Single dose captopril as a diagnostic test for primary aldosteronism.

Most diagnostic tests for primary aldosteronism use maneuvers to expand the extracellular fluid volume, thereby suppressing the renin-angiotensin system. This results in a decline in plasma aldosterone concentrations in normal subjects and essential hypertension (EH) patients, but not in patients with primary aldosteronism. Captopril blocks angiotensin II synthesis and might be used as a diagnostic test for primary aldosteronism. We have measured plasma aldosterone concentrations 2 h after the administration of 25 mg captopril in 9 normotensive subjects, 10 patients with EH, and 12 patients with primary aldosteronism while they were ingesting an unrestricted diet. The plasma aldosterone concentration decreased to less than 15 ng/dl in all normotensive subjects and in 9 of 10 patients with EH, but remained greater than 15 ng/dl in 4 of 5 patients with idiopathic hyperaldosteronism and in all patients with an aldosterone-producing adenoma. The aldosterone to renin ratio was greater than 50 in 4 of 5 patients with idiopathic hyperaldosteronism and in all adenoma patients, but less than 50 in all normotensive subjects and EH patients. A nomogram comparing the plasma aldosterone concentration with the aldosterone to renin ratio clearly separated primary aldosteronism patients from EH patients.

The prediction of anatomical morphology of primary aldosteronism using serum 18-hydroxycorticosterone levels.

Serum 18-hydroxycorticosterone, aldosterone, and potassium were measured under basal conditions in 34 patients with documented primary aldosteronism, 10 patients with essential hypertension, and 9 normal subjects. The results revealed that 22 of 23 patients with aldosterone-producing adenomas had 18-hydroxycorticosterone levels greater than 100 ng/dl, and all 9 patients with idiopathic adrenal hyperplasia had plasma levels less than 100 ng/dl. Two patients with unusual macromicronodular hyperplasia of the adrenal glands had levels greater than 100 ng/dl. We found a significant relationship between serum potassium and the ratio of 18-hydroxycorticosterone to aldosterone in patients with idiopathic adrenal hyperplasia, but not in those with an aldosterone-producing adenoma. We conclude that measurement of serum 18-hydroxycorticosterone is a useful predictor of the etiology of primary aldosteronism.

Occupational therapy: current practice and training issues in the treatment of cognitive dysfunction.

A significant relationship exists between cognitive abilities and functional performance in activities of daily living. Occupational therapists are involved in providing cognitive rehabilitation to individuals with brain damage by assisting them in fulfilling self-care, work and leisure roles. Since occupational therapists specialize in functioning in the real world, they should have a primary role on the interdisciplinary team in assessing and treating cognition as it relates to function. Particular areas of expertise include assessment and intervention in daily living tasks, safety issues and cognitive/perceptual dysfunction. Treatment strategies in occupational therapy are classified into two approaches: remedial and compensatory. A combination of the two approaches has been found to be the most beneficial method of intervention. Though current training guidelines for occupational therapists in cognitive rehabilitation are vague, the major focus has been on evaluating functional status and intervening when cognitive/perceptual deficits are present. Future training for practitioners in this area will require more specialized experiences and education. Additional research will need to be conducted by therapists to document treatment efficacy. Despite current health care constraints, occupational therapists must not lose sight of delivering quality care in an individualized and holistic manner.

The history of work in physical dysfunction.

Work has been at the core of occupational therapy for the last seven and a half decades. The tenets of work, which include providing a way of making a living and giving meaning to one's existence, have remained consistent throughout occupational therapists' use of work in the treatment of physical disabilities during three eras: World Wars I and II, the era of industrial therapy, and the work-hardening era. Although technological advances and economics have changed the scope of work, it is evident that the work-hardening programs of today have their roots in the work cure of the early 1900s.

The effect of sports on level of community integration as reported by persons with spinal cord injury.

OBJECTIVE: The purpose of this study was to determine whether participation in sports by persons with spinal cord injuries (SCIs) affected level of community integration as defined by the World Health Organization and as measured by the Craig Handicap Assessment and Reporting Technique (CHART). METHOD: Forty-eight participants were recruited from a camp for persons with physical disabilities as well as from SCI support groups. Participants were divided into groups of athletes (n = 30) and nonathletes (n = 18) on the basis of their self-reported level of sports participation. RESULTS: Athletes scored significantly higher on four of five subsections of the CHART (physical independence, mobility, occupation, social integration), indicating greater levels of community integration than nonathletes. CONCLUSION: These findings extend the literature outlining the physical and psychological benefits of sports. Occupational therapists have a unique opportunity to use the occupation of sports to integrate the roots of the profession with the cultural demands of society.

Is Running Associated with Osteoarthritis? An Eight-Year Follow-up Study.

