adolescent receive adequate antidepressant therapy to ensure complete long-term remission of the depression. In addition, learning-disabled individuals, even without apparent diagnosable depressive illness, must be offered appropriate methods for learning and communication which reduce stress. When such appropriate educational strategies are offered and poor performance still ensues (or continues), a trial of antidepressant therapy should be considered. Recognition of the depressive nature of symptoms may not be possible until treatment-induced improvement has occurred and depression-associated learning disability has resolved. Improvement in academic performance associated with improved cognitive function after treatment-induced remission of a depressive episode can be dramatic, with resolution of apparent learning disability. Poor educational achievement associated with chronic learning difficulties ultimately affects adult social functioning, and untreated or improperly treated chronic depression may result in the development of later personality disturbances. Therefore, before attributing school problems in children to untreatable conditions, depressive disorder must be excluded, and appropriate antidepressant therapy (along with removal of all apparent inappropriate stress, including inappropriate demands on brain function) should be provided to children and adolescents with evidence of depression.
Differences in skeletal muscle characteristics, metabolic profiles and functional performance between males and females were investigated using young (15--24 yrs) male and female twins as subjects. The comparison included such variables as anthropometry, muscle strength, mechanical power, maximum oxygen uptake, electrical activation of muscle, muscle fibre composition (m. vastus lateralis), and activities of several skeletal muscle enzymes. The results disclosed the following primary differences between males and females: In the various functional tests the performance of females was from 61.1 to 84.6% of that in males; distribution of slow twitch fibres in m. vastus lateralis of the females (49.1 +/- 7.7%) was lower (p less than .05) than that of the males (55.9 +/- 11.9); activities of enzymes Ca2+ stimulated ATPase, CPK, phosphorylase and LDH1a leads to py were higher (p less than .05--0.1) in the males, whereas the distribution pattern of LDH-1 isozyme was higher (p less than .05) in the females. A pronounced difference between the two groups was a almost 100% longer rise time of isometric force in females. It is concluded that the males as compared to the females demonstrate higher aerobic and strength performance capacity, more efficient neuromotoric output during contraction, more slow twitch muscle fibres and more pronounced contractile and glycolytic profiles in the skeletal muscles.
The validity and use of psychosocial assessments in occupational therapy are ongoing concerns (Moyer, 1984) and were the focus of this study. Fifty African patients with schizophrenia and 10 nondysfunctional African volunteers took an an assessment battery that included the Schroeder, Block, Campbell Adult Psychiatric Sensory Integration Evaluation (SBC) (Schroeder, Block, Trottier, & Stowell, 1978), a daily activity, work, and leisure activity interview based on the Model of Human Occupation (Kielhofner, 1985), and a culture-specific test of functional performance. Data on subjects' psychiatric histories and demographics were collected. Rationale for the assessments used, methods for devising the functional assessment, methods and procedures for data collection, and analysis are presented. A stronger relationship was found to exist between subjects' performances on the SBC and the functional activity test than between interviews based on the Model of Human Occupation and the functional activity test, both for patients and for the whole sample. All assessments were found to differentiate between patients and nonpatients, although the SBC was the best discriminator. Among psychiatric history variables, the strongest relationships were between measures of seriousness of illness and both the SBC and functional activity assessment. The most effective way to measure performance dysfunction and seriousness of illness in persons with schizophrenia was to measure the underlying sensorimotor impairment or to use a culture-specific test of functional performance.
This study examines the factors affecting functional performance of 40 hemiplegic subjects in their homes following discharge from the hospital. All subjects suffered a cerebral vascular accident at least one year prior to this research period. Barthel Index was used to assess subjects' self-reported functional level in activities of daily living (ADL). A backward elimination of stepwise regression analysis was performed to ascertain the predictive value of the variables in determining functional performance one year after the onset of a stroke. These variables are factors related to the initial onset and those affecting the patient's functional status at home. The results revealed that subjects who had a shorter length of stay in the hospital, scored a higher on the Barthel Index (p less than 0.05). It also demonstrated that subjects who were more satisfied with their current subjective health status, had a higher Barthel Index score.
For eight years a group of nonprofessional human relations trainers conducted a community-based Adult-Youth T-Group Program in a suburban community under the auspices of the Board of Education. Their history provides the material for this case analysis, which will focus on two sets of issues. One set of issues surrounds the fact that these group leaders were "independent nonprofessionals": trained but noncredentialed persons performing functions usually reserved for professionals (or performed under professional supervision) and performing them outside of institutional and professional boundaries. A second set of issues, only partially related to the first, surrounds the organizational dilemmas and social-political conflict which beset this team and the program which they conducted.
