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PubMed2003

Quality-of-life and visual function assessment after phacoemulsification in an urban indian population.

PURPOSE: To assess patients' quality of life (QoL) and overall visual function (VF) after phacoemulsification with intraocular lens (IOL) implantation in an urban Indian population. SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. METHODS: This prospective study comprised 300 patients with a mean age of 60.8 years +/- 9.2 (SD) who were evaluated preoperatively for visual acuity, QoL, VF, and demographic information. Postoperative evaluations included the same parameters with the addition of patient satisfaction. Also analyzed was the impact on the resumption of routine daily activities and professional work after phacoemulsification. Patients were divided into 2 categories: driving and nondriving. They were also categorized by profession and type and density of cataract. The relationship of patients' characteristics and QoL versus VF was determined by an analysis of variance and 99% confidence intervals. Effect sizes (change/difference / the standard deviation at baseline) were computed for intergroup longitudinal changes and intergroup differences. RESULTS: Correlation analysis showed a highly significant positive correlation between logMAR scores with VF and QoL. Overall, VF changed more significantly than QoL in effect size on all subscales. Postoperatively, 13% of respondents reported difficulty performing routine work; 40% resumed their daily activities within 1 week and 55%, within 1 month. More than 42% resumed professional activities within 1 week after surgery; 53% took 1 week to 1 month. Eight-six percent were fully satisfied with the results of cataract surgery. Overall, 88% reported that VF and QoL were "a lot better" and 10% responded little they were "a little better" than before surgery. CONCLUSIONS: Improvement in health-related QoL and VF occurred within 3 months of cataract extraction. The speed of visual acuity recovery after phacoemulsification matched the improvement across health-related QoL functions, resulting in rapid recovery of the patients' functional independence and health status.

Activities of Daily Living↗
PubMed2001

Longitudinal effects of botulinum toxin injections on voice-related quality of life (V-RQOL) for patients with adductory spasmodic dysphonia.

Adductory spasmodic dysphonia is a focal dystonia of laryngeal muscles. Patients with this disorder typically have severe vocal difficulties, with significant functional, social, and emotional consequences. There is no widely accepted cure for this condition, however, botulinum toxin injections of the thyroarytenoid muscles are considered by most voice clinicians to be the state of the art treatment. Based on extensive experience treating patients for adductory spasmodic dysphonia, we feel that traditional means of voice assessment do not adequately measure either the disease severity or the treatment outcomes. That is, listening to or acoustically analyzing limited phonatory samples does not capture the functional, social, and emotional consequences of this disorder. These consequences will be reflected in a patient's voice-related quality of life (V-RQOL). Using a validated voice outcomes instrument, the V-RQOL Measure, the purpose of this study was to quantify longitudinal changes in the V-RQOL of patients with adductory spasmodic dysphonia who are undergoing botulinum toxin injections. Twenty-seven consecutive new patients presenting with dysphonia to our institution during an 18-month period were diagnosed with adductory spasmodic dysphonia, and treated patients were evaluated prospectively using the V-RQOL Measure. Results indicated that (1) V-RQOL was initially very low for these patients, (2) botulinum toxin injections improved it significantly for each injection cycle studied, and (3) the magnitude of the treatment effect appears to change across injections.

Adult↗
PubMedDate not supplied

Structural MR image processing using the BRAINS2 toolbox.

Medical imaging has opened a new door into biomedical research. In order to study various diseases of the brain and detect their impact on brain structure, robust and user friendly image processing packages are required. These packages must be multi-faceted to distinguish variations in size, shape, volume, and the ability to detect longitudinal changes over the course of an illness. This paper describes the BRAINS2 image processing package, which contains both manual and automated tools for structural identification, methods for tissue classification and cortical surface generation. These features are described in detail, as well as the reliability of these procedures.

Brain↗
PubMed2003

Angiotensin I-converting enzyme (ACE) gene polymorphism in relation to physical performance, cognition and survival--a follow-up study of elderly Danish twins.

