Identifying dementia in Down syndrome with the Severe Impairment Battery, Brief Praxis Test and Dementia Scale for People with Learning Disabilities.

BACKGROUND: Individuals with Down syndrome (DS) are at high risk for dementia, specifically Alzheimer's disease. However, many measures regularly used for the detection of dementia in the general population are not suitable for individuals with DS due in part to floor effects. Some measures, including the Severe Impairment Battery (SIB), Brief Praxis Test (BPT) and Dementia Scale for People with Learning Disabilities (DLD), have been used in clinical trials and other research with this population. Validity research is limited, particularly regarding the use of such tools for detection of prodromal dementia in the DS population. The current project presents baseline cross-sectional SIB, BPT and DLD performance in order to characterise their predictive utility in discriminating normal cognition, possible dementia and probable dementia in adult DS. METHOD: Baseline SIB, BPT and DLD performances from 100 individuals (no dementia = 68, possible dementia = 16 & probable dementia = 16) were examined from a longitudinal cohort of aging individuals with DS. Receiver operating characteristic curves investigated the accuracy of these measures in relation to consensus dementia diagnoses, diagnoses which demonstrated high percent agreement with the examining neurologist's independent diagnostic impression. RESULTS: The SIB and BPT exhibited fair discrimination ability for differentiating no/possible versus probable dementia [area under the curve (AUC) = 0.61 and 0.66, respectively]. The DLD exhibited good discrimination ability for differentiating no versus possible/probable dementia (AUC = 0.75) and further demonstrated better performance of the DLD Cognitive subscale compared with the DLD Social subscale (AUC = 0.77 and 0.67, respectively). CONCLUSIONS: Results suggest that the SIB, BPT and DLD are able to reasonably discriminate consensus dementia diagnoses in individuals with DS, supporting their continued use in the clinical assessment of dementia in DS. The general performance of these measures suggests that further work in the area of test development is needed to improve on the AUCs for dementia status discrimination in this unique population. At present, however, the current findings suggest that the DLD may be the best option for reliable identification of prodromal dementia in this population, reinforcing the importance of including informant behaviour ratings in assessment of cognition for adults with DS.

The helminth parasite community of European badgers (Meles meles) in Ireland.

The European badger (Meles meles) is Ireland's largest terrestrial carnivore. Since first being identified as a wildlife reservoir of bovine tuberculosis in 1974 there has been an increased research focus into the behaviour of these ecologically important mammals in the Republic of Ireland (ROI). However, to date there has never been an assessment of the helminth parasite community of Irish badgers. This study of 289 badgers found helminth infection to be endemic within the sample population and we report for the first time the prevalence, abundance, intensity and aggregation of helminth infection in ROI. Eight distinct helminth taxa were recorded: Aelurostrongylus falciformis, Crenosoma melesi, Eucoleus aerophilus, Species A, Strongyloides spp., Uncinaria criniformis, and two unidentifiable but morphologically distinct nematodes. All helminths belong to the taxon Nematoda, and this is the first report of an exclusively nematode community across the badger's Eurasian distribution. Infection was not significantly influenced by the host sex, region of origin or season of sampling.

Egg-laying patterns and in vivo egg production in the monogenean parasites Heteraxine heterocerca and Benedenia seriolae from Japanese yellowtail Seriola quinqueradiata.

Egg-laying patterns and egg production in Heteraxine heterocerca from the gills and Benedenia seriolae from the skin of Japanese yellowtail Seriola quinqueradiata in Japan were investigated in vivo. Eggs were collected every 3 h from sexually mature H. heterocerca and B. seriolae infecting 3 S. quinqueradiata kept individually over 3 consecutive days and exposed to alternating periods of illumination and darkness (LD 12:12; light on 06.00, light off 18.00) and maintained at 23.8 +/- 0.1 degrees C and 35 ppt salinity. A well-defined egg-laying rhythm was demonstrated for H. heterocerca while B. seriolae was shown torelease eggs continuously. A total of 114,000 H. heterocerca eggs was collected and of these, 45.4 (42.5-49.9)% were collected during the first 3 h period following dark at 18.00 h. A total of 662,857 B. seriolae eggs was collected and these were distributed over each 3 h period ranging from 11.1 to 14.1% of the daily egg output. All eggs extracted from the uterus of each H. heterocerca were joined together forming an 'egg-string'. The contrasting egg-laying patterns of H. heterocerca and B. seriolae suggest that each species makes use of a different infection strategy to infect the same host species, S. quinqueradiata.

