CORRELATION OF PERCEPTUAL FACTORS WITH REHABILITATION OF HEMIPLEGIC PATIENTS.
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Longitudinal data that track the course of disability and well-being are being collected for older populations, with remeasurements taken at annual or longer intervals. These can miss much of the genuine dynamics that older people experience. This analysis uses a data set with fine-grained data on health and function. It involves 165 persons ages 55 and over who were followed for minimum of 1 year (up to 2 years) after hospitalization for a chronic condition (six of which were specified). Within that period, each person had nine separate contacts for assessment of cognitive, physical, social, and emotional function. Respondents also kept health diaries continuously for a year. This article reports patterns of change for the diaries only, focusing on two items recorded daily: self-rated health and activity level. We analyze the data visually, by plots of these items over time for each person, and statistically, by numerical indicators of changes and levels for the items. Differentials in changes and levels by patient characteristics (e.g., age, sex, marital status, diagnosis) were explored. Most people experience a posthospital improvement, with the majority attaining their usual levels of well-being and activity, despite their serious illness. But this recovery is usually interrupted by episodes of low well-being and activity and even further hospital stays. Statistical analyses show that, overall, physical health suffers a small decline over the year whereas activity levels tend to improve. Health is worst and activity levels lowest, gains are smallest and declines largest, for elderly (ages 75 and older) men and for nonmarried people, especially men. Together, the visual and statistical analyses confirm the profound dynamics in health and function that middle-aged and older people with chronic conditions experience.
OBJECTIVE: Previous studies have found associations of magnetic resonance imaging (MRI) signal hyperintensities with depression in the elderly. The present study investigates the association in a younger community sample (age 60-64 years) of depressed subjects and comparison groups for potential mediating and confounding variables. METHOD: A subsample of 475 persons 60-64 years of age from a larger community survey underwent brain MRI scans. White matter hyperintensities were quantified by using an automated procedure, and basal ganglia hyperintensities were quantified by using semiquantitative visual ratings. The study also assessed depressive symptoms and use of antidepressant medication. Potential mediating or confounding variables assessed included physical disability, hypertension, stroke, diabetes, head injury, cortisol, thyroid-stimulating hormone, cognitive functioning, smoking, and alcohol use. RESULTS: Depressive symptoms were found to be related to total brain white matter hyperintensities but not to basal ganglia hyperintensities. However, associations disappeared when statistical adjustment was made for physical disability and smoking. CONCLUSIONS: Depressive symptoms are related to white matter hyperintensities in mid-adult life in a community sample. Physical disability appears to play an important role in this association.
The generally observed decrease in physical activity with age has its influence on energy requirements and to a lesser extent on micronutrient requirements of the elderly. In this study it was hypothesized that physically active people can more easily obtain their recommended nutrient intake without becoming overweight, because of their increased energy needs. Nutritional intake, body composition and vitamin status were assessed in two groups of women aged 60-79 years. The groups showed large differences in pattern and level of physical activity as estimated by a previously described questionnaire. Dietary intake was assessed by dietary history. Body composition was assessed using anthropometric measures and bioelectrical impedance. Blood levels of haematological parameters, blood lipids and several vitamins were measured. Differences in food consumption were not statistically significant. However, the more physically active women tended to have a food pattern more in line with dietary allowances according to the Dutch guidelines. At the same body height the physically active and sedentary women had body weights of 64.9 +/- 10.9 and 77.1 +/- 12.0 kg (mean +/- SD) respectively (P less than 0.001). Percentage of body fat was higher in the sedentary women. Blood levels did not differ significantly between both groups of women except for higher beta-carotene in the active women.
