The Locus of Age × Health-Related Physical Fitness Interactions in Serial Choice Responding as a Function of Task Complexity: Central Processing or Motor Function?

The extent to which health-related physical fitness (HRF) attenuates age differences in psychomotor speed as a function of task complexity was examined in a sample of 48 men. Physiological measures were used to assign participants to fitness group (n 1-4 = 12): young less fit (mean age = 25.83 years), young fitter (mean age = 25.08 years), old less fit (mean age = 71.83 years), old fitter (mean age = 66.75 years). A serial choice reaction time (RT) task was used in which three conditions of two, four, or eight choices were administered. RTs for the choice and motor components of the task were recorded separately. A significant Age 2 HRF interaction was found in relation to choice RT but not motor time; older less fit individuals underperformed older fitter participants, and younger adults regardless of fitness level. This interaction remained significant having statistically controlled for motor function, suggesting benefits to central processing. The strength of this interaction did not increase as a function of task complexity. The findings suggest an association between HRF and psychomotor speed, and support the view that physically active lifestyles should be encouraged among older adults.     

Does Age Affect the Short- and Long-Term Outcomes of Coronary Bypass Grafting?

The etiology of coronary artery disease (CAD) is multifactorial, stemming from both modifiable and nonmodifiable risk factors such as age. Several studies have reported the effects of age on various outcomes of coronary artery bypass grafting (CABG). This article reviews age-related outcomes of CABG and offers direction for further studies in the field to create comprehensive, evidence-based guidelines for the treatment of CAD. Ninety-two primary sources were analyzed for relevance to the subject matter, of which 17 were selected for further analysis: 14 retrospective cohort studies, 2 randomized clinical trials, and 1 meta-analysis. Our review revealed four broad age ranges into which patients can be grouped: those with CAD (1) below the age of 40 years, (2) between the ages of 40 and 60 years, (3) between the ages of 60 and 80 years, and (4) at or above 80 years. Patients below the age of 40 years fare best overall with total arterial revascularization (TAR). Patients between the ages of 40 and 60 years also fare well with the use of multiarterial grafts (MAGs) whereas either MAGs or single-arterial grafts may be of significant benefit to patients at or above the age of 60 years, with younger and diabetic patients benefitting the most. Arterial grafting is superior to vein grafting until the age of 80 years, at which point there is promising evidence supporting the continued use of the saphenous vein as the favored graft substrate. Age is a factor affecting the outcomes of CABG but should not serve as a barrier to offering patients CABG at any age from either a cost or a health perspective. Operative intervention starts to show significant mortality consequences at the age of 80 years, but the increased risk is countered by maintenance or improvement to patients'' quality of life.     

MARS—Does It Stand the Test of Time?

Artificial liver support systems have been tested for decades in the management of liver failure. Generally, after some promising results published as case series, the device either disappears or fails to show significant benefit in controlled trials. Recently, the molecular absorbent recycling systems (MARS) or extracorporeal albumin dialysis (ECAD) technique appears to have broken this trend. Responding to the title one could summarize by saying this technique so far has stood the test of time. Data in support of its use in acute liver failure (ALF) is still scant and difficult to assess. However, in a well known but not very well defined entity of acute on chronic liver failure (AOCLF) the ECAD technique has been shown to improve survival compared to a similar randomized control group receiving standard supportive therapy. This well tolerated liver support system has real potential for widespread application if further well designed multicenter clinical trials continue to support its effectiveness. Its future lies probably in the management of the moribund hospitalized patient on the transplant list awaiting a donor liver.     

Do the Age of Patients with Tetralogy of Fallot at the Time of Surgery and the Applied Surgical Technique Influence the Reoperation Rate?

