Factors associated with depression and anxiety in children with intellectual disabilities.

BACKGROUND: Individuals with intellectual disabilities (ID) are at increased risk for depression and anxiety disorders; however, there is a paucity of research that pertains to associative factors for these mental health disorders in this population. The objective of this investigation was to determine factors associated with depression and anxiety problems in children with ID. METHODS: Children 6-17 years with ID (n = 423; 63% male) from the 2016 National Survey of Children's Health were included in this cross-sectional study. Outcome measures included depression and anxiety problems. Predictor variables included sociodemographics, ID severity, co-morbid conditions (autism spectrum disorders, epilepsy, cerebral palsy, Down syndrome and attention-deficit/hyperactivity disorder), physical factors (i.e. physical activity, sleep duration and pain) and social factors (e.g. participation in activities and bully victimisation). Multivariable logistic regression was performed to determine the association between all factors and depression and/or anxiety problems among children with ID. RESULTS: The prevalence of depression and/or anxiety problems was 35.4%. After adjusting for sociodemographics, Hispanic race was associated with lower odds [odds ratio (OR), 0.3; 95% confidence interval (CI), 0.1-0.8] of depression and/or anxiety problems. After adjusting for race, co-morbid conditions, and physical and social factors, autism spectrum disorders (OR, 4.4; 95% CI, 1.1-10.1), Down syndrome (OR, 0.2; 95% CI, 0.1-0.8), attention-deficit/hyperactivity disorder (OR, 5.9; 95% CI, 2.5-14.3), pain (OR, 7.0; 95% CI, 2.9-17.1) and bully victimisation (OR 2.3; 95% CI, 1.0-5.3) were each associated with depression and/or anxiety problems. CONCLUSIONS: The present study identified both treatable and modifiable, as well as unmodifiable, factors associated with depression and/or anxiety problems in children with ID.

Handgrip and knee extension strength as predictors of cancer mortality: A systematic review and meta-analysis.

The specific role of different strength measures on mortality risk needs to be clarified to gain a better understanding of the clinical importance of different muscle groups, as well as to inform intervention protocols in relation to reducing early mortality. The aim of the systematic review and meta-analysis was to determine the relationship between muscular strength and risk of cancer mortality. Eligible cohort studies were those that examined the association between muscular strength, as assessed using validated tests, and cancer mortality in healthy youth and adults. The hazard ratio (HR) estimates obtained were pooled using random effects meta-analysis models. The outcome was cancer mortality assessed using the HR (Cox proportional hazards model). Eleven prospective studies with 1 309 413 participants were included, and 9787 cancer-specific deaths were reported. Overall, greater handgrip (HR = 0.97, 95% CI, 0.92-1.02; P = .055; I2  = 18.9%) and knee extension strength (HR = 0.98, 95% CI, 0.95-1.00; P = .051; I2  = 60.6%) were barely significant associated with reduced risk of cancer mortality. Our study suggests that higher level of muscular strength is not statistically associated with lower risk of cancer mortality.

Adiposity attenuates muscle quality and the adaptive response to resistance exercise in non-obese, healthy adults.

BACKGROUND: Emerging data have revealed a negative association between adiposity and muscle quality (MQ). There is a lack of research to examine this interaction among young, healthy individuals, and to evaluate the contribution of adiposity to adaptation after resistance exercise (RE). OBJECTIVE: The purpose of this investigation was to examine the influence of subcutaneous adipose tissue (SAT) on muscle function among non-obese individuals before and after RE. DESIGN: Analyses included 634 non-obese (body mass index <30 kg m(-2)) subjects (253 males, 381 females; age=23.3 ± 5.2 years). SAT and muscle mass (magnetic resonance imaging-derived SAT and biceps muscle volume), isometric and dynamic biceps strength, and MQ (strength/muscle volume), were analyzed at baseline and after 12 weeks of unilateral RE. RESULTS: At baseline, SAT was independently associated with lower MQ for males (ß=-0.55; P<0.01) and females (ß=-0.45; P<0.01), controlling for body mass and age. Adaptation to RE revealed a significant negative association between SAT and changes for strength capacity (ß=-0.13; p=0.03) and MQ (ß=-0.14; P<0.01) among males. No attenuation was identified among females. Post-intervention SAT remained a negative predictor of MQ for males and females (ß=-0.47; P<0.01). CONCLUSIONS: The findings reveal that SAT is a negative predictor of MQ among non-obese, healthy adults, and that after 12 weeks of progressive RE this association was not ameliorated. Data suggest that SAT exerts a weak, negative influence on the adaptive response to strength and MQ among males.

