Research with homeless people uncovers a model of health.

This grounded theory research study, explored health experiences of 11 homeless persons in shelters in three New Brunswick cities and the strategies that they used to attain, maintain, or regain health. Audiotaped interviews were conducted, transcribed verbatim, and analyzed. The model that emerged from analysis consists of three pathways to health. This model of health has two central components, person and health. Person is influenced directly by family values and beliefs, and directly and indirectly by societal values and beliefs. Health is the outcome and is reached through two mediating factors of lifestyle behaviors and sector services. The first pathway to health contains the mediating factor of lifestyle behaviors, the second contains the mediating factor of sector services, and the third contains both mediating factors. Pathway strategies of choosing, accessing, and appraising appropriateness of methods influence the active participation of the person that directs the action within the model. Implications of the study include that a fragmented system of help hinders access to services intended to promote health in this population.     

Physician support for diabetes patients and clinical outcomes

Background  

Physician practical support (e.g. setting goals, pro-active follow-up) and communicative support (e.g., empathic listening, eliciting preferences) have been hypothesized to influence diabetes outcomes.     

Lymphoepithelioma-Like Carcinoma of the Skin: An Exceedingly Rare Primary Skin Tumor

Primary lymphoepithelioma-like carcinoma of the skin (LE-lCS) is a very rare cutaneous malignancy of uncertain origin. The neoplasm reveals typical morphological similarity to undifferentiated nasopharyngeal carcinoma (lymphoepithelioma). This case report presents a 47-year-old man with a 5 mm erythematous papule on dorsal nose of six months duration. The patient underwent complete surgical excision and is disease free 7 months later.     

老年人平衡能力特点及评估

学术背景:平衡能力是人体的一项重要生理机能,在人类生活中有非常重要的意义.特别是老年人平衡能力下降,直接影响老年人独立生活能力,严重的会引起老年人跌倒,诱发其他疾病.目的:总结老年人平衡能力的国内外研究现状,并展望未来老年人平衡能力研究的发展方向.检索策略:应用计算机检索PubMed数据库1990-12/2007-06有关老年人平衡能力方面的文章,检索词“elderly,balance“,限定文章语言种类为English,共检索到208篇文章.同时应用计算机检索中国期刊全文数据库、万方数据库1997-12/2007-06的相关文章,检索词“老年人、平衡能力“,限定文章语言种类为中文,共检索到85篇文章.对资料进行初审,选取符合研究要求的有关文章找全文.纳入标准:①平衡能力的研究.②老年人平衡特征.③平衡能力评价.④运动干预对平衡能力的研究.排除理由:①较陈旧的文献.②重复研究.文献评价:共19个研究满足全部纳入标准,予以纳入.其中6篇为老年人平衡特征的文献、8篇平衡评价的文献、5篇运动干预老年人平衡影响的文献.资料综合:①平衡能力是人体相关系统功能的集中表现,研究影响平衡能力的前庭系统、视觉系统、躯体感觉、神经系统及肌肉-骨骼等系统功能增龄性的变化趋势,探究导致平衡能力增龄性变化的主要因素是待解决的问题.②平衡测试是定量评定平衡能力的前提,针对老年群体的特殊性,逐步寻求安全、简捷能全面反映其平衡能力的测试方法.③国内专业人员日益提高了对平衡的关注,发表的论文也较多,但由于平衡评定方法不统一,对中国人民平衡能力增龄性变化的研究没有继承性,研究国民的平衡能力增龄性变化是必要的.④众多研究表明,体育锻炼可以延缓平衡能力的衰退.但研究比较分散,运动项目比较单一,探究利于干预的运动项目以及最佳时机是待解决的热点课题.结论:建立一整套适合中国国民平衡能力评价体系,研究国民的平衡能力增龄性变化是十分有必要的,为全民健身活动中的老年人科学地进行健身提供依据.     

Lateral hip pain: findings from magnetic resonance imaging and clinical examination

STUDY DESIGN: Prospective cross-sectional study. OBJECTIVES: To examine the radiological and physical therapy diagnoses of lateral hip pain (LHP), and determine the validity of selected clinical variables for predicting gluteal tendon pathology. BACKGROUND: LHP is frequently encountered by clinicians. Further investigation is required to establish the specific pathologies implicated in the cause of LHP, and which clinical tests are useful in the assessment of this problem. METHODS AND MEASURES: Forty patients with unilateral LHP underwent a physical therapy examination followed by magnetic resonance imaging (MRI) studies. Three radiologists analyzed the images of both hips for signs of pathology. Interobserver reliability of the image analyses, the agreement between the physical therapy and radiological diagnoses, and the validity of the clinical tests were examined. RESULTS: Gluteus medius tendon pathology, bursitis, osteoarthritis and gluteal muscle atrophy (predominantly affecting gluteus minimus) were all implicated in the imaging report of LHP. While prevalent in symptomatic hips, abnormalities were also identified in asymptomatic hips, particularly relating to the diagnosis of bursitis. The strength of agreement between radiologists was variable and little agreement existed between the physical therapy and radiological diagnoses of pathology. Nine of the 26 clinical variables examined in relation to gluteal tendon pathology had likelihood ratios above 2.0 or below 0.5, but the associated 95% confidence intervals were large. CONCLUSIONS: The diagnosis of LHP is challenging and our results highlight some problems associated with the use of MRI as a diagnostic reference standard. This factor, together with the imprecise point estimates of the likelihood ratios, means that no firm conclusions can be made regarding the diagnostic utility of the clinical tests used in the assessment of gluteal tendon pathology.     

Brain activity during a motor learning task: an fMRI and skin conductance study

Measuring electrodermal activity (EDA) during fMRI is an effective means of studying the influence of task-related arousal, inferred from autonomic nervous system activity, on brain activation patterns. The goals of this study were: (1) to measure reliable EDA from healthy individuals during fMRI involving an effortful unilateral motor task, (2) to explore how EDA recordings can be used to augment fMRI data analysis. In addition to conventional hemodynamic modeling, skin conductance time series data were used as model waveforms to generate activation images from fMRI data. Activations from the EDA model produced significantly different brain regions from those obtained with a standard hemodynamic model, primarily in the insula and cingulate cortices. Onsets of the EDA changes were synchronous with the hemodynamic model, but EDA data showed additional transient features, such as a decrease in amplitude with time, and helped to provide behavioral evidence suggesting task difficulty decreased with movement repetition. Univariate statistics also confirmed that several brain regions showed early versus late session effects. Partial least squares (PLS) multivariate analysis of EDA and fMRI data provided complimentary, additional insight on how the motor network varied over the course of a single fMRI session. Brain regions identified in this manner included the insula, cingulate gyrus, pre- and postcentral gyri, putamen and parietal cortices. These results suggest that recording EDA during motor fMRI experiments provides complementary information that can be used to improve the fMRI analysis, particularly when behavioral or task effects are difficult to model a priori.