Amyoplasia: a case report of an old woman

Purpose: Little information exists about the long-term outcome of amyoplasia. In this article, a case report of a 93-year old woman is presented including both the development of the physical limitations and coping strategies. Method: The medical records, physical examinations and personal interviews during the last 10 years, autobiographical essays and personal photographs were included. Results: Eleven surgical procedures were performed during childhood and ten during adulthood. Ambulation without aids was possible up to the age of 37 years. Thereafter, the muscular force declined gradually, first in the legs and later in the arms. Musculoskeletal pain decreased during ageing. There was an increasing demand to use technical aids. Seniority brought about several diseases, which complicated the quality of life. The woman stayed 32 years of her life in work. Conclusions: A high age can be achieved with amyoplasia although the disability increases due to a gradual deterioration of muscular force. The personal experiences of the woman suggest that her active and creative attitude towards her disability may have contributed to the quality of her life. This may encourage people with amyoplasia and their care givers.

Implications for Rehabilitation

• There are no data about ageing and life-long prognosis of amyoplasia.

• Severe physical limitations in amyoplasia are compatible with a long and meaningful life.

• Muscular force decreases during adult life. Therefore, a potential risk of overtraining should be considered.

     

认知式自助疗法应用于妊娠期抑郁的综合效果分析

目的:探讨认知式自助疗法应用于妊娠期抑郁的综合效果。方法:将自愿报名的90例妊娠期抑郁孕妇采用随机分配的方式分为两组每组各45例,分别为对照组(常规干预组)和观察组(认知式自助疗法组),后将两组孕妇干预前后的SCL-90量表、SDS量表及剖宫产率、产后抑郁的发生率进行比较。结果:观察组干预后的SCL-90量表及SDS量表评分均优于对照组,剖宫产率及产后抑郁发生率也低于对照组,P均<0.05。结论:认知式自助疗法可有效改善妊娠期抑郁孕妇的不良心理状态及相关因素。     

Long‐Term Effectiveness of Screening for Hearing Loss: The Screening for Auditory Impairment—Which Hearing Assessment Test (SAI‐WHAT) Randomized Trial

OBJECTIVES: To evaluate the effect of hearing screening on long‐term hearing outcomes in a general population of older veterans. DESIGN: Hearing loss in the elderly is underdetected and undertreated. Routine hearing screening has been proposed, but it is not clear whether screening identifies patients who are sufficiently motivated to adhere to treatment. A four‐arm randomized clinical trial was conducted to compare three screening strategies with no screening in 2,305 older veterans seeking general medical care. SETTING: Veterans Affairs Puget Sound Health Care System. INTERVENTIONS: The screening strategies were a tone‐emitting otoscope, a widely used questionnaire about hearing handicap, and a combination of both tools. MEASUREMENTS: Hearing aid use 1 year after screening. RESULTS: Of participants who underwent screening with the tone‐emitting otoscope, questionnaire, and combined testing, 18.6%, 59.2%, and 63.6%, respectively, screened positive for hearing loss (P<.01 for test of equality across three arms). Patients proceeded to formal audiology evaluation 14.7%, 23.0%, and 26.6% of the time in the same screening arms, compared with 10.8% in the control arm (P<.01 for test of equality across four arms). Hearing aid use 1 year after screening was 6.3%, 4.1%, and 7.4% in the same arms, compared with 3.3% in the control arm (P<.01). Hearing aid users experienced significant improvements in hearing‐related function and communication ability. CONCLUSION: In older veterans, screening for hearing loss led to significantly more hearing aid use. Screening with the tone‐emitting otoscope was more efficient. The results are most applicable to older populations with few cost barriers to hearing aids.     

Women's views of two interventions designed to assist in the prophylactic oophorectomy decision: a qualitative pilot evaluation

