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PubMed1994

The effects of attendance and effort on outcomes among older adults in a long-term exercise program.

To determine if attendance and effort could differentiate changes in cognitive and physical functioning, 66 older adults received a prescription heart rate to be achieved during supervised regular exercise sessions over a 9-month period. These 30-min sessions of aerobic training on a cycle ergometer were conducted three times per week. Cognitive variables and physical functioning were measured at baseline and following 4.5 months and 9 months of training. Attendance and effort scores (ATTEFF) were used to divide subjects into low ATTEFF (N = 29) and high ATTEFF (N = 37) groups. Following 9 months of training these groups were significantly different on life satisfaction and selected measures of health perception, but not on measures of either mental status or submaximum or resting heart rate. Maximum physical functioning improved within both groups, although the high ATTEFF group had improved more than the low ATTEFF group at posttest. Attendance and effort appear to differentiate older adults on selected measures of health perception and maximum physical functioning following a 9-month exercise program.

Aged↗

PubMed2005

Predictors of use of health care services among elderly lung cancer patients: the first year after diagnosis.

In this study, we investigated predictors of utilization of physician, hospital, and emergency room services in a sample of 277 elderly patients during the first year following a diagnosis of lung cancer. Data were obtained by a combination of patient interview and patient self-administered questionnaire at four intervals: baseline (wave 1), 3 months (wave 2), 6 months (wave 3), and 12 months (wave 4). Of the 277 patients, 242 provided data at wave 1, 209 at wave 2, 157 at wave 3, and 115 at wave 4. Symptomatology was assessed with the Symptom Experience Scale (simple count of symptoms present, chosen from a list of 37 cancer-related symptoms), and physical functioning was assessed with the Medical Outcomes Study 36-Item Short Form Health Survey. Analysis of covariance models were implemented separately for the active treatment period (0-6 months) and the continuing care period (6-12 months) to determine how age, gender, comorbidity, length of survival, treatment status, stage of disease, cancer site, physical functioning, and symptom count were related to physician visits, nights in hospital, and emergency room visits. During the active treatment period, patients with worse physical functioning reported more hospital nights (p=0.002) and more emergency room visits (p=0.013), while men reported more frequent emergency room visits (p=0.032) and more nights in hospital (p=0.006) than women. Patients reporting more symptoms also reported more physician visits (p=0.020). During the continuing care period, physical functioning had a similar relation to hospital nights (p=0.005) and emergency room visits (p=0.003), and patients with late-stage disease reported more physician visits than patients with early-stage disease (p=0.003).

Aged↗

PubMed2002

Exercise enhances and protects brain function.

Physical activity, in the form of voluntary wheel running, induces gene expression changes in the brain. Animals that exercise show an increase in brain-derived neurotrophic factor, a molecule that increases neuronal survival, enhances learning, and protects against cognitive decline. Microarray analysis of gene expression provides further support that exercise enhances and supports brain function.

Animals↗

PubMed1995

Health-related quality of life associated with recombinant human erythropoietin therapy for predialysis chronic renal disease patients.

The investigators evaluated the impact of recombinant human erythropoietin (r-HuEPO) therapy on health-related quality of life (HRQL) in predialysis chronic renal disease patients with anemia. Eighty-three patients were entered into a randomized, parallel-group, open-label clinical trial with follow-up evaluations over 48 weeks. Forty-three patients were assigned to r-HuEPO treatment, and 40 patients were assigned to an untreated control group. Hematocrit levels were measured at baseline and monthly. HRQL was assessed at baseline and at weeks 16, 32, and 48. The HRQL assessment included measures of physical function, energy, role function, health distress, cognitive function, social function, home management, sexual dysfunction, depression, and life satisfaction. Significant improvements in hematocrit levels were observed in the r-HuEPO-treated group (P < 0.0001), and no changes were seen in the untreated group. Correction of anemia (hematocrit > or = 36) occurred in 79% of r-HuEPO-treated patients and 0% of control patients. Significant improvements in assessments of energy (P < 0.05), physical function (P < 0.05), home management (P < 0.05), social activity (P < 0.05), and cognitive function (P < 0.05) were found for the r-HuEPO-treated group. No changes were observed in the control group, except for a decrease in physical function (P < 0.05). Between-group differences favoring the r-HuEPO-treated group were found for energy (P < 0.05) and physical functioning (P < 0.05). In patients receiving r-HuEPO, significant improvements were seen in hemotocrit levels, and these increases resulted in improvements in HRQL.

