DISABILITY AND MARGINAL UTILITY OF INCOME: EVIDENCE FROM HYPOTHETICAL CHOICES

It is often assumed that disability reduces the marginal utility of income. In this article, individuals' marginal utility of income in two states—(i) paralyzed in both legs from birth and (ii) not mobility impaired at all—is measured through hypothetical choices between imagined lotteries behind a so‐called veil of ignorance. The outcomes of the lotteries include both income and disability status. It is found that most people have higher marginal utility when paralyzed than when not mobility impaired at all. The two marginal utilities are evaluated at the same levels of income. Having personal experience of mobility impairment and supporting the Left Party, the Social Democratic Party, the Green Party, or the Liberal Party are associated with having a higher marginal utility when paralyzed. The results suggest that more than full insurance of income losses connected to being disabled is optimal. The results further suggest that, given a utilitarian social welfare function, resources should be transferred to rather than from disabled people. Finally, if the transfers are not large enough to smooth out the marginal utilities of the disabled and the nondisabled, distributional weights based on disability status should be used in cost–benefit analysis. Copyright © 2013 John Wiley & Sons, Ltd.     

Prevalence and Correlates of Hearing and Visual Impairments in European Nursing Homes: Results From the SHELTER Study

Background

Visual and hearing impairments are known to be related to functional disability, cognitive impairment, and depression in community-dwelling older people. The aim of this study was to examine the prevalence of sensory impairment in nursing home residents, and whether sensory impairment is related to other common clinical problems in nursing homes, mediated by functional disability, cognitive impairment, and depressive symptoms.

Methods

Cross-sectional data of 4007 nursing home residents in 59 facilities in 8 countries from the SHELTER study were analyzed. Visual and hearing impairments were assessed by trained staff using the interRAI instrument for Long-Term Care Facilities. Generalized linear mixed models adjusted for functional disability, cognitive impairment, and depressive symptoms were used to analyze associations of sensory impairments with prevalence of clinical problems, including behavioral symptoms, incontinence, fatigue, falls, problems with balance, sleep, nutrition, and communication.

Results

Of the participants, 32% had vision or hearing impairment (single impairment) and another 32% had both vision and hearing impairments (dual impairment). Residents with single impairment had significantly higher rates of communication problems, fatigue, balance problems, and sleep problems, as compared with residents without any sensory impairment. Those with dual impairment had significantly higher rates of all clinical problems assessed in this study as compared with those without sensory impairment. For each clinical problem, the magnitude of the odds ratio for specific clinical problems was higher for dual impairment than for single impairment.

Conclusion

Visual and hearing impairments are associated with higher rates of common clinical problems among nursing home residents, independent of functional disability, cognitive impairment, and depressive symptoms.     

Prognosis of Mild Cognitive Impairment in General Practice: Results of the German AgeCoDe Study

PURPOSE

The concept of mild cognitive impairment (MCI) has recently been introduced into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as mild neurocognitive disorder, making it a formal diagnosis. We investigated the prognostic value of such a diagnosis and analyzed the determinants of the future course of MCI in the AgeCoDe study (German Study on Ageing, Cognition, and Dementia in Primary Care Patients).

METHODS

We recruited 357 patients with MCI aged 75 years or older from primary care practices and conducted follow-up with interviews for 3 years. Depending on the course of impairment over time, the patients were retrospectively split into 4 groups representing remittent, fluctuating, stable, and progressive courses of MCI. We performed ordinal logistic regression analysis and classification and regression tree (CART) analysis.

RESULTS

Overall, 41.5% of the patients had remission of symptoms with normal cognitive function 1.5 and 3 years later, 21.3% showed a fluctuating course, 14.8% had stable symptoms, and 22.4% had progression to dementia. Patients were at higher risk for advancing from one course to the next along this spectrum if they had symptoms of depression, impairment in more than 1 cognitive domain, or more severe cognitive impairment, or were older. The result on a test of the ability to learn and reproduce new material 10 minutes later was the best indicator at baseline for differentiating between remittent and progressive MCI. Symptoms of depression modified the prognosis.

CONCLUSIONS

In primary care, about one-quarter of patients with MCI have progression to dementia within the next 3 years. Assessments of memory function and depressive symptoms are helpful in predicting a progressive vs a remittent course. When transferring the concept of MCI into clinical diagnostic algorithms (eg, DSM-5), however, we should not forget that three-quarters of patients with MCI stayed cognitively stable or even improved within 3 years. They should not be alarmed unnecessarily by receiving such a diagnosis.     