Abstract Background and Purpose:   Primary repair of tetralogy of Fallot (TOF) has been favored in many centers for years now and results and advantages of this management seem to verify this procedure. The authors wanted to know, if the age at the time of surgery and the surgical techniques had an influence on the long-term results. Patients and Methods:   Between 1992 and 2003, 124 patients underwent complete repair of TOF at the University Hospital Münster, Germany. Patients were subdivided into two groups based on their age (< 1 year and > 1 year of age). Patients in whom a transannular patch (TAP) was used were compared with those without (NTAP), or in whom a conduit was used. Results:   Overall mortality was 8%, with an average age of death of 9.53 years (range 0.06–19.77 years). The patients’ age at the time of surgery affected their survival as only two cases of death were reported among the group of children < 1 year of age (3.2%) whereas eight patients were older (12.9%; p = 0.0483). Six patients died within the first 30 days post surgery. Reoperation had to be performed in 21 cases, 13 (61.9%) of these patients were < 1 year of age at the time of surgery, eight were older (38.1%). A TAP, NTAP or conduit treatment did not show significant differences in long-term survival or freedom from reoperation. Conclusion:   Early repair of TOF within the 1st year of life can be recommended, because mortality is lower than in patients treated at a higher age. There seems no significant difference in the reintervention rate between patients treated within the 1st year of life or later.      

Physicians as Part of the Solution? Community-Based Participatory Research as a Way to Get Shared Decision Making into Practice

Although support among policy makers and academics for the wide scale adoption of shared decision making (SDM) is growing, actual implementation is slow, and faces many challenges. Extensive systemic barriers exist that prevent physicians from being able to champion SDM and lead practice change. In other areas of public health where implementation has been a challenge, community-based participatory research (CBPR) has effectively engaged resistant stakeholders to improve practice and the delivery of care. Might CBPR, defined broadly as research that engages participants in the conception, design, and implementation of relevant health programs, be a more effective way to engage physicians, patients, and managers in the implementation process? Consequently, we argue that adopting a participatory approach may help to overcome recognized barriers to progress in this area.     

Is a statin as part of a polypill the answer?

Statins are a necessary component of a polypill. Almost all patients have the potential to benefit from low-density lipoprotein cholesterol reduction with statins, although absolute benefits due to the reduction in coronary heart disease and stroke vary by risk level. The reduction in coronary heart disease and stroke from antihypertensive therapy is additive to the reduction in risk from statins. Used in combination with antihypertensive therapy, a moderate-dose statin would be expected to reduce cardiovascular risk by at least 50%, and a high-dose statin would be expected to reduce risk by at least 60% over an approximately 5-year period. A polypill containing aspirin in addition to a statin and antihypertensive therapy would be appropriate for most men over age 55 years, but not for high-risk women until age 65 years and moderately high-risk women until age 75 years. Polypills in development hold great promise for reducing the global burden of cardiovascular disease.     

Does a Water Protocol Improve the Hydration and Health Status of Individuals with Thin Liquid Aspiration Following Stroke? A Randomized Controlled Trial

The benefit of water protocols for individuals with thin liquid aspiration remains controversial, with mixed findings from a small number of randomized controlled trials (RCTs). This study aimed to contribute to the evidence of the effectiveness of water protocols with a particular emphasis on health outcomes, especially hydration. An RCT was conducted with patients with known thin liquid aspiration post stroke randomized to receiving thickened liquids only or a water protocol. For the 14 participants in rehabilitation facilities whose data proceeded to analysis, there was no difference in the total amount of beverages consumed between the water protocol group (mean = 1103 ml per day, SD = 215 ml) and the thickened liquids only group (mean = 1103 ml, SD = 247 ml). Participants in the water protocol group drank on average 299 ml (SD 274) of water but offset this by drinking less of the thickened liquids. Their hydration improved over time compared with participants in the thickened liquids only group, but differences between groups were not significant. Twenty-one percent of the total sample was diagnosed with dehydration, and no participants in either group were diagnosed with pneumonia. There were significantly more diagnoses of urinary tract infection in the thickened liquids only group compared to the water protocol group (χ ² = 5.091, p = 0.024), but no differences between groups with regard to diagnoses of dehydration (χ ² = 0.884, p = 0.347) or constipation (χ ² = 0.117, p = 0.733). The findings reinforce evidence about the relative safety of water protocols for patients in rehabilitation post stroke and provide impetus for future research into the potential benefits for hydration status and minimizing adverse health outcomes.