“I do like the activities which I can do…” Leisure participation experiences of children with movement impairments

Aim: To explore in depth the leisure participation experiences of children with movement impairments.

Methods: We used Interpretative Phenomenological Analysis approach to interpret and understand the experiences of 22 children with movement impairments, aged between 6 and 12?years. Children expressed their views through flexible child-centred methods of data collection that allowed the children to draw, paint, use stickers, and demonstrate their leisure activities and equipment while communicating about their experiences.

Results: Children participated in leisure activities of their choice, and expressed positive experience of fun, challenge, independence and achievement. The choice of activities depended on a combination of the motor functioning of the individual child, inspiration and support from families, friends and health professionals, as well as the possibility of adaptations and availability of community programmes. At times children felt disappointed and avoided some activities due to associated negative experience such as injury, fear, non-inclusion and the difficulty they had experienced in adapting and performing certain activities.

Conclusion: Families, therapists and community service providers such as disability organisations could enhance leisure participation experiences by suggesting and creating opportunities that could increase children’s choices of leisure activities.

• Implications for rehabilitation

• Children’s choice of activities, places and friends is important for positive experiences of fun, achievement, challenge, independence and motivation in leisure participation.

• Families and health professionals could assist children make appropriate choices for leisure activities that depends on factors such as motor abilities, adaptations and availability of activities in the community.

• In the community, widening the options for leisure activities such as non-competitive adaptive sports and indoor sports for children with variable levels of movement impairment could improve leisure participation experiences.

     

31P-MRS study of acetyl-L-carnitine treatment in geriatric depression: preliminary results

Objective:   This 12-week study of two elderly, depressed subjects investigated the effect of acetyl- L -carnitine (ALCAR) treatment on the Hamilton Depression Rating Scale (HDRS) and on measures of high-energy phosphate and membrane phospholipid metabolism.
Methods:   Two mildly depressed (HDRS 15–20), non-demented male subjects 70 and 80 years old were compared with six non-demented controls (all males, mean age of 73.6 ± 3.6 years). High-energy and membrane phospholipid metabolites were measured by phosphorus magnetic resonance spectroscopic imaging (³¹P MRSI) analysis. HDRS and ³¹P MRSI measurements were taken at entry, 6 and 12 weeks for the depressed subjects.
Results:   ³¹P MRSI analysis revealed elevated levels of phosphomonesters [PME( s  – τ_c)] in the prefrontal region of these mildly depressed subjects, which decreased with ALCAR treatment and showed a trend for correlation of the PME( s  – τ_c) levels with HDRS. ALCAR treatment also resulted in increasing levels of the prefrontal phosphocreatine (PCr), which correlated with HDRS.
Conclusions:   In the prefrontal region, the mildly depressed subjects compared with controls had elevated PME( s  – τ_c) levels which normalized after 12 weeks of ALCAR and increased PCr levels after ALCAR treatment. These preliminary findings suggest further studies are warranted.     

Maternal adipose tissue response to nicotine administration in the pregnant rat: effects on fetal body fat and cellularity

Nicotine has been implicated as a causative factor in the intrauterine growth retardation associated with smoking in pregnancy. A study was set up to ascertain the effect of nicotine on fetal growth and whether this could be related to the actions of this drug on maternal adipose tissue metabolism. Sprague-Dawley rats were mated and assigned to control and nicotine groups, the latter receiving nicotine in the drinking-water throughout pregnancy. Animals were weighed at regular intervals and killed on day 20 of pregnancy. Rates of maternal adipose tissue lipolysis and lipogenesis were measured. Fetal and placental weights were recorded and analysis of fetal body water, fat, protein and DNA carried out. Weight gains of mothers in the nicotine group were less in the 1st and 2nd weeks of pregnancy, but similar to controls in the 3rd week. Fetal body-weights, DNA, protein and percentage water contents were similar in both groups. Mean fetal body fat (g/kg) was significantly higher in the nicotine group (96.2 (SE 5.1] compared with controls (72.0 (SE 2.9]. Rates of maternal lipolysis were also higher in the nicotine group. The cause of these differences and their effects on maternal and fetal well-being is discussed.     