Mesangial cell apoptosis: the major mechanism for resolution of glomerular hypercellularity in experimental mesangial proliferative nephritis.

Increases in mesangial cell number may herald glomerular scarring, but they are not irreversible. This study sought mechanisms by which surplus glomerular mesangial cells can be cleared. A small proportion of cultured mesangial cells exhibited typical morphological features of apoptosis (programmed cell death), which was increased by growth factor deprivation or exposure to cycloheximide, stimuli known to increase apoptosis in other cell types. Apoptosis was confirmed by typical internucleosomal chromatin cleavage. In vivo, clear morphological evidence of mesangial apoptosis leading to phagocytosis by neighboring mesangial cells was obtained in self-limited mesangial proliferation induced in rats by Thy1.1 antibody, apoptosis occurring approximately 10-fold more frequently than in the healthy rat glomerulus. Indeed, changes in glomerular cell number in Thy1.1 nephritis strongly suggested that apoptosis is the major cell clearance mechanism counterbalancing cell division, thereby mediating resolution of glomerular hypercellularity in experimental mesangial proliferation.

Basic fibroblast growth factor augments podocyte injury and induces glomerulosclerosis in rats with experimental membranous nephropathy.

Podocyte injury is believed to contribute to glomerulosclerosis in membranous nephropathy. To identify the factors involved, we investigated the effects of basic fibroblast growth factor (bFGF), a cytokine produced by podocytes, on rats with membranous nephropathy (passive Heymann nephritis [PHN]). All rats received a daily i.v. bolus of 10 microg bFGF or vehicle from days 3-8 after PHN induction. In proteinuric PHN rats on day 8, bFGF injections further increased proteinuria. Podocytes of bFGF-injected PHN rats showed dramatic increases in mitoses, pseudocyst formation, foot process retraction, focal detachment from the glomerular basement membrane, and desmin expression. bFGF injections in PHN rats did not alter antibody or complement deposition or glomerular leukocyte influx. bFGF-injected PHN rats developed increased glomerulosclerosis when compared with control PHN rats. Also, bFGF induced proteinuria and podocyte damage in rats injected with 10% of the regular PHN-serum dose. None of these changes occurred in bFGF-injected normal rats, complement-depleted PHN rats or rats injected with 5% of the regular PHN serum dose. These divergent bFGF effects were explained in part by upregulated glomerular bFGF receptor expression, induced by PHN serum. Thus, bFGF can augment podocyte damage, resulting in increased glomerular protein permeability and accelerated glomerulosclerosis. This bFGF action is confined to previously injured podocytes. Release of bFGF from glomerular sources (including podocytes themselves) during injury may represent an important mechanism by which podocyte damage is enhanced or becomes self sustained.

p21-activated kinase 1 phosphorylates the death agonist bad and protects cells from apoptosis.

Bad is a critical regulatory component of the intrinsic cell death machinery that exerts its death-promoting effect upon heterodimerization with the antiapoptotic proteins Bcl-2 and Bcl-x(L). Growth factors promote cell survival through phosphorylation of Bad, resulting in its dissociation from Bcl-2 and Bcl-x(L) and its association with 14-3-3tau. Survival of interleukin 3 (IL-3)-dependent FL5.12 lymphoid progenitor cells is attenuated upon treatment with the Rho GTPase-inactivating toxin B from Clostridium difficile. p21-activated kinase 1 (PAK1) is activated by IL-3 in FL5.12 cells, and this activation is reduced by the phosphatidylinositol 3-kinase inhibitor LY294002. Overexpression of a constitutively active PAK mutant (PAK1-T423E) promoted cell survival of FL5.12 and NIH 3T3 cells, while overexpression of the autoinhibitory domain of PAK (amino acids 83 to 149) enhanced apoptosis. PAK phosphorylates Bad in vitro and in vivo on Ser112 and Ser136, resulting in a markedly reduced interaction between Bad and Bcl-2 or Bcl-x(L) and the increased association of Bad with 14-3-3tau. Our findings indicate that PAK inhibits the proapoptotic effects of Bad by direct phosphorylation and that PAK may play an important role in cell survival pathways.

Patterns of time use among regional and rural adolescent girls: Associations with correlates of physical activity and health-related quality of life.

