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PubMed2001

NIH symposium summary: organ preservation therapies for squamous cancers of the head and neck.

This symposium, sponsored by the NIH Office of Rare Diseases, the National Cancer Institute, the National Institute of Deafness and Other Communication Disorders, and the National Institute of Dental and Craniofacial Diseases, reviewed the current status of organ preservation therapies for head and neck cancers, as well as promising newer approaches for therapy and for toxicity amelioration.

Carcinoma, Squamous Cell↗
PubMed2001

After hospital: working with schools and families to support the long term needs of children with brain injuries.

Medical and rehabilitation systems care for children who sustain brain injuries. Their much needed services, however, are short in comparison with the long term needs of these children and their families. For the most part, it is schools and families who provide the long term supports to help children make the best outcomes and create a better quality of life. Professionals and families who develop collaborative models find that they can more effectively manage services for these children by carefully crafting Individual Education Plans (IEP's). Through the IEP process students' complex needs; the multiple transitions they experience; and their long term needs can be met.

Brain Injuries↗
PubMed2001

A study looking at the effectiveness of developmental screening in identifying learning disabilities in early childhood.

This is a retrospective study of children under six years of age referred to the Brothers of Charity Early Intervention Services in County Galway, a service that caters for children under 6 years with learning disabilities. The aim in doing this study was to assess the value of routine developmental screening in identifying children with learning difficulties. This study also investigates the patterns and sources of referral to the remedial services provided by the Brothers of Charity and highlights possible avoidable delays in referral. The results showed that many children were referred for remedial services late. The reasons for late referral included late identification of some children with problems, insufficient co-ordination of community-based services and a lack of awareness of the importance of early intervention in some cases. As some communication disorders such as autism, autistic spectrum disorders and specific language delay may not express themselves until the later part of the second year of life, the 18-24 month developmental assessment is of vital importance. However identification of these disorders can present difficulties and may call for additional training for professionals involved in the developmental screening of children in that age group. The interval between initial identification and referral for remedial care in many cases was more than twelve months. We propose that, in order to minimize this time, children requiring a more in-depth assessment should be assessed by a community-based multidisciplinary team, enabling integrated assessment by the different disciplines and thus speedier referral to remedial services.

Child, Preschool↗
PubMed2001

Apolipoprotein E polymorphism and Alzheimer's disease.

We aimed to determine the association and related factors of the apolipoprotein E (ApoE) genotype and Alzheimer's disease (AD) in Taiwan. We examined ApoE genotypes in 50 Chinese patients with AD and 50 age- and sex-matched controls. The patients met the criteria of probable AD of the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and AD of the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV). There were 28 females and 22 males in the case and control groups. The mean age of onset of AD was 72. 62 years. The average interval between onset and research was 3.85 years. The frequency of ApoE epsilon 4 in the AD group was significantly higher than that in the controls (0.13 versus 0.02, p < 0.05). The odds ratio for AD in individuals with at least one ApoE epsilon 4 allele was 6.0 (95% CI 1.34 to 55.3, p < 0.001). The linear trend for AD in proportion to alleles of ApoE epsilon 4 was significant (chi 2 = 8.3, p = 0.004). The risk of ApoE epsilon 4 allele for the late-onset AD patients, males, or those who received less education was higher than that for the early-onset AD patients, females, or those who had received more education. The sensitivity of the epsilon 4 allele was 24%, the specificity 96%, the positive predictive value 86%, and the negative predictive value 56%. Our results supported that the ApoE epsilon 4 allele is related to AD in Taiwan. In addition, sex and education may play important roles in the presence of ApoE epsilon 4 allele. The epsilon 4 allele seemed helpful as an adjunct for diagnostic testing of AD.

Aged↗
PubMedDate not supplied

Management of hearing loss in infants: the UTD/Callier Center position statement.