BACKGROUND: This double-blind study evaluated treatment with zalcitabine-zidovudine, saquinavir-zidovudine, or saquinavir-zalcitabine-zidovudine on the health-related quality of life of HIV-infected adults with CD4 cell counts between 50 and 350 cells/mm3. METHODS: Nine hundred and ninety-three HIV-infected male or female quality of life substudy patients aged 18 years or older, with CD4 cell counts between 50 and 350 cells/mm3 naïve to antiretroviral therapy or with less than 16 weeks of zidovudine therapy, were randomly assigned to one of three daily regimens: zalcitabine 0.75 mg and zidovudine 200 mg every 8 h (ddC/ZDV); saquinavir 600 mg and zidovudine 200 mg every 8 h (SQV/ZDV); or saquinavir 600 mg, zalcitabine 0.75 mg and zidovudine 200 mg every 8 h (SQV/ddC/ZDV). The health-related quality of life was measured using the Medical Outcome Study HIV (MOS-HIV) Health Survey subscale and physical and mental health summary scores, and a global visual analogue scale (VAS) score. The primary health-related quality of life endpoints were the MOS-HIV physical and mental health summary scores. RESULTS: After 24 weeks of treatment, no statistically significant differences were observed between the three treatment groups on physical health and mental health summary scores (global test P = 0.118). After 48 weeks of treatment, statistically significant differences among the groups were observed for physical health and mental health summary scores (global test P = 0.020); no change in physical health summary scores from the baseline were seen in the triple combination therapy, whereas the ddC/ZDV combination therapy group showed decreases from baseline in physical health summary scores (P = 0.008). Six of the 10 individual MOS-HIV subscale scores and the VAS scores showed results consistent with the physical health summary endpoints after 48 weeks of therapy. No statistically significant differences in baseline to 48 week changes in MOS-HIV subscale or summary scores were seen between the ddC/ZDV and SQV/ZDV groups (P > 0.05). CONCLUSIONS: Patients on triple combination therapy maintained their quality of life over 48 weeks compared with significant decreases in the quality of life for ddC/ZDV combination therapy.
The theory of dimension has been widely used in physics to check the validity of formulae. This theory has not been used more frequently in statistics as compared to physics for development of various prediction formulae/equations in applied physiology. An attempt has, therefore, been made in the present investigation to evolve formulae for estimation of lung volumes from cubic function of height based on dimensional considerations in boys and girls 8-13 and 16-21 years of age.
The aim of the present paper was: (1) to find out if there were any differences in the nonspecific immunological pattern of peripheral blood neutrophil between two breeds of horses (AA and SA); (2) to evaluate the effects of an exercise in the aerobic-anaerobic threshold. This has been observed in a group of 11 untrained horses (6 SA and 5 AA) of 2.5 years old. No statistically significant differences were found in the different stages of immune response between the rest and immediately after physical exercise to two breeds. However, the chemotaxis was significant higher at rest in the AA than SA breed. A positive correlation was found at rest between the phagocytic and oxidative metabolism activity for AA breed and a negative correlation too between the adherence and chemotaxis with phagocytic capacity, immediately after exercise test, for the same breed.
OBJECTIVE: To assess whether gestational weight gain (GWG) during pregnancy is linked to intimate partner violence (IPV). METHODS: A total of 394 women being delivered at term at Rio de Janeiro public maternities from March to October 2000 were randomly selected. The Revised Conflict Tactics Scales were used to assess IPV and GWG was expressed through the Net Weight Gain (NWG) indicator. Multiple linear regression was used to control for socioeconomic, demographic, reproductive, and nutritional confounding factors, as well as lifestyle factors such as alcohol, drug, and tobacco consumption. RESULTS: Even after adjustment, increased physical abuse from male partners was statistically associated with lesser weight gain during pregnancy. Compared with women unexposed to IPV, those with the highest physical abuse score showed deficits of 3245 g and 3959 g, respectively, according to 2 models that did and did not control for lifestyles factors. CONCLUSION: Physical violence between intimate partners constitutes an independent risk factor for GWG deficit during pregnancy.
