Activity Participation and Perceived Health Status in Patients with Severe Mental Illness: a Prospective Study.

OBJECTIVE: To examine associations between severe mental illness (SMI), general health symptoms, mental wellbeing, and different activity levels in patients with SMI. METHOD: Consecutive patients with SMI referred for occupational therapy were prospectively included. Their hours of activities per day during hospital stay were recorded as <1 hour, 1-3 hours, and >3 hours in three categories: basic self-care activities, interest-based activities, and role-specific activities. Patients were free to join or decline any activities. Patients' somatic and mental health were measured at admission, discharge, and 1 month after discharge using the Brief Psychiatric Rating Scale (BPRS), Patient Health Questionnaire-15 (PHQ-15), Pittsburgh Sleep Quality Index (PSQI), Chinese version of Short Warwick Edinburgh Mental Wellbeing Scale (C-SWEMWBS), and Chinese version of General Activity Motivation Measure (GAMM). RESULTS: 84 patients (35 men and 49 women) aged 16 to 63 years were assessed at the three timepoints. The mean length of hospital stay of current admission was 74.73 days. The most common diagnosis was schizophrenia (n=35), followed by depression (n=15), psychosis (n=14), bipolar affective disorder (n=10), others (n=8), and delusional disorder (n=2). The hours of activities per day was <1 hour in 32 (38.1%) patients, 1-3 hours in 34 (40%) patients, and >3 hours in 18 (21.2%) patients. Improvement in somatic and mental health was positively associated with hours of activities per day. Activities were associated with reduced psychiatric symptoms (measured by BPRS) at discharge (Z = 5.978, p < 0.01). Activities were associated with less somatic complaints (measured by PHQ-15) [χ2 = 23.478, p < 0.01], better sleep quality (measured by PSQI) [χ2 = 14.762, p < 0.01]. The BPRS score for psychiatric symptoms at discharge was inversely associated with C-SWEMWBS score for mental wellbeing (r = -0.233, p = 0.033) and C-GAMM score for activity motivation (r = -0.258, p = 0.018). Basic self-care activities were a predictor for psychiatric symptoms (measured by BPRS) at discharge (adjusted R2 = 0.091, F = 8.496, p = 0.005), whereas a combined group of badminton and Tai Chi was a predictor for general activity motivation (measured by GAMM) at 1 month after discharge (adjusted R2 = 0.047, F = 4.697, p < 0.05), and soccer alone was a predictor for somatic health (measured by PHQ-15) at 1 month after discharge (adjusted R2 = 0.06, F = 5.784, p < 0.05). CONCLUSION: Participating in activities of patients' own choice and interests is positively associated with patients' psychiatric and somatic health and subjective wellbeing. Outdoor soccer has added effect on patients' somatic health. The beneficial effects are maintained at 1 month after discharge. Daily participation of activity meaningful to patients can be a non-pharmacological treatment for patients with SMI to improve somatic and mental health.

Heterogeneity of the mechanical properties of demineralized bone.

Knowledge of the mechanical properties of the collagenous component of bone is required for composite modeling of bone tissue and for understanding the age- and disease-related reductions in the ductility and strength of bone. The overall goal of this study was to investigate the heterogeneity of the mechanical properties of demineralized bone which remains unexplained and may be due to differences in the collagen structure or organization or in experimental protocols. Uniaxial tension tests were conducted to measure the elastic and failure properties of demineralized human femoral (n = 10) and tibial (n = 13) and bovine humeral (n = 8) and tibial (n = 8) cortical bone. Elastic modulus differed between groups (p = 0.02), varying from 275 +/- 94 MPa (mean +/- SD) to 450 + 50 MPa. Similarly, ultimate stress varied across groups from 15 + 4.2 to 26 + 4.7 MPa (p = 0.03). No significant differences in strain-to-failure were observed between any groups in this study (pooled mean of 8.4 +/- 1.6%; p = 0.42). However, Bowman et al. (1996) reported an average ultimate strain of 12.3 +/- 0.5% for demineralized bovine humeral bone, nearly 40% higher than our value. Taken together, it follows that all the monotonic mechanical properties of demineralized bone can display substantial heterogeneity. Future studies directed at explaining such differences may therefore provide insight into aging and disease of bone tissue.

Can we afford to take short cuts in the management of stress urinary incontinence?

