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PubMed2001

Prospective longitudinal analysis of postoperative shoulder function : a ten-year follow-up study of full-thickness rotator cuff tears.

BACKGROUND: Rotator cuff repair is associated with good short or mid-term results, but to date there have been no long-term functional outcome studies demonstrating durability of results over time. In most long-term studies, the results have been compared with those of historical controls or with those of other, short-term follow-up studies. The purpose of the present prospective study was to evaluate short and long-term shoulder function after surgical repair in a single population of patients in order to follow changes over time. METHODS: Thirty-three patients underwent surgery, performed by one surgeon, for the treatment of a chronic, symptomatic, full-thickness rotator cuff defect. Data were obtained from questionnaires and physical examinations preoperatively, at two years, and at ten years. Identical standardized pain and function questionnaires were used and clinical evaluation was performed in a consistent fashion at all time-periods. The activity level, Constant score, level of disability, shoulder function score, and patient's subjective rating of the outcome were determined at the time of the final follow-up and compared with the same parameters at the two-year follow-up examination in order to determine if early results change with time. RESULTS: At the ten-year follow-up examination, there was no change in the raw Constant score determined at the two-year examination. When the Constant score was normalized for expected age-related changes, the percentage of patients who had a satisfactory result at ten years was even greater than the percentage at two years. Activity level decreased significantly over the time-period (p = 0.005). At the final follow-up examination, twelve patients worked at the same occupation as they had when the two-year examination was performed, two worked at a less strenuous occupation, and the remaining patients were retired. Only two patients retired because of problems related to the shoulder. The level of disability decreased over the study period, and there was a small improvement in the patients' self-assessment shoulder function score. The patients' subjective assessment of the outcome remained unchanged. CONCLUSIONS: The results of open rotator cuff repair for chronic tears do not deteriorate with time (ten years). The level of disability decreases, presumably because of a concurrent decrease in the activity level and in the demand on the shoulder as the patient ages. It is important to consider age-related changes when assessing the final outcome.

Adult↗
PubMed1994

Interrelationships between pulmonary and extrapulmonary involvement in systemic sclerosis. A longitudinal analysis.

PURPOSE: (1) To evaluate the relationship between the degree of pulmonary involvement by systemic sclerosis (SSc) and the degree of involvement of other organ systems by SSc at baseline. (2) To assess the degree of impairment in lung function at presentation and the annual rate of change in lung function to predict the rate of progression of involvement of extrapulmonary organ systems by SSc over time. (3) To determine whether survival in patients with SSc can be predicted from the degree of lung function impairment at baseline or from the annual rate of change in lung function. METHODS: Semiquantitative indices of pulmonary and extrapulmonary involvement and pulmonary function tests (PFTs) were analyzed and compared in 62 nonsmoking scleroderma patients enrolled in a 3-year prospective drug trial, vs 47 in a "study group" who underwent serial evaluation. The other 16 "early withdrawals" withdrew prior to the second evaluation. The indices of organ system involvement were based on clinical, physiologic, and biochemical findings as previously published. The PFTs included total lung capacity (TLC), forced vital capacity (FVC), FEV1, and single-breath diffusing capacity for carbon monoxide (Dsb). Annualized rates of change in PFTs and indices of extrapulmonary involvement were calculated for each subject from data collected on at least 2 separate occasions at least 6 months apart. Spearman rank correlations were performed between individual baseline PFTs (expressed as percent predicted) and (a) indices of extrapulmonary involvement at baseline, (b) annualized rates of change in PFTs, and (c) annualized rates of change in indices of extrapulmonary involvement. Correlations also were performed between the rate of change in each lung function measure and rates of change in indices of extrapulmonary involvement. The ability of PFTs at baseline and their rates of change to predict cumulative survival was assessed by Cox stepwise regression. RESULTS: The degree of impairment in baseline PFTs was related to involvement of the right side of the heart but not to other extrapulmonary system involvement. Baseline PFTs were not related to the rate of subsequent decline of lung function or worsening of extrapulmonary organ system involvement. Subsequent annual rates of decline in lung function were related to worsening skin and upper gastrointestinal involvement. Cumulative survival may be related to the rate of decline in DCO, TLC, and FVC, but was not predicted by impairment in any measure of lung function. CONCLUSION: With the exception of involvement of the right side of the heart consistent with cor pulmonale, the degree of pulmonary involvement by SSc was not correlated with the extent of extrapulmonary involvement. The degree of pulmonary involvement by SSc did not predict subsequent worsening of either pulmonary or extrapulmonary involvement. Worsening pulmonary involvement by SSc, in general, does not correlate with worsening involvement of extrapulmonary organ systems, except for the skin and upper gastrointestinal tract. A rapid decline in DCO or lung volumes may predict poor survival.

