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PubMed2002

Interhemispheric sensorimotor integration in pointing movements: a study on dyslexic adults.

In addition to reading disorders, numerous deficits have been found to be associated with dyslexia, suggesting that various neurological factors might be involved in its etiology. In the present study, we focused on three of the deficits which have been thought to accompany and to a certain extent, to explain dyslexia: an abnormal pattern of hemispheric asymmetry, abnormal hemispheric communication, and abnormal motor control. The aim of the present study was to determine whether adults with reading difficulties perform differently from control subjects in a visuo-manual pointing task, in which the subject was required to point with the right or the left hand to targets appearing to the right or left of a central fixation point. A total of 14 dyslexic adults and 14 control adults participated in this experiment. Motor control was assessed based on the time taken to perform the pointing task, hemispheric asymmetry in terms of the inter-hand differences in the reaction and movement times, and hemispheric communication based on the interhemispheric transfer time under crossed conditions, where the hand and the target were not on the same side. The results showed that neither hemispheric asymmetry nor interhemispheric transfer differed between dyslexic and control adults. However, the dyslexics were significantly slower when performing the pointing task. These results are in agreement with the hypothesis that dyslexia may involve a mild motor deficit.

Adult↗
PubMed2003

[Workflow improvement and efficiency gain with near total digitalization of a radiology department].

PURPOSE: To determine the temporal changes of the workflow caused by digitalization of the radiology department after installation of digital luminescence-radiography (DLR), a radiology information system (RIS) and picture archiving and communication system (PACS) at the Missionsärztliche Klinik in April 2000. MATERIALS AND METHODS: In a comparative study, a workflow analysis by manual registration of different work steps was performed before (1999) and after (2001) digitalization of a radiology department. RESULTS: The digitalization shortened the examination time for patients from a mean of 8 min to 5 min. The time the patient is absent from the emergency room did not change. Reporting radiographic examinations including comparison with previous studies begins earlier from a mean of 2 h 37 min to 17 min. Using PACS, 85.9 % of all cases could be interpreted on the day of the examination (without PACS 41.2 %) and 87.2 % of the reports were completed the day after the examination (without PACS 64.5 %). No time differences were found between reading conventional studies on the monitor or as soft-copy. CONCLUSION: Compared to conventional film-screen systems, complete digitalization of a radiology department is time saving at nearly all steps of the workflow, with expected positive effects on the workflow quality of the entire hospital.

Efficiency, Organizational↗
PubMed1993

A population-based study of dementia in 85-year-olds.

BACKGROUND: The aim of this study was to investigate the causes, severity, and prevalence of dementia in a representative sample of 494 85-year-olds living in Gothenburg, Sweden. METHODS: The study included a psychiatric interview, neuropsychological and physical examinations, comprehensive laboratory tests, electrocardiography, chest radiography, computed tomography (CT) of the head, and analysis of cerebrospinal fluid. A person close to each subject was also interviewed. Dementia was defined according to the criteria proposed in the Diagnostic and Statistical Manual of Mental Disorders (third edition, revised), Alzheimer's disease according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, and vascular dementia according to recently proposed criteria that incorporate information from CT scanning and the patient's neurologic history. RESULTS: The prevalence of dementia was 29.8 percent (147 subjects). The condition was mild in 8.3 percent, moderate in 10.3 percent, and severe in 11.1 percent. There were no significant sex-related differences in prevalence or severity. Of the subjects with dementia, 43.5 percent had Alzheimer's disease, 46.9 percent had vascular dementia (multi-infarct dementia in 34.6 percent, dementia related to cerebral hypoperfusion in 4.1 percent, and mixed dementia in 8.2 percent), and 9.5 percent had dementia due to other causes. The three-year mortality rate was 23.1 percent in the subjects without dementia, 42.2 percent in the patients with Alzheimer's disease, and 66.7 percent in the patients with vascular dementia. Infarcts detected by CT scanning were significantly more common in the subjects with dementia than in those without it (27.9 percent vs. 12.6 percent). CONCLUSIONS: Dementia was present in nearly a third of unselected 85-year-olds in Sweden. Almost half these subjects appeared to have vascular dementia, which may currently be more amenable to prevention or treatment than Alzheimer's disease.

