Association between handgrip strength and cognitive impairment in elderly Koreans: a population-based cross-sectional study

[Purpose] The purpose of this study was to investigate the association between handgrip strength and mild cognitive impairment in elderly adults. [Subjects] Study participants included 2,982 adults (1,366 males and 1,616 females), aged 65 years or older. [Methods] This population-based cross-sectional study used the baseline database from the Korean Longitudinal Study of Ageing. [Results] The odds ratio for mild cognitive impairment showed a significant linear decrease in relation to the quartile of handgrip strength, independent of potential covariates, in both men and women. Moreover, after excluding incident cases of mild cognitive impairment, the results showed that greater handgrip strength was associated with higher cognitive function scores in the elderly. [Conclusion] The findings presented here suggest that handgrip strength is associated with a risk of mild cognitive impairment in the Korean elderly. Moreover, greater handgrip strength is associated with higher cognitive function in cognitively normal elderly individuals.Key words: Handgrip strength, Cognitive function, Elderly     

Factors affecting symptoms and functionality of patients with carpal tunnel syndrome: a retrospective study

[Purpose] The aim of this retrospective study was to determine the associations between clinical, physical, and neurophysiological outcomes and self-reported symptoms and functions of patients after surgical carpal tunnel release. [Subjects and Methods] Among 261 patients who had undergone open surgical carpal tunnel release within the last three years, 83 (mean age 50.27 ± 11.13 years) participated in this study. Their socio-demographics and comorbidities were recorded. The intensity of pain, paresthesia, and fatigue symptoms in the hand were assessed by means of a Visual Analogue Scale, the Semmes-Weinstein Monofilaments test of light touch pressure sensation, and Jamar dynamometry for measurement of grip and pinch strengths. The Boston Carpal Tunnel Questionnaire evaluated the severity of symptoms and hand functional status, and the variables were analyzed by multivariate linear regression. [Results] The severity of the symptoms and functional status of release surgery patients was associated with diabetes mellitus, migraine, night pain, paresthesia and fatigue symptoms, impaired light touch pressure, and lack of medical treatment. [Conclusion] Appropriate post-surgery treatment programs for these factors should be taken into consideration to help patients obtain optimal functionality and health in their daily lives.Key words: Carpal tunnel syndrome, Patient outcome assessment, Surgical therapy     

Factors affecting survival from avalanche burial—A randomised prospective porcine pilot study

Background and aim

The majority of avalanche victims who sustain complete burial die within 35 min due to asphyxia and injuries. After 35 min, survival is possible only in the presence of a patent airway, and an accompanying air pocket around the face may improve survival. At this stage hypothermia is assumed to be an important factor for survival because rapid cooling decreases oxygen consumption; if deep hypothermia develops before cardiac arrest, hypothermia may be protective and prolong the time that cardiac arrest can be survived. The aim of the study was to investigate the combined effects of hypoxia, hypercapnia and hypothermia in a porcine model of avalanche burial.

Methods

Eight piglets were anaesthetised, intubated and buried under snow, randomly assigned to an air pocket (n = 5) or ambient air (n = 3) group.

Results

Mean cooling rates in the first 10 min of burial were −19.7 ± 4.7 °C h⁻¹ in the air pocket group and −13.0 ± 4.4 °C h⁻¹ in the ambient air group (P = 0.095); overall cooling rates between baseline and asystole were −4.7 ± 1.4 °C h⁻¹ and −4.6 ± 0.2 °C h⁻¹ (P = 0.855), respectively. In the air pocket group cardiac output (P = 0.002), arterial oxygen partial pressure (P = 0.001), arterial pH (P = 0.002) and time to asystole (P = 0.025) were lower, while arterial carbon dioxide partial pressure (P = 0.007) and serum potassium (P = 0.042) were higher compared to the ambient air group.

Conclusion

Our results demonstrate that hypothermia may develop in the early phase of avalanche burial and severe asphyxia may occur even in the presence of an air pocket.     

