Vitamin D deficiency and osteopenia in the hemiplegic limbs of stroke patients

BACKGROUND AND PURPOSE: Little is known about bone changes in hemiplegic stroke patients. We evaluated the vitamin D status and bone changes on the hemiplegic and intact sides of stroke patients. METHODS: Sera were collected from 87 hemiplegic stroke patients (42 outpatients and 45 inpatients) and from 28 control subjects. The sera were assayed for 25-hydroxyvitamin D (25-OHD). Bone density was measured bilaterally from radiographs of the hands. Diet and sunlight exposure were assessed for all subjects. RESULTS: Serum 25-OHD concentrations were lower in patients (9.1 +/- 4.9 ng/mL for outpatients, 5.9 +/- 4.1 ng/mL for inpatients) than in control subjects (21.6 +/- 3.1 ng/mL). The difference in serum 25-OHD between the two patient groups also was statistically significant. The patients' microdensitometric scores for osteopenia were higher on the hemiplegic side than on the non-hemiplegic side. The microdensitometric scores and their side-to-side differences in patients correlated negatively with the serum 25-OHD concentration and positively with the degree of paralysis. Dietary intake of vitamin D was below the recommended level in 72% of the patients, and 89% of the patients were considered sunlight-deprived. CONCLUSIONS: Bone mass was reduced significantly on the hemiplegic side in the stroke patients, which might increase the risk of hip fracture. Vitamin D deficiency and disuse are the probable causes of osteopenia in this population. The hypovitaminosis D might be corrected readily by routine use of vitamin D supplements.     

Assessment of spasticity in hemiplegic cerebral palsy. II: Distal lower-limb reflex excitability and function

A clinical method for measuring the stretch reflex threshold and gain of muscles acting across the ankle joint in children with congenital hemiplegia is described. The stretch reflexes of all limbs were velocity-dependent. Hemiparetic limbs were not necessarily spastic compared with non-paretic limbs, suggesting that the term 'spastic hemiplegia' should be used more selectively and emphasis be placed on the heterogeneity of the hemisyndromes of childhood. Abnormal motor control, planning and dexterity, the hemipostures and plastic (non-electrical) muscle changes may be more important measures of impairment than reflex excitability. A general scheme for assessing reflex excitability and available treatments applicable to all types of cerebral palsy is proposed.     

Evaluation of the prognostic value of general motor activity for rehabilitation of patients after cerebral stroke

Following cerebral stroke motor activity of the patient is dependent on the extensiveness of brain ischemia. Evaluation of this activity may be an exponent of brain ischemia extent. It can be used for the determination of predictability of patient survival and results of rehabilitation. Using Mathew and Barthel scales effectiveness of treatment and rehabilitation was evaluated four times during 12-month follow-up in patients of General Motor Activity Clinical Group II i III. The results obtained may be evidence of significant prognostic importance of evaluation of general motor activity of the organism in the initial period of treatment and rehabilitation only, i.e. within 3 months following cerebral stroke. However, it is no importance for evaluation of remote results (one year following cerebral stroke). The evaluation of general activity cannot be used to predict the dynamics of the improvement of neurological and functional status of patients undergoing rehabilitation following cerebral stroke.     

Social functioning of schizophrenic patients after 15 years from the first hospitalization (Part II -- the evaluation of needs for community care)

Two Eucalyptus homologues of the Arabidopsis floral homeotic gene AP1 (EAP1 and EAP2) show 60-65% homology to AP1. EAP1 and EAP2 are expressed predominantly in flower buds. EAP2 produces two different polypeptides arising from differential splicing at an intron, the shorter EAP2 protein diverging from the longer sequence after amino acid 197 and having a translation stop after residue 206. This truncated protein includes both MADS- and K-box amino acid sequences. Ectopic expression of the EAP1 or either of the two EAP2 polypeptides in Arabidopsis driven by the 35S promoter produces effects similar to the corresponding AP1 construct, causing plants to flower earlier, have shorter bolts and resemble the terminal flower mutant (tfl).     

Development of behaviorally anchored scales for the evaluation of faculty teaching.

Presented a procedure and rationale for evaluating college teaching using behaviorally anchored rating scales. In Stage 1 (n = 38 undergraduates), 9 independent dimensions important for teaching evaluation and representative behavioral incidents were identified. In Stage 2 (n = 54 undergraduates), incidents were allocated to dimensions. In Stage 3 (n = 139 undergraduates), incidents were evaluated on a scale representing effective teaching. Items with low standard deviations were retained for the final scales. The underlying notions of the resulting scales and the advantages of using the behavioral expectation procedure relative to other procedures are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rating scales for measuring the interpersonal circle in forensic psychiatric patients.