PURPOSE: Studies of younger individuals have suggested an association between ACE genotype and physical and cognitive performance. Using a longitudinal study of elderly twins we studied the association between ACE genotype and physical and cognitive functioning and survival in old age. METHODS: Participants were 684 twins aged 73+ years from the 1997 and 1999 surveys of the Longitudinal Study of Aging Danish Twins. Cognitive skills were assessed by the MMSE, while physical abilities were determined through self-report in 1997 and through both self-report and measurement of performance in two physical tasks in 1999. Survival status was obtained through linkage with a national death register. RESULTS: Neither physical nor cognitive performance was associated with ACE genotype at baseline in 1997, or at follow-up in 1999. For participants in both surveys longitudinal changes in these skills did not depend on ACE genotype. The relative risk of dying was increased in II compared with the DI and DD genotype with relative risks of 1.6 (95 percent confidence intervals 1.1-2.5) and 1.3 (0.8-2.1), respectively. CONCLUSION: We found no substantial effects of ACE genotype on physical and cognitive performance, or rate of change among elderly. Persons with the D allele may have a lower mortality at older ages.

Aged↗
PubMed2004

Clinical applications of cognitive event-related potentials in Alzheimer's disease.

This article has reviewed several abnormalities in the cognitive ERPs of AD patients. These abnormalities are prominent from latencies of approximately 200 msec and later. In contrast, sensory-dependent evoked potentials, such as N100, are generally normal in AD. This finding is as one familiar with the neuropathology of AD would predict. Predilection sites in early AD include the medial temporal lobe, other limbic areas, and multimodal association cortices with sparing of primary sensory areas. Unimodal association cortex is involved in AD, but not as heavily as multimodal cortex. Particular advantages of studying a given ERP paradigm or component depend largely on the specific application or hypothesis being tested. A P300 paradigm can be useful in detecting a disorder of attention or in quantifying the effects of drugs that improve attention, such as the cholinesterase inhibitors. For the early diagnosis of AD or other memory disorders, a word-repetition paradigm with an explicit recognition task or one that fosters associative learning would be recommended. This article has discussed potential use of N400 in tracking disease progression. ERPs provide a flexible and powerful technique, with superb temporal resolution, which can be used as a probe into subtle "subclinical" abnormalities of cognitive processes. Despite being applied to AD for about 25 years since the early P300 studies, the full potential of ERPs in helping diagnose and treat AD patients has yet to be realized. In this era of rapidly evolving brain-imaging techniques, electrophysiologic data are important in advancing understanding of cognition. Brain-mapping techniques that can inform where and when key cognitive processes occur are finally emerging. A final example of potential clinical application of cognitive ERPs is in the development of rational combinational treatment of cognitive enhancing drugs. Along these lines, P300 investigations in epilepsy proved helpful in ranking the cognitive side effects of anticonvulsant drugs. Drug studies that use 2 x 2 combinational designs, which compare the effects of drug A, drug B, with A + B, are currently prohibitively expensive for full-scale clinical trials in AD. It is likely that precise ERP measures could hasten drug development in several ways. Smaller samples could be used, at lower cost, to test the cognitive effects of each specific drug combination. Optimal doses of combinational therapy perhaps could be identified by repeated within-subject ERP measures. Longitudinal changes in the ERP hold promise as a marker of individual responsivity to a particular agent, which could have diagnostic utility (eg, testing response to cholinergic or dopaminergic therapy). This horizon and many others remain wide open for well-planned explorations.

Aging↗
PubMed1999

Postretention mandibular incisor stability after premolar serial extractions.

The purpose of this study was to evaluate the mandibular incisor alignment in serial extraction cases, using the longitudinal dental cast records of the Burlington Growth Center as a control sample. Various parameters were investigated and the statistical differences determined between the treated and untreated groups. The results were also compared with data from serial extraction groups that subsequently had orthodontic treatment. Untreated subjects and subjects treated only with serial extractions showed similar longitudinal changes. However, the extraction group that also received orthodontic treatment appeared to show more lower incisor crowding long-term. No predictors for stability of clinical significance could be determined. Mechanotherapy influences the craniofacial and dentoalveolar dimensions, which appear to cause more long-term lower incisor crowding.

Adolescent↗
PubMed1999

Unilateral intraocular lens implantation during the first six months of life.

PURPOSE: The purpose of this study was to determine the incidence of postoperative complications and the occurrence of myopic shift in infantile eyes after cataract surgery and implantation of an intraocular lens (IOL). METHODS: Cataract surgery and IOL implantation was performed on 11 infants with unilateral congenital cataracts who had a mean age of 10+/-6 weeks at 5 clinical centers. IOLs with a mean power of 26.2+/-2.3 D were implanted using a standardized protocol. The infants were then followed up for a mean of 13+/-6 months for postoperative complications and longitudinal changes in their refractive error. RESULTS: Eight of the 11 eyes had postoperative complications and were treated with a reoperation. Complications included open-angle glaucoma (n = 2), lens reproliferation into the visual axis (n = 2), pupillary membranes (n = 2), and corectopia (n = 2). A younger age at the time of surgery was positively correlated with the development of a postoperative complication requiring a reoperation (P = .03). A mean myopic shift of 5.49 D occurred in these eyes a year after surgery. No preoperative factors could be identified that correlated with the magnitude of the myopic shift. CONCLUSION: IOL implantation during infancy is associated with a high complication rate frequently requiring reoperation. A large myopic shift typically occurs that necessitates an initial or a late overcorrection with spectacles or a contact lens, depending on the power of the IOL implanted. Until ongoing randomized trials are completed, we recommend that surgeons exercise caution before implanting IOLs in the eyes of infants.