Born-Oppenheimer (BO) potentials for the ground and first-excited electronic states of He2+ are determined using high level ab initio techniques for internuclear separations R of 1.2-100 bohrs and accurately fit to analytical functions. In the present formulation, the BO potentials are nuclear mass independent, and the corresponding BO approximation is obtained by ignoring four terms of the full rovibronic Hamiltonian. These four Born-Oppenheimer correction (BOC) terms are as follows: (1) mass polarization, (2) electronic orbital angular momentum, (3) first derivative with respect to R, and (4) second derivative with respect to R. In order to enable an exact rovibronic calculation, each of the four BOC terms are computed as a function of R, for the two electronic states and for their coupling, without any approximation or use of empirical parameters. Each of the BOC terms is found to make a contribution to the total energy over at least some portion of the range of R investigated. Interestingly, the most significant coupling contribution arises from the electronic orbital angular momentum term, which is evidently computed for the first time in this work. Although several BOC curves exhibit a nontrivial dependence on R, all are accurately fit to analytical functions. The resulting functions, together with the BO potentials, are used to compute exact rovibronic energy levels for 3He 3He+,3He 4He+) and 4He 4He+. Comparison to available high quality experimental data indicates that the present BOC potentials provide the most accurate representation currently available of both the low- and high-lying levels of the ground electronic state and the bound levels of the excited state.
Larry Locke's timely and well-written introduction to qualitative research procedures will undoubtedly serve its purpose. It makes us reassess our traditional beliefs and practices, educates us on the rudiments of qualitative methodology, and, hopefully, makes us more tolerant and appreciative of alternate ways of conducting research. Although Locke focuses his paper on pedagogical research issues, it is important to realize that many other sub-disciplines within the general field of physical education also utilize qualitative procedures. For example, 10 years ago Martens (1979) called for a paradigm shift in sport psychology by appealing to researchers to abandon their labs and to embark on naturalistic field studies. While North American sport psychologists, and psychologists in general, have been slow to formalize qualitative techniques, the European psychology community has been much more active (e.g., Ashworth, Giorgi, & de Koning, 1986). Perhaps Locke's article will encourage researchers in all our sub-disciplines to consider the utility of qualitative research. Hopefully, readers will treat Locke's article as an introduction to the broad area of qualitative research and not as a rigorous set of procedures for conducting participant observation research in school physical education studies. Additionally, it must be recognized that there are other approaches and other applications, that the area has its critics and its unresolved methodological problems, and that qualitative research does not necessarily exclude the application of formalized data analyses. Keeping these issues in mind, the addition of qualitative approaches to our repetoire of research methodologies can only enhance the quality of research in physical education and exercise and sport science.
Measurement of health-related quality of life (HR-QoL) is used in patients with haemophilia as a way of assessing the effectiveness of health care, especially as cure is not possible. We report the first such study on patients with chronic coagulation disorders in Australia, using The RAND 36-item Health Survey 1.0 (SF-36), a standardized validated questionnaire combined with a semistructured interview. The mean scores for the eight domains of the SF-36 ranged from 52.5 +/- 42.1 for physical role to 80.0 +/- 20.0 for social functioning. Comparison with normative data obtained from the Australian Bureau of Statistics (ABS) demonstrated a reduction in all domains in this population with statistically significant reductions in general health, physical role limitation and vitality. Comparison with other studies indicates that the HR-QoL of patients with haemophilia and von Willebrand's disorder in Australia is comparable with other Western countries, reflecting the overall similar quality of care available to these patients. This study also provides a good cross-sectional view of the psychosocial factors of life in patients in Australia and recognizes the positive family support available to this population, while raising relevant shortcomings in schools and at the workplace that need to be studied further in a controlled manner.
AIM: This paper reports a study evaluating the relationship between social and community level supports and physical activity and dietary behaviours among a low-income Latino population with multiple chronic conditions. BACKGROUND: With consistently lower physical activity than whites and documented nutritional deficiencies, Latinos in the United States of America represent a disproportionate share of the population with chronic illness. This pattern of health disparities is seen across countries, where there is a struggle to raise the health status of low-income, immigrant and aboriginal communities. Social-ecological theories of health behaviour stress the importance of considering social and community support for health behaviour, and represent a useful framework for considering ways to improve physical activity and nutrition for immigrant and aboriginal groups. METHOD: We report here on data from a baseline assessment of 200 patients from a health clinic in the United States of America serving a low-income, primarily Latino population. Participants were enrolled in Resources for Health, a randomized controlled trial to promote multi-level support for chronic illness self-management. Measures included self-reported physical activity, dietary behaviour and multi-level support for chronic illness management as well as demographic data. Baseline data reported on here were collected between February 2002 and September 2003. FINDINGS: Use of multi-level supports (e.g. family, individual and healthcare provider) was statistically significantly associated with meeting physical activity guidelines and better dietary behaviours. Being female and having multiple chronic conditions were also associated with better dietary behaviour. These variables explained 20% of the variance in dietary behaviour. CONCLUSION: Results support a social-ecological approach for promoting healthy behaviour in this low-income, primarily Latino sample with multiple chronic conditions. Addressing multiple levels of support for healthy behaviour is important in interventions to improve physical activity and diet, and nurses may be particularly well placed to address such issues for low-income, aboriginal and immigrant patients with chronic conditions.
