Abnormal EEG slow activity in left temporal areas in senile dementia of the Alzheimer type

Resting 32-channel topographical measures of EEG slow activity were compared in 12 elderly controls and 12 patients with senile dementia of the Alzheimer type. The patients had higher amplitude delta and theta than controls, especially in the left temporal regions. This greater amount of low frequency EEG activity in the left temporal area is consistent with recent EEG, neuropsychological assessment, and positron emission tomography findings in SDAT patients. Five patients with mild-to-moderate dementia (as determined by the Folstein Mini-Mental State scale) primarily exhibited focal, abnormal slow activity in the left temporal regions. Seven patients with severe dementia exhibited increased slow activity across the head, which was still most abnormal in the left temporal regions.     

Children's risk and resilience following a natural disaster: Genetic vulnerability,posttraumatic stress,and depression

Objective

We examined children’s risk and resilience following a natural disaster, evaluating the role of stress, social support, and two genetic markers: the short allele of the serotonin transporter gene (5-HTTLPR), and the met allele of the Brain-Derived Neurotrophic Factor (BDNF).Under high levels of hurricane exposure or hurricane-related stressors, we expected children displaying the markers would report greater symptoms of posttraumatic stress disorder (PTSD) and depression than children without these markers. Social support was explored as an additional moderating variable.

Method

Eight months after Hurricane Ike, 116 children (M age=8.85 years, SD=.89; 54% girls) residing in Galveston, Texas, provided saliva samples and completed measures of hurricane exposure and stress, and symptoms of PTSD and depression; 80 also completed a social support measure.

Results

For BDNF, analyses revealed several Gene by Environment interactions; greater stress was related to more symptoms of PTSD and depression, and this effect was stronger for children with the met allele. No findings emerged for 5-HTTLPR. Stressors and social support also were associated with children’s PTSD and depressive symptoms.

Limitations

Findings should be tempered by the relatively small sample, especially for analysis that included social support.

Conclusions

The met allele (BDNF) may play a role in children’s disaster reactions. Further research should consider the complex interplay between genes, stressors, support, and psychological outcomes over time.     

“Many miles to go …”: a systematic review of the implementation of patient decision support interventions into routine clinical practice

Background

Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, the effectiveness of these decision support interventions in routine practice has yet to be established; widespread adoption has not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the success levels of strategies or methods where attempts were made to implement patient-targeted decision support interventions into routine clinical settings.

Methods

An electronic search strategy was devised and adapted for the following databases: ASSIA, CINAHL, Embase, HMIC, Medline, Medline-in-process, OpenSIGLE, PsycINFO, Scopus, Social Services Abstracts, and the Web of Science. In addition, we used snowballing techniques. Studies were included after dual independent assessment.

Results

After assessment, 5322 abstracts yielded 51 articles for consideration. After examining full-texts, 17 studies were included and subjected to data extraction. The approach used in all studies was one where clinicians and their staff used a referral model, asking eligible patients to use decision support. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows, ultimately contributing to organizational inertia regarding their adoption.

Conclusions

It seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a ‘referral model’ consistently report difficulties. We sense that the underlying issues that militate against the use of patient decision support and, more generally, limit the adoption of shared decision making, are under-investigated and under-specified. Future reports from implementation studies could be improved by following guidelines, for example the SQUIRE proposals, and by adopting methods that would be able to go beyond the ‘barriers’ and ‘facilitators’ approach to understand more about the nature of professional and organizational resistance to these tools. The lack of incentives that reward the use of these interventions needs to be considered as a significant impediment.

     

Detection of upper gastrointestinal blood with fecal occult blood tests

OBJECTIVE: Although fecal occult blood (FOB) tests have most often been used to detect occult bleeding from the lower gastrointestinal (GI) tract, their utility in detecting occult blood loss from the upper GI tract is less well understood. The aims of this study were to determine whether small amounts of blood from the upper GI tract can be detected by currently available FOB tests and, if so, to correlate FOB tests with semiquantitative GI blood. METHODS: Groups of 10 healthy volunteers without a history of GI disease drank 5, 10, or 20 ml of their own blood mixed with tomato juice for 5 or 3 consecutive days. Standard dietary and medication restrictions were observed. Consecutive stools were tested for 2 days before, as well as 4 days after, blood ingestion. Each stool was simultaneously tested for FOB with HemoQuant (HQ), Hemoccult II (HO II), Hemoccult II SENSA (SENSA), HemeSelect (HS), and FlexSure OBT (FS). RESULTS: The mean age and hemoglobin concentration of the study population were 29.3+/-0.5 yr and 14.3+/-0.3 g/dl, respectively. No subject noted GI symptoms during blood ingestion. Fecal blood levels (measured by HQ) were elevated within 2 days after initiation of blood ingestion and remained elevated until 2-3 days after cessation of blood ingestion. Mean fecal blood levels peaked at 2.1, 7.9, 8.0, and 13.5 (mg hemoglobin/g stool) in groups ingesting 5 ml/5 days, 10 ml/3 days, 10 ml/5 days, and 20 ml/3 days, respectively. The proportion of positive tests during and immediately after the period of blood ingestion was greatest in the 20 ml/3 day group; 16% of HO II samples were positive as were 64% of SENSA and 67% of HQ samples. SENSA was more sensitive than HO II in all blood ingestion groups. At least one positive SENSA test was present in 50% of subjects ingesting 10 ml of blood (each 3 and 5 day groups) and in all subjects ingesting 20 ml/day. Immunochemical tests did not detect upper GI blood in any blood ingestion group. CONCLUSION: Inasmuch as many upper GI tract lesions have been reported to bleed small quantities of blood such as that studied here, and this amount of blood is readily detected with widely used guaiac-based FOB tests including Hemoccult II SENSA, the data emphasize that caution is warranted before attributing positive guaiac tests only to sites in the lower GI tract. The data raise the possibility that a combination of a highly sensitive guaiac-based FOB test plus an immunochemical could help differentiate occult upper from lower GI bleeding.     

