Impairments,disabilities and handicap pattern in konzo - a non-progressive spastic para/tetraparesis of acute onset

Purpose: To assess impairments, disabilities and handicap pattern in konzo. Method: The study included 17 konzo subjects, of which three were males and 14 females (mean age 21, median 18 years). A detailed neurological examination was performed on all subjects. Subsequently, an assessment of impairments, disabilities and handicap was done with a constructed rating scale partially based on the ICIDH-2 framework. Results: The overall disablement picture in all subjects consisted of motor dysfunction in lower limbs leading to limitations in walking and movement activities, and restrictions in mobility. Hip mobility was severely impaired in most cases (15/17). Although konzo subjects showed normal muscle power in upper limbs (13/17), they had impaired fine motor function (10/17). Conclusion: Further studies are needed to assess the effectiveness of the WHO criteria for konzo in defining its forms. The applicability of the ICIDH-2 framework in this study demonstrates the possibility of its use as a common language among researchers in the field of motor disorders. However, a revision is suggested of its taxonomy, and a definition of operational criteria to clarify the content of different qualifiers provided to assess the level of functioning or disability.     

急性心肌梗死发病与入院时C-反应蛋白水平的关系

目的　为了明确入院时C-反应蛋白(CRP)水平与急性心肌梗死(AMI)发病间的关系。方法　96例AMI患者根据入院6小时内测得的CRP水平将其分为3组，C组53例(CRP0.002～0.006g/L)；L组25例(CRP＜0.026g/L)；H组18例(CRP≥0.026g/L)。所有入选患者入院时立即给予冠状动脉造影术，CRP测定采用散射速率比浊法。结果　入院时CRP升高较CRP不高的患者在AMI发病前不稳定型心绞痛发病率高(P＜0.05)，且在AMI发病时身体活动处于较低水平(P＜0.001)，与梗死范围及受累血管数目无关。结论　AMI发病受到梗死前炎症活动的影响。     

Impairments,disabilities and health related quality of life after treatment for breast cancer: a follow-up study 2.7 years after surgery

Purpose:?The aim of this study was to assess impairments, disabilities and health related Quality of Life (QOL) after treatment of breast cancer and to analyse the relationship between treatment modalities, impairments, disabilities and health related QOL.

Method:?Fifty-five patients who underwent a modified radical mastectomy or a segmental mastectomy with axillary lymph node dissection were retrospectively assessed with a mean follow up of 2.7 years after treatment. Impairments were assessed by means of measuring active shoulder range of motion, grip strength, arm volume and pain. Disabilities were assessed by means of the Shoulder Disability Questionnaire (SDQ) and health related QOL was assessed by means of the RAND 36-item Health Survey (RAND-36).

Setting:?University Hospital Groningen (The Netherlands).

Results:?Pain (60%) and reduction of grip-strength (40%) were the most frequent impairments found. The prevalence of impaired range of motion and oedema was 9?–?16% respectively 15%. Mean group score of the SDQ was 33.7 (sd: 32.1) and mean scores of the RAND-36 differed significantly for physical functioning, vitality and health perception to that of a female norm group. Radiotherapy and chemotherapy were significant factors in the prediction of impaired range of motion. Pain and restricted range of motion explained 61% respectively 12% of the variance in disability (SDQ). In the prediction of health related QOL, pain, grip strength and arm volume were significant factors respectively in six, three and two domains.

Conclusions:?Pain is the most frequent assessed impairment after breast cancer treatment with strong relationship to perceived disability and health related QOL. Disability is mild and health related QOL (RAND-36) differed in three of the nine domains with a female norm group.     

Impairments, disabilities and health related quality of life after treatment for breast cancer: a follow-up study 2.7 years after surgery

Purpose: The aim of this study was to assess impairments, disabilities and health related Quality of Life (QOL) after treatment of breast cancer and to analyse the relationship between treatment modalities, impairments, disabilities and health related QOL.

Method: Fifty-five patients who underwent a modified radical mastectomy or a segmental mastectomy with axillary lymph node dissection were retrospectively assessed with a mean follow up of 2.7 years after treatment. Impairments were assessed by means of measuring active shoulder range of motion, grip strength, arm volume and pain. Disabilities were assessed by means of the Shoulder Disability Questionnaire (SDQ) and health related QOL was assessed by means of the RAND 36-item Health Survey (RAND-36).

