Surgical treatment of a traumatic intracranial epidural haematoma in a dog.

A 10-month-old Czech wolf dog was unconscious after being kicked in the head by a horse. The following day, the dog was ataxic and collapsed after several steps. The level of consciousness was decreased. Cranial nerve examination was normal and right postural reactions were decreased. Spinal reflexes were intact in all limbs. The diagnostic work-up included a computed tomography (CT) scan of the head with IV contrast. A lenticular shaped, hyperdense, non-enhancing lesion was observed in the left fronto-parietal region. A diagnosis of intracranial epidural haematoma was made. Two craniotomies were performed on a different day and most of the haematoma was removed. Corticosteroids and antimicrobial therapy were administered. Fifteen days after the surgery, the clinical examinations were unremarkable. Fifteen months later, the owners considered the dog normal. Intracranial subdural or intraparenchymal haematomas have been described in the veterinary literature. To the authors' knowledge, this is the first report of the successful management of an intracranial epidural haematoma in the dog. In humans, these lesions are well described. Common locations are temporal, parietal and frontal regions or a combination of these regions. Patients can be asymptomatic, present with varying clinical signs, or be unconscious. Based on the human literature, following trauma to the head, a CT scan should be performed even if the patient is asymptomatic. Some authors believe that there are not any absolute indications for conservative management versus surgical management.

Distribution and evaluation of sense of coherence among older immigrants before and after a health promotion intervention - results from the RCT study promoting aging migrants' capability.

BACKGROUND: The migration process can be a threat to a person's sense of coherence (SOC) and to their ability to experience life as comprehensible, manageable, and meaningful. Seen from a salutogenic perspective, this may have a negative impact on the experience of health. PURPOSE: We describe the distribution of SOC and its components among older persons with an immigrant background now aging in Sweden. In addition, we evaluated whether a group-based health promotion program with a person-centered approach could support the SOC among older persons in this group. MATERIALS AND METHODS: A randomized controlled trial with postintervention follow-ups at 6 and 12 months was conducted with 131 independently living persons aged ≥70 years from Finland and the Balkan Peninsula. Participants were randomly allocated to an intervention group (4 weeks of group intervention and one follow-up home visit) and a control group (no intervention but access to ordinary health care services). The outcome measure was the SOC measured by SOC-13. Chi-square and ORs were calculated. RESULTS: There was a significant improvement in total SOC scores for the intervention group at 6-month follow-up. Also, the ORs for the SOC components were higher in the person-centered intervention group. However, we found no significant between-group differences nor did the effect last until the 12-month follow-up. CONCLUSION: Persons who have lived a long time in a host country after migration seem to have a SOC similar to native-born persons. Interventions with a person-centered approach could support the SOC by capturing individual life situations. Such interventions could support older persons by making everyday life more comprehensible and manageable and helping them to cope with challenges in daily life caused by aging.

The Conceptions of Pain and Rehabilitation Questionnaire (CPRQ): development and test of face validity and stability over time.

The heterogeneity of diagnoses included in the concept of chronic pain, as well as differences in adaptation to the situation involving chronic illness, imply the need for a variety of rehabilitation forms. Despite evidence concerning the success of multidisciplinary behaviour-orientated rehabilitation programmes, not all participants experience the expected change. The aim of the present study was to develop and test the face validity and the stability over time of a Swedish self-administered questionnaire: the Conceptions of Pain and Rehabilitation Questionnaire (CPRQ) for persons with chronic pain. The questionnaire is to be used as a guiding tool in planning for rehabilitation. Its purpose is to distinguish between individuals with expectations of and motivation for active rehabilitation and those with expectations of more supportive forms of therapy. The face validity was mainly obtained by target-group discussions including persons with chronic pain and rehabilitation staff with experience in the rehabilitation of persons with chronic pain. The test-retest stability analysis was performed using a model for identifying occasional and systematic disagreement. The questionnaire in its final form showed face validity and reliability in terms of stability over time. Further steps in the development process will include laying down the guiding principles for the questionnaire, based on new focus-group discussions, and completing work on the manual by including information about the origin of the questionnaire and instructions for its administration. Thereafter, the next step in the development process will be a test of responsiveness, i.e. to examine the degree to which the questionnaire really serves its purpose.