Dictyostelium myosin I double mutants exhibit conditional defects in pinocytosis.

The functional relationship between three Dictyostelium myosin Is, myoA, myoB, and myoC, has been examined through the creation of double mutants. Two double mutants, myoA-/B- and myoB-/C-, exhibit similar conditional defects in fluid-phase pinocytosis. Double mutants grown in suspension culture are significantly impaired in their ability to take in nutrients from the medium, whereas they are almost indistinguishable from wild-type and single mutant strains when grown on a surface. The double mutants are also found to internalize gp126, a 116-kD membrane protein, at a slower rate than either the wild-type or single mutant cells. Ultrastructural analysis reveals that both double mutants possess numerous small vesicles, in contrast to the wild-type or myosin I single mutants that exhibit several large, clear vacuoles. The alterations in fluid and membrane internalization in the suspension-grown double mutants, coupled with the altered vesicular profile, suggest that these cells may be compromised during the early stages of pinocytosis, a process that has been proposed to occur via actin-based cytoskeletal rearrangements. Scanning electron microscopy and rhodamine-phalloidin staining indicates that the myosin I double mutants appear to extend a larger number of actin-filled structures, such as filopodia and crowns, than wild-type cells. Rhodamine-phalloidin staining of the F-actin cytoskeleton of these suspension-grown cells also reveals that the double mutant cells are delayed in the rearrangement of cortical actin-rich structures upon adhesion to a substrate. We propose that myoA, myoB, and myoC play roles in controlling F-actin filled membrane projections that are required for pinosome internalization in suspension.

ZO-1 mRNA and protein expression during tight junction assembly in Caco-2 cells.

We previously identified and characterized ZO-1 as a peripheral membrane protein specifically associated with the cytoplasmic surface of tight junctions. Here we describe the identification of partial cDNA sequences encoding rat and human ZO-1 and their use to study the assembly of tight junctions in the Caco-2 human intestinal epithelial cell line. A rat cDNA was isolated from a lambda-gtll expression library by screening with mAbs. Polyclonal antibodies were raised to cDNA-encoded fusion protein; several properties of these antibodies support this cDNA as encoding ZO-1. Expression of ZO-1 mRNA occurs in the rat and Caco-2 cells with a major transcript of approximately 7.5 kb. To disrupt tight junctions and study the subsequent process of assembly, Caco-2 cells were grown in suspension for 48 h in Ca++/Mg++-free spinner medium during which time they lose cell-cell contacts, become round, and by immunofluorescence microscopy show diffuse and speckled localization of ZO-1. Within hours of replating at confluent density in Ca++/Mg++-containing media, attached cells show discrete localization of ZO-1 at cell-cell contacts. Within 2 d, fully confluent monolayers form, and ZO-1 localizes in a continuous gasket-like fashion circumscribing all cells. ZO-1 mRNA levels are highest in cells in spinner culture, and upon replating rapidly fall and plateau at approximately 10% of initial levels after 2-3 wk in culture. ZO-1 protein levels are lowest in contact-free cells and rise five- to eightfold over the same period. In contrast, mRNA levels for sucrase-isomaltase, an apical membrane hydrolase, increase only after a confluent monolayer forms. Thus, in this model of contact-dependent assembly of the tight junction, there is both a rapid assembly beginning upon cell-cell contact, as well as a long-term modulation involving changes in expression of ZO-1 mRNA and protein levels.

Muscle Weakness and Physical Disability in Older Americans: Longitudinal Findings from the U.S. Health and Retirement Study.