Setting: University Hospital Groningen (The Netherlands).

Results: Pain (60%) and reduction of grip-strength (40%) were the most frequent impairments found. The prevalence of impaired range of motion and oedema was 9 - 16% respectively 15%. Mean group score of the SDQ was 33.7 (sd: 32.1) and mean scores of the RAND-36 differed significantly for physical functioning, vitality and health perception to that of a female norm group. Radiotherapy and chemotherapy were significant factors in the prediction of impaired range of motion. Pain and restricted range of motion explained 61% respectively 12% of the variance in disability (SDQ). In the prediction of health related QOL, pain, grip strength and arm volume were significant factors respectively in six, three and two domains.

Conclusions: Pain is the most frequent assessed impairment after breast cancer treatment with strong relationship to perceived disability and health related QOL. Disability is mild and health related QOL (RAND-36) differed in three of the nine domains with a female norm group.     

Low back pain - cause and prevention of long-term handicap (a critical review)

Insurance data among United Kingdom males indicate an annual loss from back pain of 627 days per 1000 employed though detailed studies in cohorts of manual workers suggests that the loss from low back pain may be half as much again. In a sample of 2684 mixed manual workers, 151 (5.6%) were deemed to have long-term handicap using the criteria of: spells of absence in excess of 6 weeks; admission to hospital; continuous or increasingly severe pain lasting more than a year. A further study indicated that 16/10 000 employees obtained early retirement from the Post Office on grounds of low back pain. Limited evidence to support the theory that injury and heavy work loads contribute to the onset of back pain and the implications of this for prevention are discussed.     

Towards a new ICIDH. International Classification of Impairments, Disabilities and Handicaps

In 1995 a special issue of Disability and Rehabilitation was published on the use of the International Classification of Impairments, Disabilities and Handicaps (ICIDH) which was issued by WHO in 1980. Since 1995 a lot of energy has been spent by WHO and other organizations aiming at the development of a new and improved ICIDH. In 1997, a draft ICIDH-2 (Beta-1 version) was circulated by WHO in order to be tested in the field. This paper informs the reader about the content of the draft ICIDH, the revision process planning and some Dutch comments relating to the actual draft.     

Late onset polio sequelae: disabilities and handicaps in a population-based cohort of the 1956 poliomyelitis outbreak in The Netherlands.

OBJECTIVE: To investigate the prevalence of new neuromuscular symptoms, disabilities, and handicaps in a group of polio survivors. DESIGN: A self-constructed health questionnaire about neuromuscular complaints and disability and handicap levels during the stable period after recovery from polio and at present. SUBJECTS: Three hundred fifty subjects, derived from the 1,784 polio cases registered during the 1956 polio outbreak in The Netherlands. RESULTS: Respondents totaled 260 (74%), 27 of whom denied or did not recall having had paralytic poliomyelitis. The remaining 233 subjects comprised the study group (mean age, 44yrs; range, 39 to 77; SD = 6.3). Frequency of all neuromuscular complaints at present time was significantly higher than that during the stable period after polio (range in p of .001 to .004). Fifty-eight percent of cases reported an increase in muscle weakness in comparison with muscle condition during the stable period. Fifty-six percent reported an increase in disabilities, mainly a restriction in gait functions. Fifty-three percent reported increased handicaps with regard to occupation and social integration, and there was an increased need for adaptive measures and devices. CONCLUSION: Nearly 60% of a sample of Dutch survivors of the 1956 polio outbreak experience late onset polio sequelae, resulting in increased severity of disabilities and handicaps.     

Cause of death in systemic lupus erythematosus: a pattern based on age at onset

We reviewed the causes of death in 50 patients treated for systemic lupus erythematosus at the University of Mississippi Medical Center between 1973 and 1985. Two groups of patients could be distinguished based on the age at onset but not on the duration of disease. Younger patients more often died of active renal disease an infectious complications, while older patients died of other organ involvement, inactive renal disease, and miscellaneous causes. Common causes of infection were gram-positive cocci and gram-negative bacilli. Atherosclerotic cardiovascular disease was an infrequent cause of death, and no patients died of malignancy. Patients who died had more multisystemic involvement, with serositis and renal, central nervous system, and hematologic manifestations than patients who were alive at last follow-up.     

Symptoms of impairment, disability and handicap in low back pain: a taxonomy.