Bone Diseases↗
PubMed2000

[The mental health of school children after the Great Hanshin-Awaji Earthquake: II. Longitudinal analysis].

UNLABELLED: We conducted surveys to investigate the nature of the recovery processes and psychological reactions of children and adolescents affected by the Great Hanshin Awaji Earthquake. The investigations were carried out 4 times at 4 months, 6 months, one year and two years after the disaster. SUBJECTS: About 9000 school children in the 3rd grade, the 5th grade, the 8th grade living in the disaster area. METHOD: The questionnaire consisted of 9-12 items regarding situation and behavior when the earthquake occurred, and 22 items regarding mental health condition, and was filled out in the classroom under supervision by the teacher in charge. The responses were rated from 1 to 4 depending on the frequency of the symptoms, and statistically analyzed. RESULTS: By factor analysis, three factors were elicited. Factor 1 was interpreted as being related to fear and anxiety, factor 2 as related to depression and physical symptoms, and factor 3 as related to pro-social tendencies. These 3 factors were distinct and stable throughout all 4 surveys and each of them showed unique recovery processes. The mean score of factor 1 was highest at 4 months after the earthquake, and decreased as time passed. This factor shows that fear and anxiety seem to be directly related to the experience of the earthquake. According to the severity of the disaster, more severe damage brought about a higher mean score of factor 1. Furthermore, younger children and girls were more strongly affected. Each of the differences in the severity of disaster, in age, and in gender decreased as time passed. The mean score of factor 2 peaked at 6 months, and it slightly recovered after one year. However, the score at the 1st year was still higher than that of the 4th month. At two years the score returned to almost the same level as that of the 4th month. We think that factor 2, involving depressive mood and psychophysical symptoms, may be a secondary phenomenon to fear and anxiety. Other possibilities are that they may be caused by environmental changes after the disaster, inconveniences of daily life, loss of jobs of parents, or masked by hypomanic mood which covered over the disaster area soon after the earthquake (so-called heroic phase). Older children have a greater tolerance for depressive mood and psychophysical symptoms, but those symptoms occurring in older children have a tendency to continue for a longer time. Girls are more heavily affected and need more time to recover from trauma than boys. The mean score of factor 3 showed a gradual decrease as time passed. There was no difference in the way of decrease according to the severity of disaster, age and gender. It may be natural that, since the interest in the earthquake decreased as time passed, consideration for the victims decreased. CONCLUSIONS: The problems of mental health of children and adolescents after the disaster may consist of at least 2 different components; "fear and anxiety," which appeared just after the disaster and decreased earlier; "depressive and psychophysical symptoms" appeared later and stayed longer.

Adolescent↗
PubMed2005

Children's television viewing and cognitive outcomes: a longitudinal analysis of national data.