OBJECTIVE: To evaluate the health-related quality of life in children with functional defecation disorders. METHODS: One hundred children seen consecutively were enrolled and subdivided into three subsets according to the Roma II classification criteria: functional constipation (n = 57), functional fecal retention (n = 29) and nonretentive functional soiling (n = 14). The generic instrument Child Health Questionnaire - Parent Form 50 (CHQ-PF50), was used to measure quality of life and to assess the impact of these disorders from the point of view of parents. The instrument measures physical and psychosocial wellbeing in 15 health domains, each of which is graded on a scale from 0 to 100, with higher values indicating better health and greater wellbeing. Ten of these are then used to obtain two aggregated and summary scores: the physical and psychosocial scores. RESULTS: No statistically significant differences were detected between subsets in terms of demographic or anthropometric characteristics. In 14 domains, children with defecation disorders scored lower than healthy children. When subsets were compared, statistically significant differences were detected between children with nonretentive functional soiling (lower scores) and those with functional constipation. Physical and psychosocial scores for the entire sample were lower than those for the group of healthy children used as controls. CONCLUSIONS: The CHQ-PF50 was considered adequate for demonstrating compromised quality of life in children with functional defecation disorders, as has been reported for other diseases, being a useful tool for making treatment decisions and for patient follow-up.
OBJECTIVE: To investigate the efficacy and tolerability of a course of 5 injections of hyaluronan (HA) given at intervals of one week in patients with symptomatic, mild to moderate osteoarthritis (OA) of the knee. METHODS: A double blind, randomized, parallel group, multicenter (17 centers), saline vehicle-controlled study was conducted over 18 weeks. Patients received either 25 mg (2.5 ml) HA in a phosphate buffered solution or 2.5 ml vehicle containing only the buffer by intraarticular injection. Five injections were given at one week intervals and the patients were followed for a further 13 weeks. The Western Ontario McMaster (WOMAC) OA instrument was used as the primary efficacy variable and repeated measures analysis of covariance was used to compare the 2 treatments over Weeks 6, 10, 14, and 18. RESULTS: Of 240 patients randomized for inclusion in the study, 223 were evaluable for the modified intention to treat analysis. The active treatment and control groups were comparable for demographic details, OA history, and previous treatments. Scores for the pain and stiffness subscales of the WOMAC were modestly but significantly lower in the HA-treated group overall (Weeks 6 to 18; p < 0.05) and the statistically significant difference from the control was not apparent until after the series of injections was complete. The physical function subscale did not reach statistical significance (p = 0.064). Tolerability of the procedure was good and there were no serious adverse events that were considered to have a possible causal relationship with the study treatment. CONCLUSION: Intraarticular HA treatment was significantly more effective than saline vehicle in mild to moderate OA of the knee for the 13 week postinjection period of the study.