Risk factors related to falling in stroke patients: a cross-sectional study

[Purpose] The purpose of this study was to investigate a comprehensive understanding of the factors associated with falls in poststroke patients. [Subjects] Forty-eight stroke patients (22 males and 26 females; age 63.79 years) participated in this study. [Methods] This study applied a cross-sectional design. Fear of falling [Falls Efficacy Scale (FES)], balance function [Berg Balance Scale (BBS) and Modified Rivermead Mobility Index (MRMI)], ADL performance level [Modified Barthel Index (MBI)] and cognitive function [Loewenstein Occupational Therapy Cognitive Assessment for Geriatric Populations (LOTCA-G)] were assessed. [Results] Falls efficacy was moderately correlated with ADL performance, balance, and cognition. In addition, stepwise linear regression analysis revealed that ADL performance was the explanatory variable closely associated with falls efficacy in stroke patients. [Conclusion] ADL performance was the primary explanatory variable of falls efficacy according to regression analysis. Thus, we suggest that these results may be used as basic data for developing rehabilitation programs for prevention of falls in stroke patients.Key words: Activities of daily living, Fall, Stroke     

Factors affecting intracranial pressure: a descriptive study

This study examined the effects of 365 occurrences on the intracranial pressure (ICP) of four patients with severe head injuries and a Glasgow Coma Score below five. The occurrences were in: 1) health care activities, 2) patient-initiated activities, and 3) environmental stimuli. The health care activities that increased intracranial pressure were suctioning, turning, and flexion of the head; decreases were realized by elevating the head of the bed and repositioning the patient. The patient-initiated activities that increased intracranial pressure were flexion of extremities, rotation of the neck, and coughing. In contrast to previous reports, environmental stimuli did not affect intracranial pressure and bathing increased it. Recommendations for nursing care include: turning patients more slowly to less acute angles; proper head/neck positioning; and more direct psychosocial interactions with families of patients who have low Glasgow Coma Scores.     

Effects of therapeutic recreation on the brain quotient in the elderly dementia patients

[Purpose] This study investigated how participation in a recreation program influences electroencephalogram changes in the demented elderly. [Subjects] Fourteen patients were included in the experimental group and 18 in the control group. [Methods] They had no regular exercise habits, and walked independently, and scored 11–23 points on the Mini-Mental State Examination, and thus had no apraxia and could communicate. To empirically verify changes in electroencephalograms of the demented elderly for depression, sleep disorder, and life quality through their participation in the therapeutic recreation program, male and female citizens >65 years old at a geriatric hospital were included. The experimental group attended therapeutic recreation programs regularly for 3 months and control group did not. [Results] Electroencephalogram values were higher in the experimental than in the control group, demonstrating that the therapeutic recreation program enhances electroencephalogram values. However, post-program electroencephalograms between the two groups showed minor differences for all variables, except for the anti-stress index and brain quotient. [Conclusion] The therapeutic recreation program caused changes in brain activation, and this method revealed the relation between the activity program and emotion via the anti-stress index.Key words: Recreation program, EEG, Dementia     

Age-associated changes in the level of physical activity in elderly adults

[Purpose] This study aimed to clarify how light-, moderate-, and vigorous-intensity physical activity in older adults changes with age, subdividing physical activity according to intensity levels, by using an accelerometer. [Subjects] Older adults living independently in the community were included (n = 106, age: 65–85 years). [Methods] A triaxial accelerometer was used to measure the amount of light-, moderate-, and vigorous-intensity physical activity (1–2.9, 3–5.9, and ≥6 metabolic equivalents, respectively) and inactive time over 7 days. Light- and moderate-intensity physical activity levels were further subdivided into 1–1.9, 2–2.9, 3–3.9, and 4–5.9 metabolic equivalents, respectively. [Results] The amount of moderate-intensity physical activity at both sub-levels showed significant inverse correlations with age (r = −0.34, −0.33, respectively), but this was not seen with other levels. Both levels of moderate-intensity physical activity were independently predicted by age using multiple regression analysis adjusted for gender and body mass index. [Conclusion] These results suggest that understanding the reduction in moderate-intensity physical activity with age in older adults, subdivided according to intensity level, could be a useful index to increase the amount of higher intensity physical activity in stages, considering individual health conditions.Key words: Physical activity, Age, Older adults     