Aged↗
PubMed1996

A population-based study on the incidence of dementia disorders between 85 and 88 years of age.

OBJECTIVE: To investigate the incidence of Alzheimer's disease, vascular dementia and other dementias in a population between 85 and 88 years of age. DESIGN: Prospective cohort study. Longitudinal population study of the very old. SETTING: Systematic sample of a birth cohort living in the community or in institutions in the city of Gothenburg, Sweden. PARTICIPANTS: A representative population sample of nondemented 85-year-old residents (n = 347). MEASUREMENTS: The study included neuropsychiatric, neuropsychological, and physical examinations, key informant interviews, comprehensive laboratory tests, electrocardiography, chest radiography and computed tomography (CT-scan) of the head. Information on subjects lost during the follow-up period as a result of death or refusal was traced in medical records. Dementia was defined according to the criteria proposed in the Diagnostic and Statistical Manual of Mental Disorders (3rd Edition, revised), Alzheimer's disease according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, and vascular dementia according to criteria proposed by Erkinjuntti. RESULTS: Sufficient information was obtained about 92% of the subjects at risk. Sixty-three subjects (18.2%) became demented between ages 85 and 88, giving an incidence of 90.1/1000/year (61.3/1000/year for men and 102.7/1000/ year for women; P = .085). The incidence of Alzheimer's disease was 36.3/1000/year, vascular dementia 39.0/1000/ year (P = 1.000), and that of other dementias 9.1/1000/year. CONCLUSION: This study shows that almost one-tenth of nondemented persons between the ages of 85 and 88 become demented each year, emphasizing the magnitude of the dementia problem in the very old, the fastest growing segment of western populations.

Aged↗
PubMed1998

Prevalence of Alzheimer's disease and other dementias in rural India: the Indo-US study.

OBJECTIVE: To determine the prevalence of AD and other dementias in a rural elderly Hindi-speaking population in Ballabgarh in northern India. DESIGN: The authors performed a community survey of a cohort of 5,126 individuals aged 55 years and older, 73.3% of whom were illiterate. Hindi cognitive and functional screening instruments, developed for and validated in this population, were used to screen the cohort. A total of 536 subjects (10.5%) who met operational criteria for cognitive and functional impairment and a random sample of 270 unimpaired control subjects (5.3%) underwent standardized clinical assessment for dementia using the Diagnostic and Statistical Manual of Mental Disorders-fourth edition diagnostic criteria, the Clinical Dementia Rating Scale (CDR), and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable and possible AD. RESULTS: We found an overall prevalence rate of 0.84% (95% CI, 0.61 to 1.13) for all dementias with a CDR score of at least 0.5 in the population aged 55 years and older, and an overall prevalence rate of 1.36% (95% CI, 0.96 to 1.88) in the population aged 65 years and older. The overall prevalence rate for AD was 0.62% (95% CI, 0.43 to 0.88) in the population aged 55+ and 1.07% (95% CI, 0.72 to 1.53) in the population aged 65+. Greater age was associated significantly with higher prevalence of both AD and all dementias, but neither gender nor literacy was associated with prevalence. CONCLUSIONS: In this population, the prevalence of AD and other dementias was low, increased with age, and was not associated with gender or literacy. Possible explanations include low overall life expectancy, short survival with the disease, and low age-specific incidence potentially due to differences in the underlying distribution of risk and protective factors compared with populations with higher prevalence.

Aged↗
PubMed2000

[The phylogenesis of language. New approaches of old questions].