Adolescent↗

PubMed1996

Prognostic factors for functional outcome of total knee replacement: a prospective study.

BACKGROUND: The objective was to investigate whether baseline physical functioning, medical, psychosocial, or demographic variables predict functional outcome in patients undergoing total knee replacement. METHODS: A prospective cohort study was performed between December 1991 and August 1993. Consecutive, unilateral tricompartmental total knee replacement patients aged > or = 55 yr with osteoarthritis, who met criteria, were enrolled and evaluated one month before and 3 months after total knee replacement. The primary outcome measure was the Medical Outcome Study 36 Item Short Form Health Survey (known as the SF36) Physical Functioning Scale score. The outcome evaluator was not involved in patient care. RESULTS: A hierarchical multiple regression analysis was performed to calculate the contribution of baseline variables to TKR outcome. Of the 27% of outcome variance explained by the model, demographic variables accounted for 4%, psychosocial variables (motivation, role functioning-emotional, and social functioning) for 19% (p = .013), medical variables (previous reconstruction, comorbidity, body mass index, bodily pain) for 2%, and baseline physical function for 2%. CONCLUSIONS: Psychosocial variables are significantly related to total knee replacement functional outcome. Assessment of baseline psychological and social functioning may identify a subset of patients at risk for worse outcome. Specific interventions for these patients should be developed and evaluated as components of patient management prior to and after the procedure.

Activities of Daily Living↗

PubMed2006

[Nursing experience with reducing delirium in a hospitalized elderly patient].

This article describes an experience of providing nursing care to an eighty year-old patient with urinary tract infection (UTI). The author cared for this patient in the role of clinical geriatric nurse specialist from May 11 to 23 in 2005. Through comprehensive assessment, careful review of medical records, contact with family and nursing home healthcare workers, it was determined that the patient's cognition and physical function declines were due to delirium resulting from the last time the patient had been hospitalized in the intensive care unit (ICU). In order to prevent incidents of delirium, three nursing goals were set: controlling infection, avoidance of delirium recurrence, and recovery of prior levels of physical function and self-care ability. Nursing interventions used included UTI control, tube and catheter removal as early as possible, control of environmental factors, and muscle strength and exercise training. After two weeks of care, the patient could take food orally and the nasogastric (NG) tube had been successfully removed. Physical function and self-care ability improved from "dependent" to "partial assistance". Although UTI was controlled, removal of the foley tube failed due to prostate hypertrophy. No delirious event occurred during hospitalization and cognitive functions improved. From this experience, early assessment and intervention should be conducted for high-risk elderly patients in order to prevent delirious events and declines in cognitive and physical functions. The author hopes this case report will prove a useful reference to nurses charged with caring for elderly patients at risk for delirium.

Aged↗

PubMed2003

Gulf war illness--better, worse, or just the same? A cohort study.

OBJECTIVES: Firstly, to describe changes in the health of Gulf war veterans studied in a previous occupational cohort study and to compare outcome with comparable non-deployed military personnel. Secondly, to determine whether differences in prevalence between Gulf veterans and controls at follow up can be explained by greater persistence or greater incidence of disorders. DESIGN: Occupational cohort study in the form of a postal survey. PARTICIPANTS: Military personnel who served in the 1991 Persian Gulf war; personnel who served on peacekeeping duties to Bosnia; military personnel who were deployed elsewhere ("Era" controls). All participants had responded to a previous survey. SETTING: United Kingdom. MAIN OUTCOME MEASURES: Self reported fatigue measured on the Chalder fatigue scale; psychological distress measured on the general health questionnaire, physical functioning and health perception on the SF-36; and a count of physical symptoms. RESULTS: Gulf war veterans experienced a modest reduction in prevalence of fatigue (48.8% at stage 1, 43.4% at stage 2) and psychological distress (40.0% stage 1, 37.1% stage 2) but a slight worsening of physical functioning on the SF-36 (90.3 stage 1, 88.7 stage 2). Compared with the other cohorts Gulf veterans continued to experience poorer health on all outcomes, although physical functioning also declined in Bosnia veterans. Era controls showed both lower incidence of fatigue than Gulf veterans, and both comparison groups showed less persistence of fatigue compared with Gulf veterans. CONCLUSIONS: Gulf war veterans remain a group with many symptoms of ill health. The excess of illness at follow up is explained by both higher incidence and greater persistence of symptoms.

