Link between the CSF shunt and achievement in adults with spina bifida. (49/2498)

OBJECTIVES: A few enterprising adults with shunt treated spina bifida live independently in the community, have a job in competitive employment, and drive to work in their own car. By contrast others with similar disability but lacking their motivation remain dependent on care and supervision. The aim of this study was to identify events in the history of their shunt which may have influenced their subsequent achievement. METHODS: Between June 1963 and January 1971 117 babies born in East Anglia with open spina bifida had their backs closed regardless of the severity of their condition. When reviewed in 1997 every case was ascertained. Sixty had died and the 57 survivors had a mean age of 30. These were assigned to two groups: achievers and non-achievers, according to their attainments in independence, employment, and use of a car. RESULTS: Of the 57 survivors nine had no shunt and eight of these were achievers. All were of normal intelligence (IQ>/=80) and only one was severely disabled. Of the 48 with shunts only 20 were achievers (OR 11.2, 95% confidence interval (95% CI) 1.3-96.8). Lack of achievement in these 48 was associated with revisions of the shunt, particularly when revisions were performed after the age of 2. Sixteen patients had never required a revision and 11 (69%) were achievers; 10 had had revisions only during infancy and five (50%) were achievers; 22 had had revisions after their second birthday and only four (18%) were achievers (p<0.001). Elective revisions were not performed in this cohort and in 75% of patients revisions had been preceded by clear symptoms of raised intracranial pressure. CONCLUSION: Revisions of the shunt, particularly after the age of 2, are associated with poor long term achievement in adults with spina bifida.  (+info)

Do elderly women have more physical disability than men do? (50/2498)

This study investigated whether the commonly observed higher prevalence of physical disability among women is due to higher incidence rates or to other factors such as selective mortality or poor recovery. Methods included observed measures of prevalent lower body physical disability and potential risk factors at baseline (1989-1991) and 4-year follow-up of 2,025 community-dwelling adults aged 55 years and older in Marin County, California. Incidence, recovery, and mortality rates were determined at the follow-up examination. Results indicated that women had higher age-specific and age-adjusted prevalence rates at both examinations (odds ratios = 1.66 and 1.60, p<0.001) but that incidence rates were not significantly different (odds ratio = 1.12, 95% confidence interval: 0.77, 1.64). In the classic formulation, prevalence = incidence x duration, the higher prevalence rates in women could not be due to a higher incidence rate, but could be explained by longer duration due to lower recovery and mortality rates in women. Incident physical disability was predicted by prevalent chronic illnesses, poor vision, obesity, physical inactivity, poor memory, fewer social activities, and higher depression scores, but not by sex. Prevention efforts should concentrate on reducing known risk factors in both men and women and on promoting higher recovery rates among women.  (+info)

Guillain-Barre syndrome: rehabilitation outcome and recent developments. (51/2498)

Guillain-Barre syndrome is the most common polyneuropathy causing major disability and respiratory failure. Respiratory complications are the main cause of death. Improved respiratory care and new treatment strategies such as plasmaphoresis and immunoglobulin have been shown to improve outcome. We studied the course and outcome of 37 patients with Guillain-Barre syndrome who were admitted to a rehabilitation and respiratory care facility over a 10-year period. There were 21 males and 16 females with a mean age of 62+/-3 years. Fourteen patients developed respiratory failure requiring endotracheal intubation and mechanical ventilation. The mean duration of mechanical ventilation was 38+/-10 days. All patients were successfully liberated from the ventilator. However, 83 percent of the patients were moderately to severely disabled at the time of discharge. Thirteen out of 37 (35 percent) developed long-term disability. None of the patients died over the period of follow-up. These results indicate that early recognition and treatment of respiratory complications in Guillain-Barre syndrome could reduce the morbidity and mortality of this condition.  (+info)

Morbidity in older people with self-reported asthma. (52/2498)

OBJECTIVE: To investigate the differences in physical and psychological morbidity in older people with and without self-reported asthma and whether these are associated with use of more medication and hospital services. DESIGN: Cross-sectional study of changes in health services for older people. SETTING: South Wales in 1990 and 1992. SUBJECTS: A population-based random sample of 2818 people aged 65 years and over. MAIN OUTCOME MEASURES: Prevalence of self-reported asthma; assessment of disability, anxiety, depression and memory using standardized measures; mobility; use of prescribed medication and hospital services. RESULTS: 231 subjects with self-reported asthma were identified. The prevalence of asthma was 8%, which was not significantly different between the sexes (P = 0.88), age groups (P = 0.06) or social classes (P = 0.108). There was a significant relationship between asthma and functional and physical disability (severe disability 29% vs 16%, P < 0.0001), mobility (housebound 7% vs 4%, P < 0.05), anxiety (37% vs 20%, P < 0.0001), depression (19% vs 10%, P < 0.001), poor perceived health status (23% vs 9%, P < 0.0001), number of different medications (seven or more, 13% vs 4%, P < 0.0001) and inpatient (P < 0.0001) and outpatient (P < 0.05) use of hospital services. CONCLUSIONS: There is excess psychological and physical morbidity and poorer perceived health status in older people with self-reported asthma.  (+info)

Identifying disability: comparing house-to-house survey and rapid rural appraisal. (53/2498)