The philogenesis and the anthropogenesis of language are the primary elements for the anatomic and physiologic understanding about the mechanisms of human communication, as well as their clinical applicability. During the process of primates'evolution, significant changes in the animal's body, specially on the heads, has occurred since the arboricole life that influences the genesis of language. The adaptation of a semi-vertical body posture, the exploratory use of the hands and the improvement of vision at the expenses of olfaction have caused the enlargement of the cranium and the encephalon. Furthermore, as the primates went back to the floor, and from the development of the biped march in the Australopithecus, a progressive "fan-like" increase of the frontal, parietal and temporal regions took place allowing the simultaneous development of the neuroanatomical centers of language, facial expression and manual motor activity.

Animals↗
PubMed2000

Computerization of leprosy records: national leprosy recording and reporting system in China.

This paper describes the national system of leprosy recording and reporting in China and the computerization of records. The system was designed for data collection at local level and data entry by optically scanned or manual mode as well as for sophisticated data analysis. The major functions include data entry, data check, sum-up, maintenance, communication, inquiry, statistics, graph and print. A total of 17 options for epidemiological and clinical data analysis are available. Through the implementation for about 10 years, the system has gained widespread acceptance. This acceptance would facilitate introduction of computer analysis to other leprosy projects and other disease control programs in China. Up to 1998, a database of more than 740,000 records covering all the leprosy patients detected since 1949 had been established by this system.

Adolescent↗
PubMed1994

Characteristics of health data: structure and relationships.

The characteristics of health data are diverse and vary by discipline. Health data can be viewed from three perspectives. They can be examined at a basic level of different variable types and database constructions. At an intermediate level, the way data are structured in a facility is a model of how an organization works. A computerized information system is a model of how work is performed. An understanding of facility data architecture and data structure is essential for adapting both manual and computerized systems to the rapid changes occurring in health care today. Lastly from the highest-level perspective, for communication and exchange of health data to be possible across all components of the health care delivery system, standards for data must be adopted by all institutions and individuals involved in the development of health data information systems. To expedite such exchange, the American Medical Informatics Association (AMIA) has recommended standards for patient, provider, and site-of-care identifiers; computerized message exchanges; and medical record content and structure. AMIA has also recommended the use of the universal medical language system as the basis for future developments in a universal medical language.

Abstracting and Indexing↗
PubMed1998

[Use of Intranet in the hospital setting].

In the Intranet system, the organization uses technologies developed and applied in the Internet network world-wide. Hospitals can use Internet technologies to make hospital information systems more efficient by improving use of existing systems and by adding additional possibilities. Furthermore, the hospital can improve its relations with its customers and also bring the organization additional customers. Intranet implementation can be divided into the areas of: communication, managing and distributing information, and application linkage. Implementation must be modular, gradual and planned according to economic, technological and organizational aspects of the hospitals. By the Intranet, organizations can achieve benefits that include: improving communication array, availability of data and information, using existing information systems and their applications, enhancing customer satisfaction and saving costs of manual application systems.

Hospital Information Systems↗
PubMed1995

Alzheimer and vascular dementias and driving. A prospective road and laboratory study.

OBJECTIVE: To characterize on-the-road, behind-the-wheel driving abilities and related laboratory performances of subjects with mild Alzheimer's disease (AD) and vascular dementia. DESIGN: Prospective, experimental study involving two mild dementia and three age and health control groups. Road test reliability and validity were assessed. SETTING: Greater western Los Angeles. Subjects were enrolled from the community by referral and from the Veterans Affairs dementia and diabetes clinics. PARTICIPANTS: Eighty-seven driving subjects were enrolled; 83 completed the study. A sample of eligible dementia clinic subjects consisting of 15 mild AD patients met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association probable AD criteria, while 12 met Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition and Hachinski diagnostic criteria for multi-infarct dementia (vascular dementia). Clinic control subjects consisted of 15 age-matched patients with diabetes and without a history of stroke or dementia. Community controls consisted of 26 healthy, age-matched, older subjects (> 60 years) and 16 young subjects (20 to 35 years). MAIN OUTCOME MEASURES: Drive score from the Sepulveda (Calif) road test and laboratory measures of attention, perception, and memory. RESULTS: The drive scores in the mild AD group (mean, 22.1; SD, 3.8) and in the vascular dementia group (mean, 24.0; SD, 7.8) differed significantly (P < .001 studentized range test) from the drive scores in the diabetic control group (mean, 31.5; SD, 3.9), the older control group (mean, 32.6; SD, 2.8), and the young control group (mean, 33.6; SD, 3.2). Drive score among the three control groups did not vary significantly. Short-term memory (Sternberg), visual tracking, and Folstein Mini-Mental State Examination scores correlated best with drive score, with a cumulative R2 of 0.68. Drive score and number of collisions and moving violations per 1000 miles driven were negatively correlated (r = -0.38; P < .02). CONCLUSIONS: Based on this study, type and degree of cognitive impairment are better predictors of driving skills than age or medical diagnosis per se. Specific testing protocols for drivers with potential cognitive impairment may detect unsafe drivers more effectively than using age or medical diagnosis alone as criteria for license restriction or revocation.