OBJECTIVE: To test the independent effects of television viewing in children before age 3 years and at ages 3 to 5 years on several measures of cognitive outcomes at ages 6 and 7 years. DESIGN: Using data from a nationally representative data set, we regressed 4 measures of cognitive development at ages 6 and 7 years on television viewing before age 3 years and at ages 3 to 5 years, controlling for parental cognitive stimulation throughout early childhood, maternal education, and IQ. RESULTS: Before age 3 years, the children in this study watched an average of 2.2 hours per day; at ages 3 to 5 years, the daily average was 3.3 hours. Adjusted for the covariates mentioned earlier, each hour of average daily television viewing before age 3 years was associated with deleterious effects on the Peabody Individual Achievement Test Reading Recognition Scale of 0.31 points (95% confidence interval [CI], -0.61 to -0.01 points), on the Peabody Individual Achievement Test Reading Comprehension Scale of 0.58 points (95% CI, -0.94 to -0.21 points), and on the Memory for Digit Span assessment from the Wechsler Intelligence Scales for Children of -0.10 points (95% CI, -0.20 to 0 points). For the Reading Recognition Scale score only, a beneficial effect of television at ages 3 to 5 years was identified, with each hour associated with a 0.51-point improvement in the score (95% CI, 0.17 to 0.85 points). CONCLUSIONS: There are modest adverse effects of television viewing before age 3 years on the subsequent cognitive development of children. These results suggest that greater adherence to the American Academy of Pediatrics guidelines that children younger than 2 years not watch television is warranted.

Adolescent↗
PubMed1992

Disability and depression among high utilizers of health care. A longitudinal analysis.

We evaluated, among depressed medical patients who are high utilizers of health care, whether improved vs unimproved depression is associated with differences in the course of functional disability. At baseline, 6 months, and 12 months, depression and disability were assessed among a sample of enrollees in health maintenance organizations (N = 145) in the top decile of users of ambulatory health care who exceeded the 70th percentile of health maintenance organization population norms for depression. Improved depression was defined as a reduction of at least one third in depressive symptoms averaged across the two follow-up times. At the 12-month follow-up, persons with severe-improved depression experienced a 36% reduction in disability days (79 days per year to 51 days per year) and a 45% reduction in disability score. Persons with moderate-improved depression experienced a 72% reduction in disability days (62 days per year to 18 days per year) and a 40% reduction in disability score. In contrast, persons with severe-unimproved depression reported 134 disability days per year at baseline, while persons with moderate-unimproved depression reported 77 disability days per year at baseline. Neither group with unimproved depression showed improvement in either disability days or disability score during the 1-year follow-up period. High utilizers of health care with severe-unimproved depression were more likely to have current major depression and to be unemployed. Improved (relative to unimproved) depression was associated with borderline differences in the severity of physical disease and in the percent married. We conclude that depression and disability showed synchrony in change over time. However, depression and disability may show synchrony in change with disability because both depression and disability are controlled by some other factor that influences the chronicity of depression (eg, chronic disease or personality disorder). The finding of synchronous change of depression and disability provides a rationale for randomized controlled trials of depression treatments among depressed and disabled medical patients to determine whether psychiatric intervention might improve functional status in such patients. Such research is needed to determine whether there is a causal relationship between depression offset and reductions in functional disability.

Activities of Daily Living↗
PubMed1998

Partial portacaval shunt for variceal hemorrhage: longitudinal analysis of effectiveness.

