Meanings and experiences of assistive technologies in everyday lives of older citizens: a meta-interpretive review

Purpose: The purpose of this study was to synthesize the available qualitative studies on the meaning of assistive technologies (AT) in elderly people's everyday lives in order to identify central concepts, themes, and findings from existing research. Method: A systematic search of the literature was conducted, using predetermined search strategies. Exclusion criteria were, in accordance with the meta-interpretive approach, developed iteratively during the reading of abstracts and articles. Interpretations from the studies were used as data for thematic analysis and synthesis of findings. Results: Review of these studies show that older people not only have positive attitude towards AT, but also that acceptance of technologies is a potentially stressful process where trust towards technologies and other people are of importance. Older people have ambivalent experiences with technology, as it gives rise to possibilities as well as constraints, and safety as well as worries. AT enact sometimes conflicting values related to self and society. Conclusions: Although AT seem to support societal discourses on active aging, the empirical studies in this field show that the technologies enter older people’s lives in complex ways, enacting social values and ambivalences and interact with caretakers, relatives and other actors, within specific institutional settings.

• Implications for rehabilitation

• In implementing AT, attention should be paid to ambivalences and conflicting values enacted by AT in older people's lives

• In implementing AT, attention should be paid not only to independency but also to the eventually dependencies, created by the use of AT

     

Combined transcranial direct current stimulation and home-based occupational therapy for upper limb motor impairment following intracerebral hemorrhage: a double-blind randomized controlled trial

Purpose: To investigate the combined effect of transcranial direct current stimulation (tDCS) and home-based occupational therapy on activities of daily living (ADL) and grip strength, in patients with upper limb motor impairment following intracerebral hemorrhage (ICH). Methods: A double-blind randomized controlled trial with one-week follow-up. Patients received five consecutive days of occupational therapy at home, combined with either anodal (n?=?8) or sham (n?=?7) tDCS. The primary outcome was ADL performance, which was assessed with the Jebsen–Taylor test (JTT). Results: Both groups improved JTT over time (p?p?=?0.025). However, this difference was attenuated at one-week follow-up. There was a non-significant tendency for greater improvement in JTT in the anodal group compared with the sham group, from baseline to post-assessment (p?=?0.158). Conclusions: Five consecutive days of tDCS combined with occupational therapy provided greater improvements in grip strength compared with occupational therapy alone. tDCS is a promising add-on intervention regarding training of upper limb motor impairment. It is well tolerated by patients and can easily be applied for home-based training. Larger studies with long-term follow-up are needed to further explore possible effects of tDCS in patients with ICH.

• Implications for Rehabilitation

• Five consecutive days of tDCS combined with occupational therapy provided greater improvements in grip strength compared with occupational therapy alone.

• tDCS is well tolerated by patients and can easily be applied for home-based rehabilitation.

     

Use of plasma C-reactive protein,procalcitonin, neutrophils,macrophage migration inhibitory factor,soluble urokinase-type plasminogen activator receptor,and soluble triggering receptor expressed on myeloid cells-1 in combination to diagnose infections: a prospective study

Introduction  

Accurate and timely diagnosis of community-acquired bacterial infections in patients with systemic inflammation remains challenging both for clinician and laboratory. Combinations of markers, as opposed to single ones, may improve diagnosis and thereby survival. We therefore compared the diagnostic characteristics of novel and routinely used biomarkers of sepsis alone and in combination.     

Hydrocortisone and the mitogen-activated protein kinase inhibitor U0126 acutely suppress reactive oxygen species generation from circulating granulocytes after gunshot injuries in the pig

