Factors contributing to malnutrition in patients with Parkinson's disease.

Our objective in this study was to evaluate the nutritional status and to identify clinical, psychosocial, and nutritional factors contributing to malnutrition in Korean patients with Parkinson's disease. We used a descriptive, cross-sectional study design. Of 102 enrolled patients, 26 (25.5%) were malnourished and 27 (26.5%) were at risk of malnutrition based on Mini-Nutritional Assessment scores. Malnutrition was related to activity of daily living score, Hoehn and Yahr stage, duration of levodopa therapy, Beck Depression Inventory and Spielberger's Anxiety Inventory scores, body weight, body weight at onset of Parkinson's disease, and body mass index. On multiple logistic regression analysis, anxiety score, duration of levodopa therapy, body weight at onset of Parkinson's disease, and loss of body weight were significant factors predicting malnutrition in Parkinson's disease patients. Therefore, nutritional assessment, including psychological evaluation, is required for Parkinson's disease patients to facilitate interdisciplinary nutritional intervention for malnourished patients.

Impact of the COVID-19 pandemic on infection control nurses: A path analysis of job stress, burnout, and turnover intention.

BACKGROUND: A infection control nurse (ICN) has played substantial roles in infection control and epidemiology programs in hospitals to protect patients and coworkers during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to explore the association between intention to leave in ICNs and job stress and burnout. METHODS: This cross-sectional study was conducted among ICNs working in hospitals with ≥200 beds in South Korea from October 1 to 22, 2021. Variables included were related to general and job characteristics specific to COVID-19, as well as measures of job stress, burnout, and turnover intention for ICNs from previous studies. Path analysis was used to examine the relationships between job stress, burnout, turnover intention, and COVID-19-related work characteristics. RESULTS: A total of 203 participants were included, of whom 95% were women. The results showed that work intensity in COVID-19 infection control was significantly associated with job stress (P<.001) and burnout (P = .035). Furthermore, job stress (P = .019) and burnout (P < .001) were positively correlated with turnover intention. CONCLUSIONS: In a pandemic with emerging infectious diseases, strategies to reduce turnover among ICNs and ensure a sufficient workforce are crucial to reducing work intensity, considering the factors that affect job stress and burnout.

No effect of recumbency duration on the occurrence of post-lumbar puncture headache with a 22G cutting needle.

BACKGROUND: Supine recumbence has been widely performed to prevent post-lumbar puncture headache (PLPH). However, the optimal duration of supine recumbence is controversial. The aim of the study is to compare the occurrence of PLPH according to the duration of supine recumbence in patients with neurological disorders. METHODS: A non-equivalent control/experimental pre-/post-test study design was used. Seventy consecutive patients were prospectively enrolled between July 2007 and July 2008. Thirty-five patients underwent supine recumbence for four hours after lumbar puncture (Group 1) and 35 patients underwent supine recumbence for one hour (Group 2). RESULTS: The overall frequency of PLPH was 31.4%. The frequency of PLPH was not significantly different between the Group 1 (28.6%) and Group 2 (34.3%) (P = 0.607). In patients with PLPH, the median severity (P = 0.203) and median onset time of PLPH (P = 0.582) were not significantly different between the two groups. In a logistic regression analysis, the previous history of post-lumbar puncture headache was a significant risk factor for the occurrence of PLPH (OR = 11.250, 95% CI: 1.10-114.369, P = 0.041). CONCLUSIONS: Our study suggests that short duration (one hour) of supine recumbence may be as efficient as long duration (four hours) of supine recumbence to prevent PLPH.

Factors predicting response to dopaminergic treatment for resting tremor of Parkinson's disease.

