Factors associated with life satisfaction in Parkinson's disease.

OBJECTIVES: To identify factors associated with life satisfaction (LS) in people with Parkinson's disease (PD), including a specific focus on those with late-stage PD. MATERIAL AND METHODS: The study included 251 persons with PD (median age 70 years; PD duration 8 years). Analyses involved the total sample and a subsample with late-stage PD, that is Hoehn and Yahr stages IV and V (n=62). LS was assessed with item 1 of the Life Satisfaction Questionnaire (LiSat-11). Simple logistic regression analyses were performed for both the total sample and for the subsample with late-stage PD. For the total sample, a multivariable logistic regression analysis was also performed. RESULTS: In the total sample, 12 of the 20 independent variables were significantly associated with LS: need of help with ADL; walking difficulties; number of non-motor symptoms (NMS); fatigue; depressive symptoms; general self-efficacy; motor symptoms; pain; PD severity; freezing episodes; gender (woman); and fluctuations. When controlling for age and gender in the multivariable logistic regression model, depressive symptoms were negatively associated with high LS and general self-efficacy was positively associated with high LS. In late-stage PD, simple logistic regression analyses (controlling for age and gender) identified the following factors as associated with LS: number of NMS, general self-efficacy, walking difficulties and fatigue. CONCLUSIONS: This study provides new knowledge on factors associated with LS in a PD sample, including those with late-stage PD. As the ultimate goal for PD care should be improvement in LS, the results have direct clinical implication.

Quality of life and hormone therapy in women before and after menopause.

OBJECTIVE: To study how women evaluate their quality of life (QoL) in relation to age, menopause and hormone therapy (HT). DESIGN: An anonymous postal questionnaire comprising the Gothenburg QoL Instrument and items concerning menopause, symptoms, diseases, drugs and smoking. SETTING: A primary care district in southern Sweden. SUBJECTS: All women aged 45, 50, 55 and 60 in 1995 (n = 126), 1996 (n = 130), 1997 (n = 134) and 1998 (n = 145). MAIN OUTCOME MEASURES: QoL (global, social, physical/mental well-being) and number of symptoms (psychological, physical) reported during the past 3 months. RESULTS: The older women rated their QoL, especially social well-being (p < 0.001), higher and reported a lower number of symptoms, particularly psychological symptoms (p = 0.02), than the younger women did. Pre- and post-menopausal women in the various age groups did not differ on the main outcome measures. A history of HT and use of hormonal contraceptives tended to be associated with lower well-being and a greater number of symptoms, an association found in women 55 years of age to be highly significant (p < 0.01-0.001) for all the main outcome measures. CONCLUSION: The effects of menopause on QoL seemed generally to be of minor importance. QoL in women was lower in those with a history of HT than in those with no such experience.

[Climacteric--medicalization, minimalization or normalization?]. / Klimakteriet--sjukligt, bagatelliserat eller normalt?

Women's experiences and ideas about the climacteric are not in accord with the biomedical model, in which the climacteric and the menopause are characterized as being a risk factor for various diseases and a cause of "estrogen deficiency", a hormonal disease which is assumed to persist during the rest of life. The biomedical model may lead to medicalization and pathologizing, increasing the subordination of women and making them dependent on the health care system. Women who use hormonal therapy during the climacteric have many characteristics differentiating them from women who do not use such therapy. Thus, epidemiological studies will be difficult to interpret with respect to the long term effects of hormonal therapy. It is argued that the consultation for women of middle-age should be characterized by a holistic view of the woman taking account of her gender identity, life conditions and life situation. Such a view should focus on the woman's own ideas as to diagnostic procedures, treatment and solutions. In view of the lack of knowledge about the pros and cons of hormonal therapy, women themselves should make the decision, and such decisions should be encouraged. Also, the efforts directed towards women's compliance to hormonal therapy can be questioned. Women's climacteric symptoms should neither be medicalized, pathologized or minimized.

Three-dimensional measurement of rearfoot motion during running.

Excessive ranges of motion during running have been speculated to be connected to injuries to the lower extremities. Movement of the foot and lower leg has commonly been studied with two-dimensional techniques. However, differences in the alignment of the longitudinal axis of the foot with the camera axis will produce measurement errors for projected angles of the lower extremities. A three-dimensional approach would not have this limitation. The purpose of this study is to present a three-dimensional model for calculation of angles between lower leg and foot, lower leg and ground, and foot and ground, and to compare results from treadmill running derived from this model with results derived from a two-dimensional model for different alignment angles between foot axis and camera axis. A two camera Selspot system was used to obtain three-dimensional information on motion of the studied segments. It was found that several two-dimensional variables measured from a posterior view are very sensitive to the alignment angle between the foot and the camera axis. Some variables change as much as 1 degrees for every 2 degrees of change of the alignment angle. The large influence of rotations other than the measured one in two-dimensional measurements makes advisable the use of a three-dimensional model when studying motion between foot and lower leg during running.

Incidence and prevalence of juvenile chronic arthritis: a population survey.

In a population based epidemiological survey of juvenile chronic arthritis (JCA), performed in Western Sweden in 1983, an incidence of 12/100,000 was found. The estimated prevalence was 56/100,000. Subgroup distribution showed a preponderance of mono- and pauciarticular forms. The peak age of onset was between 0 and 4 years of age. Girls predominated over boys in a ratio of 3:2. Overall, 30% were antinuclear antibody (ANA) positive, 9% rheumatoid factor (RF) positive, and eye involvement occurred in 10% of the children. The results suggest differences in population based studies of JCA compared with previously reported hospital based series.

Release and retention in Alpine ski bindings.

Six different designs of alpine ski bindings were semistatically tested in a MTS machine, and measurements of release forces were performed at the toe and at the heel, perpendicularly, and at 30 degrees backward and 30 degrees forward from the normal of the ski, respectively. In the conventional, two-part bindings examined, there was no difference between the forces acting in perpendicular and oblique planes. The release resistance in oblique directions was lower than the retention force perpendicularly to the ski in two binding designs with a spring-loaded, moveable toe unit (Besser, "Jack" prototype). A low release resistance obliquely forward is important for the prevention of injury to the lower extremity when a skier falls forward. On analysis of the injury-preventing properties of a release binding, consideration should also be paid to release resistance in oblique planes.

Immediate effects of meniscectomy on the knee joint. The effects of tensile load on knee joint ligaments in dogs.

Tensile strength variables for the collateral ligaments were compared after excision of the meniscus in one knee, the corresponding meniscus in the contralateral knee of the same dog being intact. Removal of the meniscus was associated with a three-fold increase in initial laxity, two-fold for the lateral and three-fold for the medical ligament. The maximum tensile load uptake of the medial collateral ligament was reduced by more than 10 per cent after medial meniscectomy; the load uptake of the lateral ligament was not affected by lateral meniscectomy. It is proposed that tensile loads are distributed more favourably in the medial collateral ligament by the intact medial meniscus with firm capsular attachments than in the "normal" ligament after meniscectomy.