Age Factors↗

PubMed2004

Development of a cancer-specific anterior skull base quality-of-life questionnaire.

OBJECT: The goal of this study was to develop a disease-specific, multidimensional quality of life (QOL) assessment instrument for patients undergoing surgical extirpation of anterior skull base tumors. METHODS: This investigation included 35 patients who had been surgically treated for more than 3 months before the study was begun. Relevant QOL questions were generated from a review of the literature and interviews with health professionals, patients, and their caregivers. The initial multidimensional, 80-item questionnaire was reduced to a 35-item questionnaire by using standard psychometric criteria. Six relevant domains were identified using factor analysis: performance, physical function, vitality, pain, specific symptoms, and influence on emotions. The internal consistency of the instrument had a correlation coefficient of 0.8 and a reliability coefficient (test-retest reliability) of 0.9. The validity of the construct was assessed by testing whether the clinical variable of the patient influenced his QOL domain score as hypothesized. Patients older than 60 years of age had significantly poorer scores in the domains of performance and physical function than younger patients. Patients with malignant tumors had significantly poorer scores in the domains of specific symptoms, influence on emotions, physical function, and performance compared with patients with benign tumors. Radiotherapy was associated with poorer scores in the domains of specific symptoms and influence on emotions. Comorbidity was associated with poor physical function scores. Using the final questionnaire, we prospectively evaluated the QOL of 12 additional patients before they underwent surgery and again between 5 and 6 months postoperatively to test the utility and validity of the instrument further. Again, significantly poorer QOL scores were recorded for patients with malignancy. CONCLUSIONS: The proposed questionnaire appears to be sufficiently reliable and valid in estimating a patient's QOL after extirpation of anterior skull base tumors. The instrument can be used in face-to-face interviews and via electronic or regular mail.

Activities of Daily Living↗

PubMed2006

[A short-term efficacy and safety study of infliximab in active ankylosing spondylitis].

OBJECTIVE: To evaluate the efficacy and safety profile of a loading regimen of the anti-TNFalpha antibody infliximab in ankylosing spondylitis (AS). METHODS: This was an open-labeled trial. Subjects eligible for this study were adults with a diagnosis of definite AS. Active disease was a Bath AS disease activity index (BASDAI) > or = 4 and spinal pain VAS > or = 4. Concurrent stable treatment with nonsteroidal anti-inflammatory drugs was permitted during the study. Subjects were not permitted to be on methotrexate, systemic corticosteroids, cytotoxic drugs or disease-modifying anti-rheumatic drugs for various time periods before screening. Infliximab 5 mg/kg was infused at weeks 0, 2, 6. All patients were followed up to 10 weeks. The primary endpoint was proportion of ASAS 20 responders at week 10. The secondary endpoints were the proportion of subjects achieving an ASAS partial remission, the change from baseline in bath AS functional index and in the physical component summary score of the short form-36 in health survey questionnaire at week 10. Other secondary endpoints, related to reducing signs and symptoms of AS and improving range of motion and physical function, were evaluated. RESULTS: 63 patients (79% males, 90% HLA-B(27)(+), median age 32 yr, median disease duration 10 yr) completed the treatment. The proportion of ASAS 20 responders at 2, 6, 10 week was 75%, 84%, 84% respectively. The proportion of ASAS partial remission patients at 2, 6, 10 week was 10%, 21%, 30% respectively. Results for other secondary efficacy endpoints showed that infliximab could provide substantial benefits to patients with AS by reducing clinical signs and symptoms and improving range of motion, physical function, and quality of life. Sixty-five percent of subjects reported treatment-related adverse events. The most frequently occurred were upper respiratory tract infection and skin and appendages. Secondary was elevation of liver enzymes. Most treatment-related adverse events were mild to moderate in severity. Two patients had serious dermatitis and one stopped treatment owing to an infusion reaction. Short-term follow up indicated that effect of Remicade lasted for about 2 to 8 months without any new side effect. CONCLUSION: A loading regimen of infliximab demonstrated consistent evidence of efficacy and was well tolerated in the treatment of active AS.