We aimed to evaluate the clinical factors predicting response to dopaminergic treatment for resting tremor in patients with Parkinson's disease (PD). Eighty-five PD patients with prominent resting tremor, defined as tremors of score greater than 3 in at least one limb on the Unified Parkinson's Disease Rating Scale (UPDRS), were divided into those responsive or nonresponsive to dopaminergic treatment. Responsiveness was defined as a reduction of at least two points for more than 3 months in the UPDRS tremor score. Of the 85 patients, 36 (42.4%) were responsive and 49 (57.6%) were nonresponsive to dopaminergic treatment. Initial UPDRS III score (P = 0.015) and Hoehn and Yahr stage (P = 0.010) were each significantly higher in the RG than in the NRG. UPDRS subscores for rigidity (P = 0.012), bradykinesia (P = 0.021) and postural impairment (P = 0.018) also correlated with responsiveness to dopaminergic treatment. Resting tremor in PD patients was more responsive to dopaminergic treatment when accompanied by moderate degrees of bradykinesia and rigidity than in patients without other prominent parkinsonian features.

Association between simple renal cysts and development of hypertension in healthy middle-aged men.

OBJECTIVES: The temporal relationship between simple renal cysts and incident hypertension is unknown. In this study, we assessed the time-dependent relationship between simple renal cysts and incident hypertension in a cohort of healthy middle-aged men. METHODS: A cohort study was conducted with data for 4516 healthy men with no evidence of hypertension at baseline. Study participants received a health checkup including abdominal ultrasonography between 2003 and 2004, and were followed in annual or biennial health examinations until May 2011. We matched groups with and without renal cysts by age. RESULTS: Renal cysts were found in 123 participants (2.7%). The age-matched control group included 1476 men. Mean age of the cyst group did not differ from that of the control group (42.3 ±â€Š6.6 and 42.2 ±â€Š6.8 years, respectively; P = 0.939). SBP was lower in the cyst group than in the control group (118.0 ±â€Š13.2 and 120.5 ±â€Š12.2, respectively; P = 0.044). During 10,731.5 person-years of follow-up, 169 participants developed hypertension (1.6/100 person-years). Cumulative incidence of hypertension was higher in the cyst group than in the control group (29.9 and 15.4%, respectively; P = 0.000). After adjusting for confounding factors, renal cysts still significantly increased risk for hypertension (hazard ratio, 3.28; 95% confidence interval 2.24-4.80; P = 0.000). Age, BMI, mean arterial pressure and a family history of hypertension were also risk factors. CONCLUSION: Simple renal cysts independently predicted incident hypertension in this cohort of middle-aged men. Further research is justified to test the causal role of renal cysts in the development of hypertension.

Lateralized effects of unilateral thalamotomy and thalamic stimulation in patients with essential tremor.

BACKGROUND AND PURPOSE: Stereotactic thalamotomy has been an effective surgical procedure in the treatment of medically refractory essential tremor (ET), however, little is known about the bilateral effects of unilateral ventralis intermedius (Vim) thalamotomy and Vim deep brain stimulation (DBS). We studied the lateralized effects of unilateral Vim thalamotomy and Vim DBS in ET patients. METHODS: Vim thalamotomy was performed in 6 patients and Vim DBS in 6. Patients were evaluated preoperatively and at 3 and 6 months postoperatively using the Clinical Rating Scale for Tremor (CRST). RESULTS: The contralateral Part A (tremor localization/severity rating) and Part B (specific motor tasks/function rating) subscores, and axial subscores of CRST significantly improved after unilateral Vim thalamotomy or Vim DBS. On the side ipsilateral to surgery, ET patients demonstrated no significant improvements in the Part A and Part B subscores of CRST. The Part C (functional disabilities resulting from tremor) subscores and total scores of CRST were significantly improved after surgery. CONCLUSIONS: Vim thalamotomy and DBS may be equally effective for the management of contralateral and axial tremor in ET patients, but both interventions may not improve tremor on the side ipsilateral to surgery.

Use of complementary and alternative medicine by Korean patients with Parkinson's disease.