OBJECTIVE: Several external stimuli, including trauma, increase the endogenous production of reactive oxygen species that spontaneously attack vital biological molecules. In addition to their direct toxic effects, several secondary messenger systems are induced. To forestall a subsequent organ dysfunction, a short-term posttraumatic down-regulation of granulocyte function has been advocated. Corticosteroids are potent and universal anti-inflammatory agents, but they have well-known side effects. Modulation of the mitogen-activated protein kinase cascade is an alternative approach. The purpose of this study was to investigate how the posttraumatic production of reactive oxygen species can be modulated by hydrocortisone or the extracellular signal-regulated kinase inhibitor U0126. DESIGN: Prospective randomized trial. SETTING: Field hospital and research laboratory. SUBJECTS: Seventeen male pigs. INTERVENTIONS: In general anesthesia, the pigs were exposed to a standardized insult: one gunshot hitting the right femur from a distance of 25 m, and one pistol shot to the left upper abdomen from close range. Following immediate first aid treatment, the animals were transported to a nearby field hospital. According to randomization, the animals received either hydrocortisone 250 mg intravenously (group 1, n = 9) or a similar amount of saline (group 2, n = 8). The injections were given 5 mins after the last shot. Blood samples were drawn before shooting, immediately before hydrocortisone was given, and 60 mins after shooting. Circulating neutrophils were isolated, and the production of reactive oxygen species was measured fluorometrically. Neutrophils from nine randomly chosen animals (five from group 1 and four from group 2) were treated in vitro with the extracellular signal-regulated kinase inhibitor U0126. MEASUREMENTS AND MAIN RESULTS: The injuries as evaluated by the abbreviated injury scale did not differ between the animals. All survived the first 60 mins. While the in vivo production of reactive oxygen species tended to increase in the controls, a significant reduction was measured in the hydrocortisone group. Subsequent treatment with U0126 further reduced the synthesis of reactive oxygen species by about two thirds in both groups, independently of time. CONCLUSIONS: Early injection of hydrocortisone after trauma inhibits the synthesis of reactive oxygen species from circulating neutrophils. Inhibition of the extracellular signal-regulated kinase branch of the mitogen-activated protein kinase signaling cascade is an alternative approach. The powerful in vitro capacity of selective extracellular signal-regulated kinase inhibitors to reduce the posttraumatic reactive oxygen species generation deserves further investigations, and compelling evidence of their in vivo usefulness is still lacking.     

Diet quality in 116 Norwegian men and women with coronary heart disease.

BACKGROUND AND AIMS: Clinical intervention studies have provided strong evidence that a healthy diet can prevent coronary heart disease. The aims of this study were to describe the diet quality in Norwegian subjects from Sogn and Fjordane County with coronary heart disease, and to investigate if the diet quality was associated with demographic and lifestyle variables. METHODS: We used a self-administered questionnaire to assess information from 116 participants. A Healthy Diet Score (HDS) indicated the diet quality. Multiple Linear regression analyses were used to investigate associations between relevant variables and the HDS. RESULTS: We found that 26.7% of the participants had a poor HDS, 64.6% had a fair HDS and 8.7% had a good HDS. We found that the widespread suboptimal diet quality (poor or fair HDS) was partially related to low consumption of nonhydrogenated mayonnaise products, vegetables, and fruit/berries/juice. Multiple linear regression analysis showed that women had better HDS than men, and that subjects with high education had better HDS than subjects with low education (P < 0.05). CONCLUSION: We found that 91.3% of the participants had a suboptimal diet quality. The consumption of nonhydrogenated mayonnaise products, vegetables and fruit/berries/juice were poor and a principal goal should be to increase the consumption of these food items. Health professionals should keep in mind that gender and educational level may be associated with dietary habits. An important clinical implication of this study is that more attention should be paid to dietary counselling.     

Secondary heat hyperalgesia induced by melittin in humans.

Melittin, which is a principal protein of honeybee venom, can induce mechanical hyperalgesia in humans. The characteristics of the melittin induced mechanical hyperalgesia are quantitatively and qualitatively different from those evoked by capsaicin. The aim of the present study was to investigate in detail secondary heat hyperalgesia induced by melittin in humans. In six healthy volunteers, 10 microg of melittin was injected intradermally on the volar forearm, and VAS score to radiant heat stimuli (focused light from a xenon lamp) was assessed around the injection site 5, 30, and 60 min after injection. For normalization purposes, a pain rating index was calculated as the individual heat evoked VAS scores obtained after melittin divided by the individual baseline VAS scores. A two-way ANOVA revealed a significant increase of the pain rating index over time (F=3.6; P=0.03). The pain rating index at 60 min was significantly larger than at 5 min (P=0.04) and at 30 min (P=0.03). These results demonstrated slowly developing secondary heat hyperalgesia after injection of melittin. A possible contribution of peripheral inflammatory responses to the manifestation of secondary heat hyperalgesia is suggested, which in reality render the distinction between the primary and secondary area of heat hyperalgesia unnecessary.