Use of multivariate measures of disability in health surveys.

It has been claimed that the aggregation of information from several areas of life into a small set of global measures has certain advantages for describing disability. Global measures of disability were constructed from a modified version of an existing health survey instrument and the sickness impact profile (SIP) and their properties were tested. The disability items grouped satisfactorily into five global measures (physical, psychosocial, eating, communication, and work). All disability measures (global and original category scores) were poor predictors of service use by individuals but were related as expected to age and number of medical conditions. The global measures generally had lower standard errors and better repeatability. All scores exhibit J-shaped distributions for cross sectional data but the change in global measures over time was consistent with the normal distribution. Preferably, both global and category measures should be used for comparing changes over time between groups of individuals.     

Micronutrient dilution associated with added sugar intake in elderly black South African women

OBJECTIVES: To investigate the association between added sugar and macronutrient and micronutrient intakes, and to assess whether added sugar intake is related to biochemical indices of nutritional status, Mini-Nutritional Assessment (MNA) score, body mass index (BMI) and performance on physical function tests. DESIGN: A cross-sectional, analytical study. SETTING AND SUBJECTS: Convenient sample of 285 institutionalised and community-dwelling black South African men and women aged 60+ y. METHODS: An interviewer-administered 24-h dietary recall and MNA were performed. Serum albumin, vitamin B12, ferritin, cholesterol, haemoglobin, red blood cell (RBC) folate and plasma vitamin C were measured. Handgrip strength, BMI, 'sit-to-stand' and 'get-up-and-go' tests were measured. Outcome variables were analysed according to tertiles of added sugar, in grams and as a percentage of total energy (% E). RESULTS: In each tertile of sugar intake, mean MNA score fell in the 'at-risk' classification. In women, energy, protein, % E protein, fibre, thiamin, riboflavin, niacin, vitamin B6, folate, pantothenic acid, biotin, vitamin C, calcium, iron, magnesium, phosphorus, zinc, copper and selenium intake were significantly lowest in subjects in the highest % E sugar tertile. In men, no differences were found for micronutrient intake according to tertiles of total added sugar or % E added sugar. Physical function declined with increasing sugar intake, and suboptimal RBC folate and plasma ascorbic acid status was associated with increasing sugar intake (in women). No relationship was found between added sugar intake and the very high prevalence (65%) of obesity in women. CONCLUSION: A nutrient-diluting effect of added sugars intake was demonstrated in elderly black South African women. Further studies in this population are required in order to develop food-based dietary guidelines, which include messages on added sugar intake.     

Major motor atrophic patterns in the face and neck: CT evaluation

Cranial nerve deficits from various pathologic processes of the head and neck may result in characteristic patterns of denervation muscular atrophy. Such atrophic patterns may be clues to the location and extent of the lesion, particularly when cranial nerves are involved early in the course of the disease process. Thirty-six patients with computed tomographic (CT) evidence of muscular atrophy secondary to pathologic conditions involving the motor division of cranial nerves were examined. Five characteristic denervation muscular atrophy patterns seen on CT scans were identified. In several patients, identification of the muscular atrophy pattern was the only clue to the presence of a pathologic condition. Recognition of these atrophic patterns can prevent misinterpretation of their CT appearance and direct the CT examination to the course of the compromised cranial nerve from the brainstem to its peripheral innervation.     

Spondylolysis and spondylolisthesis of the cervical spine

Spondylolysis and spondylolisthesis of the cervical spine are rare entities. The nomenclature and detailed anatomic features of these conditions are discussed. Four new cases are presented and the world literature is reviewed.Picker Scholar, James Picker Foundation     

Effect of head posture on tracheal tube position in children

Changes in the tracheal tube tip to carina distance were measured by radiographic screening following various head postures in 45 children undergoing cardiac catheterisation under general anaesthesia who were intubated via nasal and oral routes. Extension of the head moved the tracheal tube away from the carina and flexion moved it towards the carina in both routes. Endobronchial intubation was noted during neck flexion in a significant proportion of children intubated orally but none occurred during nasal intubation. Extension produced greater upward movement of the tracheal tube tip in the oral route than the nasal route. In contrast, flexion produced greater downward movement in the nasal route in some patients. The direction of movement with lateral rotation and use of a shoulder roll was inconsistent.     

Repeatability of an optimised lower body model

The optimisation technique, optimised lower-limb gait analysis (OLGA), is described together with a preliminary study of repeatability compared to an implementation of the Newington-Helen Hayes gait model. The study of repeatability used a single healthy subject, three physiotherapists as observers and provided approximately 100 gait cycles. Improvement in intra- and inter-observer repeatability of the lower limb model was found for OLGA, indicated by significantly lower standard deviations (S.D.s) in local marker co-ordinate (a measure of rigidity of the marker attachment), together with reduced S.D. in the estimated length of the bone segments. The S.D. in the inter-hip distance measured by OLGA (N = 25) was found to be only 2.4 mm. The repeatability of clinically significant output variables (joint angles, forces and moments) was also improved, with the inter-observer variations for joint angles and forces being significantly lower for OLGA. Euler angle component cross-talk effects frequently reported at the hip, knee and ankle were also successfully reduced by OLGA, this being the chief cause of the improvement in inter-observer repeatability.