Differentiation between organic and functional psychiatric illness in the elderly: An evaluation of four cognitive tests

One hundred and sixty-four patients admitted to a psychogeriatric unit were given a combination of four different cognitive tests: the Mini Mental State Examination (MMSE), the Abbreviated Mental Test Score, The Felix Post Unit Score and the compilation of tests recommended by the MRC Alzheimer's Disease Workshop. The tests were compared with respect to their ability to sort accurately cases of dementia and depression, and the effects of age and education on test score and misclassification rate with diagnosis controlled for. The MMSE had a very high misclassification rate for the poorly educated and depressed group. The logistical discriminant functional analysis selected only eight items as the best discriminators between organic/ functional or dementia/depression groups. Only one of these eight was not either a memory or orientation test. The value of simply adding up tests of different aspects of cognitive function in dementia assessment or screening is questioned.     

An evaluation of the effectiveness of four mechanical plaque-removal devices when used by a trained care-provider

Many care-dependent elderly individuals live in nursing homes and must depend on nursing home aides for oral hygiene care. It is generally agreed that the level of oral hygiene care among care-dependent nursing home residents is less than optimal. Two reasons are time constraints and the difficulty involved in brushing other individuals' teeth. The identification of effective and efficient plaque-removal devices for use by care-providers should make it easier for nursing home aides to incorporate effective oral hygiene care into their daily routines. This pilot study was undertaken to determine the relative effectiveness of four plaque removal devices with different basic designs when used by a non-professional careprovider on 10 healthy volunteers. A brush with curved bristles on the lateral aspect of the brush head and short straight bristles in the center (Collis-curve) and an electric toothbrush with tuffs that rotate reciprocally (Interplak) were the most effective, a conventional brush (Oral-B) was somewhat less effective, and a disposable foam brush (Abco) was least effective and similar to the prebrushing plaque score (baseline). All the volunteers reported that the Collis-curve as the most comfortable brush, and the care-provider reported that it was the easiest to use.     

Self-efficacy and AIDS Prevention for Pregnant Teens

AIDS education, the only immediate solution to containment of AIDS, encourages active risk reduction among high-risk populations. Self-efficacy is a construct that can measure the likelihood preventive behaviors will be performed, and thus could be applied to identify specific areas where AIDS education should be augmented. In this study, pregnant, mostly black, teens (N = 58) attending an alternative school in a large, midwestern city completed a self-efficacy scale to identify self-perceived areas of vulnerability to participating in preventive behaviors and avoiding high-risk behaviors concerning AIDS. The AIDS Self-efficacy Scale identified four areas of greatest vulnerability: using condoms, discussing previous homosexual activity, discussing previous bisexual activity, and telling a partner about an experience with a bisexual. The last three situations result from an inability to discuss a partner's past sexual history, indicating a need to be very specific in these areas. School health interventions should recognize and deal with issues sexually active teens have identified as most difficult, particularly specific aspects of sexual histories, and provide these adolescents with prevention skills necessary to reduce high-risk behaviors.     

In vivo 31P NMR studies of paraplegics' muscles activated by functional electrical stimulation

The bioenergetics of paralyzed muscles of spastic paraplegic patients under functional electrical stimulation (FES) was studied in vivo using ³¹P NMR. The protocol included rest, 3 min of induced tetanic isometric contraction through surface electrodes and 40 min of recovery. The continuous stimulation, the force recording and the ³¹P NMR measurements were sampled simultaneously inside the whole body imager. Normal values were found for the phosphorous metabolite ratios at rest. During contraction, prominent changes were detected including: a) accumulation of inorganic phosphate (P) accompanied by an unusually strong signal in the phosphomonoester (PME) region, b) phosphocreatine (PCr) decline, and c) a decrease in the intracellular pH. In the following recovery period the physiological state of the muscle was monitored and quantitated by ³¹P NMR. No metabolic and mechanical irreversible damage was detected in the paraplegics' muscles activated by FES under our experimental conditions.     

Evidence for the interaction between antacid and gastric mucosa using an "artificial stomach" model including gastric mucosa.

In light of evidence that certain aluminum-based antacids adhere to the gastric mucosa, we modified our previously described "artificial stomach" (AS) model by including a piece of hog stomach and compared the antacid activity of six aluminum-containing antacid products in the model with and without gastric mucosa. The activity of three of these, Maalox, Riopan and Supralox, was not significantly different in the two systems. In contrast, the activity of the other three, Aludrox, Phosphalugel and Simeco, was significantly greater with mucosa. Antacid activity of one product from each set (Supralox, Phosphalugel) was evaluated in two in vivo methods in human volunteers. For both antacids, results in vivo were similar to those obtained with the AS-containing mucosa. Without mucosa, in vivo and in vitro results were dissimilar for Phosphalugel, thus validating the modified AS. The difference between the two sets of antacids can be explained by 1) the fact that the Al:Mg ratio in the set affected by mucosa is greater than that of unaffected antacids, and 2) a weaker antacid load than in unaffected Supralox. We suggest that in an acid milieu, aluminum ions in antacids like Aludrox, Phosphalugel and Simeco are bound to sialic acid residues in mucus glycoproteins, thus retarding the transit of these antacids through both the AS and the real stomach and prolonging their activity in both situations. When the Al:Mg ratio is low or when the amount of antacid salts is large, aluminum ions tend to be buried in complexes, giving them less chance to interact with gastric mucus, so they transit the stomach more quickly.     

The implementation of a knowledge-based pathology Hypertext under HyperCard

A knowledge-based Hypertext of Pathology integrating videodisc-based images and computer-generated graphics with the textual cognitive information of an undergraduate pathology curriculum has been developed. The system described in this paper was implemented under HyperCard⁰⁰ during 1988 and 1989. Three earlier versions of the system that were developed on different platforms are contrasted with the present system. Strengths, weaknesses, and future extensions of the system are enumerated. The conceptual basis and organizational principles of the knowledge base are also briefly discussed.