The multiple meaning of home as experienced by very old Swedish people.

The aim of this study was to explore aspects of the meaning of home as experienced by very old single-living people in Sweden. A grounded theory approach was used, and interviews were conducted with 40 men and women aged 80-89. The findings indicate that home has a central place in the lives of very old people because it is where they live and spend so much time. The significance of the home is based on the fact that it means so many different things to the participants. The theme comprises two key categories: home means security and home means freedom. Each of these has three sub-categories. In home means security, these are: living in a familiar neighborhood, everything functions, and having memories to live on. Home means freedom comprises a place for reflection, a social meeting-point, and leaving your own mark. Home is part of the environment and influences the meaning and selection of activities that very old people decide to engage in. When occupational therapists prescribe assistive devices or recommend changes in the home environment, they must be very well aware of and reflect on what home means to their clients and base their measures on that.

Computed tomography study of implantation corridors in canine vertebrae.

OBJECTIVES: To define the characteristics of optimum implantation corridors in vertebral bodies C2 to C7 and T10 to S1, using computed tomography examination. METHODS: Measurements were taken from 207 vertebrae from 35 different adult dogs. RESULTS: Implantation corridors of the cervical vertebrae are narrow. The width preserving the transverse hole is less than 2.5 mm in 68.6 per cent of the 86 vertebrae C2 to C6. Dorsal implantation corridors of the last four thoracic vertebrae are narrow, and major anatomical structures are very close to their emergence point. In 63 per cent of the 40 thoracic vertebrae, the right azygos vein is at a distance less than or equal to 1 mm from the vertebral body. The first six lumbar vertebrae have broader corridors. Furthermore, vascular structures are far from the emergence point. The last lumbar vertebra and the sacrum have a broad pedicle, which provides an alternative site for implant placement. CLINICAL SIGNIFICANCE: For the vertebrae L1 to S1, the dorsal implantation can be performed. For the cervical vertebrae, the risk of laceration of the vertebral artery is high. For the last four thoracic vertebrae, the dorsal implantation should not be used.

A cost-effectiveness analysis of a health education programme for elderly persons with age-related macular degeneration: a longitudinal study.

PURPOSE: To analyse the cost-effectiveness of the activity-based Health Education Programme 'Discovering New Ways' versus a standard Individual Programme. METHOD: Two-hundred and twenty-nine persons were randomized to either the Health Education Programme or an Individual Programme. The present study is based on 131 persons who participated in the 28-month follow-up. Costs for the low vision clinic were documented prospectively along with external costs. A cost-effectiveness analysis was done using cases with an improved level of perceived security in daily activities as the effectiveness measure. RESULTS: The Health Education Programme led to significantly more cases with an improved level of perceived security (45 vs. 10%, CI 95%: 21-49, p value < 0.001) and the total social cost per treatment was lower (28,004 vs. 36,341 SEK). Taken separately the low vision clinic costs were slightly higher due to a higher prescription of assistive devices, but external costs were lower for the Health Education Programme compared to the Individual Programme, though neither of these differences was statistically significant. CONCLUSION: The results suggest that replacing the standard Individual Programme with the Health Education Programme 'Discovering New Ways' is cost-effective as more persons experience increased security to a lesser total cost.

Assistive devices in activities of daily living used by persons with age-related macular degeneration: a population study of 85-year-olds living at home.

The purpose of this study was to investigate the overall use of assistive devices among persons with age-related macular degeneration (ARMD) and how it is related to dependence in daily activities. This was a retrospective, descriptive, cross-sectional population study of 85-year-olds. The most common category of assistive devices was bathing devices followed by mobility devices. The overall use of assistive devices was 82%, and around 80% of the device users were independent in activities of daily living. They were multiple device users (57%) and used more mobility devices and personal assistance in mobility. In conclusion, the ARMD group comprises very frequent users of assistive devices and uses assistive devices to remain independent. This implies that health services should provide assistive devices at an early stage in the disablement process to avoid the development of dependence and should consider the likelihood of multiple health problems when assessing the needs of assistive devices among persons with ARMD.

