The effects of Snoezelen (multi-sensory behavior therapy) and psychiatric care on agitation, apathy, and activities of daily living in dementia patients on a short term geriatric psychiatric inpatient unit

A randomized, controlled, single-blinded, between group study of 24 participants with moderate to severe dementia was conducted on a geriatric psychiatric unit. All participants received pharmacological therapy, occupational therapy, structured hospital environment, and were randomized to receive multi sensory behavior therapy (MSBT) or a structured activity session. Greater independence in activities of daily living (ADLs) was observed for the group treated with MSBT and standard psychiatric inpatient care on the Katz Index of Activities of Daily Living (KI-ADL; P = 0.05) than standard psychiatric inpatient care alone. The combination treatment of MSBT and standard psychiatric care also reduced agitation and apathy greater than standard psychiatric inpatient care alone as measured with the Pittsburgh Agitation Scale and the Scale for the Assessment of Negative Symptoms in Alzheimer's Disease (P = 0.05). Multiple regression analysis predicted that within the multi-sensory group, activities of daily living (KI-ADL) increased as apathy and agitation reduced (R2 = 0.42; p = 0.03). These data suggest that utilizing MSBT with standard psychiatric inpatient care may reduce apathy and agitation and additionally improve activities of daily living in hospitalized people with moderate to severe dementia more than standard care alone.     

Aetiology and management of work-related upper extremity disorders

Work-related upper extremity disorders are a major cause for complaints and disability in worker populations. They may consist of a range of symptoms in the upper extremity, either clearly localised or more widespread, and are usually preceded or affected by exposure to physical activities and/or postures at work. In order to develop effective management strategies, both from a prevention and treatment perspective, more knowledge is needed with regard to the nature, pathophysiological mechanisms and risk factors of this group of disorders. This chapter reviews the clinical manifestations, mechanisms and aetiology of work-related upper extremity disorders through an exploration of the literature. We also examine and discuss the evidence for the effectiveness of several preventative and therapeutic interventions.     

Distinct monocyte gene-expression profiles in autoimmune diabetes

OBJECTIVE—There is evidence that monocytes of patients with type 1 diabetes show proinflammatory activation and disturbed migration/adhesion, but the evidence is inconsistent. Our hypothesis is that monocytes are distinctly activated/disturbed in different subforms of autoimmune diabetes.RESEARCH DESIGN AND METHODS—We studied patterns of inflammatory gene expression in monocytes of patients with type 1 diabetes (juvenile onset, n = 30; adult onset, n = 30) and latent autoimmune diabetes of the adult (LADA) (n = 30) (controls subjects, n = 49; type 2 diabetic patients, n = 30) using quantitative PCR. We tested 25 selected genes: 12 genes detected in a prestudy via whole-genome analyses plus an additional 13 genes identified as part of a monocyte inflammatory signature previously reported.RESULTS—We identified two distinct monocyte gene expression clusters in autoimmune diabetes. One cluster (comprising 12 proinflammatory cytokine/compound genes with a putative key gene PDE4B) was detected in 60% of LADA and 28% of adult-onset type 1 diabetic patients but in only 10% of juvenile-onset type 1 diabetic patients. A second cluster (comprising 10 chemotaxis, adhesion, motility, and metabolism genes) was detected in 43% of juvenile-onset type 1 diabetic and 33% of LADA patients but in only 9% of adult-onset type 1 diabetic patients.CONCLUSIONS—Subgroups of type 1 diabetic patients show an abnormal monocyte gene expression with two profiles, supporting a concept of heterogeneity in the pathogenesis of autoimmune diabetes only partly overlapping with the presently known diagnostic categories.There is evidence that monocytes of patients with type 1 diabetes are functionally aberrant, showing raised production of interleukin (IL)-1β, IL-6, superoxide anion, and prostaglandin-endoperoxide synthase 2 (PTGS2) (1–3); aberrant generation of antigen-presenting cells (4,5); and abnormal chemotaxis, adhesion, and migratory potential (6). These aberrancies are thought to play a role in the pathogenesis of the disease by disrupting tolerance and aggravating the β-cell cytotoxic potential of infiltrating monocyte-derived dendritic cells and macrophages. However, these aberrant functional findings could not always be reproduced, particularly with regard to the enhanced production of PTGS2 (7) and the poor generation of antigen-presenting cells from monocytes (8). Two issues could be relevant to these discrepancies. First, raised production of proinflammatory monocyte-derived cytokines could be related to hyperglycemia (9). Second, there might be heterogeneity within autoimmune diabetes, such as has been noted previously between adult and juvenile forms of type 1 diabetes on the basis of genetic, immune, and metabolic characteristics (10). This possible heterogeneity in autoimmune diabetes might also become evident in different monocyte activation profiles.To resolve these issues, we focus here on patterns of inflammatory gene expression in monocytes from selected patients distinguished by clinical characteristics and age at diagnosis, as well as from control subjects. Our hypothesis is that monocytes might be distinctly activated and disturbed within the known diagnostic categories of diabetes.Recently, we reported a signature of 18 inflammatory-related genes in monocytes of bipolar patients (11); activated monocytes are thought to play a role in the pathogenesis of bipolar disorder (12,13). Given the reported association between bipolar disorder and autoimmune diabetes (14), and given the possible central role of monocytes in both disorders, we tested this set of 18 proinflammatory monocyte genes in patients with autoimmune diabetes. To these 18 monocyte genes, we added 7 genes identified in a whole-genome expression profile of a set of juvenile-onset type 1 diabetic patients who had been compared with healthy control subjects and type 2 diabetic patients (see supplementary Fig. 1 [available in an online appendix at http://dx.doi.org/10.2337/db08-0496]). Thus, using quantitative RT-PCR (Q-PCR), we validated abnormal expression of 25 monocyte activation genes in latent autoimmune diabetes of the adult (LADA), adult-onset type 1 diabetic and juvenile-onset type 1 diabetic patients, and, as controls, type 2 diabetic patients and healthy subjects.Open in a separate windowFIG. 1.Color-coded correlation matrix illustrating pairwise correlations between the expression levels of the 24 genes aberrantly expressed in patients with various forms of diabetes (相似文献   