Introduction A qualitative pilot evaluation of two different decision interventions for the prophylactic oophorectomy (PO) decision: a Decision Chart and a computerized clinical guidance programme (CGP) was undertaken. The Decision Chart, representing current practice in decision interventions, presents population‐based information. The CGP elicits individual values to allow for quality‐adjusted life years to be calculated and an explicit guidance statement is given. Prophylactic oophorectomy involves removal of the ovaries as an adjunct to hysterectomy to prevent ovarian cancer. The decision is complex because the operation can affect a number of long‐term outcomes including breast cancer, coronary heart disease and osteoporosis. Methods Both interventions were based on the evidence and were administered by a facilitator. The Decision Chart is a file, which progressively reveals information in the form of bar charts. The CGP is a decision‐analysis based program integrating the results from a cluster of Markov cycle trees. The research evidence is incorporated with woman's individual risk factors, values and preferences. A purposive sample of 19 women awaiting hysterectomy used the decision interventions (10 CGP, nine Decision Chart). In‐depth semi‐structured interviews were undertaken. Interviews were transcribed and analysed to derive themes. Results Reactions to the different decision interventions were mixed. Both were seen as clarifying the decision. Some women found some of the tasks difficult (e.g. rating health status). Some were surprised by the ‘individualized’ guidance, which the CGP offered. The Decision Chart provided some with a sense of empowerment, although some found that it provided too much information. Conclusions Women were able to use both decision interventions. Both provided decision clarification. Problems were evident with both interventions, which give useful pointers for future development. These included the possibility for women to see how their individual risks of different outcomes are affected in the Decision Chart and enhanced explanation of the CGP tasks. Future design and evaluation of decision aids, will need to accommodate differences between patients in the desire for amount and type of information and level of involvement in the decision‐making process.     

Determinants of eye drop size

Ophthalmic solutions are available for multidose or single-dose administration in a wide variety of glass and plastic dropper bottles which deliver drops with a volume between 25 and 70 microl. From a biopharmaceutical and economic point of view, however, smaller volumes of 5 to 15 microl should be instilled. In this review, the technical, pharmaceutical, and therapeutic aspects of eye drop formation and delivery are presented. The different types of containers are described and the determinants of eye drop size are discussed, such as the design and physical characteristics of the dropper tip and bottle, the physico-chemical properties of the solution, and the manner in which the patient dispenses the drops. Preferred and alternative instillation techniques and aids to facilitate the administration of eye drops by elderly patients are described.     

Effect of creatine supplementation on cardiac muscle of exercise-stressed rats

The role of creatine supplementation in altering the physiological parameters regulating cardiac muscle's functional capacity through the initiation of cardiac hypertrophy and altered contractile protein expression has not been determined. The purpose of this study was to determine the effect of creatine supplementation, with and without exercise stress, on physiological parameters regulating functional capacity through alterations in rat cardiac mass and contractile-protein expression. Thirty male Sprague-Dawley rats were subjected to 30 min of exercise stress 5 days/week for 3 weeks with 2% of total body mass attached to the tail. Animals were randomly assigned to one of four treatment groups: group 1 (Con) received (1 ml/day) sucrose water by intubation tube (n=8); group 2 (Cr) received (1 ml/day) sucrose/creatine solution (n=6); group 3 (EX) received 1 ml/day sucrose water and the exercise stimulus (n=8), and group 4 (Cr/EX) received (1 ml/day) sucrose/creatine solution and the exercise stimulus (n=8). At the conclusion of the 21-day exercise-training period, the heart was collected and weighed for determination of wet weight, total protein, total RNA, and myosin heavy chain protein expression. RNA concentration decreased significantly (13%) in the EX group, but not in the CR/EX group, indicating an interactive effect of creatine and exercise. Total RNA significantly decreased (15%) in the EX group. Protein concentration significantly increased (9%) in the exercising treatments, while total protein did not change. Cardiac myosin heavy chain expression significantly shifted towards a predominant expression of the β-isoform in the Cr/EX group [54.53% (3.42) β]. These results indicate an interaction of creatine supplementation and swimming exercise stress that potentially alters cardiac protein synthesis and demonstrates a possible mechanism through which the combination of creatine supplementation and swimming stress stimuli act to alter the physiological parameters regulating cardiac functional capacity. Electronic Publication     

Understanding the Low Vision Patient

ABSTRACT Over the past decade, the role of optometry in low vision care has steadily increased. Unfortunately many optometrists feel they lack the skills to fully service these patients. A functional classification of the visual losses and the aids prescribed for low vision patients has been prepared to encourage and assist the practitioner dealing with such patients.     

Rehabilitation: An Essential Component of Low Vision Care*

ABSTRACT This paper reviews the concept of rehabilitation in the delivery of care to the low vision patient. It defines low vision in functional terms and suggests that a multidisciplinary approach to management is necessary. The personal, psychological, educational and vocational factors in the successful management of a patient are discussed. Improvements in the delivery of future care are suggested.     

Geriatric Optometry

ABSTRACT Geriatric optometry differs from the more usual form of optometric care in that the geriatric patient suffers specific and characteristic visual symptoms and problems on the one hand, and has a reduced capacity for dealing with them on the other. This paper presents the origin and nature of the important problems of visual functioning for the geriatric patient and the presently available means of coping with them. There is a great need and a great scope for these services.