Is continent diversion using the Mitrofanoff principle a viable long‐term option for adults requiring bladder replacement?

OBJECTIVE

To audit the long‐term outcome of patients with Mitrofanoff continent urinary diversion (MUD) to inform counselling of future patients concerning the procedure.

PATIENTS AND METHODS

All patients who underwent MUD between 1990 and 2003 were identified. Continence, urinary tract infection (UTI), calculus formation and renal function were assessed by chart review and interviews.

RESULTS

Of the 29 patients identified 12 were women and 17 men with a mean (range) age of 48 (18–79) years at operation. The median (range) follow‐up was 126 (5–190) months. On questioning, 25 of 28 (89%) patients stated that they were continent. There was more than one confirmed UTI per year in two patients. Half of the patients had at least two UTIs within the follow‐up period but with no deterioration in renal function. Calculi developed in eight (29%) patients; four with bladder, three with renal and one with both renal and bladder calculi. Stomal stenosis developed in 15 (54%) patients requiring intervention at a mean (range) rate of 0.4 (0.1–2.4) episodes per year and nine ultimately required stomal reconstruction. Five (18%) patients required conversion to ileal conduit, two of these for persistent incontinence and three for recurrent stomal complications, at a mean (range) of 82 (9–140) months.

CONCLUSIONS

MUD is effective in offering continence with no major deterioration of renal function; however, this needs to be balanced against the need for subsequent additional interventions for stomal stenosis, stone formation and UTI on an individual basis.     

Actions of the selective protein kinase C inhibitor PKC412 on B-chronic lymphocytic leukemia cells in vitro

BACKGROUND AND OBJECTIVES: The staurosporine derivative PKC412 (CGP41251) is a more selective inhibitor of the conventional isoforms of protein kinase C (PKC) than is the parent compound. In addition to its growth inhibitory properties, PKC412 reverses the efflux function of the multidrug resistance (MDR)-1 gene product, P-glycoprotein (P-gp). DESIGN AND METHODS: The in vitro actions of PKC412 were investigated in peripheral blood lymphocytes (PBL) from 4 normal volunteers, B-cell isolates from 3 normal tonsils and 31 patients with B-cell chronic lymphocytic leukemia (B-CLL). Following incubation with PKC412 for 2 days, the viability of B-CLL cells was decreased relative to that of controls (63+/-23% at 1 micromole/L; 52+/-30% at 10 micromole/L; n=20). Normal PBL were significantly more resistant to the drug (91+/-5% viable cells at 1 micromole/L; 73+/-18% at 10 micromole/L; n=4). Thirteen of the B-CLL patients were treated with oral PKC412 in a phase II trial. RESULTS: PKC activity in malignant cells from these patients showed a reduction post-treatment of 25-96% of their respective pre-treatment levels. Morphologic analysis, as well as in situ assay for DNA strand breaks (TUNEL assay) showed that B-CLL cells were killed by an apoptotic mechanism. In B-CLL cells the mean IC50, for PKC412, as measured by the reduction of 3-(4,5-dimethylthiozol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT), was 2.1 micromol/L in 16 samples in which the IC50 were below the maximum concentration of PKC412 used for the assay. In tonsillar B-cells, the mean IC50 was 11 micromol/L whereas PBL cells were resistant. Four of eight and 1/3 B-CLL samples that were resistant to chlorambucil and fludarabine, respectively, were sensitive to PKC412. In 15/31 B-CLL samples a dose-dependent reversal of P-gp-mediated drug efflux by PKC412 was observed. A statistically significant correlation (p<0.001) was observed between P-gp protein expression as measured by FACScan analysis and the reversal of efflux activity by either PKC412 or verapamil. PKC412 increased the sensitivity of B-CLL cells to 2'-chlorodeoxyadenosine and chlorambucil. INTERPRETATION AND CONCLUSIONS: This study establishes the in vitro cytotoxic and multidrug resistance (MDR) modulatory properties of PKC412 towards malignant cells from B-CLL patients. The direct antitumor activity combined with the potential for P-gp modulation make PKC412 an attractive drug for the treatment of malignancies expressing the MDR phenotype, or in combination with conventional drugs.