Two studies are reported on nurses' assessments of interpersonal style in hospitalized male forensic psychiatric patients. In Study 1, interpersonal behaviors were rated on a Chart of Interpersonal Reactions in Closed Living Environments (CIRCLE) in a derivation sample (n?=?210) and a replication sample (n?=?102). Rating items generated a circular arrangement within both samples consistent with recent conceptualizations of the Leary interpersonal circle (T. Leary, 1957), and scales constructed to measure the octants of the circle demonstrated acceptable psychometric properties. Study 2 showed that the 8 scales met the geometric requirements of a circumplex in the same 2 samples. As measures of dysfunctional interpersonal style, CIRCLE scales may have some utility in treatment planning, risk assessment, and the evaluation of personality disorders in inpatient populations. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Multimodal evaluation of risperidone for destructive behavior: Functional analysis, direct observations, rating scales, and psychiatric impressions.

Risperidone, an atypical neuroleptic, has become a popular option for treating destructive behaviors of persons with developmental disabilities. A few studies have been conducted that evaluate the effects of risperidone on destructive behavior; however, none of these studies have combined objective measures with rating scales to evaluate the effects of risperidone on destructive behavior across home and clinical settings. This study evaluated the wide range of effects of risperidone on destructive behavior of 2 persons with developmental disabilities using weekly functional analysis sessions, daily observations, hourly home data, weekly rating scales, and monthly psychiatric impressions. Results indicate that risperidone does decrease destructive behavior and that, for the most part, all of the various measures yielded similar results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional outcomes of posthospital care for stroke and hip fracture patients under medicare

BACKGROUND: Medicare's introduction of the Prospective Payment System for hospitals has led to tremendous growth in ways of providing posthospital care. Despite substantial differences in costs per episode of care, the type of posthospital care that produces the best results for specific types of patients is not clear. This study analyzed the outcomes of different types of posthospital care for a cohort of older Medicare patients (who had diagnoses associated with the use of a range of posthospital care modalities) for up to a year after hospital discharge. METHODS: Medicare patients hospitalized with strokes and hip fractures were enrolled consecutively just before discharge from 52 hospitals in three cities in 1988-1989. These diagnosis-related groups were chosen because patients were discharged to all three major types of Medicare-supported posthospital care. Patients were interviewed in-person before discharge and again at 6 weeks, 6 months, and 1 year after discharge. The functional outcomes of posthospital care were evaluated by the instrumental variables estimation approach to correct for selection bias caused by nonrandom treatment assignment. The impacts of discharge locations on the functional outcomes were examined by one-way analyses of variance (ANOVA). RESULTS: In general, the more disabled patients went to nursing homes and rehabilitation, but the overlap in distribution was sufficient to conduct the analyses. Stroke patients discharged to nursing homes had the highest mortality rate (P<.01). Stroke patients discharged to home health had the lowest rehospitalization rates (P<.05). Hip fracture discharged to home health care had the highest adjusted rehospitalization rate, whereas those discharged to nursing homes had the lowest adjusted rehospitalization rate (P<.05). For stroke patients, posthospital care in rehabilitation facilities or home health care was associated with significantly better functional improvement compared with stroke patients discharged elsewhere. However, functional outcomes deteriorated by 1 year posthospitalization among stroke patients who received their posthospital care at nursing homes or received no formal posthospital care. For hip fracture patients, all four types of posthospital care were associated with functional improvement, but patients discharged to rehabilitation facilities experienced the most functional improvement. CONCLUSIONS: The choice of posthospital care can influence the course of Medicare patients. Careful attention should be paid to how hospital discharge decisions are made and to the financial incentives for different types of posthospital care provided under the current payment system. The current supply of nursing homes is not well suited to the demands of posthospital care.     

Psychometric evaluation of the restructured clinical scales of the MMPI-2.

Conceptual overlap and heterogeneity have long been noted as weaknesses of the Minnesota Multiphasic Personality Inventory's clinical scales. Restructured clinical (RC) scales recently were developed to address these concerns (A. Tellegen et al., 2003). The authors evaluated the psychometric properties of the RC scales in psychology clinic clients (N=285) and military veterans (N=567). The RC scales were as internally consistent as the clinical scales and correlated strongly with their original counterparts (except for RC3/Hysteria). They also were less intercorrelated, produced conceptually clearer relations with measures of personality and psychopathology, and yielded somewhat greater incremental utility than the clinical scales. Thus, the RC scales demonstrated several psychometric strengths while utilizing 60% fewer items, but the 2 sets of scales cannot be used interchangeably. Interpretive considerations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rating scales for the psychosocial evaluation of organ transplant candidates. Comparison of the PACT and TERS with bone marrow transplant patients

Two scaled formats for summarizing the results of psychosocial evaluations of transplant candidates have been published, the Psychosocial Assessment of Candidates for Transplantation (PACT) and the Transplant Evaluation Rating Scale (TERS). In this study, 40 consecutive candidates for bone marrow transplant were rated on the PACT and TERS. The PACT and TERS were comparable in interrater reliability. Similar conceptual items for each scale correlated fairly highly with one another. The PACT and TERS differ in several scale characteristics. The authors discuss the relationship between scale characteristics and clinical utility.     