Adult↗
PubMed1990

Enhancing parents' use of SEE-2. Progress and retention.

This study documented the changes in spoken and signed input of five hearing parents to their hearing-impaired children over a 12-month time period. Two baseline sessions per parent were videotaped and analyzed (Moeller & Luetke-Stahlman, 1990), and then two intervention sessions and one retention session were filmed. Parents were seen individually by one author of this study after each session and given feedback on specific characteristics of their communication abilities. Transcription sheets, graphs, and their child's IEP (Individual Educational Plan) objective were used to help parents target goals for improvement. All parents improved in at least one linguistic area of need, and several parents changed impressively in form, content, and use of Manually Coded English. These improvements allowed the parents to completely and consistently provide comprehensible messages to their children.

Child, Preschool↗
PubMed1986

Communicable disease and mental health: restrictions of the person.

Laws for the protection of public health control either the environment, as in the case of sanitation or air pollution regulations, or human conduct. This Article deals with limitations imposed upon individuals in order to prevent the spread of communicable disease and the harm resulting from mental illness. The restraints discussed include compulsory examination and immunization, and forms of compulsory detention or commitment. This Article is a revised chapter of the author's Public Health Law Manual, first published by the American Public Health Association in 1965. The Manual is intended to help public health professionals to understand the law relevant to their practice, and to apply it more effectively.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Reporting quality improvement data by key functions: one step closer to continuous quality improvement.

Medical care systems must demonstrate that they provide cost-effective, quality care if they are to remain viable in the wake of healthcare reform. A basic premise of continuous quality improvement is that an organization can measure and improve the performance of key functions (a group of goal-directed processes). Accordingly, the Joint Commission on Accreditation of Healthcare Organizations has been restructuring its accreditation manual, moving from department-specific standards to functional standards. In early 1992, our hospital began reporting quality improvement data by key functions rather than by service. As a result of this change, departments communicated and worked together better and more interdisciplinary efforts occurred, resulting in some dramatic improvements in the quality of care.

Data Collection↗
PubMed1990

A study of the tactual and visual reception of fingerspelling.

A method of communication in frequent use among members of the deaf-blind community is the tactual reception of fingerspelling. In this method, the hand of the deaf-blind individual is placed on the hand of the sender to monitor the handshapes and movements associated with the letters of the manual alphabet. The purpose of the current study was to examine the ability of experienced deaf-blind subjects to receive fingerspelled materials, including sentences and connected text, through the tactual sense. A parallel study of the reception of fingerspelling through the visual sense was also conducted using sighted deaf subjects. For both visual and tactual reception of fingerspelled sentences, accuracy of reception was examined as a function of rate of presentation. In the tactual study, where rates were limited to those that could be produced naturally by an experienced interpreter, highly accurate reception of conversational sentence materials was observed throughout the range of naturally produced rates (i.e., 2 to 6 letters/s). In the visual study, rates in excess of those that can be produced naturally were achieved through variable-speed playback of videotapes of fingerspelled sentences. The results of this study indicate that performance varies systematically as a function of rate of presentation, with scores of 50% correct on conversational sentences obtained at rates of 12 to 16 letters/s (i.e., rates roughly double to triple normal speed). These results suggest that normal communication rates for the visual reception of fingerspelling are restricted by limitations on the rate of manual production. Although maximal rates of natural manual production of fingerspelling correspond to the presentation of a new handshape on the order of once every 150-20 ms, the data from the sped-up visual study suggest that experienced receivers of visual fingerspelling are able to receive sentences at substantially higher rates of fingerspelling (which are, in fact, comparable to communication rates for spoken English).

