Examination of the correlation between hand grip strength and muscle mass, balance, mobility, and daily life activities in elderly individuals living in nursing homes.

BACKGROUND: Aging is a process that includes progressive physiological changes. Grip strength is an important indicator of current health in the elderly. OBJECTIVE: The aim of the study was to examine the correlation between dominant-hand grip strength (HGS) and cognitive function, mid-upper arm circumference, muscle-bone mass, balance, mobility, and daily life activities in elderly individuals living in nursing homes and determine the effect rates of these factors on HGS. METHODS: Seventy-two elderly individuals aged over 65 who lived in a nursing home were included in the study. Dominant HGS and mid-upper forearm circumference were measured. Muscle and bone masses were measured with bioelectrical impedance analysis. Mid-upper arm circumference was measured using a non-elastic tape. HGS was measured using a hand dynamometer. Cognitive function was evaluated with the Standardized Mini-Mental Test (SMMT); mobility and balance were evaluated with the Timed Up and Go Test (TUGT) and Berg Balance Scale (BBS); the Katz Activities of Daily Living Scale (KATZ ADL) was used to evaluate daily life activities. RESULTS: There was a significant correlation between HGS and muscle and bone masses (p < 0.001). A significant correlation was found between HGS and TUGT, ADL (p = 0.001, p = 0.016). There was no significant correlation between HGS and BBS (p = 0.2). There was a correlation between HGS and SMMT at the statistical significance limit (p = 0.055). On HGS, the Body Mass Index had a 64.9% effect; the muscle mass had a 30.9% effect; the TUGT had a 27.7% effect. These parameters were found to explain 59.9% of the variance. CONCLUSION: As a global indicator of muscle strength, HGS can be used to predict age-related functional changes. Approaches to increase physical activity levels in elderly can be effective in reducing age-related negativities.

Impaired exercise capacity in electrostatic polyester powder paint workers.

PURPOSE: Limited number of studies investigated the effects of Electrostatic powder paints (EPP) on human health. We investigated the effects of EPP exposure on lung function, exercise capacity, and quality of life, and the factors determining exercise capacity in EPP workers. METHODS: Fifty-four male EPP workers and 54 age-matched healthy male individuals (control group) were included. Lung function and respiratory muscle strength were measured. The lower limit of normal (LLN) cut-points for FEV1 and FEV1/FVC were calculated. An EPT was used to evaluate bronchial hyperactivity. The handgrip and quadriceps muscle strength were evaluated using a hand-held dynamometer. An ISWT was used to determine exercise capacity. The physical activity level was questioned using the IPAQ. The SGRQ and NHP were used to assessing respiratory specific and general quality of life, respectively. RESULTS: Duration of work, FEV1, MIP, handgrip strength, and ISWT distance were significantly lower, and the change in FEV1 after EPT and %HRmax were significantly higher in the EPP group compared to the control group (p < 0.05). There were no subjects with a < LLN for FEV1 and FEV1/FVC in both groups. In the EPP group, ISWT distance was significantly related to age, height, duration of work, FEV1, change in FEV1 after EPT, MIP, MEP, handgrip strength, IPAQ, SGRQ, and NHP total scores (p < 0.05). The change in FEV1 after EPT, MIP, and duration of work explained % 62 of the variance in the ISWT distance (p < 0.001). CONCLUSIONS: Changes in lung function based on LLN for the FEV1 and FEV1/FVC were not clinically relevant in EPP workers. Exercise capacity is impaired in EPP workers. Degree of exercise-induced bronchospasm, inspiratory muscle strength, and duration of work are the determinants of exercise capacity in EPP workers.

Perceived social support systems` and depression`s effects on attitudes regarding coping strategies for the disease in patients with epilepsy.

OBJECTIVE: To investigate the perceived social support systems`, and depression`s effects on attitudes regarding coping strategies for the disease in patients with epilepsy. METHODS: This cross-sectional study was conducted on 182 epileptic patients who applied to the Neurology Polyclinics of the Faculty of Medicine at Erciyes University, Kayseri, Turkey between November 2011 and November 2012. As data collection tools, we used the Multidimensional Scale of Perceived Social Support Systems, Beck Depression Inventory, and the Assessment Scale for Coping Attitudes. RESULTS: We found that epileptic patients most frequently employed emotion-oriented coping strategies. Among the emotion-oriented coping strategies, religious coping ranked first, positive reinterpretation and growth came second, while using instrumental social support, which was one of the problem-oriented coping strategies, ranked third. The most frequently used non-functional coping methods were `focus on and venting of emotions`. The most influential variables on coping strategies of epileptic patients were age, gender, educational level, family structure, type of seizures, and the interference of the disease in communication. We found a negatively significant correlation among the scores of depression and emotion-oriented coping strategies, dysfunctional coping strategies, and problem-based coping strategies, while there was a positive correlation found between dysfunctional coping strategies and emotion-oriented coping strategies. CONCLUSION: The most influential variables on the coping strategies of epileptic patients were age, gender, educational level, family structure, type of seizures, and the interference of the disease in communication.