Recreational exercise programs, particularly running, remain popular for a variety of reasons. It has been estimated that as many as 20 to 30 million Americans exercise, and that this includes perhaps 5 to 15 million runners/joggers. Until recently, scant information was available regarding long-term effects, if any, of exercise on the musculoskeletal system. We, and others, therefore studied and reported our observations on the possible association of the development of lower extremity osteoarthritis (OA) in runners. This eight-year, follow-up study of our original 18 nonrunners and 17 runners obtained information on 16 runners (12 of whom were re-examined) and 13 nonrunners (10 of whom were re-examined) in 1992. One runner was deceased (cancer), 14/15 were exercising, 11/15 were running, and 3/15 were engaged in other recreational exercises. In 1992, as in 1984, pain, swelling, and range of motion of hips, knees, ankles, and feet were comparable for runners and nonrunners, and radiographic examinations (for osteophytes, cartilage thickness, and grade of OA) of hips, knees, ankles, and feet were without notable differences between groups. Thus, we did not find an increased prevalence of OA among our runners, now in their seventh decade. These observations support the suggestion that running need not be associated with predisposition to OA of the lower extremities.

Human pinch-force discrimination.

Pinch-sustaining tasks such as holding a pencil, fork, or key require the exertion of different levels of force. There is little information concerning normal subjects' ability to discriminate differences in their pinching force, so the purpose of this study was to evaluate the ability of 24 normal young women to discriminate differences in their self-generated isometric tip and lateral pinching force. Resistance forces of 10, 25, 50, and 75% of known normal maximum pinching force were selected as standards. Subjects were presented a series of paired resistance settings of which the first resistance in each pair was the standard and the second resistance a comparator of some greater amount. This procedure of paired comparisons was continued until subjects' threshold of discrimination between two pinching forces was established. The results indicated that subjects' pinch-force discrimination at the standard of 50% of reported maximum pinching force was significantly better for the tip condition than for the lateral condition. This study has described an instrumentation and the methodology for assessing individuals' ability to discriminate differences in their pinching force at submaximal levels.

The relationship between participation in a sports cAMP and students' attitudes towards persons with disabilities.

This study measured the attitudes of students before and after volunteering in a two-day camp for persons with disabilities. The Attitudes Toward Disabled Persons scale (ATDP) Form A was used to measure the attitudes of 54 university students in various health care majors. Twenty-five experimental group participants were volunteers at the camp. The students completed the scale three times: before, immediately following, and six weeks after the camp. The control group consisted of twenty-nine students and were administered the ATDP scale initially, then at one week and six weeks later during a scheduled health professions class. Results showed no significant difference in ATDP scores between groups and suggest that the camp alone was not a strong enough factor to produce a difference in attitudes. Further analysis did suggest that the camp may promote positive attitude changes for students with less positive attitudes initially, while not further changing the attitudes of students which were already positive. This study adds to the body of knowledge exploring different methods to change attitudes towards persons with disabilities and suggests that a camp could serve as a observation experience for students in occupational therapy curricula as a way to provide contact with persons with disabilities.

A pilot study: attitudes toward leisure and leisure motivation in adults with spinal cord injury.

This pilot study explored the effect that an introduction to wheelchair sports would exert on attitudes and motivation toward leisure in a sample of adults with spinal cord injury. Individuals were tested using the Leisure Attitude Measurement (LAM) and the Leisure Motivation Scale (LMS) both before and after participating in a wheelchair sports program. Camp participants were demographically matched with a control group of persons who did not participate in a sports camp during the testing sessions. No significance was detected in within-group comparisons but high effect size and power on subscales of the LMS suggest a need for further studies. The experimental group, however, had significantly lower scores in stimulus avoidance as a leisure motivator which emphasizes the importance of social interaction in sports participation.

Detecting submaximal efforts in grip strength testing with the coefficient of variation.

The use of the coefficient of variation (CV) to determine level of effort in grip strength testing was examined empirically. Twenty-nine asymptomatic subjects participated in two conditions of testing: 100% effort and 50% effort. Order of conditions was counterbalanced and each subject was run in both conditions twice in the same order in order to assess the stability of the method. The number of trials (grasps) per condition was three for a total of 12 grasps for the study. The submaximal (50%) effort condition showed significantly more variability than the maximal effort condition in both sets of conditions (p<.01). Intra-class correlation coefficients were very low for both maximal effort and submaximal efforts (.036 and .025) indicating very low stability for the coefficient of variation. Classification rates were also found to have unacceptably large errors with 69% of the submaximal efforts being classified as maximal with the traditional 15% CV cutoff and 55% misclassification of submaximal efforts with an optimized 11% CV cutoff. It was concluded that the currently practiced method of using a low number of repetitions to calculate the CV may result in very unstable measures. Furthermore the "false negative" rate in using this method is unacceptably high for practical application. The implications of using the method and suggestions for improvement are discussed.