Cognitive processing and body balance in elderly subjects with vestibular dysfunction

Abnormal body balance and cognitive dysfunction may develop in elderly patients with chronic vestibular dysfunction.AimTo evaluate the relationship between cognitive processing and body balance in elderly patients with chronic peripheral vestibular disease. Type of Study: Cross-sectional.MethodsSeventy-six patients (≥ 60 years) with chronic peripheral vestibular dysfunction and dizziness for more than three months were enrolled. The tests for investigating body balance were: the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Timed Up and Go Test (TUGT) Timed Up and Go Test modified (TUGTm); the Mini Mental State Examination (MMSE), Test Clock (RT,) and Verbal Fluency Test (VF) were applied for assessing cognition.ResultsThe mean age was 69.03 years (SD=6.21 years); most were female (82.9%). There was a significant negative correlation between the MMSE and the TUGT (ρ=-0.312; p=0.01), MMSE and TUGTm (ρ=-0.306; p=0.01), FV and TUGT (ρ=-0.346; p=0.01), and FV and TUGTm (ρ=-0.536; p=0.01); there was a significant positive correlation between the TR and BBS (ρ=0.343; p=0.01), TR and DGI (ρ=0.298; p=0.01), FV and BBS (ρ=0.299; p=0.01), and FV and DGI (ρ=0.306; p=0.01).ConclusionElderly patients with chronic peripheral vestibular disease and worse performance in body balance tests have functional impairment in cognitive skills.     

Adjuvant radiotherapy for atypical and malignant meningiomas: a systematic review

Atypical meningiomas (AMs) and malignant meningiomas (MMs) are tumors with a lower incidence and poorer prognosis than benign meningiomas. The role of radiotherapy as an adjuvant to surgical resection, especially for AMs, is incompletely defined. In this study, the English-language literature was systematically reviewed for studies that reported tumor characteristics, treatment parameters, and clinical outcomes after adjuvant radiotherapy for AM and MM, including overall survival, progression-free survival, and/or time to recurrence or mortality. Clinical outcomes were further assessed in the context of resection status, timing of administration, and radiation dose. Outcomes after stereotactic radiosurgery were also examined. Treatment toxicity and other potential prognostic or confounding factors were appraised. Ten and 11 studies for AM and MM, respectively, met the inclusion criteria. The median 5-year progression-free survival and overall survival after adjuvant radiotherapy were 54.2% and 67.5%, respectively, for AM and 48% and 55.6% for MM. The complication rates were 11.1% for AM and 5.1% for MM. Incomplete resection and radiation dose <50 Gy conferred significantly poorer 5-year progression-free survival. Most studies were unable to demonstrate a statistically significant prognostic benefit for adjuvant radiotherapy in AM. In conclusion, adjuvant radiotherapy significantly improved local control of AMs and MMs, especially after subtotal resection. Study limitations, including inadequate statistical power, may underlie the studies'' inability to demonstrate a statistically significant benefit for adjuvant radiotherapy in AM. Because these tumors preferentially recur within 5 years of surgical resection, future studies should define whether early adjuvant therapy should become part of the standard treatment paradigm for completely excised tumors.     

Uncomfortable loudness levels among children and adolescents seeking help for tinnitus and/or hyperacusis

Objective: To assess the prevalence of hyperacusis and severe hyperacusis among children and adolescents seen at an audiology outpatient tinnitus and hyperacusis service.

Design: This was a retrospective study. Hyperacusis was considered as present if the average uncomfortable loudness level (ULL) at 0.25, 0.5, 1, 2, 4 and 8?kHz for the ear with the lower average ULL, which is denoted as ULLmin, was ≤77?dB HL. Severe hyperacusis was considered as present if the ULL was 30?dB HL or less for at least one of the measured frequencies for at least one ear.

Study sample: There were 62 young patients with an average age of 12?years (SD?=?4.1?years, range 4–18?years).

Results: Eighty-five percent of patients had hyperacusis and 17% had severe hyperacusis. On average, ULLs at 8?kHz were 9.3?dB lower than ULLs at 0.25?kHz. For 33% of patients, ULLs were at least 20?dB lower at 8 than at 0.25?kHz.

Conclusions: Among children and adolescents seen at an audiology outpatient clinic for tinnitus and hyperacusis, hyperacusis diagnosed on the basis of ULLs is very prevalent and it is often characterised by lower ULLs at 8 than at 0.25?kHz.     

Early Experiences of Threat,but Not Deprivation,Are Associated With Accelerated Biological Aging in Children and Adolescents

Background

Recent conceptual models argue that early life adversity (ELA) accelerates development, which may contribute to poor mental and physical health outcomes. Evidence for accelerated development in youths comes from studies of telomere shortening or advanced pubertal development following circumscribed ELA experiences and neuroimaging studies of circuits involved in emotional processing. It is unclear whether all ELA is associated with accelerated development across global metrics of biological aging or whether this pattern emerges following specific adversity types.

The assessment of fitness to stand trial for defendants with an intellectual disability: A proposed assessment procedure involving mental health professionals and lawyers

Guidelines for mental health professionals regarding an assessment of fitness to stand trial procedure that is functional, context‐dependent and pragmatic (Grisso, 1988) are clearly required; no published tool exists in Australia. This article addresses Victorian legal criteria as outlined by the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 based upon the Presser criteria. It is argued that the procedure should include the lawyer's predictions regarding the complexity of the forthcoming trial and the ability of the defendant to communicate, together with the mental health professional's assessment of the capacity of the defendant to make decisions. Current difficulties in assessing fitness to stand trial will be presented and an assessment procedure to overcome them is proposed.     

Outdoor fungi and child asthma health service attendances

Asthma is a significant global public health issue. Severe asthma exacerbations can be triggered by environmental factors and require medical care from health services. Although it is known that fungal exposure may lead to allergic sensitization, little is understood about its impact on asthma exacerbations. This review aims to examine whether outdoor fungi play a significant role in child asthma exacerbations. Systematic search of seven electronic databases and hand searching for peer‐reviewed studies published in English, up to 31 August 2013. Inclusion criteria were study population aged <18 yr, diagnosis of asthma, attended a health service; outdoor fungi exposure was reported. Quality and risk of bias assessments were conducted. Due to significant heterogeneity, meta‐analysis was not conducted. Of the 1896 articles found, 15 were eligible. Findings were not consistent, possibly due to methodological variations in exposure classifications, statistical methods and inclusion of confounders. Cross‐sectional studies found no or weak associations. All but one time series studies indicated an association that varied between fungal species. Increasing evidence indicates that asthmatic children are susceptible to asthma exacerbations when exposed to outdoor fungal spores. There is limited understanding of the contributions of different fungal species. Research is needed to investigate interactions of outdoor fungi with pollen, air pollutants and respiratory viruses.