Normal hip, knee and ankle range of motion in the Turkish population.

OBJECTIVE: The aim of this study was to ascertain the effect of gender and cultural habits on hip, knee and ankle range of motion (ROM) and to determine the differences between the ROM of right and left side symmetric joints of the lower extremities. METHODS: The study included 987 (513 males and 474 females) healthy volunteers. Individuals with a history of illness, prior surgery or trauma involving any joint of either lower extremity were excluded from the study. The terminology and techniques of measurements used were those suggested by the American Academy of Orthopedic Surgeons. RESULTS: Left side passive hip flexion and active internal rotation was higher than the right side. Passive flexion of the hip joint was higher in male subjects and internal and external rotation was higher in female subjects. In the knee joint, passive extension was higher in males. Plantarflexion and inversion of the ankle joint were higher in male subjects and dorsiflexion and eversion were higher in female subjects. The differences were considered insignificant in clinical terms as all were less than 3 degrees. CONCLUSION: There is no clinically significantly difference between right and left side hip, knee and ankle joints ROM. Gender and cultural habits do not appear to have clinically significantly effects on lower extremity joint ROM.

The Effects of the Sleep Quality of 112 Emergency Health Workers in Kayseri, Turkey on Their Professional Life.

OBJECTIVES: Sleep adequacy is one of the major determinants of a successful professional life. The aim of this study is to determine the sleep quality of emergency health workers and analyze its effects on their professional and social lives. METHODS: The study was carried out on 121 voluntary emergency health workers in 112 Emergency Aid Stations in Kayseri, Turkey, in 2011. The data was collected through the Socio-Demographics Form and the Pittsburgh Sleep Quality Index (PSQI) and analyzed via SPSS 18.00. The statistical analysis involved percentage and frequency distributions, mean±standard deviations, a chi-square test, correlations, and logistic regression analysis. RESULTS: The mean score of the participants according to the Pittsburgh Sleep Quality Index was 4.14±3.09, and 28.9% of participants had poor sleep quality. Being single and being a woman accounted for 11% (p=0.009, 95% CI: 0.111-0.726) and 7% (p=0.003, 95% CI: 0.065-0.564) of poor sleep quality respectively. There was a positive correlation between sleep quality scores and negative effects on professional and social life activities. Negative effects on professional activities included increased loss of attention and concentration (40.0%, p=0,016), increased failure to take emergency actions (57.9%, p=0.001), reduced motivation (46.2%, p=0.004), reduced performance (41.4%, p=0.024), and low work efficiency (48.1%, p=0.008). Poor sleep quality generally negatively affected the daily life of the workers (51.6%, p=0.004), restricted their social life activities (45.7%, p=0.034), and caused them to experience communication difficulties (34.7%, p=0.229). CONCLUSIONS: One third of the emergency health workers had poor sleep quality and experienced high levels of sleep deficiency. Being a woman and being single were the most important factors in low sleep quality. Poor sleep quality continuously affected daily life and professional life negatively by leading to a serious level of fatigue, loss of attention-concentration, and low levels of motivation, performance and efficiency.

Comparison of SF-36 and WHOQOL-100 life quality scales in early period tuberculosis subjects.

OBJECTIVE: To determine the quality of life levels of early-period tuberculosis subjects by using the Short Form-36 and World Health Organisation's Quality of Life-100 scales and to compare the similar fields of the two scales. METHOD: The cross-sectional research, including 92 active tuberculosis subjects, was conducted from January 2007 to January 2008 at the Ministry of Health and Research's Sanitorium in Kayseri, Turkey. The two standard formats and a survey form developed by the authors were used as a means of data collection. The Bland-Altman method was used to determine the adaptation of standard protocols in physical, social and psychological functions, general health perception, pain and vitality areas. SPSS version 15 was used for data analysis. RESULTS: As a result of applied correlation analysis, a positive significant, but moderate, common relation was found between the two scales as regards similar subfields (physical function r=0.391, general health perception r=0.436, social relations r=0.411, and spiritual health r=0.546) (p< 0.001). The subgroups of the scales Cronbach-Alfa reliability coefficient were observed to vary between 0.63 to 0.94.The adaptability of the two scales was observed under physical, social and psychological functions, general health perception, pain and vitality/energy subfields by the Bland-Altman method. CONCLUSION: Our study revealed the fact that there was adaptability between similar subfields of the two standard protocols in early-period tuberculosis subjects.