The aim of this cross-sectional study was to investigate whether two types of physical exercise affect the growing skeleton differently. We used calcaneal quantitative ultrasound measurements (QUS) and dual-energy X-ray absorptiometry (DXA) for measurement of bone mineral density (BMD), and to test how QUS values reflect the axial DXA values in these various study groups. A total of 184 peripubertal Caucasian girls aged 11-17 years (65 gymnasts, 63 runners, and 56 nonathletic controls) were studied. Weight, height, stage of puberty, years of training, and the amount of leisure-time physical activity were recorded. Broadband ultrasound attenuation (BUA) and sound of speed (SOS) through the calcaneus were measured. The BMD of the femoral neck and the lumbar spine were measured by DXA. The differences in mean values of bone measurements among each exercise group were more evident in pubertal than prepubertal girls. The mean BUA and SOS values of the pubertal gymnasts were 13.7% (77.8 dB/MHz versus 68.4 dB/MHz, P < 0.05) and 2.2% (1607.7 m/s versus 1572.4 m/s, P < 0.001) higher than of the controls, respectively. The mean BMD of the femoral neck in the pubertal gymnasts and runners was 20% (0.989 g/cm2 versus 0.824 g/cm2, P < 0.001) and 9.0% (0.901 g/cm2 versus 0.824 g/cm2, P < 0.05) higher than in the controls, respectively. The amount of physical activity correlated weakly but statistically significantly with all measured BMD and ultrasonographic values in the pubertal group (r = 0.19-0.35). The correlation between ultrasonographic parameters and BMD were weak, but significant among pubertal runners (r = 0.47-0.55) and controls (r = 0.39-0.42), whereas the DXA values of the femoral neck and the ultrasonographic parameters of the calcaneus did not correlate among highly physically active gymnasts. By stepwise regression analysis, physical activity accounted for much more of the variation in the DXA values than the ultrasonographic values. We conclude that the beneficial influence of exercise on bone status as measured by ultrasound and DXA was evident in these peripubertal girls. In highly active gymnasts the increase of the calcaneal ultrasonographic values did not reflect statistically significantly the BMD values of the femoral neck.
The purpose of this article is to provide an overview of neural networks and their applications in physical medicine and rehabilitation. Conventional statistical models may present certain limitations that can be overcome by neural networks. We show what neural networks are, how they "learn" regularities from the data, and how they can classify previously unseen cases. We present advantages and disadvantages of using neural networks and compare them with regression models. We explain how neural networks can be used as statistical tools for making inferences using the example of a prognostic model that predicts ambulation after spinal cord injury.
BACKGROUND: There is accumulating evidence that individuals with multiple sclerosis (MS) are less physically active than nondiseased populations. One method for increasing the level of participation in physical activity among MS patients involves the identification of factors that correlate with physical activity and that are modifiable by a well-designed intervention. PURPOSE: This study adopts a social cognitive perspective and examines self-efficacy, enjoyment, social support, and disability as correlates of participation in physical activity among individuals with MS. METHODS: We recruited 196 individuals with a diagnosis of MS from the Midwest region of the United States. The participants completed a battery of questionnaires and then wore a belt with an accelerometer for a 7-day period. The data were analyzed using covariance modeling. RESULTS: Enjoyment (gamma=.38, p<.001), social support (gamma=.15, p<.05), and disability (gamma=.18, p<.01) had statistically significant direct relations with self-efficacy, and self-efficacy (beta=.29, p<.001) and enjoyment (gamma=.28, p<.001) had statistically significant direct relations with physical activity. CONCLUSIONS: Future researchers should consider examining self-efficacy and enjoyment as possible components of an intervention that is designed to increase physical activity participation in MS patients.
Measurement of cutaneous vibrotactile thresholds may be useful for assessment of the functional integrity of the somatosensory system. To validate a rapid method of determining vibrotactile thresholds that uses a commercially available electromechanical device, vibrotactile thresholds were compared with standardized physical examination findings of sensory function and electrophysiological parameters in 79 patients referred to the Mount Sinai Hospital Neurophysiology Laboratory for clinical electrophysiological evaluation. A statistically significant monotonic association between graded physical examination of vibration perception and vibrotactile threshold was observed for all digits tested in the upper and lower extremities. Statistically significant associations were also observed between vibrotactile thresholds and a variety of electrophysiological measures of the median, ulnar, tibial, peroneal, and sural nerves. The strongest associations were observed between great toe vibrotactile thresholds and late response latencies measured in nerves in the lower extremities. Determination of vibrotactile thresholds may be useful in settings where quantitative measures of large fiber nerve function are desirable and electrophysiological study is not feasible.