IMPORTANCE: Muscle weakness is an important indicator of disability, chronic disease and mortality. While we recently proposed sex/race specific grip strength cutpoints for clinical muscle weakness in a diverse, nationally representative sample of older Americans, the extent to which these cutpoints predict physical disability remains unknown. OBJECTIVE: To examine whether sex/race specific muscle weakness cutpoints predict physical disability status in a nationally representative sample of Americans age 65+. DESIGN: We used data from the 2006-2010 Health and Retirement Study. Fully-adjusted, weighted multinomial logistic regression models were used to quantify the odds of experiencing the onset, progression or persistence of disability in activities of daily living (ADL) among weak versus non-weak individuals over a 2-year period. SETTING: General community, nationally representative sample of older Americans. PARTICIPANTS: Population-based, community dwelling sample of older American adults aged 65-years+; 57 percent were women, 91% were White and the mean age was 75 years. Main Outcome(s) and Measure(s): The primary outcome of interest was disability dynamics, defined by changes in ADL status across at 2- year period. The primary exposure was clinical muscle weakness as defined by previously identified cutpoints. Hypotheses were formulated before analyses were conducted. RESULTS: In this nationally representative sample (n= 8,725), 44% of individuals were classified as weak at baseline. At follow-up, 55% remained independent with no change in their ADL status, 11% had an onset of disability and 4% progressed in their disability status. The odds of experiencing an onset of ADL disability was 54% higher among weak individuals compared those who were not weak at baseline (OR= 1.54, 95% CI= 1.54, 1.5, p<.0001); the odds of experiencing a progression in physical disability status was 2.16 times higher among those who were weak at baseline compared to non-weak individuals (OR= 2.16, 95% CI= 2.15, 2.16, p<.0001). CONCLUSIONS: This is the first study to use grip strength weakness cut-points to identify those who may be at greatest risk for experiencing physical disability in later life. Results underscore the importance of using population-specific cutpoints for clinical weakness in order to identify individuals at greatest risk for adverse health outcomes.

Treadmill training in Parkinson's patients after deep brain stimulation: Effects on gait kinematic.

OBJECTIVE: The purpose of this study was to evaluate the effect of treadmill training with body weight support on gait kinematics parameters in patients with PD using DBS. DESIGN: Twelve patients completed the protocols (age: 60.9±10.6 years; disease duration: 20±7 years; and time since DBS surgery: 20±4 months). The same set of patients underwent two trainings protocols and four gait analyses (before and after each training). They received eight weeks of treadmill training without body weight support (16 sessions) in conjunction with physiotherapy program followed by six weeks of wash out period, followed by eight weeks of body-weight-supported treadmill training in conjunction with a same physiotherapy program. The Gait Kinematic Analysis involved eight infrared cameras that detected 19 reflective spherical markers attached in limb lower of patients. Statistical analysis used the Wilcoxon test (p≤0.05). RESULTS: Both the training no showed significant differences in linear variables. As the angular variables, only training with support showed significant increase of ranges of motion: pelvis tilt, obliquity and rotation amplitude; hip adduction-abduction and rotation amplitude; percentage of peak flexion in swing phase; foot progression amplitude. CONCLUSION: The body weight supported treadmill training may promote increase of mobility of lower limbs during gait and it could be a targeted intervention for PD patients treated with DBS.

Magnetic enhancement of electron dose distribution in a phantom.

We have measured the effect of a 10-kG magnetic field on the dose distribution of electrons in a polystyrene phantom. Isodensity plots and depth-dose curves are presented for 22- and 28-MeV electron beams with and without the magnetic field applied. The measurements show that magnetic fields as low as 10 kG can produce a substantial modification of the absorbed dose distribution. When compared with the zero-magnetic-field distribution of the same energy, the magnetic field significantly improves the Dmax- surface dose ratio and increases the fall off in dose past the Dmax region.

Muscular strength and bone density with weight training in middle-aged women.