Functional outcome and depression in the elderly with or without fatigue.

We evaluated the influence of fatigue on functional outcomes and depression in older people. Fatigue was measured using the fatigue severity scale (FSS). Activity of daily living function was assessed using the functional independence measurement (FIM), the geriatric depression inventory (GDI) was used to assess depression. The average FSS score was 5.66 ± 1.03 for subjects in the fatigue group, with 50 patients (40.3%) having FSS scores ≥ 4 points. Significant relationships were found between fatigue and GDI (p<0.001, r = 0.363) and FIM (p<0.04, r = -0.183). Binary logistic regression analysis identified GDI as a significant predictor of fatigue (p < 0.001). We found that 40.3% of older people had fatigue. Fatigue showed a significant correlation with depression and functional status. These findings emphasize the need for careful clinical screening of both fatigue and depression in older individuals.

Should the Nottingham Health Profile or the Short Form-36 be given preference in stroke?

OBJECTIVE: To compare the usefulness of the Nottingham Health Profile (NHP) and the Short Form 36 (SF-36) as general outcome measures for chronic stroke patients with respect to the response rate, internal consistency reliability, validity analyses, and agreement in similar domains of the 2 instruments. METHODS: In this prospective study, 90 consecutive stroke patients attending the Neurology outpatient clinic at Erciyes University, Kayseri, Turkey from March 2004 to March 2005 were evaluated for the study. Seventy outpatients who had a stroke 6 months previously were included in the study. As a datacollecting device, SF-36 and NHP scales were used. RESULTS: The prevalence of patients with highest quality of life score (ceiling effect) was higher for the NHP scale (10-35.7%) than for the SF-36 scale (1.4-37.1%). The prevalence of patients with lowest quality of life score (floor effect) was also higher for the NHP scale (1.4-45.7%) than for the domains of SF-36 (1.4-30%). The internal consistencies of the subscales of both the SF-36 and the NHP showed satisfactory values. Regarding convergent validity, correlations were found between comparable subscales of the 2 instruments. Limits of agreement in similar domains of the 2 instruments were very large. In all 5 demonstrated Bland-Altman plots, there was agreement of the scales in the measurement of the similar fields of quality of life. CONCLUSION: Both the SF-36 and the NHP have acceptable degrees of reliability, convergent validity, and response rate. Limits of agreement in similar domains of the 2 instruments were very large.

Is the quality of life different in patients with active and inactive tuberculosis?

OBJECTIVE: The aim of this study was to evaluate the quality of life (QOL) in outpatients with active and inactive tuberculosis, and to study the relations between QOL and demographic and socio-cultural chracteristics and variables concerning the disease and depression. MATERIAL AND METHODS: Included in the present study were 196 active and 108 inactive cases who attended Dispensary for Tuberculosis within a one year period, plus 196 healthy controls. In this study, questionnaire form, SF 36 quality of life scale and Beck Depression Inventory (BDI) were used. RESULTS: It was determined that in all fields of QOL, scores of the control group were higher than those of the patient groups. QOL scores in physical and social functionality dimensions of inactive cases were higher than in active cases (p < 0.001 ). As BDI scores increased in active and inactive cases, physical component summary (PCS) and mental component summary (MCS) decreased. As the treatment period increased in active cases, MCS increased. In active and inactive cases, marital status and accompanying diseases have an effect on the decrease of PCS scores (p < 0.05). In patients with tuberculosis, the QOL of men, single, patients with a high level of education and those not having a disease that accompanies tuberculosis were found to be high (p < 0.05). The QOL was negatively correlated with age and BDI, while being positively correlated with monthly income, daily sleep period and treatment period (p < 0.05). CONCLUSION: It is stated that in inactive tuberculosis cases, as in active cases, QOL is deformed and demographic-socio cultural chracteristics, depression, daily sleep period, treatment period and accompanying diseases are factors that affect quality of life.

Poststroke depressive symptoms and their relationship with quality of life, functional status, and severity of stroke.