Adolescent↗

PubMed2001

Physical and functional interactions between Drosophila TRAF2 and Pelle kinase contribute to Dorsal activation.

Signaling through the Toll receptor is required for dorsal/ventral polarity in Drosophila embryos, and also plays an evolutionarily conserved role in the immune response. Upon ligand binding, Toll appears to multimerize and activate the associated kinase, Pelle. However, the immediate downstream targets of Pelle have not been identified. Here we show that Drosophila tumor necrosis factor receptor-associated factor 2 (dTRAF2), a homologue of human TRAF6, physically and functionally interacts with Pelle, and is phosphorylated by Pelle in vitro. Importantly, dTRAF2 and Pelle cooperate to activate Dorsal synergistically in cotransfected Schneider cells. Deletion of the C-terminal TRAF domain of dTRAF2 enhances Dorsal activation, perhaps reflecting the much stronger interaction of the mutant protein with phosphorylated, active Pelle. Taken together, our results indicate that Pelle and dTRAF2 physically and functionally interact, and that the TRAF domain acts as a regulator of this interaction. dTRAF2 thus appears to be a downstream target of Pelle. We discuss these results in the context of Toll signaling in flies and mammals.

Animals↗

PubMed2001

Effects of a functional therapy program on motor abilities of children with cerebral palsy.

BACKGROUND AND PURPOSE: The purpose of this study was to determine whether the motor abilities of children with spastic cerebral palsy who were receiving functional physical therapy (physical therapy with an emphasis on practicing functional activities) improved more than the motor abilities of children in a reference group whose physical therapy was based on the principle of normalization of the quality of movement. SUBJECTS: The subjects were 55 children with mild or moderate cerebral palsy aged 2 to 7 years (median=55 months). METHODS: A randomized block design was used to assign the children to the 2 groups. After a pretest, the physical therapists for the functional physical therapy group received training in the systematic application of functional physical therapy. There were 3 follow-up assessments: 6, 12, and 18 months after the pretest. Both basic gross motor abilities and motor abilities in daily situations were studied, using the Gross Motor Function Measure (GMFM) and the self-care and mobility domains of the Pediatric Evaluation of Disability Inventory (PEDI), respectively. RESULTS: Both groups had improved GMFM and PEDI scores after treatment. No time x group interactions were found on the GMFM. For the PEDI, time x group interactions were found for the functional skills and caregiver assistance scales in both the self-care and mobility domains. DISCUSSION AND CONCLUSION: The groups' improvements in basic gross motor abilities, as measured by the GMFM in a standardized environment, did not differ. When examining functional skills in daily situations, as measured by the PEDI, children in the functional physical therapy group improved more than children in the reference group.

Analysis of Variance↗

PubMed1985

Psychological outcome of extremity sarcoma survivors undergoing amputation or limb salvage.

When compared to amputation, limb salvage procedures for extremity sarcomas have been advocated because of potential functional benefits and presumed psychological-outcome advantages. The purpose of this study was to compare psychological outcomes between survivors who underwent either amputation or limb salvage procedures for extremity sarcomas. Fifteen amputees and 20 patients with salvaged limbs (mean age, 37.9 years; range, 15 to 71 years) were evaluated 1 to 5 years after surgery for extremity sarcomas. Demographic and medical information was obtained and cognitive functioning, affect, mood, body image, physical functioning, global psychological adjustment to illness and surgery, and lifetime prevalence of psychiatric disorders before and after surgery were assessed. Two patients were excluded because of the presence of an incapacitating organic mental syndrome. The remaining patients, 14 amputees and 19 patients with salvaged limbs, had a variety of soft-tissue and bone sarcomas. No significant differences were found between the groups in age, sex, marital status, surgically involved extremity, chemotherapy status, and social class at the time of surgery and interviews. There were no significant differences between the groups in scores of cognitive capacity, symptoms, mood, body image changes, global physical functioning, global adjustment to illness and surgery, and lifetime prevalence of psychiatric disorders before or after surgery. Most patients revealed only mild psychological symptoms and 55% demonstrated good to excellent adjustment to their surgeries and diseases. There were no significant differences in measures of psychological outcome for patients with extremity sarcomas who underwent limb salvage procedures compared to those who underwent amputation. A psychological-outcome advantage of limb-salvage surgery compared to amputation has yet to be demonstrated.

