Maintaining independence in older people Beswick, AD; Gooberman-Hill, R; Smith, A ...
Reviews in clinical gerontology,
05/2010, Volume:
20, Issue:
2
Journal Article
Appropriate social and medical interventions may help maintain independence in older people. Determinants of functional decline, disability and reduced independence are recognized and specific ...interventions target the treatment of clinical conditions, multiple health problems and geriatric conditions, prevention of falls and fractures, and maintenance of physical and cognitive function and social engagement. Preventive strategies to identify and treat diverse unmet needs of older people have been researched extensively. We reviewed systematically recent randomized controlled trials evaluating these ‘complex’ interventions and incorporated the findings of 21 studies into an established meta-analysis that included 108,838 people in 110 trials. There was an overall benefit of complex interventions in helping older people to live at home, explained by reduced nursing home admissions rather than death rates. Hospital admissions and falls were also reduced in intervention groups. Benefits were largely restricted to earlier studies, perhaps reflecting general improvements in health and social care for older people. The wealth of high-quality trial evidence endorses the value of preventive strategies to help maintain independence in older people.
Acquired cutis laxa (generalized acquired elastolysis) is a condition of unknown etiology characterized by a degeneration of elastic fibers in the skin, resulting in laxity with reduced elastic ...recoil. We describe a patient with acquired cutis laxa associated with an underlying heavy chain deposition disease. Direct immunofluorescence testing of lesional skin demonstrated immunoglobulin G deposition on elastic fibers, suggesting that in some cases, cutis laxa may have an immune-mediated etiopathogenesis.
Neurotrophin-3 Prevents the Proximal Accumulation of Neurofilament Proteins in Sensory Neurons of Streptozocin-Induced Diabetic
Rats
Nicola M. Sayers 1 ,
Lisa J. Beswick 1 ,
Alicia Middlemas 1 ,
...Nigel A. Calcutt 2 ,
Andrew P. Mizisin 2 ,
David R. Tomlinson 1 and
Paul Fernyhough 1
1 School of Biological Sciences, University of Manchester, Manchester, U.K
2 Department of Pathology, University of California at San Diego, La Jolla, California
Address correspondence and reprint requests to Dr. Paul Fernyhough, 1.124 Stopford Bldg., School of Biological Sciences, University
of Manchester, Oxford Road, Manchester M13 9PT, U.K. E-mail: paul.fernyhough{at}man.ac.uk
Abstract
The relation between neurofilament expression and/or phosphorylation in the proximal versus distal components of the sensory
peripheral neuraxis was studied and related to disorders in structure and function of the distal axon of streptozocin (STZ)-induced
diabetic rats studied for 14 weeks. The ability of neurotrophin-3 (NT-3) to prevent abnormalities in neurofilament biology
was also investigated. Compared with age-matched controls, neurofilament heavy (NF-H) (3.3-fold) and neurofilament medium
(NF-M) (2.5-fold), but not neurofilament light (NF-L), subunits accumulated in the proximal axon of sensory neurons of the
lumbar dorsal root ganglia (DRG) in untreated diabetic rats. Neurofilament accumulation was prevented by NT-3. Small- and
large-diameter sensory neurons exhibited elevated levels of NF-H protein accumulation and phosphorylation in the DRG of untreated
diabetic rats, levels that were ameliorated by NT-3. The sural nerve of untreated diabetic rats showed a 50% decrease in the
levels of NF-H and NF-M, but not NF-L, subunits; NT-3 only partially normalized the defect in NF-M expression. These observations
were associated with significant lowering of motor and sensory nerve conduction velocity but no alteration in the mean axonal
diameter of myelinated axons in the sural nerve in untreated diabetic rats. It is proposed that the accumulation of NF-H and
NF-M subunits in the proximal axon is an etiologic factor in the distal axon degeneration observed in diabetes.
DRG, dorsal root ganglia
JNK, c-Jun NH2-terminal kinase
ERK, extracellular signal–regulated kinase
FITC, fluorescein isothiocyanate
MNCV, motor nerve conduction velocity
NCV, nerve conduction velocity
NF-H, neurofilament heavy subunit
NF-L, neurofilament light subunit
NF-M, neurofilament medium subunit
NT-3, neurotrophin-3
SAPK, stress-activated protein kinase
SNCV, sensory nerve conduction velocity
STZ, streptozocin
Footnotes
Accepted June 5, 2003.
Received February 10, 2003.
DIABETES
ABSTRACT
Frequent and excessive tanning persists despite a growing understanding of its associated morbidity and mortality, suggesting that ultraviolet radiation may impart rewarding effects beyond ...the assumed cosmetic benefits. To empirically measure putative centrally rewarding properties of ultraviolet radiation (UVR), we assessed the effects of a commercially available tanning bed upon regional cerebral blood flow (rCBF), a measure of brain activity, using single‐photon emission computed tomography (SPECT). Seven frequent salon bed tanners were placed under a UVA/UVB tanning light during two sessions; one session with UVR and the other with filtered UVR (sham UVR). Session order was randomized and subjects were blinded to study order. During the UVR session, relative to sham UVR session, subjects demonstrated a relative increase in rCBF of the dorsal striatum, anterior insula and medial orbitofrontal cortex, brain regions associated with the experience of reward. These changes were accompanied by a decrease in the subjective desire to tan. These findings suggest that UVR may have centrally rewarding properties that encourage excessive tanning.