HIV RNA and HIV DNA in peripheral blood mononuclear cells are consistent markers for estimating viral load in patients undergoing long-term potent treatment.

The aim of this study was to evaluate residual viral replication by assessing the HIV load of circulating infected cells in patients given an effective antiprotease-containing treatment for 1 year. PBMC HIV RNA and HIV DNA was quantified by techniques standardized and evaluated by interlaboratory quality control testing. Viral markers identified in a multicenter study were validated in a cross-sectional study of 121 patients beginning treatment. A longitudinal study of 3 viral markers was carried out in 18 patients, each of whom had fewer than 200 copies of HIV RNA per milliliter of plasma after 12 months of treatment. The cross-sectional study showed that viral replication in PBMCs was correlated with the number of circulating infected cells (Spearman rank correlation; p = 0.0001, r = 0.35) and the concentration of virus particles in the plasma (Spearman; p = 0.0001, r = 0.54). The longitudinal study showed that the decrease in HIV RNA levels was smaller in PBMCs than in the plasma. The largest decrease in HIV DNA levels after 12 months of treatment was recorded in patients with low levels of intracellular replication (Spearman; p = 0.005, r = 0.69). PBMC HIV RNA and HIV DNA levels were very informative markers, complementary to plasma HIV RNA levels. They should be used in future trials evaluating the long-term efficacy of new associations of highly active antiretroviral treatments.

Development of a health education programme for elderly with age-related macular degeneration: a focus group study.

Age-related macular degeneration is a serious public health problem, and in most cases no cure exists. One available intervention is low vision rehabilitation, and there is a lack of programmes for the elderly. The purpose of this paper is to present the results of an evaluation of a group-based health education programme. This programme comprised six to eight 2-3 hour meetings, once a week, for persons with age-related macular degeneration. Each group consisted of four to six participants. The goal of the programme, which has its roots in the health belief model, was to sustain and restore the participants' performance of their daily activities. The tool used for process evaluation was focus group methodology, and eight focus groups were involved. Forty five persons, whose average age was 80 years, took part in the evaluation. The results indicated that the participants were, on the whole, pleased with the content of the programme. There were, however, some indications that they did not understand all the information provided. Social support, regained hope and meeting others with the same disease were reported as positive aspects of the health education programme. The importance of the group leader's role in guiding this health education programme was emphasised. Furthermore, with regard to the composition of the groups, the participants pointed out that it was important to consider variation in visual acuity, so as to provide different models for comparison, and whether both sexes should participate in all groups. Finally, several suggestions for improving the programme are put forward.

Questionnaire to evaluate the effects of assistive devices and altered working methods in women with rheumatoid arthritis.

The objectives of the study were to identify perceived difficulty and reduction of difficulty when using assistive devices and altered working methods in performing daily activities and to detect which activities were unaffected by interventions. Twenty-one women aged 29-65 years with rheumatoid arthritis answered the Evaluation of Daily Activity Questionnaire (EDAQ), which contains 102 items divided into 11 dimensions of daily activities. The women rated their perceived difficulty twice: first when not using devices or altered methods and then when using them. The use of devices or altered methods led to a reduction in perceived difficulty in 42% of the ratings. The number of items that the women found difficult when not using devices/altered methods ranged between 13 and 99. With the interventions, the number of items still found difficult decreased to between 6 and 57, 91% of the devices provided were still in use. The dimensions Eating, Cooking and Toileting contained the most items affected by the use of devices such as lever taps, springy scissors, breadknife and wrist orthosis. Few effective devices were identified for the dimensions Dressing, Washing, Cleaning and Mobility Outdoors. It was concluded that the EDAQ represents a new approach to demonstrating difficulties in performing various daily activities, to describing the effects of assistive devices/altered methods, and to identifying areas not affected by interventions.