Adult↗
PubMed1998

Abuse of and dependence on alcohol in Swedish women: role of education, occupation and family structure.

The present study, which is part of a multipurpose study on alcohol use among women, focuses on the association between education, occupation, family structure and development of alcohol dependence or abuse in women. A total of 316 women were selected by stratified random sampling from all women in a defined part of Gothenburg, Sweden. In a face to face interview, questions were asked about occupation, education, family structure and other variables reflecting socioeconomic conditions and relations within the family. As outcome measures we used alcohol dependence and abuse (ADA), diagnosed in a clinical interview according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R). We found that never having been married, or having poor communication with the spouse, as well as having no children at home to take care of, were strongly associated with ADA in women. The role of social class depended on whether education or occupation was used as a measure. Our findings are compatible with the hypothesis that development of alcohol-related problems among women to a large extent is influenced by matters that relate to home and private life.

Adolescent↗
PubMed2000

Ten-year incidence of dementia in a rural elderly US community population: the MoVIES Project.

OBJECTIVE: To determine incidence rates by age, sex, and education of overall dementia and probable/ possible AD in a largely rural community. METHODS: Ten-year prospective study of a randomly selected community sample aged 65+; biennial cognitive screening followed by standardized clinical evaluation. Incidence rates were estimated for overall dementia (Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised, criteria and Clinical Dementia Rating [CDR]) and for probable/possible AD (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria). RESULTS: The cohort consisted of 1,298 individuals free of dementia at study entry. Among these, 199 incident (new) cases of overall (all-cause) dementia with CDR stage > or = 0.5, including 110 with CDR > or = 1, were detected during follow-up. Among the incident cases, 153 (76.9%) had probable/ possible AD. Age-specific incidence rates are reported for all dementia and for probable/possible AD, by sex and CDR stage. Among all-cause dementias with CDR = 0.5, controlling for age and education, men had a higher incidence rate than women. In the same group, those with less than high school education had significantly higher incidence rates than those with more education. Rates did not vary significantly by sex or education for probable/possible AD or for dementia with CDR > or = 1. CONCLUSIONS: Incidence rates of all dementias and of AD increased with age; men and those with lesser education had higher rates of possible/incipient dementia (CDR = 0.5) in this community. Potential explanations for these sex and education effects are discussed.

Aged↗
PubMed2003

Psychoanalytic peregrination. V: The Zollikon Lectures.

This article is to prepare the reader, along with the previous peregrination, for the article that follows by Professor Lang. It introduces the thinking of Heidegger at the Zollikon Seminars, conducted by the Swiss psychoanalyst Medard Boss, founder of Daseinanalyse and presented to a group of Swiss psychiatrists. Heidegger opposed Freud's scientific Weltanschauung and his hydraulic system of metapsychology, objecting that it dehumanizes the patient. He emphasized the importance of the therapist's "presence" and openness to the patient. He utilized phenomenology to prevent relating to the patient as an "other" or "thing" and advocated a hermeneutic approach instead. This approach involves the use of questions and answers to gain a gradual explicit understanding of the unique communications from the individual patient. He opposed the approach of the drug companies that impel psychiatry to use classification of disorders through manuals such as DSM-IV and then subject the patient to the recommended drug for that disorder, which he maintained was a form of domination of the patient as the "other."

Humans↗