Risk factors for stress in children after parental stroke.

Objectives: To assess risk factors for stress in children 3 years after parental stroke. Participants: Questionnaires were filled in by 44 children aged 7–18 years, parents who suffered a stroke and healthy spouses from 29 families recruited in 9 participating rehabilitation centers across the Netherlands. Method: We measured patient functioning (cognitive disorders, communicative disorders and ADL dependency), parental depression and perceived quality of marital relationship at 4 assessments, from the start of rehabilitation until 3 years post-stroke. Children assessed their stress level 3 years after parental stroke. Results: Girls experienced more stress than boys. Spouses' depressive symptoms during the first year after stroke were positively correlated with stress in children. Patients' depressive symptoms 2 months post-rehabilitation (2 months after discharge from the rehabilitation center), 1 year and 3 years post-stroke were also positively correlated with stress in children. The perceived quality of marital relationship decreased over time and at 2 months postrehabilitation, it was related to stress in children. Stress was not related to patient gender and functioning. Conclusions: Early prediction of long-term stress in children after parental stroke may be most accurate on the basis of children's female gender and depressive symptoms of the patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dimensionality of self-esteem: II. Hierarchical facet model for revised measurement scales.

A hierarchical facet model of self-esteem proposed by R. J. Shavelson et al (see record 1978-30429-001) was partially tested in a previous study by J. S. Fleming and W. A. Watts (see record 1981-28061-001). Their 3 factors, which were labeled Self-Regard, Social Confidence, and School Abilities, corresponded to 3 of the 4 dimensions posited by Shavelson et al. Predictions of other individual-difference variables from these factors were also tested by correlational analysis. Improvements to the instrument led to a replication of their 3 factors plus 2 predicted physical factors: Physical Appearance and Physical Abilities. In the present study, with 259 undergraduates, a 2nd-order factor analysis yielded a single, superordinate factor of global self-esteem, supporting the hierarchical interpretation of the facet model. Construct validity was further examined by replication of the correlational findings of Fleming and Watts and by correlations with other measures of personality and adjustment, including a global measure of self-esteem: the Rosenberg Self-Esteem Scale. The facet model as presently operationalized measures dimensions of relevance for the intended population, but these dimensions are not so broadly defined as to be redundant with related constructs. (65 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional evaluation of the 10-year outcome after modified Evans repair for chronic ankle instability

The Evans tenodesis is an operative treatment for chronic ankle instability with good short-term results. The disadvantage of impaired hind foot kinematics and restricted motion has been described, and only few reports of long-term results can be found. No techniques have been used to assess the outcome objectively. We wanted to determine whether a modified Evans procedure led to a satisfactory clinical and functional outcome. Nineteen patients were available at a 10-year follow-up. The clinical examination included a detailed questionnaire and stress radiographs. Foot function was evaluated with plantar pressure distribution measurements during walking and peroneal reaction time measurements elicited on a rapidly tilting platform (recorded with surface electromyography). High subjective patient satisfaction was contrasted with a high rate of residual instability, pain, and swelling. The radiographs showed an increased number of exostoses. The gait analysis revealed reduced peak pressures under the lateral heel and increased values under the longitudinal arch. The reaction times of the peroneal muscles were shorter on the operated side (significant: peroneus longus). The persistent clinical problems as well as the functional changes indicate that the disturbed ankle joint kinematics permanently alter foot function and may subsequently support the development of arthrosis. Therefore, the Evans procedure should only be applied if anatomical reconstruction of the lateral ankle ligaments is not feasible.     

MRI evaluation of the brain in infantile neuronal ceroid-lipofuscinosis. Part 2: MRI findings in 21 patients

The purpose of this study was to demonstrate the course of infantile neuronal ceroid-lipofuscinosis with brain magnetic resonance imaging (MRI) in children aged 3 months to 11 years. Twenty-one patients and 46 neurologically normal controls of the same age were examined. The images were evaluated visually; then signal intensities were measured and related to those of references. MRI abnormalities were detectable before clinical symptoms. The radiologic picture of the brain varied with the duration of the disease. Pathognomonic MRI findings in the early stage of the disease were generalized cerebral atrophy, strong thalamic hypointensity to the white matter and to the basal ganglia, and thin periventricular high-signal rims from 13 months onward on T2-weighted images. In patients over 4 years old, cerebral atrophy was extreme, and the signal intensity of the entire white matter was higher than that of the gray matter, which is the reverse of normal. This study showed that the abnormalities seen on MRI progress rapidly during the first 4 years of life, then stabilize, in conformity with the clinical and histopathologic pictures of infantile neuronal ceroid-lipofuscinosis.     