OBJECTIVES: To describe patterns of time use among regional and rural adolescent girls and compare identified clusters with respect to correlates of physical activity (PA) and health-related quality of life (HRQoL). DESIGN: Cross-sectional PA and lifestyle survey. METHODS: Data were from Year 7-9 adolescent girls (aged 12-15 years) from 16 schools involved in a cluster-randomised trial in regional and rural Victoria, Australia (n=494). Time use data were collected using 24-h Previous Day Physical Activity Recall (PDPAR-24) questionnaire, collapsed into 17 categories of time use. Differences between time use clusters with regard to demographics, correlates of PA and HRQoL measured using PedsQL 4.0 Generic Core Scales, were investigated. RESULTS: Two time use clusters were identified and were associated with correlates of PA and HRQoL. Girls who spent significantly more time in teams sports, non-team sports, school classes, watching TV and sleeping had higher levels of positively aligned PA correlates (e.g. self-efficacy, perceived sports competence) and HRQoL than girls characterised with high levels of computer use and video gaming. CONCLUSIONS: These findings highlight how different activity patterns of regional and rural girls affect HRQoL and can inform future intervention strategies to improve PA levels and HRQoL. Clusters characterised by low levels of PA and high computer use and video gaming require targeted interventions to address barriers to their participation.

Development and integration of a Surveillance Monitoring solution to provide earlier detection of the deteriorating patient.

This paper presents recent improvement of a Wi-Fi based vital signs monitor used for in-hospital monitoring in medium-risk settings. Valuable insight into design strengths and weaknesses has been gained and device improvements have been confirmed with real-world use. Integration with intuitive central station software is considered with respect to balancing functionality and performance. Practical use of the early warning system in challenging clinical environments has enabled further understanding of the potential impact of the system. A tool to provide a convenient method of tracking patient condition and alerting on deterioration is offered.

Treating patients with hypertriglyceridaemia saves lives: triglyceride revisited.

The statin trials in secondary and primary prevention have shown that lowering LDL cholesterol produces a reduction in coronary event rates of around 35%. The most common dyslipidaemia in MI survivors is mixed hyperlipidaemia rather than hypercholesterolaemia. New evidence from VA-HIT and BIPS suggests that relatively low levels of triglyceride may be associated with a significant increase in coronary risk. In patients with established coronary disease, treatment with a fibrate that lowers triglyceride and raises HDL cholesterol, but which has little effect on LDL cholesterol, slows the rate of progression of coronary lesions. In hypertriglyceridaemic patients who have survived an MI or who have angina pectoris, fibrate treatment reduced the incidence of fatal and non-fatal MI by 40% (p = 0.03) (BIPS). In patients with coronary artery disease, who have low levels of HDL, fibrate treatment reduced the incidence of fatal and non-fatal MI by 22% (p = 0.006) (VA-HIT). These patients represent around 25% of the post-MI population. Work in progress will shortly define the effect of fibrate treatment on coronary event rate in patients with peripheral vascular disease and Type 2 diabetes.

Measures of community health status for health planning.

The National Health Planning and Resources Development Act of 1974 (P.L. 93-641) requires health systems agencies (HSAs) to assess the health status of their area populations but limits their data-collecting activity. Numerous measures of health status have been devised, but many of these require data that are not yet available or are available only on the national level. Proposed measures are reviewed, and the problems of applying them to the measurement of health status in small areas, under current technical and practical constraints, are discussed. Several measures have promise for giving reasonable results, but only with further development of data sources, estimation techniques, and social indicator models; under present constraints, HSAs will have to work with less precise and less useful methods.

Economic change and sex-specific cardiovascular mortality in Britain 1955-1976.

Analyses directed toward recent declines in cardiovascular disease mortality rates have typically focused on alterations in important physiological and behavioral risk factors resulting from lifestyle changes and medical advances. In this study, a multivariate model of the impact of more fundamental changes in the socioeconomic and bio-physical environments has been developed and applied to cardiovascular disease mortality rates, by sex, in England and Wales and Scotland during 1955-1976. The predictive model includes factors associated with (1) long-term growth in the economy, (2) deleterious behavioral risk factors loosely associated with economic growth--especially cigarette consumption per capita, (3) economic instability--especially recession as indicated by factors related to unemployment, income loss, and recessional declines in average weekly hours worked in manufacturing industries, (4) health care, and (5) physical environmental disturbances--especially very cold temperatures. This model proves to be an excellent instrument for the statistical explanation of trends and fluctuations in CVD mortality rates for both sexes and both regions in Britain in the post-War period. In general, the overall exponential rate of economic growth is found to be the most powerful factor in the long-term decline in CVD mortality rates. Similarly, disturbances to the national and regional economic situations--especially recessions--have regularly been associated with elevated death rates for all populations observed. Cigarette and unusually high spirits consumption, as well as particularly cold winter temperatures, have also had important deleterious effects on CVD mortality. The proportion of government expenditures devoted to health care is associated with a reduction in CVD mortality in England and Wales.