低年资护士离职原因的探讨

目的探讨低年资护士离职的原因,为护理管理者有针对性地采取措施提供依据。方法选取上海市3所三级甲等医院主动离职的13名低年资护士进行半结构式访谈,采用内容分析法对资料进行分析。结果护士离职原因归纳为5个主题,分别为压力过大;个人价值难以体现;缺乏人性化管理;薪酬与其他替代补偿未达标、职业认可度不高,获取外部工作的机会大。结论低年资护士离职原因有其群体特殊性,护理管理者需针对不同护士群体做出应对策略,减少离职行为发生。     

Factors affecting the serologic response to SARS-CoV-2 vaccination in patients with solid tumors: A prospective study

ObjectiveTo evaluate the factors affecting seropositivity and antibody levels after SARS-CoV-2 vaccines in patients with cancer because they were excluded from clinical studies of SARS-CoV-2 vaccines.MethodsThis prospective, observational, single-center study included 290 patients with solid tumors followed up in our medical oncology clinic between March 2021 and August 2021. SARS-CoV-2 antibody status was determined before the first dose of vaccine. Fifty-one patients with positive prevaccine baseline antibody tests were excluded from the study, regardless of whether they had previously confirmed SARS-CoV-2 PCR positivity. To determine the quantitative IgG antibody response of the vaccines, blood samples were collected at least 28 days after each dose of vaccine. Quantitative IgG levels against virus spike protein receptor binding domain (RBD) were measured using chemiluminescent enzyme immunoassay (CLIA). Demographic and clinical features affecting seropositivity were analyzed.ResultsOne hundred and fifty-one (69.3%) patients were vaccinated with two doses of CoronaVac followed by one dose of BNT162b2 (Biontech) (group 1). Sixty-seven (30.7%) patients were vaccinated with three doses of BNT162b2 (group 2). The proportion of patients who developed seropositivity was significantly higher in group 2 (78.6% vs. 54.9%, p < 0.012). Antibody response increased significantly after the second dose of vaccine in both groups. Female sex, being younger than 65 years, and chemotherapy status were significantly related to higher anti-SARS-CoV-2 S antibody levels (p = 0.033, p = 0.036, and p = 0.047, respectively). Antibody levels were significantly higher in patients who had previously received chemotherapy than in patients receiving active chemotherapy (p = 0.042).ConclusionsOur study is the first to evaluate basal SARS-CoV-2 IgG levels before the first dose of vaccine and after three doses in patients with solid tumors. The rate of development of seropositivity with two doses of mRNA vaccine was found to be higher than with two doses of inactivated SARS-CoV-2 vaccine. More attention should be paid to preventive measures in addition to vaccination in patients aged over 65 years and men with cancer diagnoses.     

Factors affecting image quality and diagnostic efficacy in abdominal sonography: A prospective study of 140 patients

A study was undertaken to evaluate the limitations of abdominal sonography in a group of predominantly elderly patients. In the majority of patients (98%) sonography, using 3.5 MHz and 5 MHz array transducers permitted visualization of the major abdominal organs with image quality sufficient for definitive diagnosis, but improved image quality would be desirable in 78% of this sample. Obesity and immobilization were associated with poor sonographic image quality. In 31 of the 45 (69%) poor image quality studies, no near-field artifacts (less than 3 cm depth) were observed. Obstacles in the acoustic path were noted in 77% of the poor image quality studies. © 1993 John Wiley & Sons, Inc.     

