Validation of the AX3 triaxial accelerometer in older functionally impaired people.

BACKGROUND: Studying physical activity (PA) trends in older populations and potential interventions for increasing PA is important, as PA is a factor in many age-related health outcomes such as chronic disease, premature mortality, physical function and injuries from falls. Objective measures of PA provide valuable information regarding the functional impact that ageing and chronic disease states may have on a patient's life. AIMS: The purpose of this study was to test the validity of the AX3 PA monitor in an older population and to investigate whether the AX3 is a valid measure of distinct types or levels of activity in older people with a spectrum of mobility. METHODS: Validity of the AX3 PA monitor was tested using the RT3 as a means of cross-validating the AX3. Study participants wore both the AX3 and the RT3 accelerometers, positioned on their non-dominant side, whilst completing a series of standardised everyday activities. RESULTS: Although overall correlation was high (r > 0.8) between the RT3 and lower-limb-mounted AX3 counts, the correlation between the two devices was much stronger for walking activity than for any of the non-walking activities. DISCUSSION: Activity counts at all lower limb positions for the AX3 and RT3 were highly correlated. Correlation between wrist-mounted AX3 counts and lower limb AX3 counts was only moderate, and worsened when walking aids were in use. CONCLUSIONS: The results of this study indicate that the AX3 monitor is a valid tool, which might be used to objectively measure walking activity in older functionally impaired adults, a welcome finding for this under-researched area.

Relationship Functioning in Vietnam Veteran Couples: The Roles of PTSD and Anger.

OBJECTIVE: Posttraumatic stress disorder (PTSD) and anger have been implicated separately in relationship dysfunction for veterans; however, no studies have simultaneously examined the roles of each of these constructs. METHOD: This study examined the roles of PTSD and anger in the relationships of Vietnam veterans and their partners (n = 33 couples) with actor-partner interdependence modeling (APIM). Couples in which the veteran was diagnosed with PTSD (PTSD-positive; n = 20) were compared to couples in which the veteran did not have PTSD (PTSD-negative; n = 13) on measures of frequency of anger and relationship functioning. RESULTS: PTSD-positive and PTSD-negative couples reported similar levels of relationship functioning, yet PTSD-positive veterans reported experiencing anger significantly more often than PTSD-negative veterans. Across groups, anger was predictive of relationship functioning, but PTSD severity was not. CONCLUSIONS: Trait anger may have a more deleterious effect on relationship functioning than PTSD symptoms. Theoretical and clinical implications are discussed.

Participatory and Spatial Analyses of Environmental Justice Communities' Concerns about a Proposed Storm Surge and Flood Protection Seawall.

In response to increasing threats from sea-level rise and storm surge, the City of Charleston, South Carolina, and the US Army Corps of Engineers (USACE) propose constructing a seawall around the Charleston peninsula. The proposed seawall will terminate close to lower wealth, predominantly minority communities. These communities are identified as environmental justice (EJ) communities due to their history of inequitable burdens of industrial and urban pollution and proximity to highways and US Environmental Protection Agency (EPA) designated Superfund sites. The present study documents community concerns and opinions related to the proposed seawall, existing flooding problems, and other issues. The project was guided by knowledge co-production and participant-observation approaches and included interviews with community members, collection of locality-specific data, GIS mapping to visualize key issues, development of an ArcGIS Story Map, and participation in public meetings. Community concerns are reported in the voices of community members and fell into eight major themes: community connections, drainage, impacts of road infrastructure, displacement, increasing vulnerability, sense of exclusion and isolation, mistrust of government, and civic engagement. Community members were significantly engaged in the study and are the owners of the results. As one of the first US East Coast cities pursuing major structural adaptation for flooding, Charleston is likely to become a model for other cities considering waterfront protection measures. We demonstrate the importance of meaningful engagement to ensure that climate adaptation will benefit all, including marginalized communities, and have as few unintended negative consequences as possible. Bringing more people to the table and creating vibrant, long-term partnerships between academic institutions and community-based organizations that include robust links to governmental organizations should be among the first steps in building inclusive, equitable, and climate resilient cities.

Is Living in a U.S. Coastal City Good for One's Health?

BACKGROUND: Evidence suggests that living close to "blue spaces" (water features), particularly coastlines, has salutary effects on human health. METHODS: We analyzed five years of annual, self-reported general health and unhealthy days data from the Behavioral Risk Factor Surveillance System of the U.S. Centers for Disease Control and Prevention for 165 urban areas across the contiguous U.S. We compared health self-reports for people living in coastal vs. non-coastal urban areas and for residents of the disaster-prone Gulf of Mexico region vs. other locations. Coastal urban areas were defined as those having ≥50% of their population living within 20 km of a coast. RESULTS: We found no overall health advantage of residing in a coastal urban location when all urban areas were considered. However, residents from non-Gulf of Mexico coastal urban areas reported modestly better health than residents from non-coastal areas. In contrast, self-reported health of Gulf coastal urban residents was significantly poorer than that of residents from other urban areas. CONCLUSIONS: The frequency of disasters and history of health and socioeconomic disparities in the Gulf region may be responsible, at least in part, for the apparent lack of health promoting effects of coastal location there.