This study compared house-to-house survey and rapid rural appraisal as methods used to identify people with disabilities in a sample rural population in South India. The research showed that by using these methods, two distinctly different populations were identified. The factors that influenced the identification processes were: local perceptions and definitions of disability; social dynamics, particularly those of gender and age; relationships within the rapid rural appraisal groups and between the health auxiliary and the respondents in the house-to-house survey; and the type of disability and the associated social implications and stigma of that disability. While a few more people were identified through the house-to-house survey, the rapid rural appraisal was a better approach for identifying disability in the community because of the greater community participation. The researchers believe that this community participation provided a greater understanding of the complex contextual dynamics influencing the identification of disability, thereby increasing the validity of the study findings. Another advantage of the rapid rural appraisal was the methodological and analytical simplicity. Both methods, however, failed to identify some individuals with disabilities who were later identified on the follow-up verification visits. Taking into account the factors discussed above, the researchers conclude that no single method could be used to comprehensively identify people with disability in a community. They suggest that a judicious combination of methods which takes into account local perceptions and priorities, includes more specific screening techniques, and facilitates informed voluntary referrals, would be the most effective approach.  (+info)

Racial differences in prevalence of cobalamin and folate deficiencies in disabled elderly women. (54/2498)

BACKGROUND: Many previous investigations of cobalamin and folate status were performed in white populations. OBJECTIVE: Our objective was to determine whether there are racial differences in the prevalence of cobalamin and folate deficiency. DESIGN: The study was a cross-sectional comparison of baseline serum cobalamin, folate, methylmalonic acid (MMA), total homocysteine (tHcy), and creatinine concentrations, complete blood count, and vitamin supplementation in 550 white and 212 African American subjects from a cohort of physically disabled older women. RESULTS: The mean (+/-SD) serum MMA concentration was significantly higher in whites than in African Americans: 284 +/- 229 compared with 218 +/- 158 nmol/L (P = 0.0001). tHcy concentration was higher in African Americans than in whites: 12.4 +/- 7.0 compared with 10.9 +/- 4.6 micromol/L (P = 0.001). Serum cobalamin was lower in whites (P = 0.0002). Cobalamin deficiency (serum cobalamin <258 pmol/L and MMA >271 nmol/L) was more frequent in the white women (19% compared with 8%; P < 0.0003). Folate deficiency (serum folate <11.4 nmol/L, tHcy >13.9 micromol/L, and MMA <271 nmol/L) was more prevalent in African Americans than in whites (5% compared with 2%; P = 0.01). Multivitamin use was associated with lower tHcy but not with MMA concentrations. Regression models showed that age >85 y, African American race, serum creatinine >90 micromol/L, and high MMA concentration were all significantly correlated with higher tHcy. Creatinine > 90 micromol/L, white race, and folate concentration were positively associated with MMA concentration. CONCLUSIONS: Cobalamin deficiency with elevated serum MMA concentration is more prevalent in elderly white than in African American women and elevated serum tHcy and folate deficiency are more prevalent in elderly African American than in white women.  (+info)

Stroke in the very old : clinical presentation and determinants of 3-month functional outcome: A European perspective. European BIOMED Study of Stroke Care Group. (55/2498)

BACKGROUND AND PURPOSE: The oldest old represent the fastest-growing segment of the elderly population in developed countries. Knowledge of age-specific aspects of stroke is essential to establish diagnostic and therapeutic pathways and to set up prevention and rehabilitation programs. We sought to evaluate stroke features and functional outcome in patients aged >/=80 years compared with the younger age groups. METHODS: In a European Union Concerted Action involving 7 countries, 4499 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month disability (Barthel Index) and handicap (Rankin Scale). RESULTS: Overall, 3141 patients (69.8%) were aged <80 years, and 1358 (30.2%) were aged >/=80 years. At baseline, female sex, prestroke institutionalization, and a worse prestroke Rankin score were significantly more frequent in the older patients, as were coma, paralysis, swallowing problems, and urinary incontinence in the acute phase (all P values <0.001). Brain imaging and other diagnostic tools were significantly less used in the older patients. Paralysis, swallowing problems, and incontinence during hospitalization independently predicted 3-month disability or handicap in both groups. For the older patients, prestroke institutionalization proved a further strong and independent determinant of 3-month disability (odds ratio, 2.33; 95% CI, 1.22 to 4.45) and handicap (odds ratio, 7.04; 95% CI, 1.62 to 30. 69). CONCLUSIONS: In the very old, both medical and sociodemographic factors may significantly influence stroke outcome, showing peculiar characteristics. Knowledge of these determinants may reduce the burden on health systems, improving quality of care.  (+info)

The long-term prognosis of whiplash-associated disorders (WAD). (56/2498)

Somatic and mental symptoms in 22 patients (16 women and 6 men) 22-73 months after a whiplash injury are described. The results of the present study are compared with the corresponding results of a previous study on the same patients. According to the Quebec Classification System, the whiplash injuries of 15 patients were classified as grade 2 and those of 7 patients as grade 3. Pain intensity was evaluated by means of a visual analogue scale and muscular tenderness was assessed by pressure algometry. Algometry was also used to measure the pain tolerance level. The Mood Adjective Check List was used as a measure of mental well-being. During the 2 years that had passed since the previous study, the patients had improved regarding pain intensity, pain tolerance level and mental well-being. The results show that patients with prolonged disability after a whiplash injury can improve even after a long time.  (+info)