Platelet-inhibitor treatment of diabetic nephropathy: a 10-year prospective study

We prospectively evaluated a platelet-inhibitor regimen of dipyridamole and aspirin in 28 patients with insulin-dependent diabetes mellitus and well-established nephropathy. After a mean treatment period of 4.3 years, iothalamate clearance (Ciot) was reasonably well maintained and urinary protein excretion was reduced in 7 patients (25%), whereas 21 (75%) had progressive nephropathy. Analysis of outcome revealed that all 7 patients with stable nephropathy and 9 of the 21 with progressive disease had baseline Ciot values that exceeded 50 ml/min per 1.73 m2. Shortened platelet survival improved after 3 months of treatment, and the distribution between patients who had stable and those who had progressive disease was approximately equal. Mean changes in fasting plasma glucose level, glycosylated hemoglobin, and blood pressure did not differ between these two groups. In a short-term protocol, urinary protein and thromboxane B2 significantly declined, whereas variable urinary levels of prostaglandin E2, 6-ketoprostaglandin F1 alpha, and Ciot did not change after 3 months of treatment with dipyridamole and aspirin. These findings suggest that treatment with dipyridamole and aspirin may stabilize renal function by reducing platelet hypersensitivity and production of thromboxanes by platelet or renal tissue (or both). In turn, constrictor activity in the glomerular vessels, mesangial contractility, and glomerular membrane permeability are decreased. These data also add evidence in support of a role for thromboxane A2 in the pathogenesis of experimental and human glomerular disease.     

Factors affecting the benefits of a six-month supervised exercise program on community-dwelling older adults: interactions among age,gender, and participation

[Purpose] This study determined the effects of age, gender, and participation on the benefits of a 6-month supervised exercise program on older adults. [Subjects and Methods] Eighty-five (37 women, 48 men) community-dwelling older adults participated. The chair sit-and-reach test, the 8-foot up-and-go test, the 6-minute walk test, the Berg Balance Scale, lower-body flexibility, dynamic balance, aerobic endurance, balance, metabolic rate, muscle strength, and position sense were evaluated. Repeated-measures of analysis of variance was performed including dependent variables of age, gender, and participation in the exercise program as dependent inter-subject factors and time of assessment as an intra-subject factor. [Results] Mean exercise participation was 29.88 ± 1.29 sessions. Flexibility, balance, position sense, and strength showed a significant main effect of time. There was a significant gender interaction for right shoulder flexion strength and knee extension strength, a significant gender-participation interaction for pre-/post-intervention measures of functional mobility, and a significant age-participation interaction for flexibility. [Conclusion] Exercise training improved outcomes after 6 months of supervised exercise, but the changes were similar regardless of participation level. Changes in strength were more pronounced in men than women.Key words: Exercise benefits, Older adults, Age     

Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study

[Purpose] To assess the effects of different numbers of platelet-rich plasma (PRP) applications on pain and physical function in grade 3 knee osteoarthritis (OA). [Subjects and Methods] A total of 102 patients with grade 3 knee OA were randomly divided into three groups: Group 1 received a single injection of PRP, Group 2 received two injections of PRP two weeks apart, Group 3 received three injections of PRP at 2-weeks intervals. All patients were evaluated with a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the Timed-Up and Go test (TUG) before the treatment and at 1, 3 and 6 months after the treatment. [Results] Ninety-eight patients (15 males, 83 females) completed the study. The mean ages of the patients were 53.5±6.6, 54.9±5.3, and 55.1±5.6 years in Group 1, Group 2, and Group 3, respectively. Statistically significant improvements were noted in all of the evaluated measures in all of the groups. The mean differences of Group 1-Group 2 and Group 1-Group 3 WOMAC total, WOMAC pain, WOMAC stiffness, and WOMAC function scores were statistically significant. [Conclusion] PRP is an effective treatment for functional status and pain in moderate knee osteoarthritis and a minimum of two injections is appropriate.Key words: Platelet-rich plasma effectiveness, Moderate, Knee osteoarthritis     

Effects of a 12-week healthy-life exercise program on oxidized low-density lipoprotein cholesterol and carotid intima-media thickness in obese elderly women