Risk of selected cardiovascular diseases and posttraumatic stress disorder among former World War II prisoners of war.

PURPOSE: American World War II (WWII) prisoners of war (POWs) suffered both mental and physical deprivation while interned. The long-term health consequences of the internment were studied for an increased risk of cardiovascular diseases and posttraumatic stress disorder (PTSD). METHODS: This study evaluated healthcare utilization data for 10 years (1991-2000) from Veterans Affairs (VA) and non-VA healthcare providers for 19,442 former WWII POWs and 9728 non-POW controls. The risk of diseases was approximated by odds ratios adjusted for race and age. RESULTS: Collectively, former POWs had statistically significant increased risk of PTSD, and those POWs with PTSD also had statistically significant increased risks of cardiovascular diseases including hypertension and chronic ischemic heart disease when compared to both non-POWs and POWs without PTSD. CONCLUSIONS: Among former WWII POWs, risk of cardiovascular disease is related to having PTSD.

Hearing aid use in nursing homes. Part 1: Prevalence rates of hearing impairment and hearing aid use.

UNLABELLED: Although hearing impairment is among the most common chronic ailments of older persons, the problem is even greater among those in nursing homes. It is estimated that 70% to 90% of elderly residents in long-term care facilities have some degree of hearing impairment. Despite this high prevalence, significant underuse of hearing aids or other assistive devices exists, especially among those with dementia. OBJECTIVES: The current study assessed rates of hearing impairment and hearing aid use among residents in a large, mid-Atlantic nursing home. SETTING AND DESIGN: In a cross-sectional survey, interviews were conducted at a large, mid-Atlantic nonprofit nursing home. PARTICIPANTS: Reports were obtained from 279 resident-caregiver dyads, as well as from the Minimum Data Set (MDS) and research assistants performing the structured interviews. MEASUREMENTS: Measures included the MDS and the Barriers to Hearing Aid Use Questionnaire, which was developed for this study. RESULTS: Results show an inconsistency in reports of both hearing impairment and hearing aid use by multiple sources, as well as the underuse of hearing aids. These inconsistencies suggest that gross hearing impairment is undetected in clinical practice in over half of the residents. CONCLUSION: The findings highlight the need for regular hearing assessments in the nursing home population. They also suggest the need for evaluation of institutional-level policies regarding screening and hearing aid management, as well as the need for further information regarding potential barriers to effective hearing aid use. These issues are addressed in part 2 of this study following this report.

Hearing aid use in nursing homes. Part 2: Barriers to effective utilization of hearing AIDS.

OBJECTIVE: This study examined barriers to hearing aid use among persons who were reported to have a hearing aid and among those reported to have hearing difficulties but no hearing aids. SETTING: Interviews were conducted at a large, mid-Atlantic nonprofit nursing home. PARTICIPANTS: Both nursing home residents (279) and nursing staff members (51) were interviewed. DESIGN AND MEASUREMENTS: In a cross-sectional survey of nursing home residents, brief structured interviews were performed by trained research assistants with both residents and caregivers to obtain information regarding residents' hearing ability, hearing aid use and daily maintenance, and potential barriers to such use. RESULTS: Among residents reported to have hearing problems but who did not use a hearing aid, the major problem was neglect of the issue; participants did not know why residents did not have a hearing aid, residents had not had hearing evaluations, and staff members were not aware of hearing problems in residents. Among residents who did use a hearing aid, the majority (69%) of those for whom information was available had problems with the devices. The most common problems reported were that the device was hard or inconvenient to use, it did not fit well or hurt, and the device was not functioning well. The vast majority (86%) needed help taking care of the hearing aids. Close to half of the staff members had not received any training in the use or maintenance of the devices. Lack of delegation of responsibility for the management of hearing was identified for 29%, and relatives were used for maintenance of hearing aids in 14% of residents with hearing aids. CONCLUSIONS: Barriers to hearing aid use are therefore complex and multifactorial, involving lack of system commitment to utilization of hearing aids, lack of knowledge by staff members, inappropriate delegation and care procedures, hearing aid design and fit issues, and difficulties for residents in handling the hearing aids. Addressing these issues requires change on multiple levels, including change at the institutional level, concerning policy and training; change at the unit level, regarding care procedures and follow up; change at the individual level, providing better checks of fit and function of the hearing aids; and finally, change at the societal level, addressing design and cost issues for hearing aids in this population.

Disseminated Mycobacterium avium infection in a cat.

