Visual Field Dependence Is Associated with Reduced Postural Sway, Dizziness and Falls in Older People Attending a Falls Clinic.

Moving visual fields can have strong destabilising effects on balance, particularly when visually perceived motion does not correspond to postural movements. This study investigated relationships between visual field dependence (VFD), as assessed using the roll vection test, and reported dizziness, falls and sway under eyes open, eyes closed and optokinetic conditions. Ninety five falls clinic attendees undertook the roll vection test (i.e. attempted to align a rod to the vertical while exposed to a rotating visual field). Sway was assessed under different visual conditions by centre of pressure movement. Participants also completed questionnaires on space and motion discomfort, fear of falling, depression and anxiety. Thirty four (35.8%) participants exhibited VFD, i.e. had an error > 6.5º in the roll vection test. Compared to participants without VFD, participants with VFD demonstrated less movement of the centre of pressure across all visual conditions, were more likely to report space and motion discomfort and to have suffered more multiple falls in the past year. VFD was independent of fear of falling, anxiety and depression. VFD in a falls clinic population is associated with reduced sway possibly due to a stiffening strategy to maintain stance, dizziness symptoms and an increased risk of falls.

Six minutes of walking leads to reduced lower limb strength and increased postural sway in people with Multiple Sclerosis.

BACKGROUND: Fatigue, lower limb weakness and poor balance can significantly limit safe mobility in people with Multiple Sclerosis (MS). Further research is required to elucidate relationships among these factors. OBJECTIVE: To investigate the effect of walking-induced fatigue on lower limb strength and postural sway in people with moderately disabling MS. METHODS: Thirty-four people (26 female) with moderate MS (mean Expanded Disability Status Scale of 3.7 ± 0.7) underwent assessments of acute fatigue, postural sway and lower limb strength before and after six-minute conditions of seated rest and walking. A matched sample of 10 healthy controls also undertook identical assessments before and after a six-minute walk. RESULTS: Significant time by condition effects for all assessment measures indicated the six-minute walk induced fatigue with associated increases in postural sway and reductions in lower limb strength in people with MS. Increases in sway with eyes closed correlated with increases in acute fatigue and self-reported impact of fatigue on physical and psychological functioning. No changes were observed in healthy controls. CONCLUSION: People with MS show signs of fatigue after 6 minutes of walking, including strength and balance deficits. These findings have implications for both mobility and fall risk in this group.

Continuing medical record education in a changing environment.

In addition to the financial problems encountered in providing educational programs, health care providers and health professionals themselves now face another challenge--that of maintaining and updating professional skills in an area of rapidly expanding knowledge and technology. Also, health professionals must stay abreast of the constantly changing legal, ethical and legislative issues which confront the health care industry. This may be more true in medical record administration than in almost any of the other allied health occupations.

Education and the medical record professional: obligation or opportunity?

The present health care environment demands an emphasis on continuing education and the constant upgrading of ones' professional skills and abilities. The pressure to update and maintain skills can be a burden on the members of our profession, or it can pose exciting challenges to our creativity. This article discusses the career opportunities available to medical record professionals in the area of providing educational programs to other health care professionals, and some ways to take advantage of these opportunities.

Field boundaries in Great Britain: stock and change between 1984, 1990 and 1998.

Field boundaries are man-made features found worldwide and their multiple functions in agricultural landscapes are now widely recognised. These landscape features have declined drastically in many developed countries as a result of agricultural intensification. In Great Britain, field boundaries are regarded as elements of particular significance in the countryside, both in term of extent and value, whether ecological, cultural, or aesthetic. The Countryside Surveys of Great Britain, a national ecological, surveillance programme initiated in the late 1970s, provides information about the change in extent and ecological condition of field boundaries. In this paper, we present the main results on field boundaries derived from the latest survey, Countryside Survey 2000. These include stock and change of boundaries for the 1990-1998 period as well as an update of the previously published 1984-1990 data. Special attention is given to the evolution of the length of hedges. Applicability of the Countryside Survey methodology to other monitoring programmes and further use of the data is discussed together with the potential ecological consequences of the changes described in the paper.

The ITE Land classification: Providing an environmental stratification of Great Britain.