[Purpose] This study examined the effects of a 12-week exercise program on plasma level of oxidized low-density lipoprotein cholesterol in obese elderly women, who are at increased risk of heart disease morbidity. [Subjects and Methods] Twenty participants were assigned into either a control (n = 10) or a supervised exercise program (n = 10) group. The 12-week exercise intervention was performed 3 days per week and involved combined aerobic exercise, resistance exercise, and traditional Korean dance. [Results] Two-factor analysis of variance revealed significant group × time interactions for body mass, diastolic blood pressure, appendicular muscle mass. For high-density lipoprotein cholesterol, oxidized low-density lipoprotein cholesterol, and the ratio of oxidized low-/high-density lipoprotein cholesterol, two-factor analysis of variance revealed significant interactions (group × time), indicating responses differed significantly between the control and exercise groups after 12 weeks. [Conclusion] A 12-week low- to moderate-intensity exercise program appears to be beneficial for obese elderly women by improving risk factors for cardiovascular disease.Key words: Exercise, Obesity, Oxidized LDL     

Tall T waves during metabolic acidosis without hyperkalemia: a prospective study

The specific ECG characteristics of metabolic acidosis have not been satisfactorily defined in man. We addressed this question by prospectively studying 14 consecutive patients admitted with metabolic acidosis and without hyperkalemia. Arterial blood gas analysis and serum potassium determinations were performed during acidosis and after its correction. ECGs were recorded at the same times. Mean pHa increased from 7.11 +/- 0.05 to 7.40 +/- 0.01 (p less than .001) in response to an increase in total CO2 content from 6.8 +/- 1.4 to 21.2 +/- 0.7 mmol/L (p less than .001). Serum potassium concentration decreased only slightly after correction of the acidosis from 4.2 +/- 0.1 to 3.9 +/- 0.14 mmol/L (p less than .05). T waves were taller during acidosis than after correction (0.68 +/- 0.1 vs. 0.28 +/- 0.04 mV, p less than .001 and 0.64 +/- 0.08 vs. 0.38 +/- 0.04, p less than .005, in precordial leads V2 and V3, respectively). Moreover, the amplitude of T waves in V2 was correlated positively with the arterial concentration of H+ (r = .786, p less than .001) and negatively with the arterial total CO2 content (r = -.71, p less than .005). In addition to their augmented amplitude, T waves were peaked and symmetrical with a narrow base ("tent-shaped"). Thus, metabolic acidosis may be accompanied by an increase in the amplitude of T waves, even in the absence of hyperkalemia.     

Spatiotemporal gait parameters and recurrent falls in community-dwelling elderly women: a prospective study

BACKGROUND:

Falling is a common but devastating and costly problem of aging. There is no consensus in the literature on whether the spatial and temporal gait parameters could identify elderly people at risk of recurrent falls.

OBJECTIVE:

To determine whether spatiotemporal gait parameters could predict recurrent falls in elderly women.

METHOD:

One hundred and forty-eight elderly women (65-85 years) participated in this study. Seven spatiotemporal gait parameters were collected with the GAITRite(r) system. Falls were recorded prospectively during 12 months through biweekly phone contacts. Elderly women who reported two or more falls throughout the follow-up period were considered as recurrent fallers. Principal component analysis (PCA) and discriminant analysis followed by biplot graph interpretation were applied to the gait parameters.

RESULTS:

After 12 months, 23 elderly women fell twice or more and comprised the recurrent fallers group and 110 with one or no falls comprised the non-recurrent fallers group. PCA resulted in three components that explained 88.3% of data variance. Discriminant analysis showed that none of the components could significantly discriminate the groups. However, visual inspection of the biplot showed a trend towards group separation in relation to gait velocity and stance time. PC1 represented gait rhythm and showed that recurrent fallers tend to walk with lower velocity and cadence and increased stance time in relation to non-recurrent fallers.

CONCLUSIONS:

The analyzed spatiotemporal gait parameters failed to predict recurrent falls in this sample. The PCA-biplot technique highlighted important trends or red flags that should be considered when evaluating recurrent falls in elderly females.