Adaptation, Psychological↗

PubMed1996

Transient congenital hypothyroidism and hyperthyrotropinemia: normal thyroid function and physical development at the ages of 6-14 years.

Since the introduction of screening programs for congenital hypothyroidism, transient disturbances of thyroid function, especially transient congenital hypothyroidism and hyperthyrotropinemia, mostly due to iodine deficiency or contamination have been observed with variable frequencies. This study was carried out to reevaluate the thyroid function and physical development of 61 schoolchildren with transient congenital hypothyroidism or transient congenital hyperthyrotropinemia. Abnormalities were observed in 3 children. Thyroid function and growth were normal in all children, except 2 with moderately elevated TSH levels at the age of 7.7 and 10 yr in the presence of normal thyroid hormone levels. In 1 child, the TSH elevation was due to an ectopic hemithyroidea; in the other child, an unknown familial cause was suggested. In 1 girl (aged 12 yr), a euthyroid goiter caused by autoimmune thyroiditis was detected. We conclude from our investigation that frequent monitoring of thyroid function in children with transient congenital hypothyroidism or transient congenital hyperthyrotropinemia is not necessary during childhood if, postnatally, thyroid function recovered spontaneously. However, the growth and development of children with neonatal thyroid dysfunction should be followed, and if abnormalities occur, thyroid function tests are essential.

Adolescent↗

PubMed1989

Physical performance measures in aging research.

Evaluation of physical functioning plays a valuable role in clinical geriatrics as well as in aging research. Physical functioning has generally been assessed through self- or proxy-report. An important addition to this form of assessment is the use of performance measures of physical function, in which individuals are asked to actually perform specific tasks and are evaluated using standardized criteria. Although there has been limited methodological work on physical performance instruments, this approach offers a number of potential advantages. Several performance assessments have been developed that correlate highly with other measures of health status and predict need for long-term care and mortality. It is suggested that more widespread use be made of physical performance assessments and that they be evaluated as measures of functioning in cross-national studies, as indicators of change in functioning over time, as endpoints in intervention studies, as tools for identifying persons functioning at high levels, and as sources of relevant information for the clinician.

Activities of Daily Living↗

PubMed2005

Development of the Qualeffo-31, an osteoporosis-specific quality-of-life questionnaire.

INTRODUCTION: Vertebral deformities are a common consequence of osteoporosis and are known to decrease quality of life. The Qualeffo-41 is a quality-of-life questionnaire especially developed for measuring quality of life in patients with vertebral deformities. It consists of 41 questions arranged in five domains: pain, physical function, social function, general health perception, and mental function. The objectives of this study were: (1) to develop a shorter version of the Qualeffo-41 by removing redundant questions; and (2) to investigate the scale characteristics, reliability, and validity of this shorter version. METHODS: The study was performed using data from the Qualeffo validation study and the Multiple Outcomes of Raloxifene Evaluation (MORE) study. The analyses were performed in patients with vertebral deformities (n=579). Factor analysis on polychoric correlations and an item response theory (IRT) model, i.e., the generalized partial credit model (GPCM), were used to create a shorter version of Qualeffo-41. Using GPCM, scoring weights were computed for all items. RESULTS: Three items were removed from the data set because of too many missing values. Factor analysis identified three instead of five domains: (1) pain, (2) physical function, and (3) mental function. Five items had factor loadings <0.4 and were not included in the GPCM. After excluding several items, the domains pain (four items), physical function (18 items), and mental function (nine items) showed a good, reasonable, and excellent fit, respectively. This indicates that the mental function domain and the pain domain are more unidimensional than the physical function domain. All three domains showed a very high correlation (r > or =0.95) with the corresponding domains of the Qualeffo-41. CONCLUSIONS: Qualeffo-31 was developed, consisting of three domains with a reasonable to excellent fit to the GPCM. Although the fit to the GPCM supports the construct validity of the Qualeffo-31, validation in a new study should be performed before using it in practice.

Activities of Daily Living↗

PubMed2000

The integrins alpha3beta1 and alpha6beta1 physically and functionally associate with CD36 in human melanoma cells. Requirement for the extracellular domain OF CD36.