Lack of seasonal variation in the endoscopic diagnoses of Crohn's disease and ulcerative colitis

BACKGROUND: Conflicting data have been reported about the seasonal variation of inflammatory bowel diseases (IBD). The purpose of the present analysis was to assess the occurrence of seasonal variations in the endoscopic diagnosis of Crohn's disease (CD) and ulcerative colitis (UC). METHODS: The Clinical Outcomes Research Initiative (CORI) uses a computerized endoscopic report generator to collect endoscopic data from 73 diverse practice sites throughout the United States. We utilized the CORI database to analyze the date-specific occurrence of colonoscopy, as well as the colonoscopic diagnoses of CD and UC. Time trends were analyzed by autocorrelation, linear, and nonlinear regression. RESULTS: Between January 2000 and December 2003, the number of colonoscopies increased 4.1-fold. The proportion of colonoscopies with a CD diagnosis fell by 28%, and the proportion of colonoscopies with a UC diagnosis fell by 50%. The occurrence of neither CD nor UC was shaped by any clear-cut seasonal periodicity. However, the trends of the two diseases revealed strikingly similar patterns with four resembling peaks superimposed on their monthly fluctuations. CONCLUSIONS: Endoscopic diagnosis of IBD is unaffected by any seasonal variation. The decline in the diagnostic rate of colonic IBD may reflect a relative increase in the utilization of colonoscopy for colon cancer screening. The similarity in the monthly fluctuations of both IBD suggests that their incidence or flare-ups may be influenced by identical exogenous risk factors.     

Cardiorespiratory fitness and body mass index values in 9-year-old rural Norwegian children

Aim: To describe cardiorespiratory fitness and body mass index (BMI) values in a representative population of 9-year-old Norwegian children in two rural communities and compare present values with previous findings.
Methods: Two hundred and fifty-nine 9-year-old children were invited, and 256 participated in this study. Maximal oxygen uptake was directly measured during a continuous progressive treadmill protocol. Body mass and height were also measured.
Results: The mean ± SD relative maximal oxygen uptake was 52.8 ± 6.5 for boys and 46.9 ± 7.2 mL/kg/min for girls. Eight percent of the boys and 16.8% of the girls were classified as overweight, and 1.6% of the boys and 6.9% of the girls as obese. Mean age, body mass, height and Ponderal index were not significantly different between sexes. Girls had a higher BMI than boys (p = 0.05).
Conclusion: Compared to earlier Norwegian studies, children's BMI values seem to have increased substantially. This increase is most pronounced in girls. When assessing these differences using the PI, this increase is less marked. Comparing maximal oxygen uptake data with that in earlier Nordic studies, there is no evidence that fitness has declined among 9-year olds. However, the limitations of the few earlier studies make reliable comparisons difficult.     

Evaluating an activity intervention with hemodialysis patients in Israel

As a life-threatening and potentially disabling disease, End Stage Renal Disease and its treatment cause stress as well as other psychosocial problems for patients and their families. This paper examines the results of an innovative activity-based intervention aimed at reducing some of the psychosocial repercussions of hemodialysis. A modified withdrawal/reversal design was employed to compare patients participating in the intervention and those who did not, at two points in time. The findings confirmed that dialysis patients in general have relatively high levels of psychological distress, difficulty adhering to the treatment regimen and poor self-rated health. Patients participating in the group activity were more anxious and had lower levels of interdialytic weight gain than the non-participants. After the intervention was terminated, levels of psychological distress, hostility and phobic anxiety among patients in the treatment group dropped, while their weight gain continued to be less than that of non-participating patients. The implications of these findings as well as the methodological difficulties entailed in this type of study are examined.