The surface of Great Britain (GB) varies continuously in land cover from one area to another. The objective of any environmentally based land classification is to produce classes that match the patterns that are present by helping to define clear boundaries. The more appropriate the analysis and data used, the better the classes will fit the natural patterns. The observation of inter-correlations between ecological factors is the basis for interpreting ecological patterns in the field, and the Institute of Terrestrial Ecology (ITE) Land Classification formalises such subjective ideas. The data inevitably comprise a large number of factors in order to describe the environment adequately. Single factors, such as altitude, would only be useful on a national basis if they were the only dominant causative agent of ecological variation.The ITE Land Classification has defined 32 environmental categories called 'land classes', initially based on a sample of 1-km squares in Great Britain but subsequently extended to all 240 000 1-km squares. The original classification was produced using multivariate analysis of 75 environmental variables. The extension to all squares in GB was performed using a combination of logistic discrimination and discriminant functions. The classes have provided a stratification for successive ecological surveys, the results of which have characterised the classes in terms of botanical, zoological and landscape features.The classification has also been applied to integrate diverse datasets including satellite imagery, soils and socio-economic information. A variety of models have used the structure of the classification, for example to show potential land use change under different economic conditions. The principal data sets relevant for planning purposes have been incorporated into a user-friendly computer package, called the 'Countryside Information System'.

Changing landscapes, habitats and vegetation diversity across Great Britain.

This paper describes how Countryside Survey 2000 (CS2000) and earlier Countryside Surveys in 1990 and 1984, can be used to develop an integrated view of the changes in land cover, landscape and biodiversity that have taken place at the regional scale in Great Britain. A particular concern is to develop an understanding of how the national patterns of stock and change are distributed across Great Britain, and whether such changes are leading to more or less regional differentiation in our landscapes and biodiversity. A further concern is how the structure of landscape is changing.A description of the major Environmental Zones that make up Great Britain is given. Analysis of the regional patterns of change observed suggests that there has been considerable geographical variation in the gains and losses of the stock of the Biodiversity Action Plan Broad Habitats. Between 1984 and 1990, in the lowlands of the south and west of England and Wales, there were significant increase in the area of the Arable and Horticultural and Broadleaved Woodland Broad Habitats, and a marked loss of Improved Grassland. Over the same period, in the uplands of England and Wales, significant losses of Acid Grassland were observed, with associated gains in Improved Grassland. The Environmental Zones in Scotland were more stable in terms of the changes in stock of Broad Habitats. In addition to the analysis of net changes in stock of the Broad Habitats, the paper provides an analysis of the exchanges of land between major cover categories or each of the Environmental Zones. In contrast to the regionally concentrated changes in habitat stock, more ubiquitous and uniform changes in habitat quality were detected between 1990 and 1998, which continue trends observed for the 1980s. The quality of freshwater habitats increased. However, there were declines in the quality for some terrestrial biotopes, as indicated by the loss of species diversity from agricultural habitats, and the gains in diversity in semi-natural habitats, such as Acid Grasslands, more usually associated with vegetation types that are poor in species. An important driver of qualitative change appears to be widespread nutrient enrichment from nitrogen. However, such processes are probably superimposed upon more local factors, such as changes in the way land is managed for agriculture. The importance of understanding the various drives of change for future countryside policy is emphasized.

Assessing stock and change in land cover and biodiversity in GB: an introduction to Countryside Survey 2000.

Countryside Survey 2000 (CS2000) is the latest in a series of surveys designed to measure and evaluate stock and change of land cover, landscape features, freshwaters, habitats and the vegetation of Great Britain. The ideas behind CS2000 developed during the 1960s and 1970s and culminated in the first survey of vegetation and land cover in 1978. One kilometer sample squares were selected at random using an environmental stratification. Subsequent surveys took place in 1984, 1990 and 1998, revisiting the original sample locations, whilst progressively expanding in scope and sample size; CS2000 included soils, breeding birds, remotely sensed imagery, freshwater biota and hydromorphology. Countryside Survey data may be interpreted using the pressure-state-response model, by selecting indicators of process and quality, and by identifying models of expected responses to different pressures. Thus, results showing losses of hedgerows between 1984 and 1990 stimulated new protection for these features. Ideally, CS2000 data should be used to stimulate experiments to distinguish between different pressures, in order to ensure that policy and management responses are both appropriate and achievable.The experience from CS2000 may prove helpful for the design and management of other large scale monitoring programmes of ecosystems. In particular, the scope of the survey, and the use to which the data are applied, have evolved through time, and yet continuity was essential for change to be detected efficiently. These objectives were reconciled by collecting the data in a disaggregated form, allowing a high degree of flexibility in both analysis and reporting.