OBJECTIVES: Many patients with Parkinson's disease (PD) often utilize complementary and alternative medicine (CAM). We aimed to survey the prevalence, spectrum of use, and factors related to utilization of CAM in patients with PD in Korea. PATIENTS AND METHODS: Between 15 December 2005 and 30 April 2006, we studied 123 patients with PD who volunteered to be interviewed using semi-structured questionnaires. RESULTS: Ninety-four (76%) patients had used CAM. The mean cost of CAM paid by patients (out-of-pocket costs) was 102.3 US Dollars (USD) per month, while medical costs of treatment for PD paid by patients (out-of-pocket costs) averaged 72.8 USD per month. Patients using CAM sought to improve motor symptoms (57.6%), fatigue (19.6%), pain (4.3%), constipation (5.4%) or specified no single reason (13.0%). The spectrum of CAM use included oriental medicines (76.6%), traditional food (44.7%), non-prescribed drugs (31.9%), traditional therapies (7.4%), massage (7.4%) and behavioral therapy (7.4%). Factors related to current use of CAM were disease duration, degree of education, and daily levodopa equivalent dose. In a logistic regression analysis, the duration of PD was a significant factor for CAM use. CONCLUSIONS: These results suggest that a high proportion of Korean PD patients employed CAM, associated with high costs and serious side effects in some patients.

Polycyclic aromatic hydrocarbons in human milk of nonsmoking U.S. women.

The determination of polycyclic aromatic hydrocarbons (PAHs) in human milk is relevant in assessing the dose to mothers and infants. Since measurements for the United States are lacking, we analyzed 13 PAHs in human milk from 12 nonsmoking American mothers. Analytes were extracted from milk by using a combination of centrifugation, liquid-liquid, and solid-phase extraction techniques. Following method validation with spiked bovine milk, PAH concentrations in human milk were determined by isotope dilution gas chromatography/mass spectrometry. Phenanthrene, fluorene, fluoranthene, and pyrene were found at median concentrations of 11.8, 3.0, 1.6, and 1.1 ng/g milk fat, respectively, whereas 9 additional analytes including benzo[a]pyrene were not detected (<0.04 ng/g). Calculated average daily doses from ingestion (high: 75.8, phenanthrene; low: 6.1 ng/kg/day pyrene) were compared to doses from air pollution inhalation. Milk ingestion accounted for 47.9-81.4% of the total dose of individual PAHs to the infant. However, calculated total average daily doses of phenanthrene and pyrene from ingestion and inhalation combined (12.2 to 110.3 ng/kg-day, respectively) were 3 orders of magnitude lower than documented doses known to cause health effects. These first measurements of PAH levels in U.S. human milk are comparable to concentrations reported previously for European and Asian women.

Volatile organic compounds in human milk: methods and measurements.

The present study was conducted to optimize methods for measurement of volatile organic compounds (VOCs) by use of headspace solid-phase microextraction (HS-SPME) and to provide a preliminary assessment of levels in human milk. MTBE (methyl tert-butyl ether), chloroform, benzene, and toluene were measured from two sources of milk: a North Carolina milk bank (n = 5) and multiple samples from three women within nonsmoking households in inner-city Baltimore, MD (n = 8). In Baltimore, indoor air VOC concentrations in the respective households were also measured by active sampling and thermal desorption gas chromatography/mass spectrometry in selective ion monitoring (GC/MS/SIM) over each of the 3 days of milk collection. By application of these optimized methods, we observed median VOC concentrations in Baltimore human milk of 0.09, 0.55, 0.12, and 0.46 ng/mL for MTBE, chloroform, benzene, and toluene, respectively. For benzene, toluene, and MTBE, milk levels trended with observed indoor air concentrations. On the basis of measured concentrations in air and milk, infant average daily dose by inhalation exceeded ingestion rates by 25-135-fold. Thus, VOC exposure from breast milk is vastly exceeded by that from indoor air in nonsmoking households. Accordingly, strategies to mitigate infant VOC exposure should focus on the indoor air inhalation pathway of exposure.

Concentrations of vehicle-related air pollutants in an urban parking garage.