Age Factors↗
PubMed2001

Long-term follow-up of sleep disordered breathing in older adults.

OBJECTIVE: The current study was designed to determine whether, with increasing age, sleep apnea improves, becomes worse, or stays the same. BACKGROUND: There is a high prevalence of sleep disordered breathing (SDB) in older adults, but little is known about longitudinal changes. This study followed older adults to examine the natural history of SDB. METHODS: Subjects were randomly selected community-dwelling elderly (n=427). A subset of subjects was studied approximately every 2 years over an 18-year period. Overnight sleep recordings and sleep questionnaires were completed at each time point. RESULTS: Multiple linear regression showed that three variables were associated with change in respiratory disturbance index (RDI):body mass index (BMI) at initial visit (P=0.001), change in BMI (P=0.02), and a consistent self-report of high blood pressure (P=0.005). RDI increase was associated with BMI increase and presence of self-reported high blood pressure. CONCLUSIONS: The changes in RDI that occurred were associated only with changes in BMI and were independent of age. This underscores the importance of managing weight for older adults, particularly those with hypertension.

Journal Article↗
PubMed2002

Kinetics of exsheathment of infective ovine and bovine strongylid larvae in vivo and in vitro.

The aim of the study was to investigate the longitudinal changes of exsheathment of ovine and bovine 3rd-stage strongylid larvae in an artificial rumen (RUSITEC) and to compare the results with in vivo data obtained from rumen-fistulated sheep. Infective larvae were incubated in nylon mesh bags in the sheep rumen or the RUSITEC apparatus for periods of 1, 6 and 12 h, respectively. The 12 h exsheathment rates in the rumen and the RUSITEC apparatus (in parentheses) were as follows: Haemonchus contortus: 100% (100%), Ostertagia circumcincta: 100% (76%), O. leptospicularis: 100%. (100%), O. ostertagi: 53% (59%), Trichostrongylus axei: 100% (100%), T. colubriformis: 37% (36%), Cooperia curticei: 94% (76%), C. oncophora: 95% (89%), Nematodirusfilicollis: 0% (N.D.), N. spathiger: 11% (15%), N. battus: 7% (5%), Oesophagostomum venulosum: 17% (9%), Chabertia ovina: 7% (2%), Dictyocaulusfilaria: 1% (N.D.). Larvae of Nematodirus spp. and T. colubriformis showed a quick rise of the exsheathment rate 2 h after transfer into the abomasum. These results confirm that exsheathment generally occurs in the part of the gastrointestinal tract immediately anterior to the habitat of the adult parasite. The overall similar course of exsheathment in both systems indicates that the essential stimuli for exsheathment were generated and maintained under in vitro conditions of the artificial rumen. In both systems, the bicarbonate concentration and the pH reflected a similar status of the H2CO3/HC-3 buffer system, which is known to provide the essential stimuli for larval exsheathment of the abomasal species. These results give evidence that the RUSITEC system represents a valid system for studying the kinetics of exsheathment of strongylid nematodes under in vitro conditions. For 7 of the species investigated the obtained results represent the first data on larval exsheathment in vivo and in vitro.

Animals↗
PubMed2005

Serial assessment of variability in heart rate in children with the Fontan circulation.

Autonomic nervous control of the heart can be studied by analysing variability in heart rate. Although earlier studies have shown reduced variability in patients with the Fontan circulation, we are not aware of any previous study examining longitudinal changes in such children. We have examined 13 patients who had undergone total cavopulmonary connection, and 37 healthy controls matched for age and gender. The examinations included complete echocardiography, and 24-hour ambulatory electrocardiogram for analysis of the parameters for variability in heart rate. After the Fontan procedure, three follow-up examinations were performed at a mean of 4.4 years, 5.6 and 7.2 years. Reduced variability was found in those with the Fontan circulation. A significant difference was found between patients and their controls with respect to high-frequency power at the second, p equal to 0.05, and third, p equal to 0.03, examination. The ratio of low-to-high-frequency components progressively increased in those with the Fontan circulation, a phenomenon that led to a significant difference, p equal to 0.03, at the third examination. Our study shows that, in patients with the Fontan circulation, routine ambulatory electrocardiographic monitoring including analysis of variability in heart rate, detects over time a progressive sympatovagal imbalance.