OBJECTIVE: To determine rates of survival, long-term patency, and recurrent variceal hemorrhage among patients with alcoholic cirrhosis treated by partial portacaval shunt. DESIGN: Single-institution cohort follow-up study of 72 consecutive patients who underwent small-diameter portacaval H-graft shunt with collateral ablation during a 10-year period (1981 through 1990). Subjects were enrolled and followed up for up to 15 years. Shunt patency was assessed by portography and/or ultrasonography. We performed 7-year Kaplan-Meier analyses of survival (in 65 patients in Child classes A and B), shunt patency, and absence of variceal bleeding. SETTING: Tertiary academic referral center of the US Department of Veterans Affairs. PATIENTS: Patients with alcoholic cirrhosis were considered for operation after at least 1 proven episode of variceal hemorrhage. Patients with portal vein thrombosis were excluded; patients in Child class C underwent operation only for compelling indications. Of the 72 who underwent partial shunting, 38 were in Child class A, 27 were in class B, and 7 were in class C. INTERVENTIONS: Partial portacaval shunt (6-, 8- or 10-mm polytetrafluoroethylene H-graft with collateral ablation) and serial follow-up. MAIN OUTCOME MEASURES: Study end points were death, recurrent variceal hemorrhage, and unavailability for follow-up. Other measures included graft patency and nonvariceal rebleeding. RESULTS: Cumulative probability of 7-year patency for grafts at risk was 95%. The 7-year probability for absence of variceal bleeding in patients at risk was 92%. In 65 patients in Child classes A and B, operative mortality was 7.7% and the cumulative probability of 7-year survival was 54%. CONCLUSION: For variceal bleeding associated with alcoholic cirrhosis, the small-diameter polytetrafluoroethylene portacaval H-graft with collateral ablation affords durable patency and protection against variceal rebleeding.

Adult↗
PubMed1980

A longitudinal analysis of the effect of experience on the therapeutic approach: revisited.

The published results of readministering the Therapist Orientation Questionnaire to a group of "low experience" therapists (N = 60) 4 years after an initial administration were recalculated due to scoring errors. Ss had been classified into Freudian, Sullivanian, and Rogerian schools. Differences present among schools on several TOQ factors were present initially and were mostly still there at the readministration. Although relative to each other the groups were stable, many scores shifted, essentially, away from a Freudian philosophy.

Attitude of Health Personnel↗
PubMed2001

Longitudinal analysis of human cytomegalovirus glycoprotein B (gB)-specific and neutralizing antibodies in AIDS patients either with or without cytomegalovirus end-organ disease.

Serum neutralizing and glycoprotein B (gB)-specific antibody levels were monitored prospectively in AIDS patients who either did or did not develop human cytomegalovirus (HCMV) end-organ disease, to delineate further the role of antibodies in protecting against HCMV disease. Antibody levels declined substantially (at least 4-fold) only in patients who developed HCMV disease; this decline in turn occurred concurrently with antigenemia. Nevertheless, AIDS patients who remained free of HCMV disease and did not become antigenemic during the follow-up period maintained stable levels of serum antibodies, with only minor fluctuations. The impact of HAART on the levels of functional anti-HCMV antibodies was investigated in a number of AIDS patients. Serum levels and kinetics of gB and neutralizing antibodies did not differ significantly between patients who responded biologically and virologically to therapy and those who failed to respond. In addition, CD4 + cell counts and HIV viral RNA levels did not correlate with anti-HCMV antibody titers.

AIDS-Related Opportunistic Infections↗
PubMed2003

Longitudinal Analysis when the Experimenter does not Determine when Treatment Ends: What is Dose-Response?

The most appropriate amount of psychotherapy to address a particular problem is of interest to clinicians, consumers and those responsible for funding of care. The dose-response relationship has been examined within the context of randomized clinical trials, meta-analysis as well as naturalistic studies; however, each of these approaches has limits. Many of these approaches have conceptually blurred two distinct concepts: do participants with different characteristics need different amounts of therapy and do otherwise equal participants show different outcomes when given different levels of (a particular type of) therapy? For any study design, if the experimenter does not determine the duration of therapy, then the length of therapy is said to be endogenous. This endogeneity can bias any attempt to untangle the answer to these two questions. An extension of the biasing effect of this endogeneity involves the choice of times to assess outcome; if outcome assessment depends on when therapy is terminated (rather than exogenously chosen) then estimates of the trajectory of outcome may be biased. Design considerations to minimize this effect are discussed.

Journal Article↗
PubMed2001

A Longitudinal Analysis of Elementary School Students' Achievement Goals in Literacy Activities.