The National Service Framework for coronary heart disease (CHD) states that cardiac rehabilitation should be provided for all patients who may benefit, and that priority should be given in the first ...instance to those who have survived a myocardial infarction (MI) or undergone revascularisation. 1 This was recently endorsed by the fifth report on the provision of services for patients with heart disease. 2 Previous surveys of provision of cardiac rehabilitation in the UK have shown that patients attending such programmes tend to be male, middle aged, and diagnosed with uncomplicated MI. 3 Little is known of the current UK provision of cardiac rehabilitation or adherence to such programmes in those from traditionally under-represented groups. Table 1 Referral, uptake and completion rates for UK cardiac rehabilitation programmes in the year 2000 Median IQR Range *Number of programmes % of referrals All patients Referred 271 164-424 2-1564 156 Joined 172 101-254 2-1066 153 63 Completed 130 75-186 3-450 133 48 MI patients Referred 160 78-286 0-881 97 Joined 91 49-149 0-446 88 57 Completed 66 31-103 0-425 69 41 Revascularisation patients Referred 86 47-142 0-563 91 Joined 50 22-99 0-407 83 58 Completed 45 13-82 0-367 65 52 Male patients Referred 213 111-334 2-1066 83 Joined 118 66-185 2-747 84 55 Completed 84 43-154 2-329 65 39 Female patients Referred 85 36-130 1-498 83 Joined 36 17-60 1-319 84 42 Completed 27 12-45 0-140 65 32 Patients over 65 years old Referred 142 61-228 0-887 66 Joined 72 37-152 0-596 71 51 Completed 54 30-110 4-212 51 38 Black/Asian patients Referred 5 1-19 0-196 59 Joined 2 0-7 0-127 63 Completed Heart failure patients Referred 0 0-2 0-28 61 Joined 0 0-1 0-12 59 Completed 0 0-1 0-9 46 Angina patients Referred 6 0-27 0-200 71 Joined 1 0-8 0-134 70 Completed 0 0-5 0-73 51 *Data were not provided for all questions by all services so the numbers of respondents to each question are provided of a possible maximum of 191.
Total (as opposed to culturable) bacterial number counts are reported for four sites in the United Kingdom measured during campaigns over four separate seasons. These are interpreted in relation to ...simple climatic factors, i.e. temperature, wind speed and wind direction. Temperature has a marked effect at all four sites with data for a rural coastal site conforming best to a simple exponential model. Data for the other rural and urban locations show a baseline similar to that determined at the coastal rural location, but with some very significant positive excursions. The temperature dependence of bacterial number is found to conform to that typical of bacterial growth rates. At the coastal rural location, bacterial numbers normalised for temperature show no dependence on wind speed whilst at the inland sites there is a decrease with increasing wind speed of the form expected for a large area source. Only one site appeared to show a systematic relationship of bacterial concentrations to wind direction that being a site in the suburbs of Birmingham with highest number concentrations observed on a wind sector approaching from the city centre. PCR techniques have been used to identify predominant types of bacteria and results are presented which show that Bacillus was the dominant genus observed at the three inland sites during the winter and summer seasons. Pseudomonas appeared with comparable frequency at certain sites and seasons. There was in general a greater diversity of bacteria at the coastal site than at the inland sites.
The paper presents results and analysis from an on-going investigation to better understand and quantify the effects of constraint on cleavage fracture under various initial stress and plastic strain ...conditions. Specifically, new fracture toughness data obtained with three-point bend specimens with crack-to-width ratios 0.4, 0.2 and 0.05 is shown for as-received material and material with 5% initial uniaxial plastic strain. Firstly, analysis with the J-Q approach is used to argue that while pre-strain initial conditions change the fracture toughness, the shape of the failure locus in the J-Q space might remain unaffected. The implication is significant reduction of tests required for assessments taking constraint into account. The potential to use current local approach methods to allow a fracture prediction, which is independent of initial conditions, is then investigated by application of modified Beremin models. It is demonstrated that the local approaches can predict changes in the apparent toughness across the three constraint levels for the as-received material. It is further shown that accommodation of load history effects, such as the initial plastic strain, requires an advancement of the classical approach, a subject of on-going work.
Chronic joint pain is common and is a leading cause of disability. Most chronic joint pain is managed in primary care. Opioid pain medication is one option for pain management, but research suggests ...that its use by general practitioners (GPs) may be suboptimal. There is a widespread perception that doctors' concerns about misuse and addiction limit use of opioids.
To explore GPs' opinions about opioids and decision-making processes when prescribing 'strong' opioids for chronic joint pain.
Qualitative semi-structured interviews were conducted with 27 GPs. Using thematic analysis methods, the data were coded and grouped into themes.
GPs described a variety of prescribing habits for chronic joint pain. Opioids engendered strong opinions. GPs said that decisions about prescribing were based on careful assessment of patients' needs and their personal views about the management of adverse effects. Although addiction and misuse were discussed, there was limited concern about these issues. The overarching influence on prescribing decisions was GPs' previous experience, including previous outcomes and exposure to palliative care settings.
GPs' prescribing decisions are primarily influenced by previous professional experience of opioids. Much existing literature stresses that opioids are not prescribed due to concerns about addiction or misuse, but our study indicates otherwise. Augmenting GPs' exposure to and experience of opioids may be key to providing better pain management for patients.
PDF