Time-frequency analysis of heart murmurs. Part II: Optimisation of time-frequency representations and performance evaluation

OBJECTIVE: We hypothesized that carriage of Staphylococcus aureus among continuous ambulatory peritoneal dialysis (CAPD) patients was influenced by their spouses. Furthermore, this carrier status was compared to previous Staph. aureus peritonitis episodes in order to identify the influence of Staph. aureus carriage on peritonitis rate. DESIGN: A combined prospective surveillance study (Staph. aureus carriage) and retrospective chart review (Staph. aureus peritonitis). SETTING: A single peritoneal dialysis unit in a county hospital. PATIENTS AND METHODS: Cultures from patients (n = 32) and spouses (n = 16) were obtained twice, with a 1-month interval, from the anterior nares, the umbilical, and one groin area. All positive cultures were phage typed. Retrospective chart review of all episodes of Staph. aureus peritonitis among the patients was carried out. RESULTS: Twelve of 32 patients (37.5%) and 5 of 16 spouses (31%) evaluated were carriers. Half of the spouses of patients who were Staph. aureus carriers, were also carriers, as opposed to 20% of spouses of noncarrier patients (p = 0.30). Patients and spouses always shared the same phage type. Among patients, Staph. aureus was found in the nose only (n = 9), in all three regions (n = 2), and extranasally only (n = 1). If only one nasal culture was used to establish carriage, the sensitivity and negative predictive value would be 92% and 95%, respectively. A trend toward a higher incidence (p = 0.062) of Staph. aureus peritonitis was found among carriers (patients), 0.37 versus 0.28 peritonitis episode/dialysis-year. CONCLUSIONS: Only one positive nasal culture was necessary when carriage of Staph. aureus was to be established. Staph. aureus carriage was found more often in patients who had previously suffered from Staph. aureus peritonitis. The phage types isolated remained fairly constant, and the patients and spouses often had the same carrier state and shared the same phage types, although transmission does not always take place.     

Transcranial Doppler ultrasonography and hyperventilation test in assessment of cerebral vasoreactivity after ischemic stroke

In 36 patients 3 month after ischaemic stroke in regions supplied by MCA (Middle Cerebral Artery) physical examination, CT scanning and blood flow velocity recordings in ICA (Internal Carotid Artery) and MCA were performed. In both MCA blood flow velocity was measured in resting state and after 30 sec. of hyperventillation. The control group consisted of 40 healthy volunteers. In the control group blood flow decrease after hyperventillation was nearly equal in both hemispheres (38% in right and 37% in the left hemisphere). In studied group in the symptomatic hemisphere blood flow reduction was 21%. Vasoreactivity in the opposite hemisphere was similar to that in control group (35% decrease). The results suggest that vasoreactivity diminution is a local phenomenon limited to the infarcted area. Hyperventilation test, despite its simplicity, seems to be sufficient for screening vasoreativity.     

Natural history of global and critical brain ischaemia. Part II: EEG and neurological signs in patients remaining unconscious after cardiopulmonary resuscitation

Of 125 patients who had no detectable cortical activity (DCA) on the electroencephalograph (EEG) immediately upon resuscitation from circulatory arrest of primary cardiovascular aetiology, 88 remained unconscious; these patients had their EEG and neurological status serially investigated until they died. Immediately upon re-establishment of circulation all cerebral functions could be absent; the brain death (irreversible loss of functions) was then signified by the appearance of poikilothermia, diabetes insipidus and reflex extension of the upper limb. Most often, some cranial nerve reflexes were present; the EEG configurations and related neurological signs then appeared in a sequence which resembled orderly postischaemic recovery: A phase without DCA was at first characterized by an exclusive presence of cranial nerve reflexes and then by the appearance of decerebrate posturing this phase was followed by another phase of intermittent cortical activity (ICA) with decorticate and stereotypic motor responses and a phase of continuous cortical activity (CCA) accompanied by stereotypic reactivity. These phases were most often incomplete due to failure of recovery of some cranial nerve reflexes or were abnormal due to the appearance of intermittent spikes and sharp waves. Progressive recovery could stagnate at any step and the cerebral functions be lost abruptly or gradually in reverse order of recovery. The decay was invariably due to cardiovascular or pulmonary complications. Brain autopsy revealed extensive neuronal loss and intravital autolytic changes in patients who had fulfilled clinical criteria of brain death for more than 72 h, but the histopathology showed no relationship to other clinical findings during the postischaemic course.