The functional consequences on everyday living which result from chronic low back pain commonly require services which are difficult to access. This deficiency in meeting the needs of these patients is partially explained by inadequacies in clinical assessment. Medical evaluation may be exhaustive, but frequently the assessment of physical and psycho-social dysfunction at the personal and family level is inadequate. In low back pain, as with most chronic ailments, there is no agreed-upon taxonomy of the functional consequences of the disorder upon which to establish a comprehensive clinical appraisal. In this paper a taxonomy is presented for the impairments, disabilities and handicaps which result from chronic low back pain. The taxonomy has been based on data from a survey of 74 individuals with low back pain and is structured generally according to the International Classification of Impairments, Disabilities and Handicaps (WHO 1980). The taxonomy is proposed as a conceptual framework and vocabulary for both clinical practice and research. The taxonomy is not a measurement instrument nor does it indicate the frequency of occurrence of disabilities. A classification is basic to the advancement of scientific understanding, and usage of a standard vocabulary such as this plays an important role in establishing a responsive health service capable of meeting the needs of the population with chronic low back pain.     

Increase and change in pattern of hospital antimicrobial use, Denmark, 1997-2001

OBJECTIVES: To analyse the changes and compare antimicrobial consumption in public hospitals in Denmark over the period 1997-2001. METHODS: Data on the number of WHO defined daily doses (DDD) were obtained from the Danish Medicines Agency. Data on the number of bed-days were obtained from the National Board of Health. We calculated antimicrobial consumption in hospitals as the number of DDD per 100 bed-days for all antibacterials for systemic use i.e. group J01 of the Anatomical Therapeutic Chemical (ATC) classification and for classes of this group. RESULTS: During 1997-2001, antimicrobial use in hospitals in Denmark significantly increased by 18%, from 38.0 to 44.8 DDD per 100 bed-days (P < 0.005). Most of this increase (55%) was attributed to an increase in consumption of commonly used classes of antimicrobials, mainly penicillins with extended spectrum (ATC group J01CA), beta-lactamase-sensitive penicillins (J01CE) and beta-lactamase-resistant penicillins (J01CF). The 'broad-spectrum' and newer antimicrobials, i.e. combinations of penicillins with beta-lactamase inhibitor (J01CR), cephalosporins (J01DA), carbapenems (J01DH) and fluoroquinolones (J01MA) contributed to 36% of the increase. Together, these amounted to 16% of total consumption in hospitals in Denmark in 1997, rising to 19% in 2001. CONCLUSIONS: Although antimicrobial consumption in public hospitals in Denmark is low compared with other countries, the steady increase and change in pattern of their use are causes of concern, deserving close monitoring and further investigations.     

Rapid and reliable genotyping of human platelet antigen (HPA)-1, -2, -3, -4, and -5 a/b and Gov a/b by melting curve analysis

BACKGROUND: The probability for occurrence of neonatal alloimmune thrombocytopenic purpura (NAITP) depends largely on the frequency of each individual phenotype in various populations. In caucasians, antibodies to human platelet antigen (HPA)-1a are the major cause of neonatal alloimmune thrombocytopenic purpura, whereas in the Japanese population, antibodies to HPA-4b is most frequently involved in NAITP. Conventional PCR techniques for platelet antigen genotyping rely on sequence-specific primers (SSPs) and detection by gel electrophoresis, a method which is laborious and time consuming. New PCR technology, measuring the match of a hybridization probe with its target and thereby allowing simultaneous detection of both alleles, provides an efficient tool for genotyping of the HPA systems. STUDY DESIGN AND METHODS: A total of 105 healthy blood donors were genotyped for HPA-1, -2, -3, -4, and -5 a/b and Gov a/b with new primers and probes designed for mutation detection by melting curve analysis (using LightCycler technology). Donor DNA was independently genotyped by an allele-specific assay, using SSPs, in a reference laboratory. RESULTS: There was full concordance between the two genotyping methods, and genotype frequencies were comparable with previous studies in caucasians. CONCLUSION: We present rapid and reliable detection systems for HPA-1, -2, -3, -4, and -5 a/b and Gov a/b based on mutation detection of both alleles simultaneously by melting curve analysis. As the Gov system has been reported to have similar frequency of involvement in alloimmune thrombocytopenia as HPA-5, the opportunity for genotyping should aid the diagnosis of such patients.     