A domestic shorthair cat was presented for lethargy and ataxia. Clinical findings included an abdominal mass, lumbosacral pain, ataxia. Aspirates from the liver and lymph nodes revealed intracellular, negative-staining rods. Treatment for presumptive mycobacterium infection was unsuccessful and the cat was euthanized. Disseminated Mycobacterium avium was confirmed on culture.

Resurgence of leptospirosis in dogs in Ontario: recent findings.

A marked increase in leptospirosis in dogs was observed in 2000, part of an increasing trend observed in previous years in Ontario. The highest frequency of seropositive cases occurred from September to December 2000, with the peak in November. Large breed dogs were particularly affected. Clinical and clinicopathological data for 31 dogs admitted between 1998 and 2000 to the Ontario Veterinary College Veterinary Teaching Hospital were analyzed. Major clinical presenting features were acute onset of anorexia, depression, fever, and vomiting. Ninety percent of dogs, on admission, showed biochemical evidence of injury to several organs, notably combinations in the order of kidney, muscle, pancreas, and liver. Almost all dogs showed increased serum urea and creatinine levels, and the majority had increased total creatine kinase, bilirubin, alkaline phosphatase, and leukocytosis with neutrophilia. One-third were thrombocytopenic. Of dogs with liver-related abnormalities, most had evidence of cholestasis, with or without hepatocellular damage. Based on serologic studies, in the year 2000, the major serovar involved was autumnalis, but bratislava, grippotyphosa, and pomona were also implicated. The microscopic agglutination test often gave a confusing pattern of reactivities to the serovars that were tested. The high reactivity to serovar autumnalis may represent an erroneous or "paradoxical" reaction typical of early leptospiral serology. The year 2000 was the warmest in Ontario in each of the 4 fall months (September-December) of the previous decade, as well as being the third wettest in the fall period in the last decade. The increase in canine leptospirosis, therefore, may, in part, reflect climate change. The number of positive cases declined in 2001 by about one-third of those in 2000, but the number of submissions of sera for diagnosis increased markedly over previous years. Further work is required to isolate and to identify definitively serovars involved in resurgent canine leptospirosis and the common sources for dogs.

2,8-Dihydroxyadenine uroliths in a dog.

CASE DESCRIPTION: A 43-kg (95-lb) 4-year-old neutered male mixed-breed dog was evaluated because of a 2-day history of dysuria. CLINICAL FINDINGS: Radiography and ultrasonography revealed hydronephrosis, hydroureter, and radiolucent, hyperechoic uroliths in the right kidney and ureter and the urinary bladder. Serum bile acids concentration was within the reference interval. TREATMENT AND OUTCOME: The uroliths in the bladder and right ureter were surgically removed and submitted for analysis. They were initially identified as urate uroliths; however, results of further analysis indicated uroliths were composed of 2,8-dihydroxyadenine (2,8-DHA), and 2,8-DHA was identified in a urine sample of the dog. Allopurinol was prescribed for the dog, and a purine-restricted diet was recommended. CLINICAL RELEVANCE: 2,8-DHA uroliths are extremely rare in humans and dogs. Such uroliths may be underdiagnosed in humans because of variability of clinical signs and difficulty in differentiating 2,8-DHA and urate uroliths and crystalluria. Uroliths composed of 2,8-DHA may be misdiagnosed as urate uroliths in dogs.

Rich sensitivities: an analysis of conflict among women in feminist memoir.

While the North American women's movement is most known for its efforts to transform social relations between women and men, its adherents have also focused on remaking relations among women. Using an innovative data source, social movement memoir, this paper indicates the depth of disappointment feminists cause one another. Memoirists dispute notions found in the movement and mainstream that women are socially capable. The paper offers the concept "relational ideation" to describe the way feminist memoirists critically examine taken for granted understandings of women's sociality and amplify their desires for a new social ethic among them.

The effects of communication skills training on pediatricians' and parents' communication during "sick child" visits.

This article reports the development and evaluation of a physician-parent communication skills training program designed to improve communication regarding antibiotic prescribing for children. Four pediatricians and 81 parents participated in the study, which involved audiotaping "sick child" office visits and then coding transcripts for evidence of program influence on information seeking, giving, and verifying, as well as relational communication. Parents who received training were more likely to verify information, t(79) = 1.82, p = .04, and more likely to express concerns, t(79) = 1.79, p = .04, than were parents who did not receive training; there was a nonsignificant trend for trained parents to be more likely to give information, t(79) = 1.7, p = .051. In terms of physician behavior, there were nonsignificant trends for physicians to spend more time creating a partnership with parents after training than before training, t(3) = 2.29, p = .053, and to encourage more questions from parents after training than before, t(3) = 2.15, p = .06. In addition, once one outlier parent in the control condition was removed from the analysis, the results showed that physicians spent more time addressing treatment options after training than before, t(3) = 2.9, p = .03. The results of this study are considered promising, with effects shown for various important elements of physician-parent communication. Implications of results and directions for future research are discussed.