Previous research has demonstrated positive correlations between bone mass and both physical activity and muscular strength. There is a paucity of information describing the specific type of exercise which most benefits the human skeleton. The effects of a 1 yr weight training program on 18 middle-aged women participating in an endurance dance program (E + W) compared with 17 other women in the endurance dance program only (E) and with 19 sedentary controls (C) were studied by measuring muscular strength and bone mineral density (BMD). Eighteen women in the E + W group demonstrated increases in all strength measurements, whereas the E and C groups either had smaller increases or had declined. A significant group x test interaction term, indicating that groups responded differently over time, was observed for nondominant isokinetic elbow flexion measured through the range of motion at a constant velocity of 60 degrees.s-1 (P less than 0.05), nondominant isokinetic elbow extension at 180 degrees.s-1 (P less than 0.01), and nondominant isokinetic elbow flexion at 180 degrees.s-1 (P less than 0.05). BMD did not change significantly except that a significant group x test interaction term appeared for the radius ultradistal site (P less than 0.01). BMD of the humerus and femoral Ward's triangle increased nonsignificantly in both E and E + W over the year. This weight training program increased muscular strength but did not increase measured bone mass.

Instrumented posterolateral lumbar fusion. Results and comparison with anterior interbody fusion.

STUDY DESIGN: Prospective case series. OBJECTIVES: To assess the results of instrumented posterolateral lumbar fusion, using recognized outcome assessment techniques, to evaluate the correlation between technical and clinical results and the effects of assessment techniques, and to compare the outcome with that of anterior lumbar fusion. SUMMARY OF BACKGROUND DATA: Assessments of lumbar spinal fusion results have frequently been published in forms that render direct comparison difficult and thus have not provided optimal assistance in the selection of a preferred method of treatment. METHODS: One hundred and thirty-five patients with intractable back pain underwent instrumented posterolateral lumbar spinal fusion performed by a single surgeon. Review of results was undertaken by independent observers, using a recognized outcome assessment measure. RESULTS: A solid bony fusion was obtained in 82% of patients. The method of outcome assessment profoundly affected the results; whereas 65% of patients rated themselves significantly improved by the procedure, only 19% achieved a good or excellent result on the Low Back Outcome Score. Patients undergoing a second procedure did not do well, and "salvage" surgery is not recommended. Compensation status was a significant prognostic factor. Psychological distress at review had a profound effect on the disability score and on patient satisfaction ratings. Overall, the results were inferior to those in a similar series treated by anterior lumbar fusion. CONCLUSION: It is recommended that in future studies a recognized outcome score be used and that the analysis specifically include compensation status and psychological distress.

Compensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients.