Use of assistive devices in daily activities among 85-year-olds living at home focusing especially on the visually impaired.

PURPOSE: The purpose was to investigate the use of assistive devices in daily activities and its relation to daily activities. METHOD: 85-year-old persons (n = 617) were studied in a descriptive, cross-sectional population study. RESULTS: The overall use of assistive devices was 77% in the total population of 85-year-old persons and the results show that persons who have visual impairment use more assistive devices. The most common category of assistive devices in the population was connected with bathing followed by mobility devices. The majority of the assistive device users in all groups were independent in both instrumental (I-ADL) and personal daily activities (P-ADL). There was a statistically significant higher proportion of device users who were independent in daily activities in the normal vision group compared to the visual impairment groups. There was already a significant difference in the use of assistive devices at a visual acuity level of 0.7-0.5 compared to participants with normal vision. CONCLUSION: The results show that it is imperative to provide intervention such as assistive devices in P and I-ADL earlier in the disablement process in order to slow down the progression of decline, as persons with visual impairment are at high risk of developing disability.

Planning a health education programme for the elderly visually impaired person--a focus group study.

Focus group methodology was used with the aim of learning how persons with the diagnosis of age-related macular degeneration perceived and described their disease, and how the disease had changed their activities of daily living (ADL). This information is seen as critical in designing a health education programme. The focus group participants described problems in performing ADL. Factors contributing to the ADL problems were categorized as functional limitations in, and feelings about performing, ADL. The participants used a number of ADL strategies to adapt to new situations. The participants expressed uncertainty regarding whether senile macular degeneration, age-related macular degeneration and 'yellow spot' were the same disease. They expressed a desire to know more about the disease and its consequences. They particularly requested time for receiving information, and the opportunity to discuss it, as in the focus groups. This target group need a health education programme based on their own perceptions. The main issues in such a programme should be to convey information, teach ADL strategies, provide support and foster problem-solving.

Long-term evaluation of a health education programme for elderly persons with visual impairment. A randomized study.

UNLABELLED: In order to implement evidence-based practice, a randomized study was set up to evaluate the ADL- based Health Education Programme 'Discovering new ways' for elderly persons with age-related macular degeneration. PURPOSE: To investigate the impact of this program on perceived security in the performance of daily activities 28 months after the intervention. METHOD: Two-hundred and twenty-nine persons randomized to either the Health Education programme or an Individual Intervention Programme participated in the study. At the 28-month follow-up there was a dropout of 98 persons and the results are based on 62 persons participating in the Health Education Programme and 69 persons in the Individual Intervention Programme. RESULTS: There were statistically significant differences in perceived security between the groups in 15 out of 28 daily activities. Furthermore, the Health Education Group showed a significant tendency towards an improved level of security while the Individual Intervention Group tended to deteriorate. CONCLUSIONS: The findings provide strong support for the long-term effect of the programme and for the implementation of evidence-based practice. The study corroborates the effectiveness of the Health Education Programme in enhancing security and hindering a progressive decline in perceived security in daily activities.

Development of an ADL instrument targeting elderly persons with age-related macular degeneration.

BACKGROUND: In order to estimate the needs of early intervention in a health education program, an ADL instrument measuring feelings of (in)security was needed. The instrument was intended to detect early signs of decline and to evaluate ADL performance among persons with AMD. An evaluative instrument must have a high level of responsiveness, which is the ability to detect true changes over time but must also show a high level of intra-individual agreement in a test-retest assessment. PURPOSE: The purpose of this study was to develop an ADL instrument for evaluative purposes and to establish the reliability and the responsiveness of the instrument. METHOD: The target group comprised all persons referred by an ophthalmologist for low vision rehabilitation, 65 years and older, living at home, with aged-related macular degeneration as the primary diagnosis and with distance visual acuity of the better eye with best correction not lower than 0.1. A non-parametric statistical method that is developed for paired ordered parametrical data was applied in order to measure the systematic and occasional intra-rater disagreement separately and to measure the responsiveness. CONCLUSION: The test-retest study showed that the ADL-instrument had a high level of test-retest stability, which is a condition for responsiveness. The instrument was found to be responsive. It could therefore detect true longitudinal changes and be used for evaluative purposes targeting elderly with AMD.