As infants are being identified earlier and earlier by universal newborn hearing screening programs, there is a need to establish principles for professionals involved in habilitative processes. Recently, a panel of experts was convened for a 2-day conference entitled "Habilitative Issues for Infants with Hearing Loss," the Bruton Conference on Audiology/Communication Sciences, UTD/Callier Center for Communication Disorders. The purpose of this document was to summarize the panel's discussions on habilitative principles, state-of-the-art practices, and future needs for infants with hearing loss.

Child↗
PubMed1975

Development of cooperative and competitive play responses in developmentally disabled children.

A behavior management procedure for training cooperative and competitive social play was investigated. Subjects were 5 EMR children who had marked behavior and communication disorders. Baseline data indicated that the subjects exhibited no competitive responses and low levels of cooperative play. Upon instituting a token-praise-feedback procedure, the experimenters observed increases in cooperative play as well as small increases in competitive play. Reinstating the token-feedback procedure after reversal resulted in high levels of competitive play with no change in cooperative play. Several explanations were offered to account for these results.

Child↗
PubMed2002

Factors in recruitment and employment of allied health students: preliminary findings.

The efforts of a group of participants in the Coalition for Allied Health Leadership program to assess how and why allied health students became interested in their professions and students' plans for future employment are described. Results of a survey administered to 29 physical therapist assistant (PTA) and 54 communication disorders (CD) students revealed that most of the students first learned about their professions through personal experience. Almost half of the PTA students decided to pursue their career after working in another career, and most of the CD students made the decision during high school or in college. The most important factors in students' decisions to enter the professions were a desire to help others and the nature of the work. CD students preferred private practice, whereas the most desired employment setting for PTA students was an outpatient clinical facility. For both groups, the three most important factors influencing where they wish to live and work were job availability, access to medical care, and proximity to family and loved ones. Although half of the CD students hailed from small towns and rural areas, less than one third intended to work in these areas. Implications of survey findings are discussed.

Adult↗
PubMed2002

Brain perfusion follow-up in Alzheimer's patients during treatment with acetylcholinesterase inhibitors.

UNLABELLED: Transient cognitive and behavioral stabilization of patients with Alzheimer's disease (AD) is the main goal of long-term acetylcholinesterase inhibitor (AChEI) therapy, but response to treatment is variable and, indeed, only some of the patients are stabilized. This is usually assessed by means of clinical and neuropsychologic scales, whereas functional neuroimaging could allow objective evaluation of the topographic correlates of the effect of therapy on brain functioning. The aim of this study was to evaluate brain perfusion changes by SPECT in AD patients during chronic AChEI therapy in relation to their cognitive evolution. METHODS: Forty-seven consecutive outpatients with mild-to-moderate probable AD (as defined by the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association and the Diagnostic and Statistical Manual of Mental Disorders [4th edition criteria] and a score of > or =15 on the Mini-Mental State Examination [MMSE]) were enrolled in 2 centers over a 1-y period and underwent SPECT with 99mTc-hexamethylpropyleneamine oxime at the time of enrollment (t(0)). All of them started AChEI therapy. Nine patients were lost at follow-up, and drugs were withdrawn from 3 patients. Of the remaining 35 patients, who received regular AChEI therapy (donepezil, 5 or 10 mg/d; rivastigmine, 6 or 9 mg/d) throughout the observation period, only the 31 patients receiving donepezil were considered to avoid the possible confounding effect of different drugs. The 31 patients completed the study and a second SPECT examination was performed 15.0 +/- 3.0 mo later (t(1)). They were divided into stabilized (17 patients) and nonstabilized (14 patients) subgroups on the basis of the minimum expected annual rate of decline of the MMSE score, derived from a meta-analysis of the literature. SPECT data were analyzed by means of statistical parametric mapping. RESULTS: At baseline, the stabilized and nonstabilized patients were comparable for age, sex distribution, education, MMSE scores, memory impairment (selective reminding test [SRT]), apolipoprotein E genotype, AChEI dose regimen, and SPECT findings. The SRT scores decreased significantly (P < 0.01) in the nonstabilized subgroup but not in the stabilized subgroup. No significant difference was found between the baseline and repeated SPECT data in the stabilized subgroup. In contrast, in the nonstabilized subgroup a significant perfusion reduction was found in the frontal, temporal, and parietal superficial cortex and in the occipital precuneus in the right hemisphere and in the frontal and mesial temporal cortex in the left hemisphere. On repeated SPECT, regional cerebral blood flow was significantly lower in a left frontal region in the nonstabilized group than in the stabilized group. CONCLUSION: The regional cerebral blood flow decreases in several cortical regions in AD patients with cognitive deterioration despite long-term AChEI therapy, similar to that observed in untreated patients, whereas it remains stable in AD patients with stabilized cognitive performance during therapy.