Unemployment and health in the context of economic change.

Evidence relating unemployment to health is found at every level of social science analysis from national population rates to individual psychophysiological stress response. At the population level of analysis, increase in the unemployment rate indicates recession and/or structural economic decline. At the individual level, unemployment is interpreted as a stressful life event. In both cases, inverse associations are found between measures of unemployment and indicators of health. We identify social science literatures associating health indicators with each of the following: economic growth, socioeconomic status, sociocultural change, economic instability, the status of being unemployed, social stress and work stress. Outstanding research issues include the requirements to identify and measure the effects of conditional factors and control variables in multivariate analysis and to examine a broader range of both severity of unemployment and severity of health outcomes. A research agenda proposes studies at the macro, meso and micro levels of analysis. We urge such research for its potential contribution both to analytic social science and to economic and social policy.

The effect of cocaine abuse on plasma levels of sulfated dopamine and salsolinol in alcoholics.

This study investigated the effect of cocaine abuse on peripheral dopamine and its tetrahydroisoquinoline metabolite salsolinol in chronic alcoholics. Specifically, the concentration of dopamine sulfate and salsolinol sulfate was measured in plasma samples obtained from the blood of a group of alcoholics (n = 40) and alcoholics with cocaine dependence (n = 55). The concentrations of sulfoconjugated dopamine and salsolinol were measured by a radioenzymatic technique. The results of this study showed that chronic alcoholics (627 +/- 195 pg/ml) and alcoholics with cocaine addiction (409 +/- 76 pg/ml) had significantly (p < 0.05) elevated levels of salsolinol sulfate (mean +/- SEM) in their plasma as compared to controls (99.5 +/- 7.5 pg/ml). However, alcoholics with cocaine dependence produced significantly (p < 0.01) higher concentration of dopamine sulfate in their plasma (7520 +/- 1299 pg/ml) as compared to chronic alcoholics (3896 +/- 438 pg/ml) and controls (2124 +/- 104 pg/ml). Differences in plasma dopamine sulfate among alcoholics with cocaine dependence vs. alcoholics without cocaine dependence may be interpreted as a reflection of increased extracellular dopamine metabolism associated with chronic cocaine exposure.

The hospital treatment of alcoholism and drug addiction.

Inpatient treatment of alcoholism is an option indicated by certain clinical criteria. The American Society of Addiction Medicine suggests four levels of care, and six assessment dimensions determine which level of care is indicated. An addiction medicine physician can consult with the primary care physician to recommend appropriate placement in difficult cases. Abstinence is a primary goal of treatment; for without abstinence, no other recovery will be possible. The remaining goals of recovery are detoxification, medical evaluation, stabilization of life-threatening emotional issues, education, identification of barriers to recovery, readjustment of behavior toward recovery, and orientation and membership in a self-help group. Successful family contributions can make the difference between success or failure of treatment goals; the role the family plays in recovery is discussed. Treatment for family members is important; the physical, emotional, and spiritual effects on family members can be just as profound on them as they are on the alcoholic. Continuing care maintains the link between the patient and the professional recovery community after discharge and is appropriate for all patients. Extended care allows for structured support of sobriety and often further progress through psychosocial issues identified during the initial treatment phase (i.e., abuse, molestation, unresolved grief). Extended care is indicated for patients requiring further structured assistance in early recovery. A large variety of treatment options are available once the decision has been made to hospitalize the patient.

Physical child abuse.

This article discusses the background and main indicators of physical child abuse. The author points out the role of orthopaedic nurses in identifying possibly abused children and bringing their suspicions to those with responsibility for investigation of and services to families in trouble. An outline of the major forms of abuse is included, as well as a brief discussion of the role of a "mandated reporter" and the reluctance often experienced by professionals to get involved with what seems to be a "family problem."

Some body wants to be normal: an account of an HIV narrative.

Narrative accounts of illness often focus on the sociological construction of illness and neglect the body. This paper explores themes of seeing and being seen in the narrative of an HIV positive man to show the importance of uncovering the psychological and corporeal experience of HIV. Such accounts complement and enhance conventional medical accounts of illness. Poignantly, it is a story of how he understands others as reading his body and writing on it. Further, his story is not one that is in circulation. Accounts of positive heterosexual males are few. This paper seeks to add at least one account to the public record so that others may have narrative resources to draw upon. Narrative analysis provides new perspectives on the lived experience of HIV, which are crucial to appreciate how it might be possible to live a positive life.