Longitudinal MRI study in schizophrenia patients and their healthy siblings

To investigate whether genetic and/or disease-related factors are involved in progressive structural brain changes in schizophrenia, magnetic resonance imaging scans with a 5-year scan interval were acquired in patients, their same-gender siblings and matched healthy controls. Structural equation modelling was applied to assess disease and familial effects. Whole brain and cerebral grey matter volumes decreased excessively in patients compared with their siblings and the controls, suggesting that the progressive brain loss in schizophrenia may be related to the disease process.     

A pseudo-iatrogenic case of medial clavicular fracture

Medial fractures are the least common type of clavicular fracture (2-10%). The patient is a 29-year-old gynaecology resident with hyper-laxity and sternoclavicular instability. The latter had been surgically stabilized with Dacron((R)) tape, which eroded the bone causing an usura. Acute right shoulder pain occurred 10 years later. CT revealed medial clavicular stress fracture. After 4 weeks of conservative management, internal fixation followed. Five months postoperatively the patient performed all activities without pain. In this patient the weakened medial clavicle due to usura clearly played a role in both the site and nature of the fracture. Furthermore, CT is essential in arriving at the correct diagnosis.     

Isolated lumbar extensor strengthening versus regular physical therapy in an army working population with nonacute low back pain: a randomized controlled trial

Helmhout PH, Harts CC, Viechtbauer W, Staal JB, de Bie RA. Isolated lumbar extensor strengthening versus regular physical therapy in an army working population with nonacute low back pain: a randomized controlled trial.

Objective

To evaluate the effectiveness of specific lumbar extensor training compared with regular physical therapy (PT) in workers with nonspecific nonacute low back pain (LBP).

Design

A multicenter randomized controlled trial with 1-year follow-up.

Setting

PT department in (military primary care) health centers.

Participants

Predominantly male soldiers (N=129) with 4 weeks or more of low back complaints who were referred by the health center's general practitioner for PT (mean age, 35.9±10.8y; range, 20-56y), of whom 127 randomized participants were included in the analyses. One patient withdrew because of adverse effects during treatment.

Interventions

Participants were assigned to 1 of 2 treatment programs: (1) a 10-week device-supported isolated lumbar extension training, twice a week, or (2) regular PT, mainly consisting of exercise therapy and aerobic activities.

Main Outcome Measures

Functional status (Roland-Morris Disability Questionnaire, Patient-Specific Functional Scale) and global perceived effect were assessed in the short term (5wk, 10wk) and long term (6mo, 12mo).

Results

Both groups showed a favorable development in main outcomes over time: short-term improvements (after 10 weeks of treatment) remained stable or even slightly increased throughout the 12-month follow-up. No significant differences between the 2 groups were shown for any of the outcome measures, at any time.

Conclusions

Consistent with prior evidence, specific back strengthening does not seem to offer incremental benefits in LBP management compared with regular PT care that mainly consists of general exercise therapy. (ISRCTN identifier ISRCTN19334317.)