Adolescent↗
PubMed2000

Normative influences on aggression in urban elementary school classrooms.

We report a study aimed at understanding the effects of classroom normative influences on individual aggressive behavior, using samples of 614 and 427 urban elementary school children. Participants were assessed with measures of aggressive behavior and normative beliefs about aggression. We tested hypotheses related to the effects of personal normative beliefs, descriptive classroom norms (the central tendency of classmates' aggressive behavior), injunctive classroom normative beliefs (classmates' beliefs about the acceptability of aggression), and norm salience (student and teacher sanctions against aggression) on longitudinal changes in aggressive behavior and beliefs. injunctive norms affected individual normative beliefs and aggression, but descriptive norms had no effect on either. In classrooms where students and teachers made norms against aggression salient, aggressive behavior diminished over time. Implications for classroom behavior management and further research are discussed.

Adolescent↗
PubMed2001

The reproducibility of methods of assessment for cervical dentine hypersensitivity.

BACKGROUND: Many agents and toothpaste formulations have been proposed for treatment of dentine hypersensitivity. However, studies have reported equivocal or contradictory results, potentially related to a lack of clinical efficacy for agents being tested, poor study design or the use of assessment techniques which are unable to distinguish longitudinal changes in dentine hypersensitivity. AIM: To investigate the reproducibility of commonly used measurement protocols for dentine hypersensitivity on single or multiple teeth. In addition, newly-developed controlled air and cold fluid stimuli were investigated. METHODS AND MATERIALS: Standardised pain stimulation techniques were used in 2 investigations with 63 and 42 subjects, respectively. The reproducibility of perceived hypersensitivity before and following stimulation was recorded over time periods of 14 and 2 days, respectively, using visual analogue scales and threshold techniques. RESULTS: Subject demographics resembled those reported in other hypersensitivity investigations. Analysis using several measures of reproducibility indicated that subject-based reproducibility was limited, even when the stimuli were standardised. However, the data are consistent with the findings of investigations on pain assessment in other fields. CONCLUSIONS: The reproducibility of subjects in clinical trials of dentine hypersensitivity may therefore contribute to difficulties in establishing treatment efficacy of agents in clinical trials.

Adolescent↗
PubMed2002

A longitudinal evaluation of pulpal pain during orthodontic tooth movement.

OBJECTIVES: To examine the longitudinal changes in pulpal sensitivity to electrical stimulation and the relationship to pulpal sensitivity as measured by electrical stimulation and subjective reports of tooth pain after archwire insertion. DESIGN: Non-randomized, prospective trial, with matched controls. SETTING AND SAMPLE POPULATION: Regional Clinical Dental Research Center at the University of Washington School of Dentistry. Eighteen adult subjects of age 13-37 years. Nine experimental subjects planned for orthodontic treatment. Nine control subjects matched for gender and age who did not have orthodontic treatment. EXPERIMENTAL VARIABLE: Fixed orthodontic appliances and initial archwire placement in experimental subjects compared with 'no treatment' control subjects. OUTCOME MEASURE: Subjective assessments of orthodontic tooth pain were made using visual analogue scales. Electrically evoked detection and pain thresholds were determined using a computer-controlled tooth stimulator. Data were gathered at five time points: after bracket placement (baseline), 1 h after placement of initial archwires, 1 day after archwire placement, 1 week after archwire placement, and 1 month after archwire placement. Comparable time intervals were used for the 'no treatment' control subjects. RESULTS: Subjective ratings of treatment-evoked tooth pain in the experimental group were the greatest at the post-archwire day 1 observation and progressively decreased for the remaining observations. Control subjects reported little pain at any of these observation times. The detection and pain threshold changes from baseline showed no statistical differences over time or between groups. While not statistically significant, a trend was noted where reports of greater orthodontic tooth pain were associated with increased sensitivity to electrical stimulation (i.e. lower detection and pain thresholds). CONCLUSION: Orthodontic patients experience significant pain and discomfort 1 day after initial archwire placement (i.e. activation). Future research should investigate whether self-reports of treatment-evoked tooth pain intensity are associated with pulpal sensitivity.