Aged↗
PubMed2002

Pain management in the elderly.

Pain in the elderly is often unrecognized and undertreated. Ineffective pain management can have a significant impact on the quality of life of older adults, leading to depression, social isolation, and a loss of function. Proper assessment of older adults requires the physician to regularly ask about the presence of pain and be skillful in assessment strategies to evaluate the frequency and intensity of pain. Assessment of pain in older adults with dementia and communication disorders is especially challenging. Effective pain management in elderly patients should include both pharmacologic and nonpharmacologic strategies. Pharmacologic strategies call for administration of nonopioid analgesics, opioid analgesics, and adjuvant medication. Polypharmacy, drug-drug and drug-disease interactions, age-associated changes in drug metabolism, and the high frequency of adverse drug reactions need to be carefully considered in using medications in this population. Nonpharmacologic approaches such as cognitive-behavioral therapy, education, osteopathic manipulative treatment, and exercise should be applied in addition to pharmacologic therapy. Using a team approach and incorporating principles of pain management can effectively provide good analgesia for older adults.

Acetaminophen↗
PubMedDate not supplied

[Guillain-Barré syndrome in the northern area of Gran Canaria and the island of Lanzarote].

AIMS: The objective of this study is to analyse the incidence and clinical characteristics of Guillain Barre syndrome (GBS) in the Canary Islands. PATIENTS AND METHODS: We conducted a retrospective study of GBS patients (according to diagnostic criteria from the National Institute of Neurological and Communicative Disorders and Stroke) treated in the Ntra. Sra. del Pino Hospital in Gran Canaria between 1983 and 1998. Annual incidence, seasonal distribution, preceding infection, clinical and electrophysiological data, and evolution were all evaluated. Prognostic factors were studied by means of a univariate analysis. RESULTS: A total of 81 patients were selected for the study. The raw incidence was 1.04/100,000 inhab./year (CI 95%: 0.83 1.29; adjusted for age to the European population: 1.5). The rates of incidence were higher in men and increased lineally with age in both sexes. We observed an upward tendency during the winter months. 48% of the patients displayed serious motor deficits in the nadir of the disease, and 17.8% required assisted ventilation. After one year s evolution 74% were seen to experience an excellent recovery. The mortality rate was 8.2% and 37% received immunomodulatory treatment. The main variables associated with a bad prognosis at 3 and 12 months were: serious deficits in muscular balance, the need for assisted ventilation and very reduced amplitude of evoked motor potential. CONCLUSIONS: GBS incidence in the Canary Islands is similar to that found in other countries. An increase with age and an upward tendency during the winter months was observed. No differences were found in the clinical data as compared with other series.

Adolescent↗
PubMed2002

Defining dementia: clinical criteria for the diagnosis of vascular dementia.