OBJECTIVE: The present study aimed to investigate the relationship between depressive symptoms in 6 months after stroke and the quality of life (QOL), clinical and socio-demographical characteristics, functional status, and severity of stroke. METHODS: Ninety consecutive stroke patients who attended the neurology outpatient clinic at Erciyes University, Kayseri, Turkey from March 2004 to March 2005 were evaluated for the study. Seventy outpatients who had a stroke 6 months previously were included in the study. As a data-collecting device, Short Form 36, Functional Independence Measure (FIM), Canadian Neurological Scale, and Beck Depression Inventory (BDI) were used. In addition, a questionnaire was administered to obtain clinical and socio-demographic data. RESULTS: Seventy patients were included in the study. Depression measured using BDI was identified in 47.1% of the patients. Total FIM scores, especially motor subscale scores, were decreased in the depressive patients. No difference was found in the stroke severity scores of the depressed and non-depressed patients. The QOL subscale scores, such as physical functioning, bodily pain, general health perception, vitality, social functioning, and mental health, were lower in the patient group with high BDI scores. There was a positive correlation between age and BDI scores of the patients. Negative correlations were found between the scores of QOL and FIM in both total and motor subscale scores. CONCLUSION: Poststroke depression seems to be associated with age, education level, QOL, and functional status.

Comparison of SF-36 and WHOQOL-100 in patients with stroke.

BACKGROUND AND AIMS: Two widely used evaluation tools for the quality of life are the 36-item Short-Form Health Survey (SF-36) and World Health Organization Quality of Life Assessment (100-item version) (WHOQOL-100), however, these tools have not been compared for patients with stroke to date. The specific objectives of this study were: 1) to study the effect of stroke on quality of life (QOL) as measured by the SF-36 and by the WHOQOL-100, and 2) to compare these two instruments. SETTINGS AND DESIGN: Seventy patients who were admitted to the neurology clinic six months after stroke were included in this study. PATIENTS AND METHODS: As a data-collecting device, the SF-36 and WHOQOL-100 scales were used. An additional questionnaire was administered to obtain demographic data. STATISTICAL ANALYSIS: Pearson correlation analysis was performed and Blant-Altman Plots were used. Psychometric analysis was performed. RESULTS: In stroke, the most flustered domains of quality of life were vitality and general health perception fields in the SF-36 and in the WHOQL-100, independence level field, overall QOL and general health perceptions. While there was a fair degree of relationship (r= 0.25-0.50) between general health perceptions, physical, social and mental fields that were similar fields of scales, a fair and moderate to good relationship was found between different fields. Limits of agreement in similar domains of the two instruments were very large. In all four demonstrated Bland-Altman plots, there was agreement of the scales in the measurements of similar fields of quality of life. CONCLUSION: This study demonstrated that both the SF-36 and WHOQOL-100 quality of life scales are useful in the practical evaluation of patients with stroke.

The effect of spasticity, sense and walking aids in falls of people after chronic stroke.

OBJECTIVE: To study the effects of spasticity, sensory impairment, and type of walking aid on falls in community dwellers with chronic stroke. METHODS: Functional Independence Measure (FIM) Instrument, Joint Position Sense Evaluation (JPS), the Rivermead motor assessment scale (RMA), Ashworth Scale, Tinetti Assessment Tool were used to assess 100 cases. RESULTS: Fifty-three of the cases were grouped as nonfallers, 36 as one-time fallers and 11 as repeat fallers. These 3 groups were found to be different from each other in respect to FIM, Tinetti test and RMA (p < 0.001). In respect to knee JPS, nonfallers and one-time faller groups were found to be different from repeat fallers (p = 0.001). There is a difference among the groups in respect to Ashworth assessment (p < 0.001), use of walking aid (p = 0.01) and type of walking aid (p = 0.01). Some 43% of the cases use a walking aid (58.1% cane, 41.9% high cane). According to Ordinal logistic regression analysis, it was found that the possibility of fall increased (p < 0.01), as the value of spasticity increased while the possibility of the fall of the individuals with stroke decreased (p < 0.00 - 0.01) as Tinetti, RMA and FIM variables increased. CONCLUSIONS: In respect to falls, spasticity is also an indicator for chronic stroke patients, as is motor impairment, functional situation, impairment of balance and walking. Sensory impairment, using a walking aid and the type were found to be ineffective.

Influence of fatigue, depression, and demographic, socioeconomic, and clinical variables on quality of life of patients with epilepsy.