Adolescent↗
PubMed1997

Avoidance achievement motivation: a personal goals analysis.

The present research investigated one antecedent and various consequences of pursuing avoidance personal achievement goals over the course of a semester. The authors assessed participants' achievement-relevant goals using the newly devised Achievement Goals Questionnaire. The motive to avoid failure, assessed with self-report and projective measures, was established as an antecedent of avoidance goal pursuit. Avoidance regulation was shown to have deleterious consequences for a host of achievement-relevant and general well-being outcomes at the end of the semester, including longitudinal change in subjective well-being. Perceived competence was validated as a mediator of the direct relationships observed. The results highlight the need to attend to avoidance, as well as approach, forms of self-regulation and the need to consider both motive disposition and goal constructs in accounting for competence-relevant behavior.

Achievement↗
PubMed1989

The swan-song phenomenon: last-works effects for 172 classical composers.

Creative individuals approaching their final years of life may undergo a transformation in outlook that is reflected in their last works. This hypothesized effect was quantitatively assessed for an extensive sample of 1,919 works by 172 classical composers. The works were independently gauged on seven aesthetic attributes (melodic originality, melodic variation, repertoire popularity, aesthetic significance, listener accessibility, performance duration, and thematic size), and potential last-works effects were operationally defined two separate ways (linearly and exponentially). Statistical controls were introduced for both longitudinal changes (linear, quadratic, and cubic age functions) and individual differences (eminence and lifetime productivity). Hierarchical regression analyses indicated that composers' swan songs tend to score lower in melodic originality and performance duration but higher in repertoire popularity and aesthetic significance. These last-works effects survive control for total compositional output, eminence, and most significantly, the composer's age when the last works were created.

Achievement↗
PubMed2003

Plasticity of memory for new learning in very old age: a story of major loss?

Longitudinal survivors of the Berlin Aging Study (N = 96, mean age = 84 years, range 75-101 years) were instructed and trained in a mnemonic skill to examine plasticity of episodic memory performance in very old age. Performance gains after mnemonic instruction were modest, and most individuals were unable to further enhance their performance during 4 sessions of mnemonic practice. Whereas the proportion of variance explained by measures from the broad fluid-ability domain (e.g., perceptual speed) increased with training, the proportion of variance explained by crystallized-ability domain (e.g., word knowledge) and sociobiographical variables decreased. Furthermore, prior 6-year longitudinal changes (loss) in perceptual speed predicted individual differences in plasticity. Results suggest that aging-induced biological factors are a prominent source of individual differences in cognitive plasticity in very old age.

Age Factors↗
PubMed2003

The fate of cognition in very old age: six-year longitudinal findings in the Berlin Aging Study (BASE).

The authors report full-information longitudinal age gradients in 4 intellectual abilities on the basis of 6-year longitudinal changes in 132 individuals (mean age at T1 = 78.27, age range = 70-100) from the Berlin Aging Study. Relative to the cross-sectional parent sample (N = 516, mean age at T1 = 84.92 years), this sample was positively selected because of differential mortality and experimental attrition. Perceptual speed, memory, and fluency declined with age. In contrast, knowledge remained stable up to age 90, with evidence for decline thereafter. Age gradients were more negative in old old (n = 66, mean age at T1 = 83.04) than in old (n = 66, mean age at T1 = 73.77) participants. Rates of decline did not differ reliably between men and women or between participants with high versus low life-history status. They conclude that intellectual development after age 70 varies by distance to death, age, and intellectual ability domain.

Age Factors↗
PubMed1982

Effects of cancer and its treatments on plasma concentration of alpha 1-acid glycoprotein and propranolol binding.

The plasma concentrations of alpha 1-acid glycoprotein (AAG) and albumin, and the plasma protein binding of propranolol were measured in a group of cancer patients and a group of normal subjects. In cancer patients the AAG concentrations were twice that in controls (142 and 78 mg/dl, P less than 0.005), the albumin concentrations were lower (3.11 and 4.37 gm/dl, P less than 0.001), and the free fraction of propranolol was lower (0.127 and 0.190, P less than 0.005). Propranolol binding correlated strongly with AAG concentrations. These data imply that untreated or unsuccessfully treated cancer patients will have reduced free fractions for any drug for which AAG is an important binding protein. Successfully treated patients may have longitudinal changes towards normal. No consistent effect of the treatments themselves on AAG was observed after radiation therapy in five patients or after intravenous adriamycin in six patients.

Adolescent↗