丹参酮ⅡA璜酸钠注射液治疗脑梗死的临床疗效观察

目的：观察并分析丹参酮ⅡA璜酸钠注射液治疗脑梗死的临床效果。方法：选取2011年1月-2014年1月本院诊治的62例脑梗死患者的临床资料,按照完全随机法1：1分成对照组和研究组各31例,对照组行常规西医对症治疗,研究组在对照组基础上加用丹参酮ⅡA璜酸钠注射液,观察比较两组患者的神经功能与生活能力改善,自由基与血液流变学指标水平变化情况。结果：与治疗前比较,两组治疗后的SOD活性均明显升高,MDA与LPO水平均明显降低（P〈0.05）。研究组治疗后的SOD活性（5.96±0.13）U/mL明显高于对照组的（4.85±0.11）U/mL,MDA水平（8.36±0.93）mmol/mL与LPO水平（10.57±2.16）mmol/mL均明显低于对照组（10.54±0.52）mmol/mL和（13.25±2.61）mmol/mL,差异均有统计学意义（P〈0.05）。治疗2周、4周时,两组NIHSS、NDS评分均明显降低,ADL、BI评分均明显升高,且同期组间比较差异显著,均有统计学意义（P〈0.05）;研究组治疗后的全血比粘度、血浆比粘度与红细胞聚集指数均明显低于治疗前与同期对照组,差异均有统计学意义（P〈0.05）。结论：丹参酮ⅡA璜酸钠注射液治疗脑梗死的临床效果显著,值得临床推广与应用。     

蒙特利尔认知评估量表在老年轻度认知功能障碍筛查中的应用

目的探讨蒙特利尔认知评估量表（MoCA）在老年轻度认知功能障碍（MCI）患者筛查中的应用。方法选择老年MCI患者56例为MCI组和认知功能正常者50例为对照组,分别给予MoCA、简易精神状态检查量表（MMSE）评估,并分析评估结果。结果 MCI组和对照组MoCA总分明显低于MMSE总分（P〈0.01）。MoCA筛查MCI的敏感性为96.4%、特异性为84%;MMSE筛查MCI的敏感性为35.7%、特异性为100%。MoCA中除定向力项外,总分及其余各亚项的评分在MCI组和对照组间差异均有统计学意义（P〈0.01）。结论 MoCA为高敏感性的MCI筛查工具,能全面评估MCI患者的认知功能,筛查MCI的敏感性优于MMSE。     

Effectiveness of melatonin for sleep impairment post paediatric acquired brain injury: Evidence from a systematic review

Objective: To retrieve and review all the relevant literature describing the administration of melatonin to treat impaired sleep in children following acquired brain injury (ABI).

Methods: A systematic search and retrieval of the literature was conducted using advanced search techniques. The retrieval identified 589 papers, seven of which were relevant. Review/outcomes criteria were developed and study quality was determined.

Results: There is paucity of high-quality evidence to support use of melatonin for sleep impairment post paediatric ABI. Variation in dosage, screening and outcome measures, data reporting and a lack of impairment delineation and treatment stratification were recurrent themes.

Conclusion: Retrieved evidence for the effectiveness of melatonin for post paediatric ABI sleep impairment appears promising. There is a clear need for further study in this area to inform clinical and research practices. Recommendations are given.     

Microswitch-aided programs with contingent stimulation versus general stimulation programs for post-coma persons with multiple disabilities

Objective: Assessing the impact of microswitch-aided programs with contingent stimulation on response engagement (Study I) and post-session alertness (Study II) of post-coma participants with multiple disabilities.

Method: Study I included three participants whose scores on the Coma Recovery Scale-Revised (CRS-R) were 11 or 13. Study II included three participants whose CRS-R scores were 19, 13, and 14. In both studies, the participants received sessions with contingent stimulation (i.e., sessions in which activation of a microswitch with an eyelid or hand response produced 15?s of preferred stimulation) and sessions with general, non-contingent stimulation (i.e., stimulation lasted throughout the sessions).

Results: Study I showed an increase in response engagement/frequencies only during the contingent stimulation sessions. Study II showed that the participants’ level of vigilance after those sessions was higher than after non-contingent stimulation sessions.

Conclusion: Microswitch-aided programs with contingent stimulation would be more beneficial than programs with general/non-contingent stimulation.