STUDY DESIGN: Sagittal alignments, including lumbar lordosis and spinopelvic balance (measured from C7, S1, and hip axis reference points for the relative positions of the spine and sacropelvis over the hips), were studied on standing 36-in. lateral radiographs of adult volunteers (control subjects) and patients who had specific spinal disorders. OBJECTIVES: To determine the most reliable methods for measuring lumbopelvic lordosis and to define significant spinopelvic compensations for sagittal balance. SUMMARY OF BACKGROUND DATA: Measurements for standing sagittal balance, obtained using a C7 plumb line, and segmental angulations of the spinal vertebrae, including lordosis to the sacrum, have been reported. Absolute values, even for normative data, have had wide variation and limited clinical usefulness. Correlations of sagittal balance with the reported spinopelvic angulations (spinal vertebral and sacropelvic angulations) have not been well defined. In addition, determinates of balance (spinal and pelvic) have not been studied for reliability, and compensatory mechanisms for maintenance of balance have not been carefully evaluated. Better recognition of the correlations and more reliable methods to measure lordosis and balance and the spinopelvic compensations for its maintenance may be beneficial in treating patients who have spinal disorders. METHODS: Measurements on standing 36-in. lateral radiographs were made for sagittal alignments in adult volunteers (n = 50) and in adult patients who had symptomatic degenerative lumbar disc disease (n = 50), low grade L5-S1 isthmic (lytic) spondylolisthesis (n = 30), and idiopathic or degenerative scoliosis (n = 30). All participants exhibited clinical compensation for balance. Data were analyzed for significant correlations within each group to determine compensatory correlations of spinopelvic balance with the other sagittal alignments. Intraobserver and interobserver reliability for the parameters evaluated were calculated. This included two methods for determining lordosis (S1 end-plate and pelvic radius techniques). RESULTS: Plumb line measurements for balance from the S1 and hip axis reference points, as defined, were similar in all four groups. However, the groups appeared to adjust for balance by using common and distinctive spinopelvic compensations that resulted in significantly and characteristically different angular alignments among the four groups. Lordosis and balance measurements were closely correlated, and the correlation was characterized by pelvic rotation and translation around the hip axis. The subjects with less lordosis typically stood with the C7 plumb line anterior to and at a longer distance from the sacral reference point. This was primarily because of posterior sacropelvic translation around the hip axis and not because the sagittal plumb line initially moved anteriorly away from the sacrum. This was true in all four groups and gave the appearance that the sacropelvis was less well balanced over the hips in the subjects with less lordosis. Even small differences in lordosis appeared to be associated with considerable adjustments in the other spinopelvic alignments. Therefore, it was important to determine that lordosis was lumbopelvic more reliably measured by the pelvic radius technique. CONCLUSIONS: Lower lumbar lordosis, by the pelvic radius technique, and compensatory sacropelvic translation around a hip axis, in addition to measurements from this axis to the C7 plumb line, were the primary determinates and most reliable radiographic assessments for sagittal balance. Understanding the common and characteristically different compensations that occur with balance in these patients who had specific spinal disorders may help to improve their care.

The effect of operative position on lumbar lordosis. A radiographic study of patients under anesthesia in the prone and 90-90 positions.

STUDY DESIGN: The effect of intraoperative positioning on lumbar lordosis was retrospectively studied by radiographic analysis of 40 patients under general anesthesia. OBJECTIVES: The aim of this study was to document changes in segmental and total lumbar lordosis between preoperative standing and intraoperative radiographs taken in the "90-90" and prone positions. SUMMARY OF BACKGROUND: Preservation of physiologic lordosis was an important consideration in reconstructive lumbar spine surgery. To avoid iatrogenic loss of lordosis when using spinal instrumentation and to facilitate decompressive procedures, it was necessary to understand how segmental alignments were affected by intraoperative positioning. Although many positioning techniques were used, the effect on lumbar lordosis was not well established. METHODS: Preoperative (standing 36" lateral spine) and intraoperative radiographs (lateral lumbar spine L1 to the sacrum) in either the "90-90" position on a Hastings frame (n = 20) or the prone position on a Jackson table (n = 20) were measured twice by two independent observers using Cobb methodology for total and segmental lordosis between L1 and S1. Data were analyzed for intra- and interobserver reliability and changes in segmental and total lordosis between standing and intraoperative radiographs. RESULTS: Analysis of intra- and interobserver reliability revealed measurements were accurate and reproducible. The "90-90" position produced significant loss (P < or = 0.01) of total and segmental lordosis at all levels except L1-L2, which showed no change. Segmental lordosis was reduced nearly 60% at L2-L3, L3-L4, and L4-L5, and total lordosis was reduced by more than 35%. The prone position on the Jackson table increased segmental lordosis at L5-S1 by 22% (P < or = 0.01) and preserved total and segmental standing lordosis at all other levels. CONCLUSIONS: The "90-90" position on the Hastings frame was associated with significant reduction of total and segmental lordosis in the middle and lower lumbar spine. Positioning prone on a Jackson table maintained standing lumbar lordosis and increased lumbosacral lordosis.

Types of aortic stenosis in surgically removed valves.

In 109 specimens of aortic valves removed surgically from adults for isolated or dominant aortic stenosis, five types of valve were encountered. In order of decreasing frequency the types were as follows: calcification of congenitally bicuspid aortic valves (48.6%); calcification of a normally tricuspid aortic valve without commissural fusion, the so-called senile type of aortic stenosis (27.6%); calcification of an acquired bicuspid valve (12.8%); the fibrous (rheumatic)-type valve (10.1%); and calcification of congenitally unicuspid valves (0.9%). In the overall study men were more commonly represented than women by a ratio of 3:2. In only the senile type were women more commonly represented than men.