急性缺血性脑卒中患者血清CRP、TNF-α、IL-6水平变化的临床观察

目的探讨急性缺血性脑卒中患者血清c反应蛋白（CPR）、肿瘤坏死因子（TNF-a）、白细胞介素-6（IL-6）变化及其与病情严重程度的关系。方法对30例急性缺血性脑卒中患者和30名健康体检者进行对照，缺血性脑卒中患者发病后第l、2、3d测定血清CRP、TNF-a、IL-6水平。分析其与缺血性脑卒中病灶大小及与临床神经功能缺损程度评分（CNFDS）的相关性。结果急性缺血性脑卒中组血清CRP、TNF-a、IL-6含量高于正常对照组（P〈0．01）；不同临床分型组间患者血清CPR、TNF-a、IL-6水平比较，重型患者CRP、TNF-a、IL-6水平明显高于轻、中型患者（P〈0．01）；CRP、TNF-a、IL-6的变化且与临床神经功能缺损程度评分呈正相关（分别r=0．65、0．59、0．70，P〈0．01）。结论血清CRP、TNF-a、IL-6水平增高与急性缺血性脑卒中的发生和严重程度有密切关系，CRP、TNF-a、IL-6在血清中的水平可作为判断急性缺血性脑卒中患者病变严重程度的指标。     

急性缺血性脑卒中患者血清CRP、TNF-α、IL-6水平变化的临床观察

目的探讨急性缺血性脑卒中患者血清C反应蛋白(CPR)、肿瘤坏死因子(TNF-a)、白细胞介素-6(IL-6)变化及其与病情严重程度的关系。方法对30例急性缺血性脑卒中患者和30名健康体检者进行对照,缺血性脑卒中患者发病后第1、2、3d测定血清CRP、TNF-a、IL-6水平。分析其与缺血性脑卒中病灶大小及与临床神经功能缺损程度评分(CNFDS)的相关性。结果急性缺血性脑卒中组血清CRP、TNF-a、IL-6含量高于正常对照组(P<0.01);不同临床分型组间患者血清CPR、TNF-a、IL-6水平比较,重型患者CRP、TNF-a、IL-6水平明显高于轻、中型患者(P<0.01);CRP、TNF-a、IL-6的变化且与临床神经功能缺损程度评分呈正相关(分别r=0.65、0.59、0.70,P<0.01)。结论血清CRP、TNF-a、IL-6水平增高与急性缺血性脑卒中的发生和严重程度有密切关系,CRP、TNF-a、IL-6在血清中的水平可作为判断急性缺血性脑卒中患者病变严重程度的指标。     

Quality of life, disability and handicap in patients with toxic oil syndrome

AIM: This paper reports an investigation of the quality of life of patients most severely affected by toxic oil syndrome and the association between quality of life and disability variables, handicaps and depression. BACKGROUND: In 1981, an epidemic occurred in Central and Northwestern Spain. The illness, now called toxic oil syndrome (TOS), appeared to be caused by consumption of oil mixtures containing rapeseed oil denatured with aniline and affected over 20,000 individuals. Today, it is classified as a chronic disease that has resulted in a large number of sequelae. METHOD: From the 1031 people classified with permanent disability, a random sample of 292 individuals was selected. A structured interview was carried out to investigate the clinical aspects. The Nottingham Health Profile Questionnaire was used to assess quality of life. To study the relationship between quality of life and disability, handicap and depression, a univariate analysis was carried out. The chi-square test was used for inter-group comparisons. A P-value of 0.05 was adopted as the limit for inclusion of a variable in the multivariate analysis. Multivariate analysis was undertaken using logistic regression. RESULTS: Two hundred and fourteen patients were interviewed (79% response rate). Mean age was 59.3 (sd: 12.7) years. Quality of life mean score was 52.8 (sd: 22.6). The variables associated with poorer quality of life perception were depression [odds ratio (OR) = 9.66, confidence interval (CI) = 3.71-25.15], role-related disabilities (occupation role: OR = 2.82 CI = 1.28-6.22) and mobility (bending/picking up: OR = 4.74, CI = 2.31-9.72), as well as economic problems (OR = 1.62, CI = 1.07-2.46). CONCLUSION: The quality of life of those most severely affected by TOS is poor. Their health profile is characterized by depression and important functional and psycho-social disabilities that limit daily living activities and social roles, and are related to self-perceptions of poor quality of life.