Is urodynamics necessary in the management of female stress urinary incontinence? This has remained a point of contention among urologists and gynaecologists alike. In this prospective study we evaluated 28 patients urodynamically to assess our diagnostic accuracy and to audit our intended management. These patients had complained solely or predominantly of stress incontinence. None of them had previous abdominal or vaginal surgery for stress urinary incontinence or a history suggestive of voiding disorder. All 28 of them were listed for either a Burch colposuspension or Stamey endoscopic bladder neck suspension operation based on demonstrating the sign stress incontinence clinically or radiologically on screening cystography. In all these cases the diagnosis of genuine stress incontinence was presumed and urodynamics would not have been performed preoperatively, if not for this study. As a result, there was a 21% overall change in the intended management. Routine but simplified urodynamics (to include pad test, provocative cystometry, uroflowmetry and residual urine measurement) would appear to be a pre-requisite of genuine stress incontinence surgery, even in patients complaining solely of stress incontinence.

Cardiopulmonary exercise: a recently discovered secret of tai chi.

Every piece of literature or book about tai chi claims it to be the supreme martial art (soft style) and a therapeutic exercise. Nevertheless, none of the authors can describe scientifically how and why it works. Many people did not gain any health benefit in practicing tai chi and only very few people were able to apply its legendary secret power. During the last 10 years, the author thought he had discovered the secret in Hong Kong and brought it to Los Angeles. The secret lies in the fundamental movements of the body, called tai chi basic exercise routines. The entry level of the exercise has many similarities with medical treatments for respiratory illness and with walking exercise--the most recommended aerobic exercise for coronary artery disease.

Interleukin-1 receptor antagonist binds to the type II interleukin-1 receptor on B cells and neutrophils.

We have examined the binding of human and rodent interleukin-1 receptor antagonist (IL-1ra) to the type II IL-1 receptor on the human B cell line, Raji, on the mouse pre-B cell line, 70Z/3, and on human polymorphonuclear leukocytes (PMNs). Human IL-1ra binds to the receptors on the human B cells with an affinity (KD = 15 +/- 3 nM) equal to that of IL-1 alpha and only 15-fold lower than that of IL-1 beta and, likewise, binds to human PMNs with an affinity (KD = 8 +/- 4 nM) 15-fold lower than that of IL-1 beta. Mouse and rat IL-1ra bind to these two human cell types with an affinity similar to that of the human protein. Human IL-1ra binds very weakly to the type II receptor on the mouse pre-B cells with an affinity (KD = 1.4 +/- 0.2 microM) about 1500-fold lower than human IL-1 beta. Mouse and rat IL-1ra also bind to the mouse pre-B cells with low affinity. The weak binding of the three IL-1ra proteins to these mouse cells appears to be more a consequence of the cell type rather than species specificity. There may be a population of cells for which the actions of IL-1 cannot be effectively opposed by IL-1ra, although this group does not include mature B cells and PMNs.

Rabbit interleukin-1 receptor antagonist. Cloning, expression, functional characterization, and regulation during intestinal inflammation.

Genomic and cDNA clones for rabbit interleukin-1 receptor antagonist (IL-1ra) were isolate based on homology with the human, mouse, and rat IL-1ra gene. A partial genomic clone, obtained by screening a rabbit genomic library, contained coding sequences for the carboxyl-terminal 108 amino acids of rabbit IL-1ra. Two classes of cDNA for rabbit IL-1ra were obtained using RNA from inflamed rabbit colon tissue. One class of cDNA coded for a secreted form of IL-1ra, whereas the other coded for a putative intracellular form of rabbit IL-1ra. The latter form is similar to that isolated from human epithelial cells. A partially synthetic rabbit IL-1ra gene was constructed and expressed in Escherichia coli. The recombinant rabbit IL-1ra was purified to homogeneity by ion exchange chromatography. Its affinity was similar to that of human IL-1ra for the human and mouse type I IL-1 receptor. From the cDNA clone and the purified recombinant protein, specific probes were developed for measuring levels of rabbit IL-1ra mRNA and protein in normal and inflamed rabbit tissues. Unlike IL-1 alpha and IL-1 beta, IL-1RA mRNA and protein were present at detectable levels in normal rabbit colon. During the development of an experimental formalin-immune complex colitis, rabbit IL-1 alpha showed a dramatic increase in tissue levels, consistent with previous results; IL-1ra also increased 3-4-fold. Treatment of colitis rabbits with corticosteroids significantly suppressed neutrophil infiltration, corticosteroid treatment suppressed IL-1ra but not IL-1 alpha mRNA steady-state levels. Our observations demonstrate that IL-1 and IL-1ra synthesis is differentially regulated in healthy and inflamed intestinal tissue.