Computerized placement in dentistry: the Minnesota experience.

In response to identified manpower information and service requirements, the Minnesota Dental Association, the board of dentistry, and the University of Minnesota School of Dentistry established the Dental Information Service Center in 1972. One major effort of the center was to develop a computerized placement service for dentistry in the state. This service was recently subjected to a user evaluation. Of 1,030 delivered questionnaires, 431 were returned in response to a single mailing. The respondents included 216 employers and 215 employees, including dentists seeking positions. Dental employers generally found the system to be their most successful strategy in the search for employees; from the perspective of employees, other sources such as personal contact competed with the computerized system as the most successful source of information. Evidence from this evaluation indicates that the computerized placement experience in Minnesota has been quite positive. Dentists have relied on the service somewhat more heavily than other dental occupational groups, possibly because alternate sources of information traditionally have not served the health professions. Overall satisfaction ran quite high, and an overwhelming majority of the respondents thought that the service should be continued and expanded to either a regional or a national level.

A draining sinus tract of obscure etiology: a case report.

A patient presented with a draining sinus tract on the lingual alveolus of the posterior mandibular ridge. The source of the sinus tract was not readily apparent. Radiographs created the impression that a lesion of unusual and possibly metastatic origin might be involved. Comprehensive diagnostic tests were ordered, but the source of the lesion remained obscure until a surgical exploration was performed.

Dental hygiene student. Interest in advanced education.

This paper reports the results of a 1985 survey of certificate/associate degree students' interest in advanced education: baccalaureate degree completion and non-degree granting residency programs. Subjects included first- and second-year dental hygiene students enrolled in 12 vocational, community college, state, and research university institutions in a five-state region in the upper Midwest. The data collection instrument consisted of a 12-item mailed questionnaire. One hundred percent program and 78.7% student response rates were achieved. Results indicate that respondents are interested in degree completion and non-degree granting residency programs. Interest varied by age and by type of institution in which respondents were completing their dental hygiene education. While younger respondents were more likely to express interest in advanced education, respondents over the age of 30 were generally interested or undecided. Overall, respondents indicated slightly different areas of interest for degree completion versus residency programs. In general, respondents indicated an interest in pursuing advanced education on a part-time, evening basis, within five years of completion of their basic dental hygiene education. Cost, time, and family commitments were identified by respondents as major barriers to continuing their education.

Chronic disease risk among adults with cerebral palsy: the role of premature sarcopoenia, obesity and sedentary behaviour.

Premature declines in function among adults with cerebral palsy (CP) are generally attributed to weakness, spasticity and orthopaedic abnormalities, as well as chronic pain and fatigue. Very little research or clinical attention has been devoted to the confluence and consequences of early muscle wasting and obesity as mediators of secondary comorbidity in this population, and perhaps more importantly, to the role of lifestyle to potentiate these outcomes. At present, there are no national surveillance programmes that monitor chronic health in adults with CP; however, mortality records have demonstrated a greater prevalence of coronary heart disease as compared with the general population. Although by definition, CP is a 'non-progressive' condition, secondary factors such as habitual sedentary behaviour, obesity, and premature sarcoepenia may increase the severity of functional impairment throughout adulthood, and lead to cardiometabolic disease, fragility and/or early mortality. Herein we describe the heightened health risk represented in adults with CP, and discuss the hallmark phenotypic features that coincide with ageing, obesity and cardiometabolic disorders. Moreover, we provide discussion regarding the protective role of habitual physical activity to stimulate anti-inflammatory pathways and to ameliorate global risk. Although physical therapeutic modalities are already widely acknowledged as a vital component to improve movement quality in CP, the purpose of this review was to present a compelling case for the value of lifelong physical activity participation for both function and cardiometabolic health preservation.