The purpose of this study was to define the influence of fatigue, depression, and clinical, demographic, and socioeconomic factors on the quality of life of patients with epilepsy. The study was performed on 103 adult patients who visited Erciyes University Epilepsy Outpatient Clinic between 2004 and 2005. Patients were evaluated with the Form of Negotiation, Quality of Life in Epilepsy Inventory (QOLIE-89), Beck Depression Inventory, and Fatigue Severity Scale. Mean age of the patients was 34.3+/-12.6, and mean duration of disease was 12.6+/-9.3 years. Among these patients, 52.4% were men, 49.5% were married, 15.5% had a university education, 53.4% had low incomes, 45.6% had generalized seizures, and 35.0% had experienced one or more seizures per month during the preceding year. The most significant variables in the domain of Overall quality of life were seizure frequency (P<0.001), depression (P<0.001), and fatigue (P<0.001); the variables in the domain of Mental Health were seizure frequency (P<0.001) and fatigue (P<0.001); the variable in the Cognitive domain was fatigue (P<0.001); the variables in the domain of Physical Health were social insurance coverage (P<0.01), fatigue (P<0.01), and age (P<0.01); the variables in the Epilepsy Targeted domain were depression (P<0.001), seizure frequency (P<0.001), and fatigue (P<0.01). Although quality of life has multiple determinants, seizure frequency, fatigue, and depression are the most important factors affecting quality of life in patients with epilepsy. One or more seizures per month, severe fatigue, and depression are associated with lower quality of life in some but not all domains. Partial correlations demonstrated that fatigue was a significant independent predictor of quality of life. The present study confirms that fatigue can be a powerful predictor of quality of life.

Balance performance in three forms of multiple sclerosis.

OBJECTIVES: To compare and document balance performance between patients with multiple sclerosis (MS) and healthy control subjects and balance performance among patients with different MS forms using a set of clinical balance tests. MATERIAL AND METHODS: Twenty eight primary progressive (PPMS), 34 secondary progressive (SPMS), and 62 relapsing remitting (RRMS), totalling 124 MS patients were included in the present study. Results from patients were compared with those of 31 healthy control subjects matching in age, gender, weight and height. Ashworth scale, mini-mental state examination and motricity index were used consecutively to evaluate spasticity, cognitive impairment and lower extremity muscle strength. Vision, sensation, proprioception, cerebellar and vestibular tests were also performed on the patients. The balance performance was evaluated using a set of clinical tests including steady stance tests (eyes in opened and closed positions, feet apart, feet together, stride stance, tandem stance and single stance), self-generated perturbations (functional reach, arm raise and step test), external perturbations, Tinetti-gait and 10 m gait time tests. RESULTS: There were no differences in age, sex, weight, height, sense impairment and lower extremity strength in patients with the three MS forms (p>0.05). No difference was found among patients with the three MS forms and the control subjects in the test of eyes closed with feet apart (p>0.05). The PPMS patients in all the balance tests except tests of eyes closed with feet apart and eyes opened with feet together, SPMS patients in all the balance tests except that of eyes closed with feet apart and RRMS patients in tandem stance, single leg stance, self-generated perturbations, external perturbations, Tinetti-gait and 10 m gait time tests had weaker balance than the control subjects (p<0.001). There were some differences between patients in the PPMS and SPMS groups in the eyes closed and feet apart test, between patients in the PPMS and RRMS groups in all the balance tests except eyes closed and feet apart and eyes opened and feet together tests and between patients in SPMS and RRMS group in all the balance tests except right and left arm raised tests (p<0.001). CONCLUSION: Balance in MS patients is impaired. The results of the present study show that there is more impairment in progressive MS forms than in RRMS. Meanwhile, patients with progressive MS are more likely to fall.

The relationship between fatigue and depression, and event-related potentials in epileptics.

The aim of the present study was to establish the rate of fatigue and the relationship between fatigue, depression, and P300 in people with epilepsy. We compared Fatigue Severity Scale (FSS) and Beck Depression Inventory (BDI) scores and event-related potentials (ERPs) of people with epilepsy (n=73) with those of controls (n=31). The rate of fatigue was found to be 42.4%, and fatigue and depression were positively correlated. There was an interaction between fatigue and ERPs, but the effect of ERPs on fatigue was greater. While polytherapy was a major factor affecting ERPs, depression had no effect on ERPs in people with epilepsy. The data suggest that fatigue is an important finding and is strongly correlated with cognitive processes and depression. Polytherapy contributed to cognitive disturbances and, hence, fatigue, whereas depression had no effect on cognitive processes in people with epilepsy.