The recognition of cerebrovascular disease (CVD) as a contributing factor and a cause of dementia has led to the development of clinical criteria for vascular dementia (VaD). Due to high specificity, the consensus criteria developed by the National Institute for Neurological and Communicative Disorders and Stroke (NINDS)-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN) have been used in controlled clinical trials to select patients with pure VaD. VaD is predominantly a subcortical frontal form of dementia with prominent executive dysfunction. In contrast, the criteria of the NINCDS-Alzheimer's Disease and Related Disorders Association (ADRDA) emphasize memory loss as the main feature to distinguish Alzheimer's disease (AD) from VaD and from other forms of dementia. Moreover, CVD may precipitate the clinical expression of AD. Although no criteria have been created specifically for patients having AD with CVD, the ischemic score, the Informant Questionnaire on Cognitive Decline in the Elderly and a history of prestroke mild cognitive impairment (MCI) may be useful for identifying patients with this mixed form of dementia.

Aged↗
PubMed2002

Primary malnutrition. Can we always tell?

Patterns of disease in the English-speaking Caribbean have changed considerably over the past two decades. There has been a decrease in the incidence of common infectious diseases, an increase in the prevalence of chronic non-communicable disorders and an increase in the incidence and prevalence of HIV/AIDS. However, published estimates suggest that malnutrition continues to be a serious public health problem. It is possible that changing patterns of disease within the epidemiological transition may affect patterns of presentation of severe forms of childhood malnutrition. We have examined records of 435 children admitted to the clinical research ward of the Tropical Metabolism Research Unit (TMRU) from January 1, 1990, to December 31, 1999; among these were 25 children who were subsequently found to have severe childhood malnutrition (SCM) due to a defined medical or surgical disorder (i.e. secondary SCM). Among children with secondary SCM, the HIV/AIDS group was the largest and comprised 60% of these admissions. Regression analyses show that, over the ten-year period, there was a small, non-significant decline in the number of cases of primary SCM (incidence rate ratio, IRR = 0.99, 95% confidence interval = 0.96, 1.02, p = 0.98), while the number of cases of secondary SCM increased (IRR = 1.18, 95% CI = 1.03, 1.35, p = 0.02). These data are indicative of the need for continued vigilance in the evaluation of children who have clinical features of the syndromes of severe malnutrition and draw attention to the potential impact of HIV/AIDS in yet another area of healthcare delivery.

Child↗
PubMedDate not supplied

Follow-up of participants in a preschool hearing screening program in child care centres.

As part of its response to the Ontario Ministry of Health recommendation that communication disorders in preschool children be identified, the Hamilton-Wentworth Department of Public Health Services performed hearing screening tests on all preschool children in child care centres. Parents of children who had failed the hearing screening test were recommended to take their child to their family physician for further assessment. Out of 1,844 children tested between September 1990 and February 1991, 35 children failed the pure-tone audiometry test administered by nurses. A telephone follow-up interview determined that 26 children with screening test failures had received some medical follow-up. Eight children had a confirmed hearing problem; of these, five were newly diagnosed with a hearing problem, all resulting from fluid build-up in the middle ear. Three children were treated, with two having improved hearing. Of the two children not treated, one was reported to have improved hearing. As with other recently reported preschool hearing screening programs, this study raises doubts about the usefulness of such programs.

Audiometry, Pure-Tone↗
PubMed1992

[The Budapest "stroke data bank" (goals, methods)].

The Stroke Data Bank initiated by National Institute of Neurological and Communicative Disorders and Stroke (USA) has been adapted and published here in a short form. The original questionnaire has been extended with data of patients' diets and neuropsychology. A suitable computer data basis derived from 1292 questions in 22 groups provides information about the risk factors, etiology, symptoms, signs, diagnosis, prognosis of stroke, and the easy to use follow up of patients.

Cerebrovascular Disorders↗
PubMed2004

[Relatives' satisfaction with the care of elderly patients in skilled nursing wards].