The authors examined the temporal stability of elementary school students' (N = 432) motivation goals (task-mastery, performance, and work-avoidant) for literacy activities in the classroom. Task-specific assessments of students' goals were collected in the fall and spring of Grades 3, 4, and 5. Stability coefficients indicated a reasonable degree of consistency in students' goal responses over time, even though goals were initially assessed in relation to a specific learning assignment. However, there were also significant mean-level changes in students' goals within the school year and significant linear declines in task-mastery and performance goals over time. Changes were consistent across gender groups and across ability levels. Additionally, changes in task-mastery goal ratings explained variations in students' reported use of active learning strategies in reading and writing activities. The important implications of this study for future research are discussed. Copyright 2001 Academic Press.

Journal Article↗
PubMed2006

The need for substance abuse after-care: longitudinal analysis of Oxford House.

AIMS: There is a need to explore the processes of social support and self-efficacy change over time among individuals in recovery homes, and to assess the extent to which residents remain abstinent, obtain and maintain employment, refrain from criminal activity, and utilize health care systems both while within the and after leaving such settings. DESIGN: Residents were recruited and interviewed at an initial baseline phase and then re-interviewed at three subsequent 4-month intervals. SETTING: Oxford Houses are recovery home residences for individuals with substance abuse and dependence problems who seek a supportive, democratic, mutual-help setting. PARTICIPANTS: A national US sample of Oxford House residents (n=897: 604 men, 293 women). MEASUREMENTS: Information was gathered on abstinence, social support, self-efficacy, employment, criminal history, and medical care utilization. FINDINGS: Change in cumulative abstinence was predicted by support for alcohol use, abstinence self-efficacy, and length of residency in OH (i.e., less than versus >or=6 months), even after controlling for initial time spent in OH. CONCLUSIONS: Results suggest that receiving abstinence support, guidance, and information from recovery home members committed to the goal of long-term sobriety may enhance residents' abstinence self-efficacy and enable persons recovering from alcohol and other drug addiction to reduce the probability of a relapse.

Adult↗
PubMed2004

Longitudinal analysis of progression of dysphagia in amyotrophic lateral sclerosis.

OBJECTIVE: To investigate the progression of dysphagia in amyotrophic lateral sclerosis (ALS) using videofluoroscopy (VF), according to two different scales: the duration following bulbar symptom onset, and the ALS severity scale (ALSSS). METHODS: Seventy-two VF examinations, on 50 ALS patients, were performed at various time points, and the change in VF findings in the oral and pharyngeal phases was analyzed over time following bulbar symptom onset. The change according to advancement of the ALS severity scale was also assessed. RESULTS: Delayed bolus transport from the oral cavity to the pharynx, and bolus stasis at the pyriform sinus (PS), were seen in about half of the patients with no bulbar complaints. In contrast, upper esophageal sphincter (UES) opening was relatively well maintained in the late stage of dysphagia. The other parameters, such as bolus holding in the oral cavity, constriction of the pharynx, and elevation of the larynx, became worse over time following bulbar symptom onset. These parameters on VF examination also became worse as the ALSSS advanced; however, even patients in the group with normal eating habits showed disturbed bolus transport from the mouth to the pharynx, weak constriction of the pharynx, and bolus stasis at the PS. Generally, dysfunction had progressed dramatically, in most of the parameters, in the patients that required modification of food; however, UES opening and elevation of the larynx were relatively well maintained in advanced-ALSSS patients. CONCLUSION: In this study, we clearly show the progression pattern of dysphagia in ALS, and we also emphasize that VF is a useful tool to follow swallowing function in ALS patients. From our results, it would be useful to perform VF by 6 months following bulbar symptom onset, because VF can contribute to rehabilitation or appropriate diet modification; and later, around 1 year following bulbar symptom onset, VF should again be performed, since ALS patients show wide-ranging nutrition intake patterns, and they need assessment to introduce intervention, such as tube feeding, according to their varying status of dysphagia, around at this time point.

Aged↗