The aim of this study was to assess whether spontaneous interindividual variations in arousal level appreciated by telemetric recordings of physiological variables were related to mental performance and functional ability in institutionalized aged subjects. The sample studied was made up of 18 subjects (16 women and 2 men) aged 82-97, living in an old age home in Paris. Telemetric recordings of EEG, EKG, EMG and EOG were obtained over 8-hour periods, during the subjects' normal daily activity schedule. The Stockton Geriatric Rating Scale (SGRS), Benton's Visual Retention Test (VRT) and the Trail Making Test (TMT) were independently used to assess behaviour and mental performance of these aged persons. All correlations between telemetric data and psychological evaluations (the psychometric tests as well as the rating scale) were highly significant, even once the influence of the cultural level was controlled.
A previously conducted positron emission tomography (PET) study of normal humans suggested that the cerebellum makes important non-motor contributions to language processing. Beginning with the task which produced right cerebellar PET activation, we studied a 49-yr-old male (RC1) with right cerebellar damage on a variety of tasks involving complex non-motor processing. Whereas RC1's performance on standard tests of memory, intelligence, 'frontal function' and language skills was excellent, he had profound deficits in two areas: (1) practice-related learning; (2) detection of errors. Considered in relation to cerebellar contributions to motor tasks, the results suggest some functions performed by the cerebellum may be generalized beyond a purely motor domain.
Taste detection performance for representatives of the four taste qualities as a function of stimulus volume (5 x 10(-4) to 1 x 1(-1) ml) was examined in rats using high-precision gustometry, computer-controlled operant procedures, nonparametric signal detection measures of sensitivity and responsivity, and blind control procedures. The overall sensitivity index was positively related to stimulus volume (rs = .60), with optimal detection performance attained with a 5 x 10(-3) ml stimulus volume for salty tastants and a 1 x 10(-2) ml stimulus volume for the other taste qualities. The overall responsivity index was inversely related to stimulus volume (rs = -.47), especially for sour and bitter tastants. These results are consistent with prior observations and demonstrate that operant methods using small tastant samples produce sensitive estimates of the rat's taste detection performance and response bias.
We have cloned and sequenced the cDNA corresponding to the rat preproepidermal growth factor (ppEGF) mRNA. The cDNA contained 4,801 nucleotides, similar to that reported for the mouse (4,749 nucleotides) and the human mRNAs (4,871 nucleotides). The predicted protein sequence would contain 1,133 amino acids, smaller than that reported for the mouse (1,217 amino acids) and the human sequences (1,207 amino acids). The results of the sequencing of several cDNA clones suggested the existence of more than one structural gene for ppEGF. In addition, there was an occurrence of alternative splicing events, resulting in deletions of entire exons from the mature mRNA. These alternative splicing events do not create frameshift mutations but cause a deletion of one or more of the "EGF-like" repeat units from the ppEGF. There is approximately the same homology between the rat and mouse amino acid sequences both in the EGF region and in the other regions of the ppEGF protein. We conclude that, because of this conservation of homology, there may be an important function performed by these other regions of the ppEGF besides their function as a precursor for the EGF protein.
A formal analysis of an optimization problem in medical diagnosis is presented. The mathematical model of the diagnostic process corresponds in this work to an abstract machine definition which is based on the following sets and functions: Set of possible pathological states (diseases) of a patient, set of diagnostic tests (examination methods), set of all possible results of the tests (symptoms and signs), function which chooses successive tests, function performing a test (i.e., assigning to a given test its result), function assigning to each symptom a certain subset of the set of diseases. For a given abstract machine a class of pairs of graphs is formed; their analysis leads to the identification of a class of pairs of subgraphs which corresponds to an optimized diagnostic procedure. The optimization consists of a comparison of the distances between the initial and terminal vertices of the graphs and of a choice of a shortest route to a final diagnosis. For the considered class of pairs of subgraphs a mathematical model of the optimized diagnostic process is reconstructed.
The effects of hypercapnia and hypocapnia on haemodynamics, coronary blood flow, and lactate metabolism were evaluated in anaesthetized closed chest dogs. Coronary flow increased with increased pCO2 and oxygen consumption and left ventricular performance were well maintained. Hypocapnia reduced coronary flow, oxygen consumption, and left ventricular functional performance.
A marked surge of luteinizing hormone (LH) occurs daily at 18.00 h in oestrogen-treated ovariectomized rats maintained under regular lighting from 06.00 to 20.00 h. The administration of p-chlorophenylalanine (PCPA),p-chloramphetamine or 5,6-dihydroxytryptamine in treatments designed to cause a severe depletion of brain serotonin abolished this daily surge. Synthesis of serotonin may be temporarily restored in PCPA-treated animals by the administration of the serotonin precursor, 5-hydroxytryptophan. The effectiveness with which restoration of synthesis resulted in restoration of the LH surge varied according to the time at which the precursor was administered, the optimal time being 10.00 h. The results suggest that there is an essential, permissive function performed by serotonin in the production of the LH surge and that this function occurs during a critical period.