BACKGROUND: Skilled Nursing Wards (SNW) in Israel are purposely equipped and staffed for treatment of patients that, in addition to functional dependence, suffer from active diseases which require close medical supervision. Patients' surveys on satisfaction with health care are increasingly accepted as an element of quality assessment. However, given the high rate of communication disorders present in these patients, this method is not feasible for use in SNWs. OBJECTIVE: We initiated a survey of patients' relatives--based on a questionnaire specifically designed to reflect their satisfaction with the level of care provided. METHODS: Respondents were asked to rank their level of satisfaction with medical, nursing and structural aspects of the care in the SNW on a 1-5 Likert Scale. RESULTS: Relatives of 147 SNW residents answered the questionnaire. The overall level of satisfaction was high, all components being ranked at 4.2 or above. Four point fifty-five was the average rating given to the medical component of the care, 4.39 to the nursing aspect and 4.32 to the structural section. Five points were awarded to the medical component by 60% of the participants, to the nursing element by 55% of respondents and to the structural section by 40% of respondents. No differences were observed between the rankings of frequent and less frequent visitors. All respondents were highly cooperative and expressed their appreciation of the initiative to perform a satisfaction survey. CONCLUSION: The results show that the families of the skilled nursing patients that participated in this study are satisfied with the health care provided to their relatives. Such surveys contribute to the quality of care and should be considered for routine/periodical use in long-term care settings.

Aged↗
PubMedDate not supplied

Addressing health disparities through promoting equity for individuals with intellectual disability.

Intellectual disabilities (ID) are conditions originating before the age of 18 that result in significant limitations in intellectual functioning and conceptual, social and practical adaptive skills. IDs affect 1 to 3% of the population. Persons with ID are more likely to have physical disabilities, mental health problems, hearing impairments, vision impairments and communication disorders. These co-existing disabilities, combined with the limitations in intellectual functioning and in adaptive behaviours, make this group of Canadians particularly vulnerable to health disparities. The purpose of this synthesis article is to explore potential contributory factors to health vulnerabilities faced by persons with ID, reveal the extent and nature of health disparities in this population, and examine initiatives to address such differences. The review indicates that persons with ID fare worse than the general population on a number of key health indicators. The factors leading to vulnerability are numerous and complex. They include the way society has viewed ID, the etiology of ID, health damaging behaviours, exposure to unhealthy environments, health-related mobility and inadequate access to essential health and other basic services. For persons with ID there are important disparities in access to care that are difficult to disentangle from discriminatory values and practice. Policy-makers in the United States, England and Scotland have recently begun to address these issues. It is recommended that a clear vision for health policy and strategies be created to address health disparities faced by persons with ID in Canada.

Adult↗
PubMed2005

[Epidemiology of falls among stroke patients hospitalized in a rehabilitation unit: a three year survey].

BACKGROUND: Falls are major complications in inpatient stroke rehabilitation. The early identification of those at risk is an important issue in preventive strategies. AIMS: The study aimed to assess the risk factors for falls for patients hospitalized in a rehabilitation unit as a result of an acute stroke. METHODS: We studied a cohort of 36 falls in 25 patients during the years 2000-2002. The questionnaire on each patient included general and medical information and the description of the event. RESULTS: Eighteen patients fell once, five patients fell twice and two patients fell four times. In 89% of the falls, the patients were treated by tranquilizers, hypoglycemic, hypotensive or neuroleptic drugs. Most of the falls occurred in patients who suffered from hypotonus (72%), paralysis (58%) and hypoesthesia (52%) in the involved lower limb. A total of 67% of the falls occurred in males, 53% in patients over 65 years old, 47% during the first month after stroke and 36% in the second month. It was found that 78% of the falls happened during daytime and 64% took place in the patient's room. Communication disorders (28%), visuospatial agnosia (25%) and hemianopia (24%) were incremental risk factors for falls. CONCLUSION: Stroke is associated with a risk of falling during the rehabilitation period. The identification of patients at risk may be a first step toward the implementation of fall-prevention measures for these patients.

Accidental Falls↗