There is growing evidence that traffic-related air pollution poses a public health threat, yet the dynamics of human exposure are not well understood. The urban parking garage is a microenvironment that is of concern but has not been characterized. Using time-resolved measurement methods, we evaluated air toxics levels within an urban parking garage and assessed the influence of vehicle activity and type on their levels. Carbon monoxide (CO) and particle-bound polycyclic aromatic hydrocarbons (pPAH) were measured with direct-reading instruments. Volatile organic compounds (VOCs) were measured in 30 min intervals using a sorbent tube loaded sequential sampler. Vehicle volume and type were evaluated by video recording. Sampling was conducted from June 24 to July 17, 2002. We observed garage traffic median volumes of 71 counts/h on weekdays and 6 counts/h on weekends. The 12-fold reduction in traffic volume from weekday to weekend corresponded with a decrease in median air pollution that varied from a minimum 2- (CO) to a maximum 7 (pPAH)-fold. The actual 30-min median weekday and weekend values were: CO--2.6/1.2 ppm; pPAH--19/2.6 ng/m(3); 1,3-butadiene-0.5/0.2 microg/m(3), MTBE-7.4/0.4 microg/m(3); and benzene-2.7/0.3 microg/m(3). The influence of traffic was quantified using longitudinal models. The pollutant coefficients provide an indication of the average air pollution vehicle source contribution and ranged from 0.31 (CO) to 1.08 (pPAH) percent increase/vehicle count. For some pollutants, a slightly higher (0.5-0.6%) coefficient was observed for light-trucks relative to cars. This study has public health relevance in providing a unique assessment of air pollution levels and source contribution for the urban parking garage.

Efficacy and safety of simultaneous bilateral pallidotomy in advanced Parkinson's disease.

BACKGROUND: Although unilateral pallidotomy is generally considered a safe and effective neurosurgical treatment for advanced Parkinson's disease (PD), controversies concerning efficacy and adverse effects of bilateral posteroventral pallidotomy (PVP) exist and need to be resolved. METHODS: We studied 8 patients with advanced PD who underwent simultaneous bilateral PVP. The patients were assessed preoperatively, immediately after surgery, and 6 and 12 months later. RESULTS: Dyskinesia was almost entirely abolished immediately after surgery, as well as being significantly lower 1 year later (p < 0.05). The 'off' medication score of the Unified Parkinson's Disease Rating Scale motor part (UPDRS III) was significantly improved after surgery (p < 0.05) but increased gradually after 6 months. The off medication score of activities of daily living tended to improve immediately after surgery, but it returned to preoperative levels at 12 months. There were no major complications of surgery. CONCLUSIONS: Simultaneous bilateral PVP may be a safe and highly effective method of reducing levodopa-induced dyskinesia. Our results suggest that simultaneous bilateral PVP may be a reasonable therapeutic option for advanced PD with severe levodopa-induced dyskinesia.

Bilateral effects of unilateral subthalamic nucleus deep brain stimulation in advanced Parkinson's disease.

To investigate the bilateral effects of unilateral subthalamic nucleus deep brain stimulation (STN-DBS), we prospectively studied 9 consecutive advanced Parkinson's disease (PD) patients (2 men and 7 women) who underwent unilateral STN-DBS. Patients were evaluated preoperatively and at 3 and 6 months postoperatively with and without dopaminergic medications ('on' and 'off' medication, respectively). Postoperatively, patients were assessed with and without stimulation. We found that, when compared with baseline, the 'off' medication scores of the Unified Parkinson's Disease Rating Scale motor part (UPDRS III) and activities of daily living (UPDRS II) were improved by 37% (p = 0.028) and 50% (p = 0.046) at 6 months after surgery, respectively. Stimulation while 'off' medication improved the total UPDRS score by 42% (p = 0.028) at 6 months. At 6 months after surgery, the subscore of UPDRS III of body parts contralateral to the DBS implantation had improved by 48% (p = 0.028), and the ipsilateral subscore of UPDRS III and the axial subscore of UPDRS III had improved by 20% (p = 0.027) and 39% (p = 0.028), respectively. Daily dosage of levodopa was reduced by 15% at 6 months. No patient exhibited permanent side effects. These findings indicate that unilateral STN-DBS may be a reasonable surgical procedure for selected PD patients who have markedly asymmetric parkinsonism.