Lateral association between different transmembrane glycoproteins can serve to modulate integrin function. Here we characterize a physical association between the integrins alpha(3)beta(1) and alpha(6)beta(1) and CD36 on the surface of melanoma cells and show that ectopic expression of CD36 by CD36-negative MV3 melanoma cells increases their haptotactic migration on extracellular matrix components. The association was demonstrated by co-immunoprecipitation, reimmunoprecipitation, and immunoblotting of surface-labeled cells lysed in Brij 96 detergent. Confocal microscopy illustrated the co-association of alpha(3) and CD36 in cell membrane projections and ruffles. A requirement for the extracellular domain of CD36 in this association was shown by co-immunoprecipitation experiments using surface-labeled MV3 melanoma or COS-7 cells that had been transiently transfected with chimeric constructs between CD36 and intercellular adhesion molecule 1 (ICAM-1) or with a truncation mutant of CD36. CD36 is known to engage in signal transduction and to localize to membrane microdomains or rafts in several cell types. Toward a mechanistic explanation for the functional effects of CD36 expression, we demonstrate that in fractionated Triton X-100 lysates of the MV3 cells stably transfected with CD36, CD36 was greatly enriched with the detergent-insoluble fractions that represent plasma membrane rafts. Significantly, when these fractionated lysates were reprobed for endogenous beta(1) integrin, it was found that a 4-fold increase in the proportion of the mature protein was contained within the detergent-insoluble fractions when extracted from the CD36-transfected cells compared with MV3 cells transfected with vector only. These results suggest that in melanoma cells CD36 expression may induce the sequestration of certain integrins into membrane microdomains and promote cell migration.

Animals↗

PubMed2003

Outpatients with low back pain: an analysis of the rate per day of pain improvement that may be expected and factors affecting improvement.

OBJECTIVE: To determine, only for those who improved, the rate per day of improvement expected for outpatients with low back pain and to identify factors influencing pain improvement: pain duration before assessment, pain and physical functioning levels before assessment, age, sex, and affective factors. It was presupposed that affective factors would have an appreciable effect. DESIGN: The LIFEware System database was used. Analysis was performed on 1292 records for the Painfree measure and 1562 records for the LIFEware System Visual Analog Scale. Measures for pain, physical functioning, and affective well-being were analyzed for 0-30 days vs. >30 days of pain duration before assessment using classification and regression trees analysis. RESULTS: In both Painfree and LIFEware System Visual Analog Scale, 73% improved and 27% did not improve. Of those who improved, outpatients with 0-30 days of pain duration before assessment had higher per day rates of improvement than the >30 days group. Factors affecting improvement were, in descending order, more initial pain, younger age, and positive affective well-being; physical functioning did not affect rate of improvement. Factors affecting improvement for outpatients with >30 days since onset were, in descending order, more initial pain and better initial physical functioning; age and affective well-being were not factors. For all, neither sex nor the "satisfaction with life in general" question affected low back pain rate of improvement. CONCLUSION: Findings may be useful for clinical application because the actual rate of improvement may be compared with the expected rate. There was only a weak relationship shown between affective factors and pain improvement.

Adolescent↗

PubMed1989

CD19 is functionally and physically associated with surface immunoglobulin.

The pan-B and B cell-specific sIg and CD19 antigens are functionally and physically associated in the presence of anti-Ig mAb. Incubation of B cells with anti-Ig antibodies causes rapid, specific, reversible, concentration-dependent, and unidirectional comodulation of CD19 on every mature B cell studied. Comodulation is produced by mAbs specific for the gamma, mu, kappa, and lambda chains of Ig, and by at least one idiotype-specific mAb. Comodulation is observed using 15 CD19-specific mAbs that detect at least three different CD19 epitopes. Of 18 surface antigens studied, only CD19 is comodulated. Loss of sIg and CD19 occurs concurrently during anti-Ig modulation and demonstrates a comparable dependence on anti-Ig concentration, suggesting that these are parallel rather than serial events. Incubation with anti-Ig specifically cocaps and suggests internalization of anti-CD19 mAb. Comodulation of sIg and CD19 by anti-Ig but not anti-CD19 mAbs suggests that ligand binding enables sIg to then interact with CD19. We propose that CD19 is a component of the B cell antigen receptor and suggest that it could facilitate signal transduction by sIg-antigen complexes.

Animals↗