Medical assistance to travellers: a new concept in insurance--cooperation with an airline.

Medical assistance to travellers is a new concept in insurance. Payment of a premium makes it possible in an emergency for a traveller, by means of a phone call, to obtain free medical support, i.e., on-the-spot treatment, repatriation, hospitalization, etc. This kind of service necessarily involves a 24-h telephone system; a network of national and international correspondents, physicians and nurses trained in resuscitation; and sophisticated medical equipment, aircraft, etc. This study gathered data on the activity across 1982 of such an assistance company, especially in its cooperation with a scheduled international airline for air evacuation of patients who had become ill or had been injured far from their homes. Of 1618 repatriated patients in the single year, 1241 were evacuated by air (247 of these by the airline involved in the study) mainly from Europe or Africa. Traumatology, cardiovascular diseases, and psychiatric syndromes were the main causes of air evacuation. Medical equipment and personnel were placed aboard aircraft based on the gravity of each case. Assistance contracts provide valuable back-up for travellers' medical and psychological safety; close cooperation with airlines is of prime importance, both to the patient and to airline operations.

Testing of the Eschweiler 2500-11 blood gas analyser during inflight conditions.

Measurement of blood gas values during air transport of intensive care patients must take into account the extreme inflight variations in pressure. We tested the accuracy and reliability of the Eschweiler 2500-11 apparatus, with its incorporated pressure transducer, on four different gas mixtures equilibrated with fresh blood at two different altitudes simulated in a decompression chamber. Results for the pressure transducer show: 1) concordance of pressure values with those of ground instrumentation; 2) stable response; and 3) absence of hysteresis. Gas measurement electrodes were shown to have linear responses and were accurate for all tested values except very low PCO2 and very high PO2 figures. We conclude that the performance of this device is satisfactory during inflight conditions.

A health education program for elderly persons with visual impairments and perceived security in the performance of daily occupations: a randomized study.

OBJECTIVE: The purpose of this randomized, longitudinal study was to investigate the impact of a health education program on perceived security in the performance of daily occupations 4 months after the intervention period. METHOD: Two groups of persons with age-related macular degeneration were compared: Those who had followed a newly developed health education program that was based on occupation and those who took part in a standard individual intervention program. RESULTS: Significant differences in the level of perceived security between the groups were found for 13 of 28 occupations. Participants in the health education group maintained or improved their level of perceived security in 22 daily occupations, whereas those in the individual intervention group declined to a lower level in 17 daily occupations. CONCLUSION: This study provides support for the effectiveness of the health education program to enhance security and hinder a progressive decline in perceived security in daily occupations.

Healthy ageing and home: the perspectives of very old people in five European countries.

This paper reports on in-depth research, using a grounded theory approach, to examine the ways in which very old people perceive healthy ageing in the context of living alone at home within urban settings in five European countries. This qualitative study was part of a cross-national project entitled ENABLE-AGE which examined the relationship between home and healthy ageing. Interviews explored the notion of healthy ageing, the meaning and importance of home, conceptualisations of independence and autonomy and links between healthy ageing and home. Data analysis identified five ways in which older people constructed healthy ageing: home and keeping active; managing lifestyles, health and illness; balancing social life; and balancing material and financial circumstances. Older people reflected on their everyday lives at home in terms of being engaged in purposeful, meaningful action and evaluated healthy ageing in relation to the symbolic and practical affordances of the home, contextualised within constructions of their national context. The research suggests that older people perceive healthy ageing as an active achievement, created through individual, personal effort and supported through social ties despite the health, financial and social decline associated with growing older. The physicality and spatiality of home provided the context for establishing and evaluating the notion of healthy ageing, whilst the experienced relationship between home, life history and identity created a meaningful space within which healthy ageing was negotiated.